Declarations Gender Mainstreaming Was Defined by the Economic and Social Council of UNO

A) Declarations Gender mainstreaming was defined by the Economic and Social Council of UNO as follows: Mainstreaming a gender perspective is the process of assessing the implications for women and men of any planned action, including legislation, policies or programmes, in any area and at all levels. It is a strategy for making the concerns and experiences of women as well as of men an integral part of the design, implementation, monitoring and evaluation of policies and programmes in all political, economic and societal spheres, so that women and men benefit equally, and inequality is not perpetuated. The ultimate goal of mainstreaming is to achieve gender equality. (United Nations Economic and Social Council's agreed conclusions 1997/2. ) Following those lines the WHO has sustained the approach to Gender in Health through a series of documents which appeared in the following years (See: a) Integrating gender perspectives into the work of WHO: World Health Organization, 2002. b) Strategic action plan for the health of women in Europe. Copenhagen, World Health Organization, 2001; c) resolution AFR/RC53/r4 on Women's health: a strategy for the African Region; and resolution CD46.R16 on PAHO gender equality policy; d) EB116/2005/REC/1, Summary record of the second meeting; e) Document WHO/FCH/GWH/07.1 . At its 60th session in May 2007, the Health Assembly noted with appreciation the strategy and adopted resolution WHA60.25. The strategy was drawn up on the basis of broad consultation throughout the Organization, with representatives from ministries of health, and with external experts, from which it emerged that gender equality and equity should be integrated into WHO’s overall strategic and operational planning, in order to bring about systemic changes across all areas of work. A plan of action for implementing the strategy continues to evolve (Document WHO/FCH/GWH/07.1). The Millennium Declaration of United Nations Organizations include the promotion of gender equality and the empowerment of women as effective ways to combat poverty, hunger and disease and to stimulate sustainable development (United Nations General Assembly resolution 55/2) The United Nations is strengthening gender mainstreaming through a system-wide strategy, with which the strategy is consistent. In order to ensure that women and men of all ages have equal access to opportunities for achieving their full health potential and health equity, the health sector needs to recognize that they differ in terms of both sex and gender. Because of social (gender) and biological (sex) differences, women and men face different health risks, experience different responses from health systems, and their health-seeking behaviour, and health outcomes differ. In order to fully incorporate analysis of the role of gender and sex in health and determine appropriate action the WHO Secretariat has given itself the following principles (Strategy for integrating gender analysis and actions into the work of WHO May 2007) : • addressing gender-based discrimination is a prerequisite for health equity • leadership and ultimate responsibility for gender mainstreaming lie at the highest policy and technical levels of the WHO • programmes are responsible for analysing the role of gender and sex in their areas of work and for developing appropriate gender-specific responses in all strategic objectives on a continuing basis • equal participation of women and men in decision-making at all levels of the Organization is essential in order to take account of their diverse needs • performance management should include monitoring and evaluation of gender mainstreaming. WHO strategic directions are chosen as following:  Building WHO capacity for gender analysis and planning. In order to help to ensure that analysis of the role of gender and sex in health and appropriate planning is integrated into WHO’s work at all levels, staff need to have a basic understanding of the subject matter.  Bringing gender into the mainstream of WHO’s management. Incorporation of gender considerations – in the components of results-based management planning, budgeting, monitoring and evaluation – effectively influences the work of the Organization.  Promoting use of sex-disaggregated data and gender analysis. In line with the commitment made in the Eleventh General Programme of Work (Document A59/25, paragraph 116), WHO will use sex-disaggregated data in planning and monitoring its programmes and provide support to Member States in improving the collection, analysis and use of quantitative data on health, disaggregated by sex, age and other relevant social stratifications.  Establishing accountability. Accountability for the effective integration of gender perspectives into WHO programmes and operational plans will rest primarily with senior WHO staff.  Role of the gender, women and health network. Implementation of the strategic directions will require advocacy, information, technical support and guidance to staff.

B) Short overview on the scenario The cardiovascular disease (CVD) model One of the critical problems relevant to gender approach is found in the main and largely impacting common (for men and women) diseases ( e.g. Cardiovascular Diseases (MI, Stroke)) the knowledge of the differences are fairly understood or known, and the treatment and prevention are suffering by the state of that understanding and knowledge. Lack of knowledge is parallel to not always certified epidemiology information: The Italian data (ISTAT 2006) on mortality of main diseases are certified just till 2002.

thousands 2002 2003 2004 CVD men 105.7 108.6 100.2 CVD women 131.4 138.8 123.2 Tumours men 93.4 94.4 94.5 Tumours women 69.6 68.6 70.3

Differences between genders on the single independent risk factors of CVD are well described. The reference values of many parameters (as Blood Pressure, Waist circumference, HDL,) are consequently indicated . Prevalence of risk factors are different in men and women in the population. The risk factors taken in consideration (Lancet 2004;364: 937-52) are ApoB/ApoAI ratio, Blood Pressure, overweight/obesity, smoking, diabetes bad nutrition, sedentarity, stress, social unsatisfaction. Recently air pollution has been added. They are accounting more than 92% of the global CVD risk. Less is given to genetic risk. The correlation of those risk factors with CVD were shown marginally stronger in women than in men. These results suggest that the existence of 1 additional risk factor may increase the risk of cardiovascular disease more steeply in women than in men (Gend Med. 2006;3:196–205). Differences are described in the outcomes of Myocardial Infarction in Hospitals Hospital out come report in Italy 2003

DRG Number of Days stay admissions men not complicated MI alive 28.169 7.59 discharged women not complicated MI alive 13.763 8.82 discharged men complicated MI alive 13.617 9.54 discharged women complicated MI alive 10.154 10.78 discharged women MI deceased 3.551 6.02

women MI deceased 3.831 5.84

CVD Mortality in US Women Is Not Declining (AHA Heart Disease and Stroke Statistics–2005 Update. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001;285:2486-2497). Women tend to delay seeking treatment longer than men Þ 18’ longer vs. men; time to treatment was 12’ longer (GUSTO I; Weaver WD. JAMA 1996). More than 20% of young women with multiple risk factors delayed coming to the hospital by 12 h. or more after onset of symptoms (Barron HV. Circulation 1998). Women may experience further delay in the hospital before receiving thrombolytic therapy Þ (mean 112’ vs 89’; p<0.01); they waited 7’ longer before having their first ECG (mean 26’ vs 19; p<0.01) (Goldberg RJ. Am Heart J 1998) Much research in past 20 years on diagnosis and treatment of CHD excluded or underrepresented women. Only 20% of studies including women published sex-specific findings.Tests and therapies used to treat CHD in women based on studies conducted primarily in men (Stanford-UCSF Evidence-based Practice Centre. Profile, November 2002. Agency for Healthcare Quality and Research, Rockville, MD. http://www.ahrq.gov/clinic/epc/ucsfepc.htm) Cardiovascular diseases in men are prevalent till the age of 65 years, after that age CVDs prevail in women. Women die for CVD more than men because of the age and because of anatomical, functional and prevalence of risk factors and concomitant mobility. Beyond those differences the attention is even more focussed on treatment disparity . There is a sort of gender bias in the medical approach (NEJM 1991; 325: 274-27. Arch intern Med 1998; 158: 981-988. NEJM 2007; 356: 898-1009 . Circulation 2007; 115: 833-39) Anatomical and endothelial functional differences in vessels are described (Am Heart J 2000;139: 649-653) aging and diabetes are increasing differences (Hypertension 2004; 44: 67-71) Aging, hormonal fluctuation, oxidative stress, metabolic syndrome are getting differentely between genders inadequate the repairing activities (Circulation 2004; 109:722-725). An early menopause, gestational diabetes (as described in NEJM 2008;358:2061-3), preeclampsia, eclampsia , birth underweight, and other conditions in the young age, refer to higher risk of CVD in the advanced ages (J Am Coll Cardiol 2006; 47: 30S-35S). Stroke is a condition of CVDs were the differences of gender are known. How much of this knowledge is utilized in the management of Stroke in the Stroke Units, or in the risk assessement and prevention in the genders (Lancet 2008;371:1612-23).

Diabetes and genders Even when women were included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the reported results. Existing studies, however, reveal several differences between men and women with diabetes. The prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of triglycerides), and these risk factors for CAD have a stronger influence in women. ( Gender Med 2006 3:131-58)

Gender and pharmacology The influence of gender on the effects of aspirin in preventing myocardial infarction Gender accounts for a substantial proportion of the variability in the efficacy of aspirin in reducing MI rates across these trials, and supports the notion that women might be less responsive to aspirin than men (BMC Medicine 2007, 5:29). It is shown that 75 mg/die aspirin produce conclusive benefit in secondary prevention and in treatment in MI, Stroke and vascular disorders Men and women have apparently equal benefits in using aspirin in the secondary prevention after CVD events; women do not have equal benefit as men by using aspirin in the primary prevention of CAD. ( Women Health Initiatives results (communicated by Julie. Buring - Europrevent Congress. Paris May 2nd 2008)

Smoking and Gender Although the rate of smoking is, for the most part, higher among males, the results of this study showed that the disease is associated with smoking is higher among females. Because this risk is higher for females at both high and low levels of smoking, there may be some underlying effects that place females at a higher risk regardless of how much they oke Point Estimates in Low Level or High Level of Groups Smoking has given (respectively) different results: Both sexes 2.98 and 1.97; Males 1.42 and 1.95; Females 1.77 and 2.75; Overall 1.70 and 2.09 .The disease outcomes included in the analyses were similar for both sexes, thus the difference in risk may not be due solely to any difference in the outcomes in each group. Rather, there are other factors involved, such as a gender difference in the relationship of smoking to specific disease exacerbation. (Am J Prev Med. 2006;30:405–412. and Gend Med. 2006;3:279–291)

Molecular Biology and Genders Have been described differences in the length of telomeres (repeated sequence TTAGGG at the ends of chromosomes) of women and men cells nucleus. The telomeres are gradually eroded as life goes on, and several studies have shown that men have shorter telomeres than women do (Med Hypotheses. 2004;62:151–154). Many cells are dying when the telomeres join to a critical length. This one is considered a marker of biological life. “...the replicative history of male cells might be longer than that of female cells, resulting in the exhaustion of the regeneration potential and the early onset of age-associated disease predominantly in large-bodied males” (BMJ. 2000;321:1609–1612).

Osteoporosis and gender Projections about increasing numbers of cases of osteoporosis in the future are well- founded, since the population in general is aging and age itself is a risk factor. It is estimated that the current number of osteoporosis cases in the U.S. alone is at 10 million, with another 34 million individuals at risk of fracture due to low bone mass. Osteoporosis incidence increases with age, affecting: n 37% of women between the ages of 50 and 59; n 50% between the ages of 60 and 69; n 75% between ages 70 and 79; n and 87% of women older than 80 years of age (Improving and Measuring Osteoporosis Management National Pharmaceutical Council, by The Joint Commission 2008). Men are not immune from the disease, as 5% of men on Medicare in 2001 had an osteoporosis diagnosis(Am J Manag Care. 2006;12(Suppl 7):S181-S190).Estimates are that the number of persons older than age 50 with osteoporosis will increase to 12 million by 2010 and to nearly 14 million by 2020 (Am J Med. 2006;119(4)(Suppl 1):S3-S11). One out of two women and one out of eight men will be affected by osteoporosis in their Lifetime.There are several identified risk factors for the development of low bone mass. Chief among these is age itself. A recent study among 616 women, aged 60- 94, found that for each year of increasing age, the fracture risk increases by 3% (Bull World Health Organ. 2003;81(11):827-830) Among women, the gradual loss of estrogen at menopause contributes significantly to this decline in bone integrity and is a principal factor in what Riggs and Melton proposed in 1983 as Type I involutional osteoporosis (N Engl J Med. 1986;314(26):1676-1686) .The reduction in circulating estrogen triggers osteoclast activation and bone resorption, resulting in rapid bone loss at a rate of 1% to 5% yearly; this phase lasts from four to eight years (Am J Manag Care. 2001;7(special SP5-16)).The second phase, a more gradual bone loss, occurs 10 to 20 years after menopause and affects men as well as women. This Type II osteoporosis is marked by a rise in parathyroid hormone (PTH) levels, increase in bone turnover, and a decline in osteoblastic activity causing reduced bone formation (Am J Manag Care. 2001;7(special SP5-16)). In spite of the a.m. detailed description many questions are still open to understand the differences between gender and consequently the necessary different medical approach in treatment and prevention of the osteoporosis. Defective sight balance loss, microcirculation disorders in the diabetes feet can play a important role in the fractures of falling women with osteoporosis (::::::::::::::. Two gene variants of key biological proteins (one close to osteoprotegerin, the other close to the LDL-receptor related protein) found in men, increase the risk of osteoporosis and osteoporotic fracture. The combined effects of these risk alleles on fractures is similar to that of most well- replicated environmental risk factors, and they are present in more than one in five white people (Lancet 2008;371:1505-12)

Neurodegenerative and mental disorders and gender Globally observed brain, psychiatric, and neurological disease have a big impact both on social and economic field in Europe. Data of World Health Organization (WHO) suggest that brain diseases are responsible for 35% of Europe’s total disease burden. An analysis of all health economic studies of brain diseases in Europe, published by the European Brain Council (EBC) in June 2005, estimated the total cost of brain disease in Europe in 2004 to be 386 billion (Journal of Neurology, Neurosurgery, and Psychiatry 2006;77(suppl_1):i1- i49).That burden is set to grow, mainly due to the fact that the European population is ageing.

The major depression is ranking second among the 10 leading causes of DALY after ischemic heart disease. In the next 20 years people suffering from brain disease could grow as much as 20%. The population of Europe is ageing, and the expanding of information era, and mainly the high speed visual channel in large quantity impacting on human brain from the youth, will contribute , in a not predictable extension, to the brain disorders. More over the increasing wide geographical dispersal of families, the weakening of family networks, and the changing role of woman mean that few relatives stay at home to care for patients with brain disease. Therefore the costs burden is shifting onto professional care services.

Alzheimer Disease - AD, the most common cause of dementia, affects 3 to 4% of the population above 65 years of age: 2.5 million with an estimated incidence approaching 0.5 million. Alzheimer’s disease (AD) was accounted the eighth leading cause of death for women in the United States.. (National Vital Statistics Report, Vol 49, No. 11. Hyattsville (MD): National Center for Health Statistics, Centers for Disease Control and Prevention. U.S. Department of Health and Human Services; October 12, 2001 2001)

There have been many observations of gender differences in normal brain structure and function. “Women’s brains are different from men’s. That’s not new. What is new is that the differences are smaller than most people believe. They are not big enough to say that one sex is smarter or better at math than the other. What is also new is that the small differences can be significant when it comes to memory, arousal, reasoning, and risk of some diseases. The latter include depression, anxiety, schizophrenia, drug abuse, Alzheimer’s, diabetes, and heart disease” (William J. Cromie Harvard News Office June 25, 2007) Quantitative sex differences in brain aging of normal males and females have been reported in a number of magnetic resonance imaging (MRI) studies. It has been reported (Arch Neurol 1998 55(2):169-179) that, in men, reduction in brain volume was greater in the parieto-occipital regions. In a magnetic resonance spectroscopy study, phosphorus metabolism was reduced in the frontal lobes of women with AD as compared to men. A similar, though non-significant, effect was seen among normal elders (Ann Neurol 38:194- 201).

Subjects with mild cognitive impairment (MCI) have been shown to have reduced hippocampal volumes relative to normal elderly control subjects. The presence of the apo-lipoprotein E 4 (APOE*E4) allele has been associated with greater hippocampal atrophy in women than in men with Alzheimer disease. The APOE*E4 genotype status appears to have a greater deleterious effect on gross hippocampal pathology and memory performance in women than in men ( Arch Neurol. 2005;62:953-957). Recent epidemiological and experimental data also support a role for the gonadotropin luteinizing hormone in AD. (Clin. Med. Res 2007;5: 177 – 183). Attention is devoted to the role of mitochondria in the pathogenesis of Alzheimer's disease, and to the effect of gender on the incidence of Alzheimer's disease and the pathophysiological mechanisms involved (Antioxid Redox Signa 2007;9:1677-90). Gender

Structural and functional sex differences in the brain may be related to reproduction, sexual orientation, gender identity (i.e. the feeling of being male or female), cognition, and disease. In a number of areas of the human hypothalamus, structural and functional differences between the sexes and between homosexual and heterosexual men have been described. The mamillary body complex – MBC, in the caudal hypothalamus, has been studied in postmortem brain material from the following groups: young heterosexual men, young homosexual men, aged heterosexual castrated and non castrated men, castrated and non castrated transsexuals, young heterosexual women, and a young virilized woman. Nuclear Androgen Receptor immunoreactivity (AR-ir) did not differ significantly between heterosexual and homosexual men, but was significantly stronger than that in women. A female-like pattern of AR-ir (i.e. no to weak nuclear staining) was observed in 26- to 53-yr-old castrated male-to-female transsexuals and in old castrated and non-castrated men, 67–87 yr of age. In conclusion, the sexually dimorphic AR-ir in the MBC seemed to be clearly related to circulating levels of androgens and not to sexual orientation or gender identity. The functional implications of these alterations have to be discussed in relation to reproduction, cognition, and neuroprotection.(The Journal of Clinical Endocrinology & Metabolism 2001;86: 818-827)

Besides their well-established actions on reproductive functions, estrogens exert a variety of actions on many regions of the nervous system that influence higher cognitive function, pain mechanisms, fine motor skills, mood, and susceptibility to seizures; they also appear to have neuro-protective actions in relation to stroke damage and Alzheimer's disease. Estrogens actions are now recognized to occur via two different intracellular estrogens receptors, ER- and ER- , that reside in the cell nuclei of some nerve cells, as well as by some less well-characterized mechanisms. In the hippocampus, such nerve cells are sparse in number and yet appear to exert a powerful influence on synapse formation by neurons that do not have high levels of nuclear estrogens receptors. Sex differences exist in many of the actions of estrogens in the brain, and the process of sexual differentiation appears to affect many brain regions outside of the traditional brain areas involved in reproductive functions. Furthemore, the aging brain is responsive to actions of estrogens, which have neuro-protective effects both in vivo and in vitro. (Appl Physiol 2001;91: 2785-2801)

It remains controversial whether men and women differ in the incidence of AD and whether there are clearly recognizable sex differences in cognition and behaviour among those afflicted. A thorough defining of these differences is important for the sake of understanding the behavioural problems of AD and for developing a more refined approach to their treatment. More research into the biological underpinnings as well as the social influences on these differences is needed. (Geriatric Times, letter to November/December 2001 Vol. II Issue 6)

Hormonal changes associated with the dysregulation of the hypothalamic-pituitary- gonadal (HPG) axis following menopause/andropause have been implicated in the pathogenesis of Alzheimer's disease (AD). The marked increases in serum LH following menopause/andropause as a physiologically relevant signal could promote A secretion and deposition in the aging brain(J. Biol. Chem., 2004;279: 20539-20545). Epidemiological and experimental data also support a role for the gonadotropin luteinizing hormone in AD. Paralleling the female predominance for developing AD, luteinizing hormone levels are significantly higher in females as compared to males, and furthermore, luteinizing hormone levels are higher still in individuals who succumb to AD. Luteinizing hormone, which is capable of modulating cognitive behaviour, is not only present in the brain, but also has the highest receptor levels in the hippocampus, a key processor of cognition that is severely deteriorated in AD. Furthermore, examined cognitive performance in a well- characterized transgenic mouse that over-expresses luteinizing hormone show that these animals show decreased cognitive performance when compared to controls (Clin. Med. Res 2007;5: 177 – 183).

It is generally recognized that the prevalence of AD is higher in women, but whether incidence is increased remains a controversial issue. In a review of gender differences in the incidence of neurologic disease, ( Gender differences in diseases of the nervous system. In: Neurologic Disease in Women, Kaplan PW, ed. New York: Demos Medical Publishing Inc., pp433-442, 1998.) it has been reported that age-adjusted incidence was higher in women, particularly with advancing age. In a meta-analysis of AD incidence studies (Neurology 1008;51:728-733) it has been found no significant sex difference overall; however, there was a trend toward higher incidence among women in the oldest age groups. It remains controversial whether men and women differ in the incidence of AD and whether there are clearly recognizable sex differences in cognition and behaviour among those afflicted. The correlation of the Structural Brain Differences with the Differences in Behavioural Disturbances is not clearly defined. It has been evaluated the Gender difference in apolipoprotein E-associated risk for familial Alzheimer disease: a possible clue to the higher incidence of Alzheimer disease in women. In women, ε4 heterozygotes had higher risk than those without ε4; there was no significant difference between ε4 heterozygotes and ε4 homozygotes. In men, ε4 heterozygotes had lower risk than ε4 homozygotes; there was not significant difference between ε4 heterozygotes and those without ε4 (Am J Hum Genet. 1996; 58: 803–811).

Myeloperoxidase is an enzyme associated with the plaques that appear in the brains of people affected by AD. Some versions of the gene that encode the enzyme increase the incidence of AD in women, while other versions increase the incidence in men ( Neurology. 2000;55(9):1284-1290 and Exp Neurol. 1999;155:31-41).Gender differences in the neurodegenerative process of AD may add to gender differences in domain specific cognitive impairment ( Archives of Women's Mental Health 2002;4, 129-137).

Recognition memory for olfactory stimuli may be particularly impaired in healthy older men with the 4 allele. In patients with AD, odor memory impairments may be less severe in women who are negative for the 4 allele. The results offer new insight into how recognition memory is affected by gender, the 4 allele, and the modality of the stimulus to be remembered in healthy older adults and patients with AD (Am J Geriatr Psychiatry 15:869-878, October 2007)

There is a growing body of literature on the importance of cardiovascular risk factors in the development of Alzheimer's disease (AD), vascular dementia, and mixed dementia (AD with cerebrovascular disease). Scouting the MEDLINE, PubMed, and HealthSTAR databases between 1966 and January 2007 for English-language articles on the risk factors for dementia have been searched. The distribution and prevalence of major risk factors between the sexes and age groups are varied. Female sex has been associated with increased risk of the development of AD. In women aged >75 years, rates of hypertension, hyperlipidemia, and diabetes are higher than in similarly aged men. Midlife hypertension and hypercholesterolemia in both sexes predict a higher risk of developing AD in later life. Diabetes is increasing in frequency to a greater extent in women than in men, and is associated with a substantial risk for cognitive impairment. Dementia in women (probably) and in men (possibly) is influenced by obesity in the middle of life. It remains critical that large prospective clinical trials be designed to assess the effect of optimum management of vascular risk factors on cognitive functioning and dementia as the primary outcome, and include women and men in numbers adequate for assessment of gender effects (Gend Med. 2007;4:120-9).

The message

The amount of data showing differences between genders in the commun (to men and women) pathology is increasing. Some data are still controversy, and many need further research and understanding. The scenario is clearly supporting the necessity to increase the attention of basic scientists, clinicians, physicians, into gender differences affecting Health and Medical approach to humans. The gender health protection is demanding commitment and efforts of all stakeholders in this field of medicine, which must be seen as a transversal disciplines through the well established medical speailities.

Gender Societies

Gender Medicine focuses on the impact of the gender on human physiology, pathophysiology, and clinical features of diseases. The concept of Gender refers to a complex interrelation and integration of sex - as a biological and functional marker of the human body - and psychological and cultural behaviour (due to ethnical, social, and religious background). Human health is strictly correlated to the two fundamental constituents of the Gender: Therefore, it is necessary to increase the focus, the scientific approach, and the studies on the differences of the two genders. One of the most difficult tasks in Gender Medicine is to determine which phenomena are the results of biology and which are consequences of the environment.

Precise explanations of the Gender difference in life expectancy still elude scientists because of the apparent complex interplay of biological, social, and behavioural conditions. In order to win this exciting new battle for better health, the scientific community needs to foster a multidisciplinary approach integrating different competences and actors such physicians, researchers and experts in economics, clinical governance, communication, regulatory, health organization, education and training, and many sectors of industry.

These are some of the reasons why the Giovanni Lorenzini Medical Foundation* is helping the European Society of Gender and Health Medicine (and its Italian Branch ??) and the Italian Society of Gender and Health Medicine . Aims of the Societies is to link all the scientists and physicians who operate in the field of prevention, primary and secondary care, and rehabilitation by taking into particular consideration the biological, physiological and pathological differences between the two genders; to support researchers, medical doctors, institutions, and individuals to identify and protect the health in both genders, and to improve the cultural background, professional updating, and the training of the experts in Gender Medicine. Attention will also be devoted to the education and information of the public on the differences of the two genders in health needs.

One of the aims of the European and Italian Societies of Gender Health and Medicine is to avoid to cover areas that have already an established attention by the many Institutions and Societies active in the hormone and sexual linked diseases. On the other hand there is the necessity to avoid the bias the attention uniquely on the needs of women’s health but to cover also the needs of men’s health. While gender and age affect the health of both men and women (e.g.: the mirrored but not identical complexity of menopause and andropause) the Society places emphasis on the health consequences of not differentiated approach to women and men that exist in many medical cultures. An other aim is to avoid to overlap the activities of the Gender Societies over the areas already managed by the relevant Speciality Societies, with which there is, on the contrary, the intention to open a large and profitable collaboration. The increase knowledge and evidence on how gender differences and gender inequalities impact upon specific health problems and medical approach to women and men, can help in the optimization of effectiveness of the clinical intervention and of the health services and organisation. An other aim of the Society is to promote the inclusion of gender perspectives in the work of the public or governative Institutions, and to develop collaboration and alliances with Scientific Societies Hospitals, and Academia. The related goal is to conduct research, training and advocacy on how biological and pathophysiological gender differences and some socio-cultural factors and discrimination affect health. The Societies will develop tools to promote and expand health sector policies, interventions and programmes at the regional and country level that systematically address gender concerns. Improve public understanding of gender issues by developing advocacy increase awareness and provide support to European Member States to design and promote gender-sensitive health policies and strategies, could be one of the outcomes of the activities of the Society of the mission

These goals can only be reached through the collaboration and the active participation of all the experts, working in the field of health prevention and care, and interested in the development of this new biomedical research area, to reach a more and more personalized medicine.

*The Giovanni Lorenzini Medical Foundation, a not for profit organization based in Milan, Italy and Houston, TX, USA, active in the field of women’s health and menopause since more than 30 years. Mission of the Lorenzini Foundation is to transfer the most recent developments and results in the experimental sciences to the clinical and applied research, to inform and train the physicians on the most recent and innovative acquisitions, and to inform and educate the public on the correct life styles.

Mission

Strategic Directions Art 3

Activities Working Groups