Gender and global health: evidence, policy, and inconvenient truths
TL;DR: The evidence for the role of gender in health status is surveyed, responses to gender by key global health actors are analyzed and strategies for mainstreaming gender-related evidence into policies and programs are proposed.
About: This article is published in The Lancet.The article was published on 2013-05-18. It has received 244 citations till now. The article focuses on the topics: Social determinants of health & Health policy.
Citations
More filters
Mohammad H. Forouzanfar1, Lily Alexander, H. Ross Anderson, Victoria F Bachman1 +733 more•Institutions (289)
TL;DR: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) as discussed by the authors provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
5,668 citations
01 Jan 2016
TL;DR: The comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study 2015 was used to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational risks or clusters of risks from 1990 to 2015.
Abstract: BACKGROUND
The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.
METHODS
We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).
FINDINGS
Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.
INTERPRETATION
Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.
FUNDING
Bill & Melinda Gates Foundation.
3,920 citations
Mohammad H. Forouzanfar1, Lily Alexander1, H. Ross Anderson2, Victoria F Bachman1 +718 more•Institutions (295)
TL;DR: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) as mentioned in this paper provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
1,656 citations
01 Jan 1992
TL;DR: The body politics of Julia Kristeva and the Body Politics of JuliaKristeva as discussed by the authors are discussed in detail in Section 5.1.1 and Section 6.2.1.
Abstract: Preface (1999) Preface (1990) 1. Subjects of Sex/Gender/Desire I. 'Women' as the Subject of Feminism II. The Compulsory Order of Sex/Gender/Desire III. Gender: The Circular Ruins of Contemporary Debate IV. Theorizing the Binary, the Unitary and Beyond V. Identity, Sex and the Metaphysics of Substance VI. Language, Power and the Strategies of Displacement 2. Prohibition, Psychoanalysis, and the Production of the Heterosexual Matrix I. Structuralism's Critical Exchange II. Lacan, Riviere, and the Strategies of Masquerade III. Freud and the Melancholia of Gender IV. Gender Complexity and the Limits of Identification V. Reformulating Prohibition as Power 3. Subversive Bodily Acts I. The Body Politics of Julia Kristeva II. Foucault, Herculine, and the Politics of Sexual Discontinuity III. Monique Wittig - Bodily Disintegration and Fictive Sex IV. Bodily Inscriptions, Performative Subversions Conclusion - From Parody to Politics
1,125 citations
TL;DR: Even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health.
Abstract: In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: (a) briefly reviews definitions of discrimination, illustrated with examples from the United States; (b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; (c) concisely summarizes extant evidence--both robust and inconsistent--linking discrimination and health; and (d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
577 citations
References
More filters
Book•
01 Jan 1990
TL;DR: The body politics of Julia Kristeva and the Body Politics of JuliaKristeva as mentioned in this paper are discussed in detail in Section 5.1.1 and Section 6.2.1.
Abstract: Preface (1999) Preface (1990) 1. Subjects of Sex/Gender/Desire I. 'Women' as the Subject of Feminism II. The Compulsory Order of Sex/Gender/Desire III. Gender: The Circular Ruins of Contemporary Debate IV. Theorizing the Binary, the Unitary and Beyond V. Identity, Sex and the Metaphysics of Substance VI. Language, Power and the Strategies of Displacement 2. Prohibition, Psychoanalysis, and the Production of the Heterosexual Matrix I. Structuralism's Critical Exchange II. Lacan, Riviere, and the Strategies of Masquerade III. Freud and the Melancholia of Gender IV. Gender Complexity and the Limits of Identification V. Reformulating Prohibition as Power 3. Subversive Bodily Acts I. The Body Politics of Julia Kristeva II. Foucault, Herculine, and the Politics of Sexual Discontinuity III. Monique Wittig - Bodily Disintegration and Fictive Sex IV. Bodily Inscriptions, Performative Subversions Conclusion - From Parody to Politics
21,123 citations
TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex, using the Cause of Death Ensemble model.
11,809 citations
TL;DR: In this paper, the authors estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010.
9,324 citations
TL;DR: The concept of hegemonic masculinity has influenced gender studies across many academic fields but has also attracted serious criticism as mentioned in this paper, and the authors trace the origin of the concept in a convergence of ideas and map the ways it was applied when research on men and masculinities expanded.
Abstract: The concept of hegemonic masculinity has influenced gender studies across many academic fields but has also attracted serious criticism. The authors trace the origin of the concept in a convergence of ideas in the early 1980s and map the ways it was applied when research on men and masculinities expanded. Evaluating the principal criticisms, the authors defend the underlying concept of masculinity, which in most research use is neither reified nor essentialist. However, the criticism of trait models of gender and rigid typologies is sound. The treatment of the subject in research on hegemonic masculinity can be improved with the aid of recent psychological models, although limits to discursive flexibility must be recognized. The concept of hegemonic masculinity does not equate to a model of social reproduction; we need to recognize social struggles in which subordinated masculinities influence dominant forms. Finally, the authors review what has been confirmed from early formulations (the idea of multiple...
6,922 citations
01 Jan 2008
TL;DR: Ban et al. as discussed by the authors stated that the global community cannot turn its back on the poor and the vulnerable, and that the goals are within reach, and even in the very poor countries, with strong political commitment and sufficient and sustained funding.
Abstract: “We cannot allow an unfavourable economic climate to prevent us from realizing the commitments made in 2000,” Mr. Ban states in the foreword to the Millennium Development Goals Report 2009. “The global community cannot turn its back on the poor and the vulnerable.” He adds: “Now is the time to accelerate progress towards the MDGs. The goals are within reach, and even in the very poor countries, with strong political commitment and sufficient and sustained funding.”
5,236 citations