Declarations Gender mainstreaming was defined by the ...



A) Declarations Gender mainstreaming was defined by the Economic and Social Council of UNO as follows: Mainstreaming a gender perspective is the process of assessing the implications for women and men of any planned action, including legislation, policies or programmes, in any area and at all levels. It is a strategy for making the concerns and experiences of women as well as of men an integral part of the design, implementation, monitoring and evaluation of policies and programmes in all political, economic and societal spheres, so that women and men benefit equally, and inequality is not perpetuated. The ultimate goal of mainstreaming is to achieve gender equality. (United Nations Economic and Social Council's agreed conclusions 1997/2. )

Following those lines the WHO has sustained the approach to Gender in Health through a series of documents which appeared in the following years (See: a) Integrating gender perspectives into the work of WHO: World Health Organization, 2002. b) Strategic action plan for the health of women in Europe. Copenhagen, World Health Organization, 2001; c) resolution AFR/RC53/r4 on Women's health: a strategy for the African Region; and resolution CD46.R16 on PAHO gender equality policy; d) EB116/2005/REC/1, Summary record of the second meeting; e) Document WHO/FCH/GWH/07.1 .

At its 60th session in May 2007, the Health Assembly noted with appreciation the strategy and adopted resolution WHA60.25. The strategy was drawn up on the basis of broad consultation throughout the Organization, with representatives from ministries of health, and with external experts, from which it emerged that gender equality and equity should be integrated into WHO’s overall strategic and operational planning, in order to bring about systemic changes across all areas of work. A plan of action for implementing the strategy continues to evolve (Document WHO/FCH/GWH/07.1).

The Millennium Declaration of United Nations Organizations include the promotion of gender equality and the empowerment of women as effective ways to combat poverty, hunger and disease and to stimulate sustainable development (United Nations General Assembly resolution 55/2) The United Nations is strengthening gender mainstreaming through a system-wide strategy, with which the strategy is consistent. In order to ensure that women and men of all ages have equal access to opportunities for achieving their full health potential and health equity, the health sector needs to recognize that they differ in terms of both sex and gender. Because of social (gender) and biological (sex) differences, women and men face different health risks, experience different responses from health systems, and their health-seeking behaviour, and health outcomes differ.

In order to fully incorporate analysis of the role of gender and sex in health and determine appropriate action the WHO Secretariat has given itself the following principles (Strategy for integrating gender analysis and actions into the work of WHO May 2007) :

• addressing gender-based discrimination is a prerequisite for health equity

• leadership and ultimate responsibility for gender mainstreaming lie at the highest policy and technical levels of the WHO

• programmes are responsible for analysing the role of gender and sex in their areas of work and for developing appropriate gender-specific responses in all strategic objectives on a continuing basis

• equal participation of women and men in decision-making at all levels of the Organization is essential in order to take account of their diverse needs

• performance management should include monitoring and evaluation of gender mainstreaming.

WHO strategic directions are chosen as following:

• Building WHO capacity for gender analysis and planning. In order to help to ensure that analysis of the role of gender and sex in health and appropriate planning is integrated into WHO’s work at all levels, staff need to have a basic understanding of the subject matter.

• Bringing gender into the mainstream of WHO’s management. Incorporation of gender considerations – in the components of results-based management planning, budgeting, monitoring and evaluation – effectively influences the work of the Organization.

• Promoting use of sex-disaggregated data and gender analysis. In line with the commitment made in the Eleventh General Programme of Work (Document A59/25, paragraph 116), WHO will use sex-disaggregated data in planning and monitoring its programmes and provide support to Member States in improving the collection, analysis and use of quantitative data on health, disaggregated by sex, age and other relevant social stratifications.

• Establishing accountability. Accountability for the effective integration of gender perspectives into WHO programmes and operational plans will rest primarily with senior WHO staff.

• Role of the gender, women and health network. Implementation of the strategic directions will require advocacy, information, technical support and guidance to staff.

B) Short overview on the scenario

The cardiovascular disease (CVD) model

One of the critical problems relevant to gender approach is found in the main and largely impacting common (for men and women) diseases ( e.g. Cardiovascular Diseases (MI, Stroke)) the knowledge of the differences are fairly understood or known, and the treatment and prevention are suffering by the state of that understanding and knowledge.

Lack of knowledge is parallel to not always certified epidemiology information:

The Italian data (ISTAT 2006) on mortality of main diseases are certified just till 2002.

|thousands | |2002 |2003 |2004 |

|CVD |men |105.7 |108.6 |100.2 |

|CVD |women |131.4 |138.8 |123.2 |

|Tumours |men |93.4 |94.4 |94.5 |

|Tumours |women |69.6 |68.6 |70.3 |

Differences between genders on the single independent risk factors of CVD are well described. The reference values of many parameters (as Blood Pressure, Waist circumference, HDL,) are consequently indicated .

Prevalence of risk factors are different in men and women in the population. The risk factors taken in consideration (Lancet 2004;364: 937-52) are ApoB/ApoAI ratio, Blood Pressure, overweight/obesity, smoking, diabetes bad nutrition, sedentarity, stress, social unsatisfaction. Recently air pollution has been added. They are accounting more than 92% of the global CVD risk. Less is given to genetic risk. The correlation of those risk factors with CVD were shown marginally stronger in women than in men. These results suggest that the existence of 1 additional risk factor may increase the risk of cardiovascular disease more steeply in women than in men (Gend Med. 2006;3:196–205).

Differences are described in the outcomes of Myocardial Infarction in Hospitals

Hospital out come report in Italy 2003

|DRG |Number of admissions |Days stay |

|men not complicated MI alive discharged |28.169 | 7.59 |

|women not complicated MI alive discharged |13.763 | 8.82 |

|men complicated MI alive discharged |13.617 | 9.54 |

|women complicated MI alive discharged |10.154 |10.78 |

|women MI deceased | 3.551 | 6.02 |

|women MI deceased | 3.831 | 5.84 |

CVD Mortality in US Women Is Not Declining (AHA Heart Disease and Stroke Statistics–2005 Update. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001;285:2486-2497). Women tend to delay seeking treatment longer than men ( 18’ longer vs. men; time to treatment was 12’ longer (GUSTO I; Weaver WD. JAMA 1996). More than 20% of young women with multiple risk factors delayed coming to the hospital by 12 h. or more after onset of symptoms (Barron HV. Circulation 1998). Women may experience further delay in the hospital before receiving thrombolytic therapy ( (mean 112’ vs 89’; p ................
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