Health and Gender WHO’s Gender Policy and the importance of gender

1. Health and Gender WHO’s Gender Policy and the importance of gender in health interventions and research

2. Learning Objectives By the end of this session, students will be able to Discuss the definition of terms sex and gender Discuss why this topic is important for New Zealand Describe and discuss some health conditions of importance to New Zealand

3. Student Health Desk

4. WHO’s Gender Policy • .WHO will, as a matter of policy and good public health practice, integrate gender considerations in all facets of its work.”

5. WHO’s Gender Policy 2 • “…integration of gender considerations, that is gender mainstreaming, must become standard practice in all policies and programmes.”

6. WHO’s Gender Policy 3 “…all programmes will be expected to collect disaggregated data by sex, review and reflect on the gender aspects of their respective areas of work, and initiate work to develop content-specific materials.”

7. Define the terms • Sex • Gender

8. Definition of Terms • “Sex” refers to the biological and physiological characteristics of male and female animals: genitalia, reproductive organs, chromosomal complement, hormonal environment, etc. • “Gender” refers to the socially constructed roles, rights, responsibilities, possibilities, and limitations that, in a given society, are assigned to men and women -- in other words, to what is considered “masculine” and “feminine” in a given time and place

9. Why this topic? • This is a global issue, therefore a New Zealand issue

10. Our topic today • This session will discuss a variety of different health conditions of differing types -- infectious, non-infectious, chronic, acute, primarily biologically determined, primarily behaviorally determined, and combinations of all of these.

11. Effect of gender • The idea will be to see what looking at each condition through a “gender lens” can tell us that will be both interesting and important for dealing effectively with the condition at hand.

12. 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.

13. Approximate # of blind people -- developed countries, China, India, and Africa (millions)

14. Approximate # of blind people -- developed countries, China, India, and Africa -- by sex (millions)

15. Higher prevalence of blindness among women: Why? • Greater lifespans 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.

16. 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.

17. Change in blindness prevalence (%) with improvements in eye care - Guangdong, China

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

19. Lung Cancer Source: WHO/IARC, “CancerMondial: Worldwide Cancer Mortality Statistics”, http://www-depdb.iarc.fr/who/menu.htm, last update: June 2002

20. Age-Standardized Mortality Rate (25-85+), Lung Cancer, 1999 -- Germany

21. Trend in Age-Standardized Mortality Rate (25-85+), Lung Cancer, 1980-1999 -- Germany

22. Gender helps explain the differing trends • Men seem to have begun hearing health-based warnings about cigarette smoking. (This is the global picture)

23. Women and smoking • For women, though, smoking appears to have a gender significance -- that is to say, it is a marker of having arrived in the male world of power, action, strength control, importance, as well as, for many women, a way to “stay thin” -- that is, to maintain traditional feminine attractiveness.

24. Women and smoking • This gender significance works against health-based warnings about smoking • Tobacco companies exploit this significance, promoting women’s association of cigarettes with glamour and power.

25. NZ situation • Around one in five (19.9 percent) adults currently smoke • in New Zealand, 21.1 percent of men and 18.8 percent of females currently smoke.

26. Different Questions for Different Interventions: • For men: What has worked to bring smoking and lung cancer down? How can this trend be continued and amplified?

27. Women and smoking • For women: How can the power of smoking, as a gendered marker of arrival in the world of power and prestige and a convenient way of staying “feminine” looking, be countered, so that women can make sensible decisions about smoking and health?

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

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

30. Similar prevalence -- but varying strategies, because, for example: • Prevention: Men can use a condom without a partner’s cooperation -- women can’t. Women often are not free to refuse sex; men usually are.

31. Testing • Testing: Women often risk physical abuse and abandonment if they report a positive HIV test -- men generally don’t.

32. Treatment • 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.

33. HIV in New Zealand • What do you now about it? • What can we as nurses do about it?

34. Violence Source: WHO, World Report on Violence and Health, Geneva, 2002.

35. Death Rates Per 100,000 Population for Various Forms of Violence

36. But . . . . • Women: • “One of the most common forms of violence against women is that performed by a husband or male partner.” • Men: • “ . . . are much more likely to be attacked by a stranger or an acquaintance than by someone within their close circle of relationships.”

37. % of Total Murders Committed by Opposite-Sex Intimate Partners - Various Studies

38. So -- • To reduce the male murder rate, a focus on “public” murders -- murders by acquaintances, murders by strangers, murders taking place in connection with other crimes -- will be most important. • To reduce the female murder rate, a focus on murders by intimate partners could have a major impact.

39. But that’s not all • Murder is not like other diseases, in that it has a human perpetrator. • Much as any other disease prevention effort must focus both on the infected person and on the agent of infection, attempts to reduce murder rates must focus on murderers as well as murdered people.

40. WHO’s Answer -- ???? • Crime statistics reveal that most violent crime is committed by males • Yet WHO’s recently released World report on violence and health does not highlight sex or gender as a possible risk factor for committing violence Gender distribution,violent crime arrests, USA, 2000 Source: Crime in the United States 2000; Federal Bureau of Investigation; Washington, DC; 2001

41. WHO’s Answer -- ???? • Looking at the numbers, isn’t it at least plausible that differential socialization, or possibly even differences in biology, tend to make males more prone to use violence than females? • Given this, wouldn’t at least some discussion of this possibility be in order when discussing risk factors for violent behaviour? • Evidently, the utility of gender-aware thinking still needs reinforcement -- even at WHO!

42. NZ situation • Between 33 to 39% of New Zealand women experience physical or sexual violence from an intimate partner in their lifetime, according to a study by Janet Fanslow and Elizabeth Robinson(2004).

43. To Sum Up: • We have looked at: • A condition with many origins that significantly disables a large number of people (blindness) • A major, non-infectious, chronic killer (lung cancer) • A major infectious disease (HIV/AIDS) • A major health problem with mostly social roots (violence)

44. To Sum Up: • We have seen: • A condition which disproportionately affects women, even though there would be no a priori reason to expect that it would (blindness) • A disease which disproportionately affects men, but for which men and women exhibit very different trends over time - and which may, by implication, require different interventions for the two sexes (lung cancer)

45. Summing up • A disease which affects men and women about the same amount, in the aggregate, but which has very different implications for each (HIV/AIDS) • A problem which affects men and women at different rates and in different ways, but which is also perpetrated by one sex more than the other.

46. The message? • Looking at health with a gender perspective teaches us about factors that give rise to and sustain disease and disability -- factors that we might not notice without a gender perspective. • Knowing about these factors helps us to better fight disease and disability.

47. References • Ash Quickstats • Statistics New Zealand. Quickstats • New Zealand Womens Refuge • UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, • World Health Organisation: Gender issues • WHO/IARC, “CancerMondial: Worldwide Cancer Mortality Statistics”,http://www-depdb.iarc.fr/who/menu.htm, last update: June 2002