Gender-specific medicine in social and health policymaking in Emilia-Romagna
Gender-specific medicine is an innovative approach to inequality in health, from the onset and evolution of disease through to treatments. In order to apply it, it is first necessary to recognise that women and men have a different diagnostic and therapeutic appropriateness, which depends, to an equal extent, on biology and social, cultural, psychological and economic gaps. It is an approach that focuses on the matter of diversity and the ways with which the system established to provide treatment, care, research and training, decides to deal or not deal with it. It is known that society as a whole, science and the medical profession included, takes the male gender as its cultural reference basis. It is equally true, and yet still significantly less well known today, that this “cultural implication” produces a non-positive effect on both diagnostic and therapeutic, treatment and care processes and on their concrete outcomes in terms of prevention and health.
It is with precisely this background that the Emilia-Romagna Regional Authority’s regional framework law for equality and against gender discrimination (Regional Law no. 6 of 27 June 2014) aimed to correct a fragmentated, partial and sectorial approach to policy – all policy – which is clearly inadequate in guaranteeing personal rights. On the basis of authoritative studies and experiments, some conducted in Emilia-Romagna, article 10 of this Law introduced the concept of gender-specific medicine into the Regional Health Service, associating it with prevention, individualised treatment and specificity, towards a multidisciplinary approach that promotes differences in order to guarantee the efficacy of health care. However, it was only with the 2017-2019 Regional Social and Health Plan that the Regional Authority and the Emilia-Romagna Health Service acknowledged gender-specific medicine, and cleared the field of stereotypes that consider it alternative medicine or “only for women”. Indeed, the Plan recognises the need for “a profound change of outlook by the scientific community in order to overcome the gap in knowledge, which, as advanced as it may be, is not the result of solid gender-specific studies”. Within the organisations responsible for undertaking this commitment “it translates into making tangible a treatment appropriateness that respects the right to treatment equality for both men and women and [...] into having a more decisive effect on organisational and professional practices, by overcoming the cultural stereotypes and prejudices that drive them”.
For gender-specific medicine to translate into practice and become appropriateness in prevention and care on all levels, it is necessary to start from training, in order to share the heritage of scientific evidence gained in the international community. In this sense, the Plan implements a regional coordination scheme that guides experiments involving this approach and promotes the practices and research achieved in our community. Consequently, operative guidelines will be drawn up for the multidisciplinary approach addressing all Local Health Authorities in Emilia-Romagna and the diffusion of homogeneous training for health, public health and social sector professionals, including doctors on NHS contracts, will be fostered. This is consistent with the targets identified by Regional Framework Law 6/2014, in that it contributes, in particular, to the updating of the gender-specific data that are essential to the Authority’s Gender Budget, which was adopted in our Region in 2016. This combined system of coordination, data collection, practice sharing and the aims described, is clear evidence that the Emilia-Romagna Regional Authority intends to consolidate a transverse cultural approach that takes the new guise of a “determinant of health”, which has been underestimated to date. The Local Health Authorities are now expected to adopt gender-specific medicine – and the necessary multidisciplinary integration – as a target to be met during the Plan’s period of validity, i.e. before the end of 2019, supported by the fact that in recent years the bases have been laid to make sure that the goals identified translate into permanent practice on all levels of the Authority (planning, management, clinical governance and diagnosis/care/treatment). On a tangible level, it means that the actions taken will hinge on well-structured organisational choices through an authority supervisor and a board that assists the general directorate on equity, and which already draw up activity plans according to a transverse cultural approach. On the basis of this approach, the only one of its kind in Italy, gender-specific medicine will be able to penetrate into the “organisational life” of the Local Health Authorities.
In this planned pathway, a role is also played by the competent Commissions (Health and Equality) of the Regional Legislative Body, which will monitor its consistency and efficacy, with regard to training and organisation, clinical and diagnostic and therapeutic appropriateness and, last but not least, the factual outcomes. The results obtained will provide useful operational guidance also for the rest of Italy, in order to support the application of gender-specific medicine as it is governed by the medical and health service reform law no. 3 of 11 January 2018. Of this very recent law, I would like to draw attention to article 3, which, in particular, envisages that a national training plan shall be established by a decree issued by the Ministry of Health in concert with the Ministry of Education, University and Research, “in order to guarantee the knowledge and application of a gender-specific approach in research, prevention, diagnosis and treatment settings”. The profound change that is required for true progress by the National Health Service in the interests of the individual is only possible through effective subsidiarity and fair cooperation by the institutions. The Emilia-Romagna Regional Authority is there.
Chairperson of the Equality and Personal Rights Commission of the Emilia-Romagna Regional Authority and National Coordinator of the Regional Equality Bodies.