by Dipika Gaur (Fall 2016) and Jenna Bhaloo (Spring 2015)
Origins & Definition:
According to the World Health Organization, sex refers to the biological and physiological characteristics that define men and women. Comparatively, gender refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women (1). The gender-sensitive approach stems from the identity politics branch of feminism- specifically essentialist feminism (the belief that women share female characteristics that make them different from men) and victim feminism (the belief that women should not be victimized based on gender) (2). This model aims to address health problems through the framework that men and women may have different experiences, needs, and roles within their communities. Therefore, they require specific actions and responses to their concerns. Also known as the gender-based approach or gender perspectives, this approach was created in order to achieve gender equality by emphasizing that gender should be taken into account when creating policies and programs (3). It is critical to note that the gender sensitive approach applies to all people who identify with a specific gender, including transgender individuals - those whose gender identity does not conform to the norms associated with the sex assigned to them at birth (4).
The WHO first incorporated this gender-based approach into their work after the passage of a series of international mandates including the Economic and Social Council (ECOSOC) Resolutions of 1997 & 2006 and the Beijing Platform for Action (5). Known as the WHO Gender Strategy, the objective has been to ensure that gender equality and equity will be incorporated into the policies released by the WHO (5). This strategy's main goals are to "build WHO capacity for gender analysis in planning and programming, reflect gender in WHO's programme budgets, promote the use of sex-disaggregated data to set up successful gender interventions, and to establish accountability" (5). By doing this, initiatives and programs can specifically be catered to the needs of both women and men based on biological and social differences between the two groups.
The figure below is a descriptive model of the gender-sensitive approach. Fundamental factors including gender, socioeconomic status, genetics and biology, geographic location, poverty, money, power, and cultural/religious norms impact an individual's risk for developing a health problem. The gender-sensitive approach is incorporated in the model after the health problem has been established. Therefore, finding the best treatment to minimize the health problem requires specific actions and responses that consider how men and women experience the concern differently. For example, the above-mentioned fundamental factors may cause someone to develop alcohol addiction. This approach integrates an analysis of how the status, experiences, expectations, and needs of men and women in these communities differ and may contribute to alcoholism when determining the best intervention for an individual or a group.
Figure 1. The Gender-sensitive approach model.
Why use the gender-sensitive approach?:
The history of research studies conducted on coronary heart disease (CHD) serves as an example of the importance of incorporating the gender-sensitive approach into public health. Coronary heart disease has historically been considered a disease that predominantly affects men (6). However, women experience unique challenges with the onset of CHD due to the influence of menopause and risk factors, such as diabetes and triglyceride levels, that have a greater impact on CHD risk in woman than in men (6). Because women were not included in many initial studies conducted on risk factors and outcomes of CHD, there is a lack of accurate, gender specific information available about CHD. Women report difficulty in identifying the signs and symptoms of CHD and seeking appropriate, timely treatment for the condition (6). As a result, women are less likely than men to receive diagnostic and therapeutic procedures for CHD despite having a worse prognosis of CHD (6).
Current Global Health Concern:
Global efforts to promote men seeking mental health and sexual health services would benefit from employing a gender-sensitive approach to their recruitment and service delivery models. Historical concepts of masculinity and shame often impact the types of medical care men feel comfortable receiving and the medical concerns they discuss with their physicians. (7) In Ireland, “men have higher death rates than women at all ages, and for all leading causes of death." (7) Irish men are more likely than women to engage in the following risky behaviors: drunk driving, alcohol and drug abuse, not wearing seat belts and speeding while driving. Lastly, "men in Ireland are four times more likely to die of suicide than women." (7) These differences in health behaviors and outcomes between men and women suggest that there may be gender-based differences in how men and women approach the variety of health care services available to them.
Gender-sensitive indicators have been developed to track gender-related changes in society over time. These indicators focus on measuring changes in the status, roles, and needs of women and men over time as a method of assessing whether gender equity is being achieved. While these indicators are useful, some argue that policy makers should use these as tips and focus their attentions on the actual experiences and attitudes of women (5). For example, many of these indicators have been considered "insufficient in expressing women's experiences especially in areas such as women's empowerment" (5). In addition, as seen from the previous quote, the gender-sensitive approach is often biased towards the integration of women in addressing health problems and many times, and it fails to address the specific needs of men and LGBTQA communities. Over the past 10 years, many global health interventions that focus on improving health outcomes for women and children have often excluded or limited to the involvement of men. Women were historically excluded from many early research studies based on gender; however, in this century, we cannot afford to exclude men and LGBTQA communities from policy, programs, and research if we want to succeed in public health and medicine.
Dr. Margaret Chan, Director-General of the World Health Organization said, "The integration of gender analysis and action into the work of WHO would make an important contribution to its ongoing work on women and health" (3). The incorporation of the experiences and needs of men, women, and LGBTQA individuals globally using the gender-sensitive approach could help to alleviate external issues that arise when attempting to solve public health crises.
(1) World Health Organization. What do we mean by "sex" and "gender"? [Internet]. Available from: http://apps.who.int/gender/whatisgender/en/
(2) Mandie, JD. How political is the personal? Identity politics, feminism, and social change. [Internet]. WMST-L. Available from: http://userpages.umbc.edu/korenman/wmst/identitypol.html
(3) World Health Organization. What is a gender-based approach to public health? [Internet]. 2007 March. Available from: http://www.who.int/features/ga/56/en/
(4) World Health Organization. Transgender people. [Internet]. Available from: http://www.who.int/hiv/topics/transgender/en/
(5) World Health Organization. Integrating gender analysis and actions into the work of WHO [Internet]. Available: http://www.who.int/gender/mainstreaming/integrating_gender/en
(4) White, A. Tacking coronary heart disease: A gender sensitive approach is needed. [Internet]. BMJ. 2001 Nov. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121530/
(6) Roeters van Lennep JE, Westerveld HT, Erkelens DE, van der Wall EE. Risk factors for coronary heart disease: implications of gender. Cardiovascular Research. 2002; 53:538-549. doi: htt p ://dx.doi.org/l 0.1016/80008-6363 ( 01)00388-1
(7) McDonagh, M. Men talk about health, but not mental, sexual, or 'private' health. The Irish Times. Available from: http://www.irishtimes.com/life-and-style/health-family/men-talk-about health-but-not-mental-sexual-or-private-health-1.2799588
(1) Lear, M. The woman's heart attack. The New York Times. Available from: http://www.nytimes.com/2014/09/28/opinion/sunday/womens-atypical-heart-attacks.html?_r=O
(2) Go red for women: just a little heart attack. Available from: https://www.youtube.com/watch?v=t7wmPWTnDbE
(3) Women's heart disease: it's not just a man's disease. Ad Council. Available from: https://www.youtube.com/watch?v=r2P-RFeKzVs