Sex and gender sensitive medicine - political and scientific discourse/Expert

Background of health policy

Sex and gender-sensitive medicine has developed in recent decades from women's and, to some extent, men's health research. [1] In the wake of the second women's liberation movement, a women's health initiative was formed in the 1970s with the demand for female self-determination in medical matters. In the 1990s, the women's health movement criticized the exclusion of female volunteers from clinical studies.

The United Nations designated 1975 as the International Year of Women. The first World Conference on Women was also held in Mexico in that year. The first independent World Health Organization (WHO) report on women's health was adopted in 1994 at the Women's Health Counts, a conference on women's health in Central and Eastern Europe: The Vienna Statement on Investing in Women's Health. In this statement, general principles on women's health were formulated with six priority areas for action (see Table 1). [2]

Table 1: Vienna Declaration on Women's Health (1994) with six areas for action. [Source: Bericht der Enquetekommission des Landtags Nordrhein-Westfalen (2013)]

Vienna Statement on Women's Health: Priority areas for action

  • Reduce maternal mortality and increase maternal safety
  • Promotion of sexual and reproductive health and well-being
  • Introduction of women-friendly cost strategies
  • Support for programs to promote healthy lifestyles
  • Combating violence against women
  • Improvements for women working in the health care industry

Building on these areas of action, the Vienna Statement developed a political commitment to women's health policy at a national level. In connection with this, women's health centers were established in many countries and more women's health reports were published. In the meantime, sex and gender-sensitive health data became available for various populations (e.g. for individual countries, for large cities, etc.). [3] The political recommendations for action in the Declaration are shown in Table 2.

Table 2: Political commitment of the Vienna Statement on Women's Health (1994). [Source: Bericht der Enquetekommission des Landtags Nordrhein-Westfalen (2013)]

Vienna Statement on Women's Health: Political Recommendations for Action

  • Establishment of a women's health office for the development a cross-sectional women's health policy and action plan
  • Creation of a national women's health forum
  • Creating a reliable information base for interdisciplinary women's health policy and establishing appropriate sex and gender-specific monitoring and reporting systems on the socio-economic and health situation of women
  • Regular publication of public health reports on women
  • Support research activities in the field of women's health by developing multidisciplinary research strategies
  • Preparation of country reports on women's health as part of the WHO Regional Office for Europe's Women's Health Initiative

In 1995, at the Fourth World Conference on Women in Beijing, an action plan was adopted that included issues of women's health. [3]In addition, the countries pledged to protect women's rights, combat poverty among women, prosecute violence against women as a human rights violation and reduce gender gaps in the education system. Furthermore, gender equality in all areas of society (i.e. politics, economy and society) was to be supported. [4] The Fourth World Conference on Women can thus be seen as a platform for the so-called “gender mainstreaming”, which was finally implemented by the WHO in 1997 and made legally binding at the European level in 1999 with the ''Amsterdam Treaty''. In the same year, the Federal Republic of Germany recognized gender mainstreaming as a universal guiding principle in a resolution of the German Federal Cabinet. The concept of gender mainstreaming is used to outline initiatives for the equality of women and men in all areas of the community. In the health system, this mainstreaming combines two important objectives: The reduction of social inequality and the improvement of quality and efficacy of the health care system. [1]

At the international level, women's health was addressed in the following years mainly in the context of poverty, malnutrition and reproductive health. The WHO Regional Office for Europe, however, set other priorities. Particular attention was paid to issues such as sex and gender equity, health research and migration. In this context, the Madrid Declaration ''Mainstreaming gender equity in health - The need to move forward'' of 2001 and the international conference ''Gender & Health'' in Vienna in 2002 should be mentioned. [2]The Madrid Declaration called on the Member States of WHO Europe to consider sex and gender differences in morbidity and mortality and in access to the health care system. The need for sex and gender-sensitive research, which at that time was only available in rudimentary form, was undisputed. [5]

Recent Developments

Thanks to the progress in health policy mentioned above, the field of gender health research and practice has developed significantly over the past 20 years and been consolidated in the following areas in particular:

1. Intensification of interdisciplinary research

Whereas in the past gender and health were mostly considered from a psychosocial perspective, this has since changed. Sex, gender, health and illness are increasingly treated as health matters. At present, it is widely accepted that sex and gender medicine cover all aspects of biological (sex) and social (gender) aspects and their interactions. For this reason, interdisciplinary cooperation between human science and medical and natural science departments is essential.

 2. Systematic breakdown of the categories sex and gender

At the beginning of sex and gender-sensitive health research, the factors sex and gender were assigned key roles as differentiating variables. There is now an understanding that specific groups across both sexes may indeed be more similar in their state of health than different groups within the same sex. Variables such as age, lifestyle, socio-economic status, sexual orientation and possibly disabilities play a crucial role in this context. This broadening of perspectives has also made it possible to break up the existing dichotomization into female and male to a certain extent. An important step in this process was the amendment of the German Civil Law of 2013, in which the German Ethics Council classified the requirement to define gender as either male or female as an unjustifiable interference with individual rights. The right to equal treatment of intersexual persons was required. In the future, sex and gender studies should not only take adequate account of the health care of women and men but should also not exclude transgender or intersexual persons. The previous two-gendered system in medicine must be further expanded in order to ensure optimal care for all people specifically in terms of individualized medical care.

3. Development of sex and gender-sensitive health reporting and care practice

In 2005, the first version of a sex and gender-sensitive health report was published. This prepared the existing data in a sex and gender-comparative manner and embedded it in a theoretical framework. Subsequently, the Robert Koch Institute developed guidelines to help include the variables sex and gender in future health reports. Currently, there are very few databases which make data available without a sex and gender-sensitive analysis. Sex and gender are also slowly becoming more relevant in the area of interventions. For example, the Swiss quality system ''quint-essenz'' defines the sex and gender aspects as decisive quality features of health promotion.

4. Expansion of men's health reporting

In the course of the women's health campaign aspects of men's health were neglected and thus initially men's health reporting was not well developed. Eleven years after the first publication of a comprehensive women's health report, the ''Report on the health situation of men in Germany'' was finally published in 2014 by the Robert Koch Institute. Special emphasis was placed on the importance of employment and unemployment for health-related well-being. In addition, concrete measures for male-specific prevention and health promotion were identified. [5]

In February 2017, the Institute for Gender Health e. V.  (IGG e. V.) presented a ten-point checklist of health policy recommendations for a sex and gender-sensitive health care. According to the Institute, for sex and gender-sensitive medical treatment to be possible, the system structures, which have not been based on parity to date, must undergo fundamental changes. The following recommendations were derived from a survey in the network of the Federal Congress on Gender Health: [6]

Table 3: Ten-point catalogue for gender-sensitive health care [Source: Institute for Gender Health e. V. (2017)].

Health policy recommendations of the Institute for Gender Health

  • A sanctioned sex quota in the boards of the health insurance funds' self-governing bodies
  • Sex and gender-specific projects in the Innovation Fund - especially for health services research
  • Exam-relevant module on sex and gender-sensitive medicine in student education at medical faculties
  • Concepts of compliance as part of the quality reports of healthcare institutions
  • Family-friendly education and training concepts for medical and non-medical health care providers
  • Promotion of part-time contracts in outpatient care
  • Sex quota for university department chairs of medicine
  • Sex and gender-appropriate research policy in medicine
  • Sex and gender sensitivity as a quality feature in care facilities
  • Continuous reporting by self-governing bodies on sex and gender equality and individualized care.

Integration into education

In order to facilitate sex and gender-sensitive health care, the integration of sex and gender medicine into medical education is essential. In 2003, the cardiologist Prof. Vera Regitz-Zagrosek founded the Institute for Sex and Gender Studies in Medicine at the Charité in Berlin. Regitz-Zagrosek also published the first textbook entitled ''Sex and Gender Aspects in Clinical Medicine'' together with Dr. ''in'' med. Sabine Oertelt-Prigione in 2011. There is currently no specifically designated department chair for sex and gender- sensitive medicine in Germany at medical faculties. The Charité in Berlin is the only university with an institute for sex and gender sensitive medicine in Germany and the only university to include sex and gender aspects in the regular academic curriculum for medical students. In addition, a module on "Sex and gender-sensitive Medicine" has been introduced here (as at other universities) for master’s and medical students, which is also offered as additional training for doctors and those in the field of public health. [7] In Austria, two medical universities already have their own department chairs for sex and gender-sensitive medicine: in 2010 Prof. in Dr. in Alexandra Kautzky-Willer received the first chair at the Medical University of Vienna, and in 2014 Prof. in Dr. in Margarethe Hochleitner was appointed to second chair at the Medical University of Innsbruck. In Austria, since 2010 it has also been possible to obtain a Master of Science in ''sex and gender-sensitive Medicine'' [8] The resistance by the opinion leaders and representatives of andro-centered traditional medicine is significant in the institutionalization of sex and gender-sensitive medicine. At present, sex and gender-sensitive medicine is only partially represented in education. In the future, sex and gender-sensitive medicine must become a discipline that exists to promote specific research approaches and therapeutic concepts and ultimately to ensure that medical care is sex and gender-sensitive. Margarethe Hochleitner makes it clear in this respect: "It is by no means sufficient to integrate a sex and gender-sensitive medicine as a voluntary extra module in the course of study or as an evening lecture series. Rather, the educators must be sensitized, trained and evaluated. In doing so, she is of the opinion that contents of sex and gender-sensitive medicine must be part of the examination material in order to be learned and later applied. [9]

Status quo and outlook

Sex and gender-appropriate prevention, diagnosis, care and aftercare are undoubtedly indispensable and the knowledge gained will, if carefully collected, help to advance modern medicine. It is no coincidence, however, that the question arises as to who has the means to establish sex and gender-sensitive medicine in the curriculum for medical students. The 34 state-funded medical faculties in Germany face this challenge. But are the deans' offices for academic teaching and studies, which are still predominantly occupied by men, mindful of this? The German Medical Women´s Association (DÄB) asked four precise questions in 2015. The result is - not surprisingly - quite disappointing: 80 % of faculties have not yet addressed this socially important topic! The results in detail can be read in the Deutsches Ärzteblatt ("Themen der Zeit" December 2016, issue 51-52). The question can be asked why we are so rigid and inflexible in this area.

Sex and gender medicine received its first push in the USA. Marianne Legato published a textbook (Principles of Gender-Specific Medicine) with more than 1000 pages in 2004. She proposed that there is no such thing as sex and gender-neutral health or illness.  In the beginning the initiative came from women, mostly from the non-university sector.  These women were the same women who organized and attended most events on sex and gender-sensitive medicine. Gradually, a male audience also appeared, and it is expected men will become increasingly interested and qualified in the subject of sex and gender in medicine. It is encouraging that sex and gender-related clinical research received funding in 2016/2017 from the BMBF. Moreover, in the USA it is now a condition for allocation of research funds that the sex of the laboratory animal under investigation be considered. In Europe however, it may take some time before animal experiment proposals have to take this fact into account as a condition for approval.

The following thesis can be made, sex and gender-sensitive medicine will continue to develop and establish itself, but gradually. One of the reasons being there are too few women represented on the faculties of medicine in Germany (there was one female dean among 34 men in 2015, and only a handful of female assistant-deans). What about the individual clinical disciplines? Who holds the senior positions and is responsible for what is taught on sex and gender in medicine based on the catalogue of learning objectives? It is hard to believe, but true: on average, in Germany, you will find only 10 % women, i.e. 90 % male decision-makers determine what is important and being supported in the respective fields. When these inequalities are addressed, sex and gender-sensitive medicine will also receive a powerful boost. [10]

External Links


Click here to expand literature references.
  1. Kuhlmann, E. Gendertheorien. In: Kolip P, Hurrelmann K, editors. Handbuch Geschlecht und Gesundheit: Männer und Frauen im Vergleich. 2., vollst. überarb. und erw. Aufl. Bern: Hogrefe; 2016. p. 34–44 (Programmbereich Gesundheit).
  2. Zukunft einer frauengerechten Gesundheitsversorgung in NRW: Bericht der Enquetekommission des Landtags Nordrhein-Westfalen. Springer-Verlag, 2013.
  3. Hochleitner, M. (2013). Gender Medizin–Was ist das? Stand: 06.12.2016.
  4. Erklärung und Aktionsplattform auf der Vierten UN-Weltfrauenkonferenz in Peking. 15. September 1995, deutsche Übersetzung, Website der UN.
  5. Kolip P, Hurrelmann K. Handbuch Geschlecht und Gesundheit: Männer und Frauen im Vergleich. 2., vollst. überarb. und erw. Aufl. Bern: Hogrefe; 2016. (Programmbereich Gesundheit).
  6. Institut für GenderGesundheit e. V. (2017). Gesundheitspolitische Handlungsempfehlungen des Instituts für GenderGesundheit e. V. Stand: 21.02.2017.
  7. Krüger, Anja. Gendermedizin. "Die Charité ist Vorreiter".  Ärzte Zeitung, 07.03.2014.
  8. Universitätslehrgang Gender Medicine. Medizinische Universität Wien, abgerufen am 13.12.2016.
  9. Kaczmarczyk, Gabriele. Das Geschlecht macht den Unterschied. Eine Einführung in die Gender-Medizin. FrauenRat 6. 2014.
  10. Ludwig S. Dettmer S., Peters H., Kaczmarczyk, G. (2016) Themen der Zeit. Geschlechtsspezifische Medizin in der Lehre: Noch in den Kinderschuhen. Deutsches Ärzteblatt 113 (51-52).


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Paulina Juszczyk

Last changed: 2021-10-23 12:58:36