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GENDER SENSITIVITY. Experience from Greater Glasgow & Clyde NHS. September 2006. Noreen Shields Planning & Development Manager – Gender Corporate Inequalities Team. ‘Gender analysis’.

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GENDER SENSITIVITY

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GENDER SENSITIVITY

Experience from

Greater Glasgow & Clyde NHS

September 2006

Noreen Shields

Planning & Development Manager – Gender

Corporate Inequalities Team


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‘Gender analysis’

  • “a gender analysis identifies, analyses and helps to act upon inequalities that arise from the different roles of women and men or the unequal power relationships between them and the consequences of that inequality on their lives, their health and their well-being. Since these inequalities most often disadvantage women, a gender analysis highlights women’s problems. However, it also reveals specific health problems that men face because of the social construction of males roles.”WHO, 1998, Gender Policy

  • Make more relevant for public & ‘move it on’ – basically men & women have sometimes same health issues, some different. Our health is related to how we grow up and feel ‘valued’. Part of this is feeling valued as a ‘man’ or a ‘woman’ and how we relate to others in our lives. ‘Traditional gendered socialisation’ (gender in culture & power key, Wilkinson, 2006) can be a key factor in why men & women are suspicious of each other….lack respect for self & each other / lack empowerment, which can lead to health and other problems


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GGC History - Gender

  • 20 years women’s health, 10 years men’s health, last 5 years increased focus gender/relational approach (Sabo, 1999; White, 2006; Payne, 2006).

  • Approaches always saw other aspects of inequality (e.g. poverty, race, sexuality) as integral

  • Evidence of gender bias in medical research & treatment women & men (Payne, 2006)


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GGC History – topic examples

  • Women’s Health: ‘From women’ - reproductive health (‘Our bodies ourselves’); feminism – effects of gender inequality on women and men; abuse; poverty; mental health; prostitution

  • Men’s Health: ‘Men not using services / meeting needs’, Gay men’s health, sexual health, Men only health problems, masculinity and health

  • Gender & Health: aim all processes gender and inequality sensitive and have some gender specific services where appropriate

  • Largely development activity on men & women’s health sought ‘opportunities’ to influence ‘mainstream’ processes. Women’s Health Policy gave strategic ‘in’. National: Well Man Pilots – largely clinical focus


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GGC Women’s Health Policy

  • Women’s Health Policy, 1992 (3rd version 2003)

    Why women’s health? 3 inter-related sets

    health needs arising from:

  • women’s reproductive function;

  • sex differences in aetiology, presentation & management of many health problems;

  • gender inequalities in society (e.g. ‘triple role’, abuse).


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GGC new inequality structure

  • 9 Transformational Themes: Equality and diversity integral. Used in personal objectives GGC

  • Devolved Structure: Key leadership roles & KSFs in health ensure equality and diversity in each job

  • Corporate Inequalities Team (CIT): Coordinating, Support & Monitoring function especially regarding inequality legislation. Leadership - evidence best practice. Links to performance management, OD, Policy Development, HR, Finance, and Staff Learning Networks / Library.

  • Single Equality Scheme (RED, DED, GED) – each part of the system own Action Plan


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EXAMPLES – GENDER LEGISLATION TOPICS (1)

  • Policy/Strategy: Women’s Health Policy (1996); GBV Strategic approach; Women & Poverty strategic approach; Sexual Health Strategy (2000) – Sandyford Initiative; Mental Health Strategy 2001 – Development work agreed; Alcohol strategy (2002) – Gender Sensitive Approach Piloted; Maternity services ‘strategy’ (2006)

  • Service Change: Mainstream: Gender based violence programme, Sandyford Initiative, Public Health Midwifery & ROOP, £1 million Scottish Executive funded “Inequalities Sensitive Practice Initiative”, Forensic mental health services. Development/pilot work (Mental health & gender, Addictions, Well Man Pilots, Fathering, Prisons & Men’s Health).


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EXAMPLES – GENDER LEGISLATION TOPICS (2)

  • Performance Management: limited experience in identifying gender sensitive indicators. Abuse indicators will be considered in future. “Balance Scorecard” may be considered

  • Human Resource management: evidence of good practice around inequalities / gender. Aim influence further (recruitment strategy, family friendly policies, career advancement, SWISS)

  • Procurement: Limited experience (e.g. purchased service specifications being gender sensitive)

  • Involvement: Single Equality Scheme consultation – meaningful / ongoing link to PFPI. Provide info / raise issues / challenging assumptions sensitively. Staff involvement / ownership (Action Plans & Staff Networks aid)


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GENDER SENSITIVITY– KEY ELEMENTS IN PRACTICE

  • Understanding impact of gender socialisation and gender in culture on individuals / groups

  • Responding to effects of gender socialisation

  • Tangible aspects: accessibility, empowering relationships with staff, workers reflect on own gender socialisation etc, choice of worker, abuse response, poverty – gendered nature and “hidden debt”, sexuality – ask & respond, engage people on relationships – how gendered, gender in ‘meaningful activity’, childcare for men & women, environment, need to consider “starting points”

  • If don’t consider gender, won’t address problem systematically / factors in underlying health problem / prevent longer term problems


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GENDER SENSITIVITY– POSSIBILITIES WITH CLIENTS

  • ‘Before coming here I assumed I was simply a violent and aggressive person, a maniac. I now realise that I’m not and that I was just dealing with having been abused. I now see myself as a completely different person thanks to Thrive. In the past, I only had 2 mental states – OK & extreme rage. I now experience a wider range of emotions, some good, some bad but I’m really glad I’m experiencing them.’ (Man at service for male survivors of sexual abuse)

  • ‘Even on the first visit X could pinpoint what I thought was just the one thing that was bothering me, she could pinpoint a whole lot of other things that was coming back so that started to make my mind open up to what was really wrong and the second time around she helped me and my husband because he was ill.’ (Woman who attended WMHP Demo Project)

  • ‘I know she is depressed and she has lost her mum an all that but is it not her job to take the wean to nursery.’ (Man & woman using addiction services)


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GENDER LEGISLATION - MEASURES

  • Proportionality & relevance: national & local priorities of key relevance (e.g. mental health, abuse). ‘Hidden / ‘silenced’ groups’ (e.g. service review for mothers with learning disabilities)

  • Effectiveness: structure & ‘facilitation’ in place. Each part of structure Action Plan

  • Involvement: aim in consultation decode for public / ask qs relevant to them. Statutory & non-statutory staff

  • Transparency: decision trail documented


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Barriers / challenges…

  • Gender & Health: not a ‘public discourse’ in UK – Academia but abuse an ‘in’; or in media although men’s & women’s health & relationships – gender implicit

  • Lack of national strategy examples apart from abuse

  • NHS discourse on masculinity very limited. Also many staff – gender equates with women

  • Inequalities seen as ‘additional work’ / optional extra / ‘politically correct’

  • Challenge not ‘lose’ clients where ‘gender blind gave degree of comfort / colluded’ (DOH conversation)


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GENDER SENSITIVITY– GGC KEY LEARNING

  • Need gender sensitive & some gender specific services

  • Need to allay fears that gender sensitivity means “specialist” services

  • Staff need to be involved in ideas & support to make mistakes

  • Can be personally challenging

  • Work on abuse within gender frame can be good starting point

  • Whole system approach


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References

  • CRE, DRC, EOC (2006) Public Sector Duty: Three Commissions joint position paper. London: CRE, DRC, EOC

  • Payne S (2006) The Health of Men & Women. Cambridge: Polity Press

  • Mackenzie M, Shields N, MacDonald B (2006) Evaluation of Women’s Health Demonstration Project. Glasgow: GGCNHS

  • FMR Research Ltd (2006) Evaluation of Thrive Counselling Service. Glasgow: FMR Research Ltd

  • Sabo D (1999) Understanding men’s health: a gender and relational approach. Boston: Elseveir

  • Wilkinson R (2005) Gender and race: ‘kicking down’. Chapter in ‘What makes rich societies sick’


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Contact Details

  • Corporate Inequalities Team, Greater Glasgow and Clyde NHS Board, Dalian House, 350 St Vincent Street, Glasgow, G2 3 YU.

  • Email: [email protected] (Head of Health Improvement & Inequalities)

  • [email protected] (Lead for Gender & Sexual Orientation)

  • Tel: 0141 201 4967


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