Investigate gender disparity in health and scientific research. This is the theme on which the ninth edition of the White Paper on women's health focuses, created by the Onda Foundation with the unconditional contribution of Farmindustria, presented today in the Senate during a press conference on the initiative of Senator Maria Domenica Castellone. The volume, entitled this year 'Towards gender equity in health and research', aims to offer numerous ideas for overcoming the many inequalities from a gender perspective, which the Covid-19 pandemic and the international crisis have exacerbated. Applying a gender approach in research and treatment pathways is important – the promoters assure – not only to improve understanding of the factors determining health and disease, but also to guarantee greater equity in access to care and medicine focused on specific characteristics of the patient, helping to strengthen the centrality of the person.
“Equality and equity are two of the pillars of our National Health Service, sometimes mistakenly understood as synonyms – declares Francesca Merzagora, president of the Onda Foundation – Equality presupposes being able to benefit from the same rights, regardless of any difference, while equity is based on the modulation of interventions in relation to differences, specificities and needs. Equality is therefore the starting point, while equity represents the final objective which allows us to guarantee the same opportunities to everyone, taking differences into account. Gender medicine is based on the valorization of differences, with the aim of ensuring equal opportunities in the field of prevention, diagnosis and treatment, and this is therefore the common thread of the 2023 White Paper”.
Starting from an in-depth analysis of gender equality as an objective of the United Nations 2030 Agenda – explains a note – the first part of the volume carries out an analysis of gender as an important social determinant of health, capable of producing significant inequalities in terms of morbidity and mortality among men and women. This happens first of all because it is in turn related to the other main social determinants of health, for example the level of education: women still represent almost two thirds of the 771 million illiterate adults. Or even the employment sphere and working conditions: it is observed that worldwide, for the same qualifications, more men are hired than women and those hired, for the same job, often have a lower salary than men.
The White Paper explores the role of a sex- and gender-specific approach in ensuring appropriate and equitable interventions at different stages of life: pediatric, childbearing and geriatric age, and in many different contexts. Women in Italy become mothers later than in the past – it is observed – with an increasingly higher average age at childbirth (now 32.4 years). Pregnancy no longer represents the central moment in a woman's life, and indeed it is often experienced as a limitation to one's personal and professional fulfillment: gender inequalities significantly impact both the desire for pregnancy and the implementation of the reproductive plan. At the same time, women have a longer life expectancy than men, but in women the years of survival are characterized by a very high burden of disability. This, together with the aging of the population and the different composition of the geriatric population (the majority of elderly people are women), requires a structural change in health policies.
A gender approach in clinical practice and therapeutic management, in training, research and communication is useful for promoting appropriateness and personalization of care with consequent savings for the NHS. The gender perspective on health differences appears to be an indispensable prerequisite in the most diversified contexts on which the volume focuses – for example rare diseases, disability, violence, the foreign and prison population – an essential common denominator for setting policies aimed at addressing and overcoming inequalities.
The last part of the White Paper, focused on the gender gap in healthcare, scientific research and digital innovation, highlights how long and tortuous the road ahead is still to achieve effective equality. The variable 'sex and gender' is not always adequately considered in epidemiological research: the analyzes often report an overall figure, which does not reveal any differences between men and women. Male and female cells react differently to chemical and environmental stimuli, yet in the majority of preclinical studies the sex of the organism from which the cells derive is not reported. The identification and characterization of the factors determining sex/gender differences will allow targeted interventions and the development of sex- and gender-specific prevention, diagnosis and treatment pathways.
Another point addressed concerns female participation in the medical category, which is destined to grow considering that since 1995 female students have been studying Medicine to an equal or greater extent than male students. Yet the presence of women doctors is less than 30% in surgery. Only 8.3% of female doctors hold a managerial position, compared to 20.6% of male colleagues. The low presence of women in top positions is the result of a series of barriers – at individual, interpersonal, institutional and community levels – that prevent women from reaching the last higher level of leadership.
“Gender equity in health and research is a priority – comments Marcello Cattani, president of Farmindustria – In pharmaceutical companies the female presence is equal to 45% of the total employees and over 50% in Research and Development. And with a corporate welfare model which provides many concrete measures for well-being at work, parenting, the balance between life and work time. But also for prevention, training, development of skills. A virtuous example in a varied framework and complex which is, as always, well described in the Onda Foundation's White Paper on women's health. A precious tool for creating new synergies with the aim of improving and increasing the development of medicine and increasingly guaranteeing targeted therapies, suitable for single person”.
“The Onda Foundation has always been at the forefront in the diffusion of gender medicine and for years has collaborated with the Higher Institute of Health to advance common objectives – concludes Elena Ortona, director of the Gender Medicine Reference Center, ISS – first of all the “elimination of inequalities, the achievement of equity and appropriateness in care. I consider the publication of the White Paper an important step towards achieving these objectives and bringing about a change in perspective that sees the person at the center of treatment paths”.
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