Tijdschrift voor Genderstudies - Volume 18, Issue 4, 2015

Cardiology has long been considered as a man’s disease and the discipline has been developed with the male patient as the common standard. In the past 25 years, technical developments have revealed that distinct female patterns of ischemic heart disease and heart failure exist that require a different diagnostic and therapeutic approach compared to the male patient. Although our knowledge has enormously increased and cardiovascular disease in women is now number the number one cause of death worldwide, clinical implementation into a more gender sensitive approach of patients is hampered by resistance within the male-dominated cardiology community. This currently results in less optimal treatment of female cardiac patients. This paper will describe the historical perspective and look forward to the steps that that are needed to improve every day cardiology care for female patients.

The Dutch Alliance for Gender and Health aims to integrate more gender sensitive knowledge into Dutch psychology education, as gender competent psychologists may likely achieve better psychotherapy outcomes in men and women. In order to inspire teachers to incorporate gender sensitive knowledge into their psychology courses, this article presents an overview of relevant information on sex and gender differences in psychopathology. For instance, we discuss several forms of gender bias and possible explanations for the sex differences in prevalence of psychological disorders, involving attachment, autonomy, coping, and emotion regulation. Additionally, we offer concrete suggestions for the incorporation of this knowledge into existing courses in a time-efficient manner. Having more gender sensitive knowledge may help current and future psychologists to improve their psychotherapy outcomes in men and women.

The Alliance Gender & Health started in 2012 to generate public awareness of the differences between the sexes in health, health management, and need for health care. This alliance between women’s movement organization WOMEN Inc, experts, research programmer ZonMw, and supported by the section for Gender Equality of the Ministry of Education, Culture and Sciences has been very successful. The public in general and many practitioners have been informed and alerted to the problematic ‘one size fits all’ approach of current health care and a substantial research programme Nationaal Kennisprogramma Gender en Gezondheid is on the brink of being implemented. The author interviewed two influential players – former ZonMw chair Pauline Meurs and current ZonMw director Henk Smid – to gauge their insights about the process, the strategies, the obstacles, and the future of the project. Both point to the unique qualities of this joint venture: the academic rigor brought to the project by experts, the ability of WOMEN Inc to engage the public, and the commitment of ZonMw and the ministry to provide means. They also point to the fact that the context has changed considerably in comparison to twenty years ago: a substantial knowledge base is already in place and the health sector is fast becoming feminised in the sense of an increasing rate of women professionals. The interviewees point to the need to incorporate intersections of gender with age, lifestyle, and other important factors and stress the need for continued awareness of the importance of gender differences in health.

When does gender-based differentiation in insurance practice constitute discrimination? In life insurance, gender is used as a primary factor in risk selection. Private life insurance has long been a tool of inclusion and exclusion of clients via its process of risk selection and distributive mechanisms, which creates a series of questions relating to biological classification, difference, equality, discrimination, solidarity, and governance. The realm of insurance medicalises gender by treating it as a statistical factor in determining longevity, differential disease susceptibilities, and even treatment outcomes. In this article, the authors examine whether differentiation based on a sex/gender system constitutes discrimination under European Union law. Specifically, this article covers the Goods & Services Directive (2004/113), commonly referred to as the ‘Gender Directive’, which was adopted in 2004 and implemented by all EU member states before 2007. By examining EU documents, insurance trade journals, presentations, joints responses, and recommendations from equality and consumer groups from 2004-2014, this article examines the effects of the European Court of Justice (ECJ) ruling and ensuing European Commission guidelines from Case C- 236/09 Test-Achats (2011-2012) regarding gender-based risk-rating practices in private insurance pricing. In its ruling, the ECJ invalidated Article 5(2) of the Gender Directive per 21 December 2012, raising renewed questions as to how gender should be used by insurers in their actuarial tables and underwriting assessments, especially when deciding whether to reject or accept applicants. It further contextualises this information in EU non-discrimination law and assesses trends of favouring lifestyle factors over biological traits.

Differences in health and illness between men and women appear high on the political and research agenda in Netherlands as well as in the international arena. Gender medicine is an emerging field in which attention is paid to sex and gender in health and healthcare, mostly as homogenous fixed categories of difference in particular sex difference. Such a categorical approach is useful and necessary to answer certain questions in medicine and in health care. The knowledge agenda Gender and Health (ZonMW, 2015) is one example of how categories can be put forward in constructive ways. However, we also urge health researchers to reconsider a single use of fixed categories and a single focus on sex/gender in health research. A multiple, dynamic intersectional approach aims to study intersections of sex and gender with each other and with other dimensions of difference, such as ethnicity or class. Fluid and more complex identities of people and communities and their health must be accounted for as well. An intersectional perspective offers insight in the relationship between health, identities, and society, and helps to gain an insight in health disparities between and within groups. Besides, an intersectional perspective offers insight into the unique experiences and needs of health care users, including those with intersectional invisibility. An elaborated choice for studying categories by identifying which categories are salient to which health care problem must be made. Adding intersectionality to participatory action research (PAR), which both share the basic values social justice and reflexivity, is one way to study group intersections and health(care). Besides, such research shares its basic tenets with gender-specific medicine: empowerment and contextualisation of health problems. Aim of such research is to critically study and transform practices and improve health and health care by forming alliances between stakeholders at different social locations. A participatory action research project exemplifies how we used an intracategorical intersectional approach to increase knowledge on genetic risk and reproductive options for migrant women, many of them married to their (second) cousin. We meander strategically between fixed categories and fluid identities, in which categories are recognised and used while at the same time being deconstructed and crossed-over. Using categories and forming alliances can fuel social change. In order for diversity to be genuinely transformative, joint critical reflections of all stakeholders on daily processes of normalisation and on dominant norms about gender and other dimensions of diversity can make a difference in health and care.