Disrupting gender norms in health systems: making the case for change

The Lancet, Gender Equality, Norms, and Health Steering Committee, Published May 30, 2019

Summary

Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health.
In this Series paper, we explore how to address all three through recognition and then with disruptive solutions.
We used intersectional feminist theory to guide our systematic reviews, qualitative case studies based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research.
We found that health systems reinforce patients’ traditional gender roles and neglect gender inequalities in health, health system models and clinic-based programmes are rarely gender responsive, and women have less authority as health workers than men and are often devalued and abused.
With regard to potential for disruption, we found that gender equality policies are associated with greater representation of female physicians, which in turn is associated with better health outcomes, but that gender parity is insufficient to achieve gender equality. We found that institutional support and respect of nurses improves quality of care, and that women’s empowerment collectives can increase health-care access and provider responsiveness.
We see promise from social movements in supporting women’s reproductive rights and policies. Our findings suggest we must view gender as a fundamental factor that predetermines and shapes health systems and outcomes. Without addressing the role of restrictive gender norms and gender inequalities within and outside health systems, we will not reach our collective ambitions of universal health coverage and the Sustainable Development Goals. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.

New online learning from ASHM tackles stigma and discrimination in healthcare

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), 1 st March 2019

To mark Zero Discrimination Day, today ASHM has launched Removing Barriers, a new online learning tool for addressing stigma and discrimination in healthcare settings against people affected by HIV, hepatitis B or hepatitis C. 

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) received funding from the Australian Government Department of Health to address systemic barriers and stigma and discrimination to increase access to the health system by people at risk of or with hepatitis B, hepatitis C or HIV.

“Removing Barriers makes it everybody’s business to change what we say, change what we do and work together in removing the unacceptable barriers of stigma and discrimination across the health system.”

A guide to My Health Record: for BBV & STI healthcare providers to support their patients

ASHM  (Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine)

Healthcare providers can play a crucial role in helping patients make informed decisions about whether and indeed the extent, to engage with the My Health Record, particularly for those patients with BBVs and/or other potentially stigmatising conditions.

To support those conversations, ASHM has created A guide to My Health Record: for BBV & STI healthcare providers to support their patients. The guide outlines the key issues associated with My Health Record, and provides four key recommendations to clinicians around advising patients on how to engage with the system.

Though the opt-out period ends soon, clinicians still have an ongoing obligation to provide advice to patients around the benefits as well as the privacy and security control options available, to guide their decision-making around engaging with My Health Record.

With increased media attention on My Health Record in recent weeks, some specifics of the system may change. A guide to My Health Record is a living document and will be updated with any relevant changes as further details emerge.

Translation and implementation of the Australian-led PCOS guideline

Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Med J Aust 2018; 209 (7 Suppl): S3-S8. || doi: 10.5694/mja18.00656
Published online: 2018-10-01

Abstract

Introduction: We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will diagnoenable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women’s health conditions and beyond.

Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility.

Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as “at risk” and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple metapregnancies compared with clomiphene citrate.

National LGBT Survey: Research report [UK]

Government Equalities Office, July 2018

The Government Equalities Office launched a national LGBT survey in July 2017 in order to develop a better understanding of the lived experiences of lesbian, gay, bisexual and transgender people, and people who identify as having any other minority sexual orientation or gender identity, or as intersex.

The survey was open for 12 weeks and received 108,100 valid responses through an
anonymous online questionnaire that collected the experiences and views of
individuals who self-identified as having a minority sexual orientation or gender
identity, or as intersex, and were aged 16 or above and living in the UK. The survey placed an emphasis on issues relating to personal safety, education, the
workplace and healthcare. These were selected because existing evidence on the
experiences of LGBT people and their life outcomes tells us that these are the main
areas in which inequalities exist.

 

 

A systematic review of Indigenous narratives of culturally safe healthcare communication

The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication

Australian Journal of Primary Health
doi: 10.1071/PY17082
Volume: 24 Issue: 2

Abstract

The study aimed to explore Indigenous narrative accounts of healthcare access within qualitative research papers, to better understand Indigenous views on culturally safe healthcare and health communication represented in that literature.
A systematic literature review of peer-reviewed academic qualitative studies identified 65 papers containing Indigenous respondents’ views on accessing healthcare.
Analysis included all Indigenous voice (primary quotations) and author findings describing healthcare access across these studies.
Healthcare communication, or ‘talk’, emerged as a key theme. Indigenous clients valued talk within healthcare interactions; it was essential to their experience of care, having the power to foster relationships of trust, strengthen engagement and produce positive outcomes.
By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level.
Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system.