Gender inequality remains in healthcare

Gender-equal care means that both women and men receive the care they need. It sounds simple, but despite all the high ambitions and goals declared over the years, there are still plenty of medically unjustified gender differences in the quality of care provided in the Nordic countries. At a recent expert seminar in Mariehamn, Åland, the Nordic governments were given some tools for change.

Swedish women with Alzheimer’s receive on average three hours less home care per week than their male counterparts – a stunning example of how gender interferes with people’s need for care in a modern Nordic welfare society.

Finlands ordförandeskap 2016Several other examples are becoming all too well known: That hospitals fail to diagnose women’s heart attacks since most heart research has been conducted on men and that depression is underdiagnosed among men since the norms for this condition are based on women.

On 14-15 June, the government of Åland and the Nordic Council of Ministers arranged an expert seminar on gender-equal care, with a focus on knowledge and change.

One of experts was Kerstin Jigmo, district doctor and head of a project for a gender-equal sick-listing process in the Swedish province of Skåne.

When the rate of sick listings shot through the roof in Sweden in the early 2000s, Kerstin Jigmo and her colleagues were assigned the task of improving the sick-listing process and regional health statistics. They formed a team and set out to increase the return of long-term sick-listed individuals to the workplace.
‘We evaluated our work after one year, and the results made me irritated. We had been fairly successful with men, but the women were still on sick leave,’ says Jigmo.

Since then, Kerstin Jigmo has developed a tool to make the sick-listing process more gender equal – Genushanden, or ‘the gender hand’.

The purpose of the gender hand is to make the healthcare sector aware of five gender traps, one for each finger.
‘The general idea is that healthcare professionals should always switch a patient’s gender in their minds, meaning they should ask themselves whether they would act the same had the patient been of the opposite sex,’ says Kerstin Jigmo.

The care staff must be aware of the five ‘traps’, namely family situation, violence, somatic or psychiatric diagnosis, at-risk alcohol consumption and the rehabilitation plan.

There is a strong focus on women’s family situation, while what goes on in men’s life is not considered in the doctor’s assessment. Violence against women is a significant factor behind the need of many women to be on sick leave, something the healthcare professionals often do not know since they avoid asking about it.
‘I wish there was a standardised Nordic assessment procedure so that all healthcare centres would ask the same questions. But until that happens: Dare to ask!’ says Jigmo.

Somatic or psychiatric diagnosis is a trap because healthcare workers often think that men’s ailments are somatic while women’s problems are psychiatric. They also often fail to recognise women’s abuse of alcohol – by not asking about it – at the same time as they tend to downplay the relevance of men’s drinking habits.

A gender difference is also found in the rehabilitation process, as both the healthcare sector and employers are eager to support men to return to work while allowing women to remain on sick leave longer.

The seminar participants included healthcare workers from Åland and government officials from all Nordic countries. One of them was Åland’s Minister of Administration and EU-affairs Nina Fällman.

Half of Åland’s budget goes to healthcare, a sector struggling with high levels of sick leave among staff.

Something needs to be done and the government has promised both more gender equal salaries, better HR policy and measures against long-term sick leave.
‘The gender hand provided concrete tools to deal with the sick leaves. A more gender-aware healthcare sector would save tax money and lead to higher quality care for both women and men. I think we’ll start a project later this year where we’ll train ourselves in switching the gender of the patient and daring to ask difficult questions!’ says Nina Fällman.


Logotype Nordic Council of Ministers Logotype Swedish Secretariat for Gender Research Logotype University of Gothenburg