PPSP Year 1 : Sex, Gender and Health

GENDER MATTERS IN HEALTH : A NEW PARADIGM

by Rashidah Shuib Professor & Director Womens Development Research Centre (KANITA), Universiti Sains Malaysia 9 July 2008 (2008/2009)

OBJECTIVES
To heighten awareness on the new perspective in health and medicine i.e. gender framework. To present the gender framework in support of the MOHs effort to integrate gender into its policies, programmes and services; To assist in strengthening GMAG as the strategy chosen by the Ministry of Health in integrating gender To generate discussions from high government officials on the implementation process.

OUTLINE OF PRESENTATION
Background Brief Introduction: Evolution of shifting perspectives in health

Conceptual clarification Why GENDER matters

Gender and Diseases : Briefly Questions that you should ask

Conclusion

(WHO Commission on Social Determinants of Health 2005)

Social Determinants of Health

Gender

Income and social status Education and literacy Employment/Working conditions Social environments Physical environments Healthy child development Biology Health services Culture Compiled by: Public Health Agency of Canada

But, What is GENDER?

CONCEPTUAL CLARIFICATION
English language dictionaries, gender and sex used as synonymous terms Past 3 decades, gender evolveddifference into a different concept SEX is the biological

between males and females >>biologically determined characteristics >> distinct male & female patterns of morbidity & mortality >> specific sex related health problems

CONCEPTUAL CLARIFICATION

GENDER refers to the economic, social and cultural attributes and opportunities associated with being male or female in a particular social settings at a particular point in time. >> social construct >> societys expectations >> different roles & responsibilities >> different norms & values >> different access to & control over

Why Gender Matters?

Health is a product of physical and social environment >> complex biological & social determinants >> need to consider the realities of peoples lives Inequalities in health arise largely as consequences of: >> differences in social and economic status >> differential access to power & resources

RESOURCES
ACCESS TO CONTROL OVER

INTERNAL
RESOURCES

ECON & SOCIAL RES

POLITICAL INFO & RESOURCE EDUC S

TIME

POWER & DECISION MAKING

(WHO 2001)

Why Gender Matters?

Heaviest burden of ill-health is borne by those who are most deprived (not only economically but also in terms of capability, such as literacy levels and access to information.) >> poorest of the poor are women, elderly & children >> need to look at intersection of gender & other variables e.g class, ethnic groups

Why Gender Matters?

Exposure, risks and vulnerability >> different sexual division of labour within household >> male and female jobs >> different physical spaces Nature, severity or frequency of health problems >> impact of HIV/AIDS or STDs on men & women >> manifestation of problems >> Violence Against Women

Why Gender Matters?

Health seeking behaviour >> stigma >> poor in terms of time >> perceptions & definitions of illness differ & shaped by gender norms >> restriction in mobility because of transport or culture Access to health services >> restricted access because of restricted mobility >> lack of money

Why Gender Matters?

Ability to comply to treatments >> can they go for follow-up? Rehabilitation? Social consequences of health problems >> TB on men and women differ >> infertility, breast cancers, cervical cancer Interaction of biological and socially constructed factors increases vulnerability >> HIV/AIDS, STDs >> Maternal health problems e.g pregnancy >> Men??

IN SHORT.
Sex and gender differences between men and women and their interactions contribute to:

a) Differences in health risks, b) Health seeking behaviour c) Access to and utilisation of health services and health outcomes

Need to examine, understand and address these differences

What do we need to do?

If you dont ask, you dont know, and if you dont
know, you cant act (Kreiger, N 1993)

a)

Engendered health information i.e

Sex disaggregated data of health outcomes e.g mortality, morbidity, causes, utilisation of health services etc
Gender analysis to explain why the difference between men and women

b)

c) Need to look at specific population groups most affected e.g age, ethnic groups etc

We need to ask questions such as

Are women and men at differential risk of exposure to infection or different in terms of vulnerability? Caused by sex differences or gender roles and norms? Do these affect rates of progression of disease? Are men & women at differential risk of recurrent infection? Do gender norms differentially influence womens and mens ability to recognize health problems, their access to health services, and their ability to successfully complete treatment?

We need to ask questions such as

Are there differences in the treatment received at health facilities by women and men? Are there different health experiences at the health centres? Do these contribute to differential health outcomes? What are the consequences of these health problems? Do these consequences differ between men and women? Why?

HIV/AIDS
Source: UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, Geneva, 2002

Gender & sexuality are important factors:

a) HIV transmissions through sex b) Influences treatment, care & support

 Inequitable power
Control of women Society gives more freedom to men

Economic imbalance

HIV transmission through heterosexual relationship

Approximate # of adults living with HIV/AIDS, worldwide -- by sex (millions)

50 40 30 20 10 0 18.6 18.5

Women Men

Similar prevalence -- but varying strategies, because, for example:

Prevention: Men can use a condom w/o a
partners cooperation -- women cant. Women often are not free to refuse sex; men usually are.

Testing: Women often at risk of physical abuse and abandonment if they report a positive HIV test -- men generally dont. Treatment: Women, not men, must take PMTCT drugs -- but often men, not women, have financial and other forms of control over whether women are able to take them. (Glad that Cambodia has the Health Equity Fund)

Blindness
Source: Abou-Gareeb, I., et al., Gender and blindness: a meta-analysis of population-based prevalence surveys, Ophthalmic Epidemiology 8(1), 2001, 39-56.

Approximate # of blind people -developed countries, China, India, and Africa -- by sex (millions)
35 30 25 20 15 10 10 5 0 20 Women Men

Higher prevalence of blindness among women: Why?

Greater life span of women greater burden of degenerative blindness. But more women are blind at all ages. Must be another explanation.
Differential mortality among blind men/women? No.

Higher prevalence of blindness among women: Why?

Women suffer from more trachoma than men, due to their gender-specific childcare activities -- but, again, the difference is too small to account for the overall difference in prevalence. Most likely explanation? Differential use of eye-care services due to differences in gender roles and behaviors.

So . . . .
One of the quickest ways to reduce overall levels of blindness, and thus move toward Vision 2020 goals, may be to increase womens access to and utilization of eye-care services -through projects that address the gender realities of the intervention area.

Gender and Diseases

Gender & Tuberculosis Gender & Malaria Gender & Reproductive Health Gender & STD (HIV/AIDS) Gender & Smoking Gender & Motor Vehicle Accidents Gender & Violence Maternal mortality?? Is this a gendered issue? Is this not just a womens issue? WHO Fact sheets to show that gender matters and does make a difference to our understanding of the health problems

WHAT ABOUT MEN?

Important because men and women live in the same society, part of the equation. Men are also consumers of health care Men seen as important in reducing maternal mortality , but what and how?? Mens part important in the increase of HIV/AIDS Increase violence against women

COSTS IF GENDER NOT CONSIDERED?

Failure in assessing health risks >>avoidable mortality, morbidity & disability. Possible delays in diagnosis and treatment Wasted expenditure because of failure to address major factors associated with a health problem

CONCLUSION
Gender inequalities yield a disproportionate burden on women and some men BUT social norms can also have a negative impact upon mens sexual and reproductive health GENDER is an important determinant of health for both women and men.

CONCLUSION
Not considering gender dimensions affect quality of care & quality of research Violates the rights of people: Health is the right of all people. Not applying gender perspective is unethical

THANK YOU