Handbook of Clinical Gender Medicine. Группа авторов

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СКАЧАТЬ 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

1 Brittle C, Bird CE: Literature review on effective sex-and gender-based systems/models for care. 2007. http://www.womenshealth.gov/pub/owh/genderbased.cfm (accessed May 1, 2011).

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.

4 Azad N, Nishtar S: A call for a gender specific approach to address the worldwide cardiovascular burden. Prev Control 2005;1:223–227.

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.

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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 (accessed May 12, 2011).

12 Ostlin P, George A, Sen G: Gender health and equity: the intersections; in Evans T, Whitehead M, Diderichsen F, et al eds): Challenging Inequities in Health: from Ethics to Action. New York, Oxford University Press, 2001.

13 Cylus J, Hartman M, Washington B, et al: Pronounced gender and age differences are evident in personal health care. Health Aff (Millwood) 2011;1:153–160.

14 Bryant T, Leaver C, Dunn J: Unmet healthcare need, gender, and health inequalities in Canada. Health Policy 2009;91:24–32.

15 Sanchez NF, Sanchez JP, Danoff A: Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health 2009;99:713–719.

16 Ng N, Kowal P, Kahn K, et al: Health inequalities among older men and women in Africa and Asia: evidence for eight health and demographic surveillance system sites in the INDEPTH WHO-SAGE study. Glob Health Action 2010;27: 3.

17 Boerder S, Santana D, Santillan D, et al: The ‘so what’ report: a look at whether integrating a gender focus into programs makes a difference to outcomes. 2004. http://www.who.int/gender/documents/SoWhatReportSept.05.pdf (accessed May 15, 2011).

      Paula R. DeCola, RN, MSc

      Pfizer Inc.

      235 East 42nd Street, MS 219-9-11

      New York, NY 10017 (USA)

       Tel. +1 212 573 7473, E-Mail [email protected]

      Social and Biological Determinants in Health and Disease

      Schenck-Gustafsson K, DeCola PR, Pfaff DW, Pisetsky DS (eds): Handbook of Clinical Gender Medicine.

       Basel, Karger, 2012, pp 18–36

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A Global War against Baby Girls: Sex-Selective Abortion Becomes a Worldwide Practice

      Nicholas N. Eberstadt

      American Enterprise Institute, Washington, D.C., USA

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