# Presentation: 257754

## A Conversation on Gender, Equity and Environmental Health

**Sharon Hrynkow PhD**
- Associate DirectorNational Institute of Environmental Health Sciences

## Goals

- Consider Gender in the context of NIEHS programs, priorities, practices
- Discuss potential opportunities for action

## Why Gender?

-  “ ....  it is increasingly well recognized that there are differences in the factors determining health and the burden of ill-health for women and men. The dynamics of gender in health are of profound importance in this regard and they have long been overlooked.”
-              (World Health Organization, 1997)

## “Sex” and “Gender”

- Interchangeably used, but not the same thing
- Imprinting and hormonal factors determine the developmental sequence and characteristics of biological systems, or sex, of the individual. Gender is the result of implanting an individual into a culture or society, which assigns them relative value and gives them specific roles to play by virtue of their biological sex. These factors are important determinants of health that affect the quality and function of biological systems." — _[Dr. Marianne Legato, Director, Partnership for Gender-Specific Medicine, Columbia University College of Physicians and Surgeons](http://www.nih.gov/news/NIH-Record/12_10_2002/story01.htm)__ _

## Why Gender? A Look at Milestones in Understanding and Action 

**1980s**
- Maternal and Child Health	1987, World Bank Safe Motherhood Initiative
**1990s**
- Health as Development Objective	1993, World Bank Development Report
- 		          Health and Wealth link, Amartya Sen
- Reproductive Rights, Population	1994, Cairo conference on Pop and Development
- Women’s Issues 	1995, Beijing conference, 	          women’s empowerment, gender issues
- 		 Creation of Gender units at major organizations
**2000 – **
- Millennium Development Goals	Gender, Equity, Development
- 		2006, Disease Control Priorities Project

## Millennium Development Goals 

- Eradicate extreme poverty and hunger
- Achieve universal primary education
- Promote gender equality and empower women
- Reduce child mortality
- Improve maternal health
- Combat HIV/AIDS, malaria and other diseases
- Ensure environmental sustainability
- Develop a global partnership for development

## What Does Gender Mean in the NIH Context?

**Historical perspective:**
- Post-World War II
- Women excluded as subjects in clinical research
- 1985: PHS Task Force on Women's Health Issues concluded that health care for women and the quality of health information available to women had been compromised by the lack of research on women's health issues.
- FDA and NIH action
- Inclusion of Women, Minorities and Children in Research**: **The adequacy of plans to include subjects from both genders, all racial and ethnic groups .....as appropriate for the scientific goals of the research will be assessed. Plans for the recruitment and retention of subjects will also be evaluated (see the Research Plan, Section E on Human Subjects in the PHS Form 398).

## Aspects Of Sex Will Not Vary Substantially Between Different Human Societies, Whereas Aspects Of Gender May Vary Greatly 

**Examples of gender characteristics include the following: **
- In the United States (and most other countries), women earn significantly less money than men for similar work
- In Vietnam, many more men than women smoke, as female smoking has not traditionally been considered appropriate
- In Saudi Arabia, men are allowed to drive cars while women are not
- In most of the world, women do more housework than men (WHO)

## How Do These Broad Sets of Characteristics Influence Our Experience of Disease? 

**Consider a spectrum of determinants**
- Sex: Breast cancer, prostate cancer
- Gender: Cooking with biomass, developing world – TB, respiratory infections
- Combination of both sex and gender

## Global Summary of AIDS Epidemic, December 2007

**Global Summary of AIDS Epidemic, December 2007**

- Number of people living with HIV in 2007	33.2 million
- People newly infected with HIV in 2007	2.5 million
- AIDS deaths in 2007	2.1 million

## HIV/AIDS Prevalence for Women

**HIV/AIDS Prevalence for Women**

**In 2007 – 17.7 million women living with HIV**
**“****Feminization” of AIDS**
**In Latin America...**
**2004:**** ****27%** of _women_, aged 15-49 were living with HIV
**2006:**** ****29%** of _women_, aged 15-49 were living with HIV

## Why is it Difficult for Women to Protect Themselves?

**Why is it Difficult for Women to Protect Themselves?**

- Inequalities
- Social, cultural norms
- Violence
- Stigma

## Strategies to Tackle HIV/AIDS Include Spectrum of Efforts:

- Biomedical approaches for prevention
- Vaccines, microbicides
- Prevention and treatment strategies take into account social determinants of health
- Status  of women
- Economic empowerment, literacy....

## NIEHS Research — Through the Gender Lens

**What can the AIDS experience teach us?**
**Consideration of gender **
- Protective and risk factors for environmentally-related disease
- Access to resources to promote and protect health, including information, education, technology and services
- Manifestations, severity and frequency of disease, as well as health outcomes
- Social and cultural conditions of ill health/disease

## Possibilities

- Opportunities to use Gender to gain new insights in conjunction with developing technologies (e.g.,Exposure Biology Program)
- With climate change projections, are there research gaps in the environmental health arena to be addressed that would include a  gender dimension?
- Is there a policy research agenda, and if so, could NIEHS (and partners) address it?
- Personalized medicine, personalized environments – how does gender interact?
- Do we have adequate methodologies to measure, ask questions?

## Sum So Far 

- “Gender” goes beyond including women in clinical trials, and tackling diseases particular to women
- Gender also means men
- Roles that we play in society can protect us or put us at risk for disease
- Understanding how gender factors interact with biological factors -- or independently -- will help elucidate the disease process more fully, and could lead to enhanced ability to prevent, control and treat disease

## Training

- Are we sensitizing the next generation of researchers to gender issues?
- Do they want to be sensitized??

## Which are the Problems?

**Unequal participation of women researchers in scientific institutions*** *

**Which are the Problems?**

**How to ****address it?**** **

**Gender Blindness in Health research**

**Which are the causes?**

**VIRTUAL RESEARCH AND TRAINING PROGRAM FOR LATIN AMERICAN **
**WOMEN RESEARCHERS IN BIOMEDICAL/HEALTH SCIENCES**

- Gloria Bonder // _[www.catunescomujer.org](http://www.catunescomujer.org/)_

## “The Scissor Pattern” - Argentina

- Fuente: María Elina Estebanez, Foro Iberoamericano de Ciencia, Tecnología, FIBECYT - Diciembre  2006, Argentina

- Gloria Bonder // _[www.catunescomujer.org](http://www.catunescomujer.org/)_

## “The Scissor Pattern” - Venezuela

- Gloria Bonder // _[www.catunescomujer.org](http://www.catunescomujer.org/)_

## Women & Science: Which Are the Causes?

**Women & Science: Which Are the Causes?**

- Conflicting balance between professional, family and personal life (‘wonder woman’ model)
- Lack of educational programs and activities to promote and  support girls and young women in S&T careers
- Lack of flexible, care-supportive employment policies
- Stereotyped representations of professional development and success
- Lack of female role models and opportunities for networking
- Discrimination (overt and subtle)
- Social representation of science and scientists
- Lack of awareness of gender discrimination (both women and men scientists)
- Women self representation as a member of a elite group vs other working women
- Leaky pipes
- Glass ceilings and walls
- Chilly cultures

## Challenges

- Barriers to leadership roles for women
- Lack of in-country research mentorship

## Career Paths for Women in the Health Sciences:A Global Perspective (FIC, NIEHS, ORWH) – 2003

**Career Paths for Women in the Health Sciences:****A Global Perspective (FIC, NIEHS, ORWH) – 2003**

**Recommendations:**
- Attaining gender equity in science requires collective effort of women and men
- Research programs should include a gender perspective
- To increase women’s contributions, leadership skills needed
- Networks needed to enable women scientists to overcome challenges in their home countries

## Gender, Global Health and Globalization: 2004 (FIC, NIEHS, ORWH, Canadian Institute of Gender/Health)

**Gender, Global Health and Globalization: 2004 ****(FIC, NIEHS, ORWH, Canadian Institute of Gender/Health)**

- Again, strong support for incorporating gender into formulation of research questions and evaluation of research projects.

## Pilot Program, 2005 – 2006

- Partnership with Social Science University of Latin America, Gender Institute
- Created virtual learning environment
- Mentors (4 women, 1 man), courses, discussions on Leadership and Gender
- 50 participants from 9 Latin American nations (Argentina, Bolivia, Chile, Colombia, Brazil, Mexico, Peru, Uruguay, Venezuela)

## Our Virtual Learning Environment

**Virtual workshops,**
**seminars, tutorships, & mentorships**

_**Capacity-building**_** for:**
**Career development and transformational leadership**
**Mainstream gender analysis in health research**

**Multimedia hypertexts**
**Case analysis**
**Forums**
**Web conferences**
**Virtual Library**

**Creation of networks and collaborative projects to optimize the quality of professional practices in non-discriminatory environments**

**Latin American**
** ****Women Researchers: **
**Leaders in scientific innovation and ****gender equity**

- Gloria Bonder // _[www.catunescomujer.org](http://www.catunescomujer.org/)_

**Our Virtual Learning Environment**

## Virtual Research And Training Program For Latin American Women Researchers In Biomedical/Health Sciences

**Career Development and **
**Transformational  **
**Leadership Workshop **
**Seminar on Gender **
**Analysis in Health**
** ****Research**
*   *

- Creation of
-  **Latin American Network**
** ****of Women Researchers**
** ****in Health Sciences**

**Professional trajectories, **
**choices and capacity- **
**building  needs of ****Latin American Women**
**Researchers in Health **
**Sciences**

- With the support of  the Observatorio de Salud de la Mujer, Ministerio de
- Sanidad y Consumo**, Spain**

- Gloria Bonder // _[www.catunescomujer.org](http://www.catunescomujer.org/)_

**RESEARCH**

**TRAINING AND MENTORING**

**NETWORKING**

## Outcomes

**Outcomes**

- Evaluation: high level of satisfaction with the contents, methodology and impacts in the participant’s lives
- A **NETWORK** was created  and several collaborative projects are in progress
- Improvement of professional positions, promotion of gender-fair, institutional procedures and regulations and increase of collaborative practices
- Gender “lenses” applied to their professional and personal lives and to their research
- Growing interest in this program by different stakeholders

## Newsletter

**Latin-American Network of Women on Biomedical Science**
- _www.catunescomujer.org_

- Gender + Science

- This network was created by participants of the
**Virtual Research and Training Program for Latin American Women Researchers in Biomedical/Health Sciences**
- UNESCO Regional Chair W, S & T in LA in partnership with **Fogarty International Center**, **National Institutes of Health (NIH)**,  U.S.A

**Disseminate information on women’s participation in scientific institutions in Iberoamerica**
**Share knowledge and resources to facilitate career planning and full development **
**Stimulate the integration of gender analysis in biomedical research**
**Sensitize the scientific community on the need of assure equal opportunities for women and men**

- Promote women’s full participation in biomedical research at all levels and encourage them to participate in their institutions as transformational leaders

- No. 1. November 2007

**Editors: Alicia Aleman, Carolina Carrillo, Cecilia Catanesi and Laura García**

**Goal**

**Objectives**

## Highlights

- Awareness of GENDER determinants in :
- *Professional and personal life
- *Research field and theme
- Learn or improve NEGOTIATION skills
- Better planning of their career
- Increase of OPPORTUNITIES (conferences,grants,publications)
- LEAD projects with new perspectives and attitudes

## Next Steps - Training

- Two adaptations under consideration for current program:
- Develop community of women researchers in Latin America and Caribbean using virtual platform on topic of AIDS
- Include US Latina scientists as part of next phase  – enhance research collaboration opportunities, and provide avenues to “give back”
- Consider development of another virtual learning environment for women researchers in the environmental health sciences?

## Benefits to NIEHS of engaging on virtual program 

- Supports NIEHS priority on global environmental health
- Would address a felt need for training on leadership and gender
- Recognizes challenges facing women and men
- May provide new insights on research gaps and opportunities

## In-house Opportunities?

**In-house Opportunities?**

## Resources/Acknowledgements 

- On-line NIH course on the Science of Sex and Gender in Human Health (http://sexandgendercourse.od.nih.gov/)
- Disease Control Priorities Project, Chapter 10 dcp2.org
- Canadian Institutes for Health Research “Guide for CIHR Researchers and Reviewers on Gender and Sex-Based Analysis in Health Research”
- Writings of Lesley Doyal, Ilona Kickbusch, Miriam Stewart
-    Special thanks to Gloria Bonder, Gail Shor-Posner, Miriam Stewart, Christine Flowers and the NIEHS Communications Team and Paul Cacioppo of Image Associates