Handbook of Clinical Gender Medicine. Группа авторов

less than men. Women are also subject to higher rates of unemployment, with the unemployment gap in relation to men ranging from 15% higher in countries with developed economies to 40% higher in countries with developing economies [11]. Women are also more likely than men to be in nonformal employment for which they do not receive a salary [11]. Also, in most societies men continue to hold more political power and with it have greater rein over social and economic controls. The data is very clear with regard to the socioeconomic gradient; higher levels of wealth translate into better health, and women’s financial status within most societies is less than males.

      However, we have yet to gain adequate insights into how gender equity is affected within a socioeconomic level. We do not know if there is any difference between women and men in terms of their access to health or in their health outcomes within the same impoverished household.

      With respect to LGBT populations, for the most part they are excluded from mainstream health policy which by nature remains largely hetero-centric. These populations are rarely considered within healthcare systems outside of the domain of HIV/ AIDS and other related diseases. Moreover, the LGBT population is largely missing from inclusion in the health disparity and diversity discussions occurring within countries such as the USA and Canada [7, 8]. The focus is limited to more ‘visible’ groups such as racial and ethnic minorities. Since LGBT populations are not readily identifiable, they are usually absent from national data sets such as health surveys, censuses, and epidemiological studies. There are either limited or inadequate measures used to identify these populations. If present they are often limited to a single question related to ‘sexual preference’ which provides minimal and possibly slanted information. Finally, the structural barriers faced by LGBT populations are significant and include the limited knowledge of health care professionals, healthcare professionals’ bias which may be largely unintended, and the lack of legal status which can prevent a partner from being able to participate in health consultations or decision making in most countries [7].

      The Final Word

      The effects of gender inequities on global health are clear and far reaching. Their magnitude is a potent driver and catalyst for change. In an attempt to address these disparities, gender mainstreaming has evolved as a process in which issues related to gender inequities are given attention when making policies, designing programs, and providing services. This is included within both the legislative and the financial domains. While gender mainstreaming goes beyond the health sector, it is a critical element within it. In theory it should be framed by human rights, be inclusive of men, women, and LGBT people, and span preventive, curative, and rehabilitative healthcare services. While gender mainstreaming as a concept has great merit, it remains more of a promise than a widespread practice.

      Another strategy aimed at addressing sex-based differences is the intentional increase in women within the healthcare professionals, within leadership positions in healthcare institutions, and within key political roles. While this intervention is admirable, it will by itself do little to affect equity within health systems since it is not a panacea for creating gender-sensitive health systems. The issue is far more complex and the interventions need to address inequity in broader terms.

      Further, while the call for universal healthcare is well intentioned, it may have little or no impact on the gender-related disparities inherent in health systems unless we also address empowerment, access to education, gender-based violence, and hetero-centricity; these societal factors are prerequisites for the desired sea change and without them there will be little movement in terms of improving the overall health of society at large.

      At the core of health systems is the tenet ‘to put people first’. To do this we must put sex and gender front and center. Although gender medicine is not a new therapeutic area, it is a new dimension for healthcare professionals and healthcare systems. Since healthcare systems are shaped by the society in which they operate, the change which needs to occur must permeate how these systems operate and how people relate as well as how people operate within these systems.

      Ultimately, the success of a sex-and gender-based approach to health will be dependent on healthcare professionals who, among other actions, will need to play a leadership role as advocates in order to break the cycle of gender-based neglect. Advocacy and action must occur in a number of domains including policy, research, healthcare professional education, and clinical practice guidelines. Available and additional evidence needs to be generated and then put into practice across all of these domains. Additionally, education of patients must be coupled with broad awareness of all healthcare consumers.

      Men, women, and LGBT people are waiting for healthcare systems that minimize inequities in health status, disease distribution, and access to services. They are also waiting for gender-sensitive approaches to their care. Let us not keep these patients waiting.

      References

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2 Buor D: Gender and the utilization of health services in the Ashanti region, Ghana. Health Policy 2004;69:375–388.

3 Roy K, Chaudhuri A: Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India. Soc Sci Med 2008;66:1951–1962.

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5 Wilkins D, Payne S, Granville G, et al: Gender and Access to Health Services Study: Final Report. London, Department of Health, 2008.

6 Juel K, Christensen K: Are men seeking help too late? Contacts to general practitioners and hospital admissions in Denmark 2005. J Public Health (Oxf) 2007;30:111–113.

7 Gay and Lesbian Medical Association and LGBT Health Experts Healthy People 2010: Companion Document for Lesbian, Gay, Bisexual and Transgender (LGBT) Health. San Francisco, Gay and Lesbian Medical Association, 2001.

8 Mule NJ, Ross RE, Deeprose B, et al: Promoting LGBT health and wellbeing through inclusive policy development. Int J Equity Health. 2009;8: 18.

9 Cashin CE, Borowitz M, Zuess O: The gender gap in primary health care resource utilization in Central Asia. Health Policy Plan 2002;17:264–272.

10 Lee C, Owens R: Issues for a psychology of men’s health. J Health Psychol 2002;7:209–217.

11 World Health Organization. Women and health: today’s evidence, tomorrow’s agenda. 2009. http://www.who.int/gender/women_health_report/en/index.html