Transcript Attention to gender differences in Public Health research

Methodological and ethical
ramifications of paying
attention to gender
differences in Public
Health research
Anita Rieder
Institute of Social Medicine of the Medical University of Vienna
Kitty Lawrence
Verein Altern mit Zukunft
Public Health
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Science of prevention of illnesses, lengthening life
and health promotion
Focus on populations and not so much on the
individual, as well as, integration of social
responsibility
Public Health assumes, that illnesses and health
problems are influenced by physical factors, the
social and health political environment
Personal health behaviour as a factor having a strong
influence on morbidity and Mortality
Gender specific Medicine
and Public Health
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„Being a woman or a man is a HEALTH
DETERMINANT that is as significant as
social origin, economic situation and ethnic
origin“
Strasbourg, April 2005, Expert Committee meeting
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Measuring the Global
Gender Gap
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Criteria for Measurement:
– Economic participation – presence of
women in the workforce in quantitative terms,
income, status
– Political Empowerment – no. years female
head of state, women at ministerial level,
women with seats in parliament
– Educational attainment – primary,
secondary tertiary enrolment, literacy
– Health and well-being – life expectancy
female vs. male, sex ratio
World Economic Forum, 2006
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Gender Gap Index 2006
Rank
Country
Score
1
Sweden
0.8133
2
Norway
0.7994
3
Finland
0.7958
4
Iceland
0.7813
5
Germany
0.7524
6
Philippines 0.7516
7
N. Zealand 0.7509
8
Denmark
0.7462
9
UK
0.7365
10
Ireland
0.7335
27
Austria
0.699
World Economic Forum.
The Global Gender Gap.
2006
Gender, Public Health,
Ethics
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Population-based focus: required to examine
ethical implications – infringement on
individual liberties
a framework for public health ethics must
not only be a code of restraint to fairly and
appropriately preserve the negative rights of
citizens to non-interference, but also to
emphasise the positive rights of
commitment to improve the public’s health
and reduce certain social inequities
Kass NE. An ethics framework for public health. American
Journal of Public Health. 2001;91(11):1776-1782
Inequities between men
and women in terms of
health, access to public
health programmes and
medical treatments have in
part stemmed from the past
lack of gender
differentiated research.
Neurology
Gender aspects have so far played a minimal role in
both research and clinical practice
 Are there differences between men and women in
terms of brain function?
 Influence of pregnancy on course of illness e.g.
Multiple Sclerosis or Epilepsy – comprehensively
 New questions arise – gender specific aspects in
older age - neurodegenerative diseases, Stroke –
neue Fragen
„ No practical guidelines, since assured facts are
missing“
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Gender Medizin: A. Rieder, B. Lohff (Hrsg.), Springer Verlag, 2004
Kapitel 9: C.Schröder, C.Wenzel und K.Weissenborn
Building a competent
workforce demands
appropriate training:
“Developing a multidisciplinary public health
training is an international
as well as a national public
health issue”
Evans D, Dowling S. J Epidemiol Community Health 2002;56:744-747
“Gender Aspects of
Medical Education”
EU - research project carried out by
the department of history, ethics, and
philosophy of medicine of the Medical
University in Hannover
Aim: Documentation and evaluation of all European medical
curricula with respect to the extent and integration of gender
specific teaching offered
It became clear, that across Europe, within
the scope of medical education, practically no
such teaching models exist
Voss et al., Hannover, 2004
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Eliminating disparities in health care
and public health relies on building a
broad and reliable evidence base
Seeking out evidence, quantifying it
and taking the evidence into
consideration when making decisions
…evidence does not make decisions
people do!
Keyword
“Gender”
An important basis for
Public Health Strategies are
Target group specific
health reports
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Women‘s Health Report
Men‘s Health Report
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Women‘s health reports - pioneers in the
compilation of gender specific health
reports
Austrian women‘s health report served
as a model and paved the way for men‘s
health report
Gender und Public Health
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Compilation and analysis of health
data
Identification of gender differences
and assessing the relevance in the
health system
Creating concepts
Transfer to practice
for.....
effective health care satisfying both
demands and needs preventive and curative
 increasing health and life
expectancy as well as quality of life
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Men’s Health Report
of the city of Vienna 1999
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1st comprehensive international scientific
report on men’s health
Foundation for the definition of the main focus
points for men’s health care
Basis for the identification of priorities in public
health care and in prevention
Basis for health political discussions
Schmeiser-Rieder et al, 1999, MA-L (Hrsg)),
Rieder et al, Lancet 2001, Schmeiser-Rieder et al,
WHO-Health Report on the Aging Male, 2000
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Implementation of the Women‘s Health Report 2005
Politics
Women‘s
Health
Report
Areas of
action
Target groups
Scientific Management:
Univ.-Prof. Dr.
Beate Wimmer-Puchinger
Womens Health Commissioner
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Fields of activity and measures
 Prevention and reduction of morbidity and
mortality (e.g. CVD, breast cancer, lung
cancer etc.)
 Taking into account social situation
woman-specific socialisation and health
Taking into account women‘s individual
lifecycle needs
Support of women‘s health promotion and
prevention
Taking into account gender differences in
measures to ensure quality in health care
From research to practice
The Vienna Women‘s Health
Programme
Univ.-Prof. Dr.
Beate Wimmer-Puchinger
Executive Officer for Women‘s Health
Women‘s Health Program Vienna
Vienna Social Fund
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„A Heart for Vienna“
Vienna Health Promotion Program 2000
City of Vienna, Fonds Soziales Wien
Purpose:
 Reduce prevalence of
cardiovascular risk factors
 through optimisation of life style
factors
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Aspects to consider when
incorporating gender into public health
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Gender Medicine
The Public Health Perspective
Key issue
What do we want to achieve?
Targets and objectives?
Expected outcome?
Impact on political decision
making?
Impact on society?
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Gender-Specific Medicine
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“Much is still unknown and there is ample
scope for research”
“Current best models of care will benefit
from findings revealed by gender – based
research”
“Our major challenge will be to determine
the relative contributions to gender-specific
health of biological and social factors”
“Research findings have the potential to
bring about policy changes……. “
Correa-de Araujo, et al, JAMA, 292:2921-2922, 2004
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Gender Specific Medicine
has a major responsibility
to meet the societal needs
and to contribute to the
societal value of health
research…
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