Methodological and ethical ramifications of paying attention to gender differences in Public Health research

1. 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

2. Public Health • 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 byphysical factors, the social and health political environment • Personal health behaviour as a factor having a strong influence on morbidity and Mortality Rieder, 2006

3. Gender specific Medicine and Public Health • „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 Rieder, 2006

5. Measuring the Global Gender Gap • 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 Rieder, 2006

6. World Economic Forum. The Global Gender Gap. 2006

7. Gender, Public Health, Ethics • 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

8. 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.

9. 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“ Gender Medizin: A. Rieder, B. Lohff (Hrsg.), Springer Verlag, 2004 Kapitel 9: C.Schröder, C.Wenzel und K.Weissenborn

10. Building a competent workforce demands appropriate training: “Developing a multi-disciplinary 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

11. “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

12. 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!

13. Keyword “Gender”

14. An important basis for Public Health Strategies are Target group specific health reports Rieder, 2006

15. Women‘s Health ReportMen‘s Health Report • 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 Rieder, 2006

16. Gender und Public Health • Compilation and analysis of health data • Identification of gender differences and assessing the relevance in the health system • Creating concepts • Transfer to practice Rieder, 2006

17. for..... • effective health care satisfying both demands and needs - preventive and curative • increasing health and life expectancy as well as quality of life Rieder, 2006

18. Men’s Health Report of the city of Vienna 1999 • 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 Rieder, 2006

19. Implementation of the Women‘s Health Report 2005 Politics • 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 Health Report Areas of action Target groups Scientific Management: Univ.-Prof. Dr. Beate Wimmer-Puchinger Womens Health Commissioner Rieder, 2006

20. From research to practice

21. The Vienna Women‘s Health ProgrammeUniv.-Prof. Dr.Beate Wimmer-Puchinger Executive Officer for Women‘s HealthWomen‘s Health Program ViennaVienna Social Fund Rieder, 2006 Rieder, 2006

22. „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 Rieder, 2006

23. Aspects to consider when incorporating gender into public health Rieder, 2006

24. 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? Rieder, 2006

25. Gender-Specific Medicine • “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 Rieder, 2006

26. Gender Specific Medicinehas a major responsibility to meet the societal needs and to contribute to the societal value of health research… Rieder, 2006