Dit is een samenvatting van de minor Amsterdam Global Health aan de VU (Vrije universiteit Amsterdam). De samenvatting is voor de eerste tentamen. De samenvatting bevat: colleges en literatuur. Het is gemaakt door de studenten die hiermee een 8+ hebben gehaald.
Sex - refers to biological differences between females and males, including chromosomes,
sex organs, and endogenous hormonal profiles.
Gender- refers to socially constructed and enacted roles and behaviors which occur in a
historical and cultural context and vary across societies and over time.
Week1 Lecture 1
Positive health = health as a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity (=zwakte)
Negative health = an individual believes they have a good state of health being because
they have nothing wrong with them
Determinants of health:
- genetics
- behavior
- environment
- medical care
- social factors
Dimensions of positive health:
- bodily functions
- mental functions & perceptions
- spiritual dimension
- quality of life
- social & societal participation
- daily functioning
Focus of WHO:
- international classification of disease
- disease eradication
- disability adjusted Life Years
- UN programmes
- Millenium development goals (maternal health)
- Tobacco control
- Social determinants
- Pandemic
- Universal health coverage
- sustainable development goals
Ten threats to global health:
- Air pollution and climate change
- noncommunicable disease
, - global influenza pandemic
- fragile and vulnerable settings
- antimicrobial resistance
- ebola
- weak primary health care
- vaccine hesitancy
- Dengue
- HIV
Core values of GP:
- patient centered
- continuous care
- generalistic care
- multidisciplinary collaboration
Health challenges in community care and public health:
- social inequalities
- occupational health problems
- air pollution
- sexual health problems
- family violence
urbanization leads to improved access to educational and employment opportunities
Urbanization and challenges:
- air pollution
- urban sprawl
- nonCommunicable disease
SEX = Biological construct, sex chromosomes, hormonal, other biological characteristics
GENDER = Cultural concept referring to tasks, roles, responsibilities, behaviors in a given
context and time
intersectionality = understanding that each individual is unique, recognizing individual
differences along dimensions of race, ethnicity, gender, sexual oriantation, SES, age,
physical abilities, religious beliegd
3 main forms of social movement:
- constituency-based health social movement
- health inequalities and inequities based on race, gender etc.
- embodied health movement
- addressing disease, disability or illness experience by challenging science
- health access movements:
- equitable access to health care and improve provision of services
,Artikel: a two way view of gender bias in medicine
Two ways in which health service can involve gender bias:
- assuming women and mens health situations and risks are similar
- clinical trials only applied on men
- result: absence of knowledge about managing womens health problems
- risk factors and protective factors detected for men are EXTRAPOLATED
directly to women
- aristotelian concept: humans differ from other animals by culture, reason
and physical nature to their actions
- offers a large challenge for empirical understanding
- men and women differ in the ways they think about health problems
- sex is a confounder → effects are statistically controlled
- assuming differences where there are actually similarities
- unequal evaluation of men’s and women’s complaints:
- men: more serious
- women: psychosomatic
- therefore: higher rates of prescribing tranquilizers to women
- health professionals and society assume that women enjoy better health
status because research is done within disease that cause high mortality
among men and not among women
Outcome of the two views:
- originate in biomedical model assuming equality for physical health problems and
inequality for emotionally-toned ones
- needed: full view of social factors that underlie disease onset, patient-physician
relationship and health behavior → find basis of gender differences
CONSEQUENCES OF GENDER BIAS
1. Incorrect assumptions of no gender difference in disease experience
a. research is devoted to fatal chronic conditions and non-fatal are left as is.
b. a better balance and reorientation is needed so that conditions in
women (arthritis) are given appropriate attention.
2. no gender differences in disease manifestations
a. higher proportions of women than men are assigned diagnoses of non-
specific symptoms and signs
i. e.g. aspecific lower backpain
b. over the years → a disease classification was made more suited to men
c. diseases that are classified as non-specific symptoms can lead to worsening
among women because the research is male-based
d. CONCLUSION: CLASSIFICATION OF DISEASE IS MALE-BASED
THEREFORE ASPECIFIC SYMPTOMS (WHOM ARE BAD) IN WOMEN
CAN LEAD TO WORSENING AND IMPROPER TREATMENT
3. assumption of gender differences lies behind differential provision of health services
and treatment outcomes
a. Primary health care more used by women but short-stay and emergency
hospital is more accessible to men
i. explanation: men suffer more severe and complicated health problems
ii. or: women are healthier but have worse perceptions of their health
iii. however: research shows something different
, 1. women have higher mortality rate
b. CONCLUSION: women are delayed in receiving hospital care until their
condition is more severe than men
Limitations of research on gender bias:
1. social attitudes
a. physicians cannot believe gender bias exists
2. methodology
a. there is a need to characterize gender bias and to identify variables that
specify its occurrence or absence
Challenges in relation to gender bias:
1. health problems should be studied by both women and men
2. research design should take both differences in male and female nature
3. careful consideration of gender bias in disease classifications should be made
4. gender needs to be a substantive variable
5. patient presentation of physician attitude lead to inequalities in access and outcome
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