FORUM ON THE FUTURE OF GENDER EQUALITY IN THE EUROPEAN UNION!
The European Commission is running an event of two days of interactive discussion with other stakeholders on achieving gender equality in Europe. This dialogue will be translated into defining priority areas for political action to take place over the coming years.
The Gender and Health Workshop will be hosted by –
PEGGY MAGUIRE (Director General of the European Institute of Women’s Health)
ISABEL YORDI AGUIRRE (Gender Adviser at the World Health Organization Regional Office for Europe)
…11,589 women attended Breastcheck in January. The aim is to screen 140,000 women throughout 2015 and January represents a good start.
26,156 women were screened for cervical cancer during the month, 13.7% ahead of the projected figure….
Press and Communications Office, Department of Health(+353)1 635 4477
www.health.gov.ie| Twitter @roinnslainte
MAMMI study to shed light on mothers’ invisible health problems
The MAMMI study (Maternal health And Maternal Morbidity in Ireland) an HRB-funded longitudinal research project will follow over 2600 women through their pregnancy and for one year after the birth of their first baby, gathering information and experiences on a range of important health issues.
The study group represents almost 10% of all first-time mothers giving birth in Ireland in a given year, and will investigate topics such as urinary incontinence; mental health issues such as anxiety, stress and depression; pelvic girdle pain; sexual health; domestic violence; c-sections; and diet and activity during pregnancy. The first set of early findings investigated urinary incontinence (leaking urine) in women, before, during and after the birth of their first child. This research looked at the prevalence and mitigating factors in urinary incontinence (UI) in 860 women, before, during and after pregnancy. Some of the key findings included:
- 1 in 3 women leak urine occasionally before becoming pregnant and 1 in 12 leak urine once a month or more frequently.
- In early pregnancy, more than 1 in 3 women leak urine during pregnancy and almost one in 5 leak urine once a month or more frequently.
- Three months after the birth, 1 in 2 women leaked some amount of urine and even 6 months after the birth, 1 in 5 women still leak urine once a month or more frequently.
Preventing blood clots in people who’ve had heart attack
Final guidance: NICE, England recommends rivaroxaban (Xarelto, Bayer Healthcare), in combination with clopidogrel and aspirin, or with aspirin alone, as option preventing blood clots in people after having an acute coronary syndrome.
An acute coronary syndrome occurs when one or more of the blood vessels in the heart become narrowed or blocked. Where the blood supply to the heart is blocked, can lead to heart attacks (ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment myocardial infarction (NSTEMI)) where there is damage to the heart muscle.
People who have had a heart attack are at higher risk of having further events. In 2009/10 there were 57,000 admissions for heart attacks in England, with 28,000 subsequent heart attacks.
Rivaroxaban is licensed for the prevention of blood clots in adults who have an acute coronary syndrome severe enough to result in the release of cardiac biomarkers into the blood that show heart muscle has been damaged. It is given with aspirin and clopidogrel, another drug that helps to prevent the blood from clotting, or with aspirin alone.
Rivaroxaban is given as a tablet. It prevents the formation of blood clots by stopping a substance called Factor Xa from working. Factor Xa is necessary in the formation of thrombin and fibrin, the key components in blood clot formation. Rivaroxaban helps to maintain blood flow to the heart muscle to prevent further damage to the heart. …more
Prepared for Medical Education workshop 04/03/15
Sex and Gender in Medical Education
Sex and gender are recognised as important determinants of health for women and men as they can influence access to health services and/or how health systems respond to their different needs. Both biological aspects as well sociocultural aspects of being male or female, as well as their intersections, play a role in health and health care. The overall health of the EU population has improved over recent decades, yet that improvement has not been experienced equally everywhere, or by all. Large health inequalities can exist both between and within EU Member States.1
Women and men living in poverty or in vulnerable situations often experience poorer access to health services.2
Inequalities are usually influenced by the intersection of multiple factors such as biological differences and gender roles, age, socio-economic background, religious orientation and ethnicity. In addition, patient access to and understanding health promotion and disease prevention material can affect timely, affordable, good quality and appropriate treatment and care. There are also significant gaps in available data on health care-related issues—from the utilisation of health care facilities to participation in health care programmes.
Today, chronic diseases represent a major share of the burden of disease in Europe and are responsible for 86% of all deaths.3
Sex and gender affect all aspects of disease prevention: development, incidence, prevalence, symptoms, diagnosis and progression of both infectious and chronic diseases. Medical professionals must consider the interaction of sex, gender and health in order to deliver the most efficient and effective quality care to patients.
Cardiovascular disease (CVD)
Traditionally regarded as a male disease, CVD is the number one killer of women worldwide. The risk of CVD in women is still often underestimated in the medical community and in women themselves. The symptoms of heart disease in women can be different from those commonly seen in men, which may be at least partially due to gender differences in communication styles and underlying heart disease. For instance, the clinical manifestation of heart disease develops 7-10 years later in women compared to men.
While men overall have higher rates of diabetes than women, women between the ages of 20-34 have higher rates than men of the same age, most due to gestational diabetes (a form of diabetes in non-diabetic women during pregnancy). 5 Furthermore, gestational diabetes is a risk factor in women for developing diabetes later in life. Additionally, throughout Europe, people with low education levels are more likely to develop diabetes and die as a result. Women of some ethnic minority groups appear to have an increased risk of developing diabetes. 6
Men have a higher rate of HIV/AIDS than do women. Some studies suggest that in HIV/AIDS the rate of disease progression can vary between women and men. Strategies for HIV testing vary across Europe, however widespread and unacceptably high rates of late diagnosis amongst women suggests that current testing strategies do not adequately reach the female population.
Research has found, for example, that women miss chances for HIV testing more often than men and are more impacted by the potential negative effects of HIV testing such as the disclosure to partners.8
Apart from reproductive health, it is rare that the above topics are considered in medical education curricula. Over the last 10 years the importance of sex and gender in medical research and treatment of
medical conditions, has been increasingly recognised. However, the need for integration of this knowledge into medical education curriculum still remains a challenge. Acknowledging the impact of sex and gender
differences, increases the quality of health care provision, and thus, the quality of medical education. We must advocate for patients through curricular improvement at all levels and in all disciplines. A patient centred evidence-based sex and gender perspective is required throughout medical curricula including graduate programmes, medical programmes, nursing, rehabilitation, and pharmacy, continuing medical education and continuing nursing education across Europe. Incorporating information generated from the growing discipline of sex and gender based medicine in educational and training programmes improves access to high quality health care and thereby improve patient outcomes.
European Union and Medical Education
Currently, the regulation of medical education in Europe is the responsibility of individual Member States not the European Union (EU). The European Commission has passed legislation relevant to the medical
community, such as the mutual recognition of professional qualifications, and is participating in a number of efforts to synchronise the education systems across Europe. However, detailed regulation as well as the
assessment and evaluation of curricula remains the purview of individual Member States.
Streamlining European educational systems began with the Bologna Process in 1999. Currently, there are forty-seven participating countries in and forty-nine signatories of the Bologna Process. This process
works to harmonise third level educational systems in Europe, adopting a system that allows for easily comparable university degrees. The process aims to facilitate personal mobility in moving from one country to another with regard to qualifications, increase the attractiveness of European universities and strengthens quality assurance of educational qualifications
Participation is voluntary not mandatory – each country decides individually if they want to endorse principles adopted at bi-annual ministerial conferences. There is no intergovernmental treaty, so it is up to each country and its higher education community to decide whether or not they want to adopt any of the principles. To date, the Bologna Process
has been successful due to the collaboration and participation of the 47 countries as well as the involvement of UNESCO, the Council of Europe and the European Commission.
Another policy relevant to European education systems is EU Directive 2005/36/EC, 10 which involves the mutual recognition of professional qualifications across EU Member States. The Directives outlines
the requirements for medical undergraduate education, postgraduate education and medical professional development. However, the Directive chiefly concerns with the right to pursue a profession in another
Member State other than the one in which the person has obtained their professional qualification. Thus, the requirements are not geared specifically towards regulating or evaluating third-level education or the
contents of individual curricula.
Therefore, there is no harmonisation of medical education across Europe. Each EU Member State has its own regulatory body that accredits, regulates and evaluates medical education. For example, in Ireland the Medical Council is the regulatory body responsible for the quality of medical education. The Irish Medical Council in turn base their standards upon the WFME Global Standards for Quality Improvement in
Medical Education European Specification.
This document, jointly authored by the World Federation for Medical Education and the Association of Medical Schools in Europe, is supported by the World Health Organisation and the European Commission. The document states that control of the curriculum “…within existing rules and regulations [is] defined by the governance structure of the institution and governmental authorities” (p.18).
Both EU directive 2005/36/EC and WFME Global Standards for Quality Improvement in Medical Education
European Specification clearly state that medical education should not solely be concerned with the science of medicine. The WFME Global Standards for Quality Improvement in Medical Education European Specification argues that standards in medical education must address challenges that are due to political, socioeconomic and cultural realities, as well as institutional conservatism. 11 EU directive 2005/36/EC goes further by stating that “Basic medical training shall provide an assurance that the person in question has acquired the following knowledge and skills: sufficient understanding of the structure, functions and behaviour of healthy and sick persons, as well as relations between the state of health and physical and social surroundings of the human being” (Section 2, article 24.3.b).
What Challenges Do We Face?
Each Member State country has its own set of standards and regulations for medical education. There is no direct mandate to coordinate medical education at an EU-level. The lack of one pan-European regulatory situation impedes regulatory development at a European level. However, most Member States collaborate in the Bologna Process and are bound by EU Directive 2005/36/EC to provide some form of regulation. Consequently, there might be an opening to raise awareness of the issue of sex and gender and encourage coordination across borders to share best practice. The inclusion of vocabulary such as “socioeconomic realities” and the “social surrounding of the human beings” in EU Directive 2005/36/EC highlights an existing awareness to combine the clinical component of medical education with social and cultural questions. Sex and gender and diversity awareness must be included in the dialogue.
Medical education in Europe involves many bodies at multiple levels, such as governments, physician associations, and local universities. Although the Bologna Declaration works towards greater harmonisation of both undergraduate and graduate programmes across countries in Europe, the aim of the Declaration is for workforce mobility and comparability of degrees, not universal uniformity of curricular content. There are different approaches to integrate sex and gender into medical education: single courses (sometimes electives) or integrated (mainstreaming throughout the curriculum) or both.
Sex, gender and diversity must be included in final objectives of programmes, as part of accreditation, in quality criteria and considered by visitation committees. A multilevel approach is needed and experts much work with each other, Ministries of Health, Ministries of Education, medical schools, universities, student organisations, patient organisations and NGOs and physicians associations to integrate sex and gender into medical education and training.
High quality education and training is a fundamental to achieving high quality healthcare. Professional knowledge, skills and competences must be updated continuously. High quality education and training at all levels must respect ethical codes and enshrine up-to-date evidence-base for practice and treatment. There are the moral and ethical obligations to counteract avoidable health inequalities, which can be caused by a variety of factors, including sex and gender. Historically, there has been a male-bias in medical education and training that needs to be corrected. Medical knowledge and science have developed largely in the absence of diversity. Professional organisations need guidance and tools from experts to better incorporate sex and gender and diversity aspects into its activities. Gender sensitive and diversity responsive healthcare in the future requires education and training of all health professionals involved in the delivery of care.
Medical Education Workshop-How can we move forward?
What are the barriers to translating sex and gender difference research into evidence-based clinical practice?
How can we influence curricula change at national and regional level to incorporate gender and diversity?
What models and formulas are highly influential in changing medical curricula?
Medical Education is the remit of the EU member States, so how can the EU support the exchange of good practice in the implementation of sex and gender in curricula?
Who will lead the efforts for change, what partnerships and alliances are needed?
European Gender Medicine Network (EUGe
7 Johnson M, Afonina L, Haanyama O. 2013 “The challenges of testing for HIV in women: experience from the UK and other European countries.”
8 WHO Europe.2011.European Action Plan for HIV/AIDS2011 -2015
Rescue Party,new women’s political party launched
International Women’s Day yesterday, Toksvig , a well known uk female comedian, launched ‘The Rescue Party’, the political party with a focus on women and children.
It’s just what we need to sort out Britain – or at least force David Cameron and Ed Miliband to get a move on with gender equality.
Toksvig’s party isn’t actually real. It’s her vision of a political party to persuade the 9.1 million women who didn’t vote in last general election to go to the ballot box.
Speaking at her Mirth Control comedy night at Southbank’s Women of the World festival, Toksvig said: “What we’ve done is reach into the realm of fantasy and thought, wouldn’t it be wonderful to start a party people actually want to vote for?”
The idea of the Rescue Party uses the old lifeboat adage: ‘women and children first’. “So here’s a crazy idea,” she said. “Let’s have a party where we put women and children at the top of the agenda and not as an afterthought.
“This is not a party that would exclude men; rather it would be the first to shine a light on women and children so we can all prosper – not just some b******* in the city.” …more
A G Rumpie says:
Making it Happen—European Institute of Women’s Health hosts expert workshop on sex and gender in medicines regulation and medical education
As part of the FP7-funded European Gender Medicine (EUGenMed) Project, the European Institute of Women’s Health (EIWH) organised a workshop on 4 March 2015, bringing together a multidisciplinary, multi-sectorial group of experts to discuss Sex and Gender in Medicines Regulation and Medical Education.
Dr. Ingrid Klingmann, of the European Forum for Good Clinical Practice (EFGCP) and Hildrun Sundseth, President of the EIWH opened and co-hosted the morning session exploring Sex and Gender in Medicines Regulation. Dr. Klingmann explained the need for the event, “There is not enough data on 50% of the population—on women.”
During the morning session, experts presented important issues around sex and gender in medicines regulation. Dr. Kevin Blake of the European Medicines Agency (EMA) explained how Sex and Gender issues are currently addressed in EU Regulatory practice and how in future the new EU Clinical Trials Regulation and Pharmacovigilance initiative will generate more evidence how medicines work in different patient population groups, such as in women.
Prof. Dr. Marco Stramba-Badiale of the IRCCS Istituto Auxologico Italiano, a leading expert in cardiovascular disease (CVD) in women, provided evidence how in the past women have often been underrepresented in CVD clinical trials and when they were included, the data had not been analysed. He was followed by Dr. Christiane Druml, Vice Rector of the Medical University of Vienna, who presented the University’s Ethical Guidelines for including women in clinical trials.
Expert workshop on sex and gender in medicines regulation and medical education
The European Institute of Women’s Health hosts expert workshop on sex and gender in medicines regulation and medical education 4 March 2015, Brussels, Belgium—As part of the FP7-funded European Gender Medicine (EUGenMed) Project, the European Institute of Women’s Health (EIWH) organised the final workshop on 4 March 2015 at the European Economic Social Committee, bringing together a multidisciplinary, multi-sectoral group of about fifty experts from across the European Union Member States to discuss Sex and Gender in Medicines Regulation and Medical Education. The workshop was the final of a series of expert workshops for the project that explored focal areas of work where sex and gender (S&G) play a major role.
Dr. Ingrid Klingmann, of the European Forum for Good Clinical Practice (EFGCP) and Hildrun Sundseth, President of the EIWH, co-hosted the morning session that explored Sex and Gender in Medicines Regulation. Speakers presented the incorporation of sex and gender in EU regulatory practice, including in the new EU Clinical Trials Regulation. Best practice was examined as an example of university efforts to include women in clinical trials. Experts discussed some outstanding issues such as the under representation of women in clinical trials during the development of cardiovascular disease medications and the lack of information of the safety of medication use during pregnancy.
Peggy Maguire, Director General. EIWH welcomed the participants to the afternoon session on sex and gender in medical education , which was co-chaired by Dr. Katrín Fjeldsted of the Standing Committee of European Doctors (CPME) and Dr. Petra Verdonk of the VU University Medical Centre. Speakers presented examples of best practice in the integration of sex and gender in curricula from various Member States as well as the challenges of mainstreaming sex and gender in medical education, exploring both changes to curricula as well as online modules. Strategies on moving forward and the opportunities to integrate S&G in medical education were then discussed by leading members of the medical profession, including medical students. Presentations examined how to best fill existing gaps by working cross-nationally. The participants then discussed next steps for action following the event and made recommendations for inclusion in the EUGenMed Roadmap.
About the EUGenMed Project:
Research addressing sex and gender (S&G) in biomedical sciences and health care research is emerging as a novel and highly promising field. The interaction of S&G related mechanisms leads to different manifestation of frequent diseases in women and men. Research in this area will lead to novel, better-targeted and more efficient treatment strategies. The EUGenMed Project produce an innovative roadmap for implementation of S&G in biomedicine and health research. To achieve these objectives we will develop EUGenMed into an open European Gender Health Network that includes all stakeholders and decision makers.
For more information:
• European Institute of Women’s Health website: http://eurohealth.ie
• European Gender Medicines Project website: http://eugenmed.eu
Gender Medicine Meeting: expert workshop sex and gender in medicines regulation and medical education0
Gender Medicine Meeting
European Institute of Women’s Health hosts expert workshop on sex and gender in medicines regulation and medical education
As part of the FP7-funded European Gender Medicine (EUGenMed) Project, the European Institute of Women’s Health (EIWH) organised a workshop on 4 March 2015, bringing together a multidisciplinary, multi-sectorial group of approximately fifty experts to discuss Sex and Gender in Medicines Regulation and Medical Education.
Peggy Maguire, Director General of the EIWH, opened the afternoon session and welcomed the expert participants. Dr. Katrin Fjeldsted of the Standing Committee of European Doctors (CPME) and Dr. Petra Verdonk of the VU University Medical Centre co-hosted the afternoon session, which explored the integration of sex and gender in medical education.
EIWH Board Member Prof. Karen Ritchie of INSERM, chaired a panel of speakers who outlined examples of best practice for integrating sex and gender in medical education.
Dr. Petra Verdonk of the VU University Medical Centre presented the challenges of sex and gender mainstreaming in medical education based on her experience of integrating sex and gender issues in eight medical curricula in the Netherlands.
Prof. Dr. Margarethe Hochleitner of the Medical University Innsbruck detailed the successful integration of sex and gender in different curricula at the Medical University, Innsbruck and gave examples of best practice.
Speakers from Charite—Universitatsmedizin presented their current efforts to integrate sex and gender in medical education. Dr. Ute Seeland of the Institute of Gender Medicine at Charite—Universitatsmedizin spoke on the extension of sex and gender knowledge in medical education through their online eGender educational programme. The next presentation was by Sabine Ludwig of Charite—Universitatsmedizin, who explored how Charite Berlin integrated sex and gender throughout their new modular medical curriculum.
The second panel explored how to move forward and the opportunities to integrate sex and gender in medical education.
Prof. Dr. Hanneke de Haes of AMC-UvA explained how communication was successfully integrated into medical education and discussed how this practice could be applied to the integration of sex and gender in medical education.
Statement by Council of Europe Commissioner for Human Rights, Nils Muižnieks:
Women’s Rights are Human Rights .
As we celebrate International Women’s Day and the 20th anniversary of the Beijing Declaration and Platform for Action adopted at that Conference, I cannot but echo this statement and call on all Council of Europe member States to make gender equality and the fulfilment of women’s rights a reality and not just a promise.
Progress has been made in recent decades in a number of areas, in particular in establishing legislation and mechanisms prohibiting discrimination on the grounds of sex. Ambitious goals, including for the equal participation of women in political life, have also been set. However, full achievement of the human rights of women is still lagging in Europe.
It is particularly worrying to note in 2015 clear threats to women’s rights linked to the resurgence of reactionary trends targeting women who try to move out from the subordinated role in which they have been kept for centuries. Some would like to limit women to a role of mothers, giving birth and staying at home to rear children. It is therefore more than ever necessary to stand up for women’s rights, combat such stereotypes and raise awareness about gender equality, both in the family and in society. The Council of Europe Gender Equality Strategy 2014-2017 provides a road-map in this field, as one of its strategic objectives focuses on combating gender stereotypes and sexism.
Despite numerous international and national anti-discrimination legal instruments, discrimination on the grounds of sex remains widespread in today’s Europe. As stressed by the European Court of Human Rights in a recent judgment (case Emel Boyraz) on sex-based discrimination: “where a difference of treatment is based on sex, the margin of scope of appreciation afforded to the State is narrow […] Advancement of gender equality today is a major goal in Council of Europe member States and very weighty reasons would have to be put forward before such a difference of treatment could be regarded as compatible with the European Convention on Human Rights”. Let us not forget this.
I have observed in the course of my work that the economic crisis and ensuing austerity measures adopted in some European States have contributed to a regression in European women’s rights. Such policies have exacerbated gender inequality and discrimination by making cuts in public sector jobs and salaries (where female workers form the majority) and in the welfare system (on which more women than men rely). Disturbingly, in the countries concerned, I could see a feminisation of poverty and an increased risk of exploitation and human trafficking for women who were already overrepresented in low-paid and precarious jobs. States should react quickly and adopt measures halting this dangerous trend.
I am also worried at the intensification of hate speech against women in many European States, including on the Internet, which is characterised by threats of murder, sexual assault or rape. This form of hate speech targets prominent female politicians, journalists and human rights defenders but also ordinary women at work, in the street and at school. I call once more on Council of Europe member States to prohibit by law any advocacy of gender hatred that constitutes incitement to discrimination, hostility or violence.
If we do not combat discrimination and hate speech against women, we will never be able to eliminate violence against women, which is one of the most extreme forms of violation of women’s rights. Though cases of violence are largely under reported because of mistrust in State institutions and cultural and social taboos, there is no doubt that the number of women experiencing violence is a worrying one for the majority of European States, as also underscored by a recent study conducted by the European Union Fundamental Rights Agency concerning EU member states. To make things worse, the response of national authorities, including the police, prosecutors and judges, remains grossly inadequate in a great number of cases of violence against women.
Now is the time to act and to give new impetus to the spirit of the Beijing Declaration. As a first step, member States which have not yet done so should ratify the Council of Europe Convention on preventing and combating violence against women and domestic violence. This would not only give a clear signal that States are committed to uphold gender equality, but would also increase the chances to translate women’s rights into reality.