In 2002 the World Health Organization (WHO) released the Madrid Statement, stating: 55
- To achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities.
The word `gender' is used to define those characteristics of women and men that are socially constructed, while `sex' refers to those that are biologically determined. People are born female or male but learn to be girls and boys who grow into women and men. This learned behaviour makes up gender identity and determines gender roles.
Women and men have different life and health experiences due to biological, psychological, `economic, social, political and cultural attributes and opportunities associated with being male and female'.56 These differences can impact on health status: some conditions, such as endometriosis, affect only women; others, such as depression, are more prevalent in women; and some conditions, such as heart disease, may be managed and experienced differently by women.
The Madrid Statement recognised that the factors that determine health and ill health are different for men and women. It argued that mainstreaming gender in health is the most effective strategy for achieving gender equity. Such a strategy, if comprehensively implemented, would promote the integration of gender concerns into the development and monitoring of policies and services with the aim of ensuring that women and men achieve optimal health outcomes.
Initiatives specifically targeting either women or men or equality between them are considered to be necessary and complementary to a mainstreaming strategy. The objective of such gender specific initiatives is to create optimal outcomes for women and men by compensating for historical and social disadvantage that prevent men and women from operating on a level playing field.57
The principle of gendered analysis is integral to a population health approach, which focuses on improving the health of sub-groups of the population, rather than individuals.58 Both men and women need health policies that target specific and unique needs. Gender based analysis is used to identify health issues and health behaviours that are of particular concern for men and women. Such analyses have been carried out in countries such as Canada and the United Kingdom and in Australia, for example, by Victoria and New South Wales.