A DIFFERENT DRUM
DR. MALAYA SANTOS
Dr. Malaya Pimentel-Santos is a long-time community health advocate, having worked with several nongovernment health organizations. She is a fellow of the Philippine Dermatological Society and a professor ofmicrobiology at the St. Luke’s College of Medicine.
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“In the Western Pacific Region, poverty often wears a woman’s face. Indicators of human poverty, including health indicators, often reflect severe gender-based disparities. In this way, gender inequality is a significant determinant of health outcomes in the Region, with women and girls often at a severe societal disadvantage.”
– World Health Organization
Fifteen or so years ago, a well meaning Filipino-American professor and friend cautioned me to be especially vigilant in any business dealings. He warned me to watch out for unscrupulous individuals who would try to take advantage of me because I was doubly vulnerable, being both a woman and a foreign minority. This was shortly after I arrived in the United States for further studies; I was already a physician and had completed specialty training in dermatology.
Coming from a relatively sheltered background, this was a personal rude awakening: the realization that to random strangers I was no more than a tiny (by western standards) Asian female who spoke relatively good English but with a noticeably ‘funny’ accent that marked me as different and thus made me a potential target for discrimination. This practical piece of advice has stuck with me all these years. It is also something I frequently mention to both my children – but more to my daughter – because it highlights the global reality of gender inequality. In this day and age when gender is no longer binary (male and female) but rather a spectrum of gender identity and orientation, the situation is even more complex.
Gender and vulnerability
Recognizing the multi-dimensional nature of health, we must be able to identify and address its‘ social determinants’, or the external economic, political and cultural conditions that profoundly affect and determine health seeking behavior and access to health. Income, education, occupation, race and ethnicity all contribute to health status and inequity. Gender cuts across all of the above, creating even greater vulnerability for certain groups that are already at risk. Gender further increases inequality and discrimination and adversely affects health outcomes for individuals and in come cases, entire populations.
Integrating equity, gender, human rights and social determinants into the work of WHO, a document published by the World Health Organization (WHO) in 2015 provides examples illustrating glaring disparities that are heavily influenced by gender. In areas where the disease trachoma is prevalent, blindness occurs two to three times more frequently in women than in men. In Europe, Roma women comprise the region’s largest ethnic minority group, but for complex reasons are often excluded from existing maternal health programs. Interestingly, another study found that the accurate diagnosis of conditions such as depression and substance abuse are strongly influenced by gender stereotypes, highlighting the need for gender-awareness training among mental health professionals, in order to avoid misdiagnosis and treatment delay.
In addition to the above, the WHO has published a series of modules entitled “Integrating Poverty and Gender into Health Programmes”. These modules are intended as a guide for health professionals and policy makers in designing and implementing health programs and initiatives that address gender-based violence and many other fundamental issues relating to poverty and gender.
At present, the full impact of gender on health is not yet clear, because much of the data is combined with respect to gender. Moving forward, we must disaggregate (separate) the data and perform a gender based analysis. In doing this, we can identify gender-based health barriers and determine strategies and interventions.
According to the World Economic Forum, our country is doing pretty well on the global scale for gender equality. The Global Gender Gap 2017ranked the Philippines 10th among 144 countries, based on key indicators relating to health,education, economy and politics. Notably, educational attainment is an area where we are assessed to have no gender gap; we rank at the top (1st) for gender equality in education.
In 2015, the Commission on Higher Education (CHED) issued a memorandum order (CMO), “Establishing the Policies and Guidelines on Gender And Development in the Commission on Higher Education and Higher Education Institutions”. This CMO discusses gender issues comprehensively and mandates that all institutions of higher learning create their own Gender and Development Focal Point System (GFPS) and allocate a ‘reasonable’ budget for its operational expenses. The GFPS has the task of ensuring that the respective institutional policies – including curricula – are gender-responsive and promote gender inclusivity.
I still count myself as fortunate to not have had any blatant experiences with gender bias or for that matter, racial or ethnic bias. My educational attainment and fairly comfortable, middle-class lifestyle have placed me in a position of relative privilege, and have undoubtedly been my cushion against the worst expressions of gender discrimination. As the global data above has shown, many others around the world are not afforded the same privilege. Once local data is available and fully disaggregated, gender based disparities in the Philippines may also become apparent.
Working on the assumption that health is a basic right of every human being, it remains our duty as health professionals to continually advocate for justice and equity in health, particularly for those who are left furthest behind.