Methodological and Methodological and ethical ramifications of ethical ramifications of paying attention to paying attention to gender differences in gender differences in Public Health researchPublic Health researchAnita RiederAnita Rieder

Institute of Social Medicine of the Medical University of Institute of Social Medicine of the Medical University of ViennaVienna

Kitty LawrenceKitty Lawrence

Verein Altern mit ZukunftVerein Altern mit Zukunft

Public HealthPublic Health

Science of preventionScience of prevention of illnesses, lengthening of illnesses, lengthening life and health promotionlife and health promotion

Focus on populationsFocus on populations and not so much on the and not so much on the individual, as well as, integration of social individual, as well as, integration of social responsibilityresponsibility

Public Health assumes, that illnesses and Public Health assumes, that illnesses and health health problems are influenced byproblems are influenced by physical factors, the physical factors, the social and health political environment social and health political environment

Personal health behaviourPersonal health behaviour as a factor having a as a factor having a strong influence on morbidity and Mortalitystrong influence on morbidity and Mortality

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Gender Gender specificspecific Medicine Medicine and Public Healthand Public Health

„„Being a woman or a man is a HEALTH Being a woman or a man is a HEALTH DETERMINANT that is as significant as DETERMINANT that is as significant as social origin, economic situation and social origin, economic situation and ethnic origin“ethnic origin“

Strasbourg, April 2005, Expert Committee meeting

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Measuring the Global Measuring the Global Gender GapGender Gap

Criteria for MeasurementCriteria for Measurement::– Economic participationEconomic participation – presence of – presence of

women in the workforce in quantitative women in the workforce in quantitative terms, income, statusterms, income, status

– Political EmpowermentPolitical Empowerment – no. years – no. years female head of state, women at ministerial female head of state, women at ministerial level, women with seats in parliamentlevel, women with seats in parliament

– Educational attainment – Educational attainment – primary, primary, secondary tertiary enrolment, literacysecondary tertiary enrolment, literacy

– Health and well-being Health and well-being – life expectancy – life expectancy female vs. male, sex ratiofemale vs. male, sex ratio

World Economic Forum, 2006World Economic Forum, 2006Rieder, 2006

Gender Gap Index 2006Gender Gap Index 2006

RankRank CountryCountry ScoreScore

11 SwedenSweden 0.81330.8133

22 NorwayNorway 0.79940.7994

33 FinlandFinland 0.79580.7958

44 IcelandIceland 0.78130.7813

55 GermanyGermany 0.75240.7524

66 PhilippinePhilippiness

0.75160.7516

77 N. N. ZealandZealand

0.75090.7509

88 DenmarkDenmark 0.74620.7462

99 UKUK 0.73650.7365

1010 IrelandIreland 0.73350.7335

2727 AustriaAustria 0.6990.699

World Economic Forum. The Global Gender Gap.

2006

Gender, Public Health, Gender, Public Health, EthicsEthics Population-based focus: required to Population-based focus: required to

examine ethical implications – examine ethical implications – infringement on individual libertiesinfringement on individual liberties

a framework for public health ethics a framework for public health ethics must not only be a code of restraint to must not only be a code of restraint to fairly and appropriately preserve the fairly and appropriately preserve the negative rights of citizens to non-negative rights of citizens to non-interference, but also to emphasise the interference, but also to emphasise the positive rights of commitment to positive rights of commitment to improve the public’s health and reduce improve the public’s health and reduce certain social inequities certain social inequities

Kass NE. An ethics framework for public health. American Journal of Public Health. 2001;91(11):1776-1782

Inequities between men Inequities between men and women in terms of and women in terms of health, access to public health, access to public health programmes and health programmes and medical treatments have in medical treatments have in part stemmed from the past part stemmed from the past lack of gender lack of gender differentiated research. differentiated research.

NeurologyNeurology

Gender aspects have so far played a minimal Gender aspects have so far played a minimal role in both research and clinical practicerole in both research and clinical practice

Are there differences between men and Are there differences between men and women in terms of brain function?women in terms of brain function?

Influence of pregnancy on course of illness Influence of pregnancy on course of illness e.g. Multiple Sclerosis or Epilepsy – e.g. Multiple Sclerosis or Epilepsy – comprehensivelycomprehensively

New questions arise – gender specific aspects New questions arise – gender specific aspects in older age - neurodegenerative diseases, in older age - neurodegenerative diseases, Stroke – neue FragenStroke – neue Fragen

„ „ No practical guidelines, since assured facts are No practical guidelines, since assured facts are missing“missing“

Gender Medizin: A. Rieder, B. Lohff (Hrsg.), Springer Verlag, 2004

Kapitel 9: C.Schröder, C.Wenzel und K.Weissenborn

Building a competent Building a competent workforce demands workforce demands appropriate training: appropriate training: “Developing a multi-“Developing a multi-disciplinary public health disciplinary public health training is an international training is an international as well as a as well as a national public national public health issue” health issue”

Evans D, Dowling S. J Epidemiol Community Health 2002;56:744-747

““Gender Aspects of Gender Aspects of Medical Education”Medical Education”

EU - research project carried out by the department of history,

ethics, and philosophy of medicine of the Medical University

in HannoverAim: 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

Eliminating disparities in health care Eliminating disparities in health care and public health relies on building and public health relies on building a broad and reliable evidence basea broad and reliable evidence base

Seeking out evidence, quantifying it Seeking out evidence, quantifying it and taking the evidence into and taking the evidence into consideration when making consideration when making decisionsdecisions

… …evidence does not make evidence does not make decisions people do!decisions people do!

KeywordKeyword“Gender”“Gender”

An important basis for An important basis for Public Health Strategies Public Health Strategies areare

Target group specificTarget group specific

health reportshealth reports

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Women‘s Health Women‘s Health ReportReportMen‘s Health ReportMen‘s Health Report Women‘s health reports - pioneers Women‘s health reports - pioneers

in the compilation of gender specific in the compilation of gender specific health reportshealth reports

Austrian women‘s health report Austrian women‘s health report served as a model and paved the served as a model and paved the way for men‘s health reportway for men‘s health report

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Gender und Public Gender und Public HealthHealth

Compilation and analysis of Compilation and analysis of health datahealth data

Identification of gender Identification of gender differences and assessing the differences and assessing the relevance in the health systemrelevance in the health system

Creating conceptsCreating concepts Transfer to practiceTransfer to practice

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for.....for.....

effective health care satisfying effective health care satisfying both demands and needs -both demands and needs -

preventive and curativepreventive and curative increasing health and life increasing health and life

expectancy as well as quality expectancy as well as quality of lifeof life

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Men’s Health Report Men’s Health Report of the city of Vienna 1999of the city of Vienna 1999

1st comprehensive international 1st comprehensive international scientific report on men’s healthscientific report on men’s health

Foundation for the definition of the main Foundation for the definition of the main focus points for men’s health carefocus points for men’s health care

Basis for the identification of priorities in Basis for the identification of priorities in public health care and in preventionpublic health care and in prevention

Basis for health political discussionsBasis for health political discussions

Schmeiser-Rieder et al, 1999, MA-L (Hrsg)), Schmeiser-Rieder et al, 1999, MA-L (Hrsg)), Rieder et al, Lancet 2001, Schmeiser-Rieder et al, Rieder et al, Lancet 2001, Schmeiser-Rieder et al,

WHO-Health Report on the Aging Male, 2000WHO-Health Report on the Aging Male, 2000Rieder, 2006

Implementation of the Women‘s Health Report 2005

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

Women‘s HealthReport

Target groups

Areas of action

Politics

Scientific Management:Univ.-Prof. Dr. Beate Wimmer-PuchingerWomens Health Commissioner

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From research to From research to practicepractice

The Vienna Women‘s Health The Vienna Women‘s Health ProgrammeProgramme

Univ.-Prof. Dr.Univ.-Prof. Dr.Beate Wimmer-Puchinger Beate Wimmer-Puchinger Executive Officer for Women‘s HealthExecutive Officer for Women‘s HealthWomen‘s Health Program ViennaWomen‘s Health Program ViennaVienna Social FundVienna Social Fund

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„„A Heart for A Heart for Vienna“Vienna“

Vienna Health Promotion Program Vienna Health Promotion Program 20002000City of Vienna, Fonds Soziales WienCity of Vienna, Fonds Soziales Wien

Purpose:Purpose: Reduce prevalence of Reduce prevalence of

cardiovascular risk factorscardiovascular risk factors through optimisation of life through optimisation of life

style factorsstyle factorsRieder, 2006

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Aspects to consider when incorporating gender into public health

Gender Medicine Gender Medicine The Public Health The Public Health

PerspectivePerspective

Key issueKey issueWhat do we want to What do we want to

achieve? achieve?

TTargets and objectives?argets and objectives?EExpected outcome?xpected outcome?IImpact on political decision mpact on political decision making?making?IImpact on society?mpact on society? Rieder, 2006

Gender-Specific Gender-Specific MedicineMedicine ““Much is still unknown and there is ample Much is still unknown and there is ample

scope for research”scope for research” ““Current best models of care will benefit Current best models of care will benefit

from findings revealed by gender – based from findings revealed by gender – based research”research”

““Our major challenge will be to determine Our major challenge will be to determine the relative contributions to gender-the relative contributions to gender-specific health of biological and social specific health of biological and social factors”factors”

““Research findings have the potential to Research findings have the potential to bring about policy changes……. “bring about policy changes……. “

Correa-de Araujo, et al, JAMA, 292:2921-2922, 2004

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Gender Gender SpecificSpecific MedicineMedicinehas a major has a major responsibility to meet responsibility to meet the societal needs and the societal needs and to contribute to the to contribute to the societal value of health societal value of health research…research…

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