Lesley Doyal

Gender equity in health: debates and dilemmas.

Gender equity is increasingly cited as a goal of health policy but there is considerable confusion about what this could mean either in theory or in practice. If policies for the promotion of gender equity are to be realisable their goal must be the equitable distribution of health related resources. This requires careful identification of the similarities and differences in the health needs of men and women. It also necessitates an analysis of the gendered obstacles that currently prevent men and women from realising their potential for health. This article explores the impact of gender divisions on the health and the health care of both women and men and draws out some of the policy implications of this analysis. It outlines a three point agenda for change. This includes policies to ensure universal access to reproductive health care, to reduce gender inequalities in access to resources and to relax the constraints of rigidly defined gender roles. The article concludes with a brief overview of the practical and political dilemmas that the implementation of such policies would impose.

Engendering International Health: The Challenge of Equity

Engendering International Health presents the work of leading researchers on gender equity in international health. Growing economic inequalities reinforce social injustices, stall health gains, and deny good health to many. In particular, deep-seated gender biases in health research and policy institutions combine with a lack of well-articulated and accessible evidence to downgrade the importance of gender perspectives in health. The book?s central premise is that unless public health changes direction, it cannot effectively address the needs of those who are most marginalized, many of whom are women.The book offers evidence and analysis for both low- and high-income countries, providing a gender and health analysis cross-cut by a concern for other markers of social inequity, such as class and race. It details approaches and agendas that incorporate, but go beyond, commonly acknowledged issues relating to womens health; and it brings gender and equity analysis into the heart of the debates that dominate international health policy.

Balancing benefits and harms: the example of non-steroidal anti-inflammatory drugs.

To provide safe and effective interventions for people, reliable and valid evidence is needed. This is most easily produced by undertaking trials in samples of people who are as homogeneous as possible and applying the results to similar, well defined groups of patients. To be equitable, however, appropriate care needs to be provided for everyone in the diverse community using health services. Therefore, there is a tension between obtaining scientific evidence that is reliable but which can be applied only to a small subset of the population, and distributive justice that requires that all in need are treated equally appropriately. Drugs have potential harms as well as benefits. Doctors would like to be able to balance any risks against benefits to derive a therapeutic ratio for each patient, but this is difficult. Formal trials can tell a lot about the efficacy of a drug in a specific context, but unless they are huge and pragmatic they tell less about a drugs toxicity. Post-marketing surveillance may uncover more information on toxicity, but the data usually lack sufficient detail to lead to an understanding of the determinants of adverse reactions. Furthermore, extrapolation of the efficacy or toxicity of a drug in one disease or group of patients to those associated with different diseases or groups can be difficult and misleading. We examined aspects of these problems in the context of one commonly prescribed class of drugs—non-selective, non-steroidal anti-inflammatory agents (NSAIDs)—and their use in the management of joint pain. We compared the types of patients in whom trials of non-selective NSAIDs are conducted with those who receive the drugs in practice. Then we examined the prevalence and associations of adverse events in these two groups. ### Methods As NSAIDs are primarily used to treat arthritic pain, we studied trials of these drugs in patients with …

Challenges in researching life with HIV/AIDS: an intersectional analysis of black African migrants in London

Most social science research on HIV has focused on prevention. The arrival of new therapies generated more studies on life with HIV. However most have been carried out in developed world contexts. Much less is known about the vast majority of those living with HIV and dying from AIDS. If this gap is to be filled, more qualitative research will be needed on affected individuals in the developing world and also among migrants who have left developing countries to live in the diaspora. It will also be essential to explore the lives of individuals from the same communities who may experience HIV in very different ways as a result of their gender and/or sexuality. This paper presents findings from three studies of Black African migrants living with HIV in London. It uses an intersectional approach to examine the similarities and the differences between the experiences of heterosexual women, heterosexual men and gay and/or bisexual men. The article highlights the importance of research of this kind both for providing the evidence base for context‐specific policy development and also for making better conceptual and theoretical sense of the impact of HIV on individuals and their lives.

Reshaping the NHS workforce

Education and debate p 1067 The staffing problems of the NHS continue to make headlines.1 Junior doctors are threatening to strike, consultants are voicing their frustration, and nurses are voting with their feet.2 Though their concerns are less visible, physiotherapists, radiographers, occupational therapists and other members of the professions allied to medicine are also facing major challenges.3 The problems have been well rehearsed but solutions seem as far away as ever.If the healthcare needs of this new millennium are to be met, more radical approaches to collaborative working will need to be explored. By its very nature the healthcare labour force is an interdependent one. The different occupational groups did not develop in isolation from each other but as part of a complex and interdependent system capable of carrying out the many activities that make up a modern health service. Yet despite this obvious reciprocity, the different elements of the NHS labour force are still planned and managed in isolation. This continuing fragmentation has a major impact on the quality of patient care and on the wellbeing of health workers themselves.4 Since the 1970s there have been irresistible pressures towards collaborative working across traditional boundaries. More health workers are now organised into multiprofessional teams, and many nurses and those in the professions allied to medicine …

‘You are not yourself’: Exploring masculinities among heterosexual African men living with HIV in London

It is now clear that gender is an essential factor shaping the narratives of men as well as women. However, there have been few studies of the daily lives or sexual activities of heterosexual men. Hence, strategies developed to prevent the spread of the HIV virus are rarely based on detailed knowledge of the men whose behaviours they are intended to change; this is especially evident in the developing world where the epidemic is most severe. Nor do we know very much about those men who have already been diagnosed as HIV positive. Around 13 million men are now living with HIV of whom around 96% are in low or middle income countries. Migrants from developing countries also make up the majority of positive people in a number of developed countries. In the UK, for example, heterosexual activity is now responsible for about half of all new HIV diagnoses with the majority of those involved being of African origin. But almost nothing is known about the ways in which different constructions of masculinity affect their experiences of illness. This study used qualitative methods to explore the experiences of a sample of black African men who defined themselves as heterosexual and were receiving treatment for HIV and/or AIDS in London. It explored their feelings, their needs, their hopes and their desires as they negotiated their lives in the diaspora.

Why dentists should take a greater interest in sex and gender

This brief review highlights the lack of evidence relating to sex and gender differences in oral health as well as the widespread conceptual confusion and conflation that often underlies them. A broader biomedical understanding of these issues will offer a valuable framework within which differences in oral health between women and men can be further explored. This in turn would facilitate the development of the evidence base necessary to optimise the efficacy of dental practice in meeting the needs of both women and men patients.

'Elvis Died and I was Born': Black African Men Negotiating Same-Sex Desire in London:

This article reports on the first study of gay/bisexual men in the African diaspora. It is based on a focus group and in-depth individual interviews with eight men living in London. The main focus of the study was on the development of the mens sexual identity in their African countries of origin and the ways in which these identities and practices were reshaped and renegotiated by the move to London. The central themes to emerge were the tensions for these individuals between being African and being gay and between their same-sex preferences and mainstream religious beliefs and practices. The article demonstrates the need for further research on similar groups in different parts of the world as well as highlighting the need for reflexive methodologies that can accurately represent the complex realities of these mens lives.

Re-visiting Gender Justice in Health and Healthcare

Debates about gender justice are now common in public policy in general and in the health sector in particular. The promotion of greater equality between women and men has become a key theme in both national and international policy debates. However there has often been confusion about what ‘equality’ means in this context and how it might be achieved. The terms ‘gender equality’ and ‘gender equity’ are both in widespread use but there has sometimes been a lack of clarity about the distinctions between them as well as their practical implications.

The odd couple: using biomedical and intersectional approaches to address health inequities

ABSTRACT Background: Better understanding and addressing health inequities is a growing global priority. Objective: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. Design: We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work. Results: We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease. Conclusion: We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities.