Health and wellbeing – How do we get it right? by Catherine Mackereth and Michelle McCoy

Not one of us has had a choice in the life circumstances into which we were born. We are born in a country, with particular parents and with certain advantages and possible disadvantages – and this can have a lifelong impact on our health and wellbeing. We know that some are born with genetic conditions that have a huge effect on their lives; those brought up in poor housing conditions are more likely to suffer from respiratory diseases; children brought up in care may have less resilience to overcome difficulties (which is not to say that many don’t overcome them); and many are not able to make the most of opportunities because of the difficult and challenging circumstances they find themselves in.

Within Public Health, a discipline that has a major focus on seeking to improve health and wellbeing at a population level and reducing inequalities, a model that we often use to describe these situations is the Dahlgren and Whitehead rainbow (below). This, since its publication, has become a frequently used model for describing the underlying causes of ill health in the population and provides a helpful framework on which much of the health improvement work we are involved in is based. It offers a social model, which focuses not just on the individual lifestyle factors that impact on health, but on the wider socio-economic, cultural and environmental conditions, which make a huge difference to our health and wellbeing.

Underlying these differing life circumstances are inequalities which may be income, education, housing, environment or social conditions. The graph below shows how health and social problems are worse in more unequal countries. These inequalities can be found with regards to child wellbeing, levels of mental illness, drug use, life expectancy, infant mortality, obesity, teenage pregnancy, education, to name just a few.

These inequalities are not inevitable, and therefore should be tackled in order to ensure people have opportunities to improve their health and wellbeing. It is the role of Public Health and all our other partners to address these issues. It is not an easy task nor can it be undertaken by one agency alone.

Improving health and wellbeing must be supported at all the different levels identified in the rainbow model above. At an individual level, we need to understand why people behave in the way they do. Much of our work in improving the populations’ health and in providing preventive services is about supporting people to make their own positive life choices. However, having the ability to make choices is something not everyone has to the same extent: the very reason why we need to support people. For example, at one level, people have the choice as to whether to smoke or not. But if you are under stress, giving up smoking might be one thing that is too difficult to contemplate: we know that will power is a finite resource, and if you are juggling with a crisis, then all your efforts need to go into solving that crisis. And that is not even considering the physical addiction and the impact of tobacco withdrawal. Remember, very few people actually want to be addicted to cigarettes.

Health and wellbeing also needs to be addressed at a family level. For example, we know that some children are disadvantaged at school entry because they do not have the necessary emotional, social and cognitive skills which enable them to take advantage of the opportunities available from education. Support for parents can provide the self-confidence and self-efficacy to help counteract these difficulties, so that children can have the best start in life. This is extremely important for future life when these children become adults, and affects further wellbeing and subsequent use of health and social care services.

There are many approaches to supporting improved outcomes for population health. For example, at a wider level it is important that environmental issues are addressed. Creating enough green space for children to play or adults to walk and be physically activity can have a major impact on health and wellbeing – as can having nutritious food available locally, or accessible social activities. Having enough money is also a key element of trying to live healthily. In times of job insecurity and rising costs, this can be challenging, so ensuring access to the right kind of advice for claiming benefit, offering support to complete job applications, provide welfare rights information to support people to claim what they are entitled to, providing accessible health services and health information which is easily understood, is vital.

If, as a society, we are to reduce the burden on health and social services, we must work together to prevent and mitigate against the circumstances which act together to limit the ability for communities and individuals to achieve optimum health and wellbeing. There is a lot that can be done to support people’s health and wellbeing, and this must be underpinned by looking at what people themselves really want, not just assuming that we, as health professionals, know what is best for them. We need to listen and understand where people are coming from, and do that with compassion. We all want the freedom and autonomy to do what is best for ourselves, and we need to make sure we support people in achieving that for themselves.

Catherine Mackereth is a Consultant in Public Health and Michele McCoy is a Consultant in Public Health and Interim Director of Public Health at NHS D&G

 

Fork Handles!!! by Helen Moores

“The single biggest problem with communication is the illusion that it has taken place” George Bernard Shaw

What is the reading age of the most popular newspaper in Scotland, The Sun?

If you were to categorise it and place it on a shelf where would you put it? 8-10 yrs? 12-14? 14-16 yrs? The answer is 8 years old.

In terms of language level, vocabulary, grammar etc. The Sun is written at the same level as a school reading book for an eight year old child. According to The Literacy Trust the average reading age in Scotland is only 9 years old. This sort of information has massive implications for the way we communicate with our patients, carers, their friends and family.  If we are producing written material or talking in a way that is too technical, medical or wordy we lose, bewilder and alienate our audience whilst thinking we have been clear. It is referred to as health literacy –  the gap between what we as professionals think we have said and what our patients have actually heard or understood or are able to access. It brings to mind the confusion in the classic Two Ronnie’s sketch where a man walks into a hardware shop and asks for Fork Handles and receives 4 candles!

October is World Health Literacy Month and the aim is to raise awareness of this gap in communication. The Health Literacy Place is a website attached to The Knowledge Network and details the Making It Easy action plan to improve Health Literacy here in Scotland. It contains some frightening statistics:

• 43% of English working age adults will struggle to understand the instructions to calculate a childhood paracetamol dose
• 26% of people in Scotland have occasional difficulties with day to day reading and numeracy
• People with lower health literacy have increased rates of emergency admissions, wait until they are sicker before visiting their GP and are less likely to engage with public health programmes eg breast screening and vaccination
• In general people remember and understand less than half of what we discuss with them

The implications for patient experience, safety and access to services are clear. This is not just a welfare or financial obligation, but a legal one. The Patient Rights (Scotland) Act 2011 states that “people should be communicated with in a way that they can understand and that healthcare staff should make sure that the patient has understood the information given.” Our skill as healthcare professionals is not only to diagnose and treat but to communicate those findings in a culturally appropriate, meaningful and memorable way.

Here in D&G it has never been more timely for us to think about these issues as we plan our own Big Move, thinking about clear signage, systems for patient appointments, e-records etc in our new home. In addition our English neighbours in Cumbria are getting to grips with the Accessible Information Standards. These legal standards were introduced into NHS England on 31^st July this year and go one step further in addressing communication needs. They stipulate that a person with a disability, impairment or sensory loss should be provided with information that they can easily read or understand with support. The Standards also state that these needs should be identified and recorded prior to a patient accessing a service.

The good news is that because of the introduction of these standards in England there are lots of resources to help us look at our practice here in Scotland. So where do we start? As a communication specialist, it’s a subject close to my heart.

If you are looking at a service audit or improvements, some handy hints include:

• to never be without a pen and paper
• to download a profession specific app or animated sequence for your phone or tablet
• sit down or be at eye level for all conversations, where possible
• order a name tag and say..”Hellomynameis…”
• attend one of the specialist workshops in the Education Centre

but also…….

“Tell me your story…”

Asking this initial interview question allows you time to tune in like a radio to the person’s wavelength. By asking this I can assess fluency, coherence, intelligibility, cognitive ability, word finding skills, language level and most importantly adjust mine accordingly .. but also assess the patient’s accuracy as a historian, their interpretation of events, what they believe the doctor said, if there’s an outstanding or unresolved issue or complaint, their mood and motivation for engaging with therapy, what is important to them, their family, goals, hobbies and start to identify any hooks that I can hang my therapy on to make it personal and meaningful and therefore increase its success. Not bad for one simple question!

 

Perform the SMOG!

The simplified measure of gobbledygook – yes it’s a real thing. Created in 1969, take any piece of written material your service routinely supplies and apply the formula to calculate a reading age. If it’s higher than 9, think again. http://prevention.sph.sc.edu/tools/SMOG.pdf

 

Access The Health Literacy Place

This NES website gives some really great tailored resources for GPs and medics, AHPs and nurses including simple techniques like Teachback, but also online courses, training and templates to re-evaluate and improve your communication personally and within your service. http://www.healthliteracyplace.org.uk/media/1360/health-literacy-month-eflyer-2.pdf

Chat to a friendly Speech & Language Therapist

But then I would say that! The Royal College has a new position paper and website to support Health Literacy or Inclusive Communication as it’s sometimes known.

And Finally……

…for a chortle and a lighter look at Health Literacy as seen from the perspective of the doctor we all love to hate, click or paste the link below…. If you can’t see it you may need to upgrade your version of Internet Explorer to 11. http://www.youtube.com/watch?v=zG2DVoRP86g

Happy Friday and happy Health Literacy Month!

#healthlitmonth

Helen Moores is a Specialist Speech and Language Therapist for Adult Service & The IDEAS Team (Interventions for Dementia, Education, Assessment & Support) at NHS D&G

Follow us @SLT_DG

Find us at NHS D&G SLT Adult

 

Health Literacy Month logo and Health Literacy Heroes illustration are reprinted with permission of Helen Osborne, founder of Health Literacy Month

Gender Matters by Lynsey Fitzpatrick

 

 

 

 

 

 

On 6th September 2016 in Lockerbie Town Hall, NHS Dumfries and Galloway and Dumfries and Galloway Council, supported by the national feminist organisation ‘Engender’, jointly hosted ‘Gender Matters’ – an opportunity, in the form of a workshop, to explore the issues surrounding gender equality.

There were over 40 people from a range of organisations including NHS, Council, South West Rape Crisis and Sexual Abuse Centre, LGBT Plus, LGBT Youth Scotland, DG Mental Health Association, Support in Mind and Glasgow University, and also members of the public along with staff from other Health Board areas.
When I started to write this blog post, I was thinking back as to why the steering group behind the event decided to host this event in the first place. There is a plethora of evidence to back up why we need to support events of this nature, for example:

• Women are twice as dependant on social security than men
• In 2015 the gender pay gap in Scotland was 14.8% (comparing men’s full time average hourly earnings with women’s full time average hourly earnings)
• Also gender pay gap in Scotland when comparing men’s full time average hourly earnings with women’s part time hourly earnings was 33.5%
• This means, on average, women in Scotland earn £175.30 per week less than men.
• The objectification and sexualisation of women’s bodies across media platforms is so commonplace and widely accepted that it generally fails to resonate as an equality issue and contributes to the perception that women are somehow inferior to men.
• Femininity is often sexualised and passive whereas masculinity is defined by dominance and sometimes aggression and violence.
• At least 85,000 women are raped each year in the UK.
• 1 billion women in the world will experience physical or sexual violence in their lifetime.
• In 2014/15, there were 59,882 incidents of domestic abuse recorded by the Police in Scotland. 79% of these incidents involved a female ‘victim’ and male perpetrator.

 

So there are plenty of reasons as to why we held this event; to challenge social gender norms, to progress thinking around changing perceptions in our homes, at work and how we confront the media (not least our legal duty under the Equality Act 2010).

But what is it that made us so passionate about being part of this work?
A huge reason for me personally is that I have an (almost) 5 year old daughter. In my current post as Equality Lead for NHS D&G I have become much more aware of some of the research and facts around gender equality and often reflect on how her future is being shaped as we speak; because of the gender norms all around her, expectations from her family, her peers and her school.
I’m horrified to think that she is more likely in later life to be paid less than a male counterpart for doing the same level of work, or that her relationships and self esteem will be impacted by the stereotyping of her gender in the media.

A friend and I had a discussion at one of the film screenings for “16 days of action against Gender Based Violence” which focused on the sexualisation of children from an early age. We talked in particular detail following the film about the impact the internet might have on our daughters as they grow up – the availability of porn, more opportunity to be groomed, shifting expectations of how our bodies should look and what we should be doing with them – and decided that we really wanted to do something about this, to make a difference to our daughter’s lives, and hopefully many more at the same time.
As NHS employee’s we are legally obliged to consider gender issues in everything we do. The often dreaded impact assessment process is designed to help with this. Yet at times it is seems more of a burden than a way of informing services how best to prevent discrimination and advance equality for all.

I came across the following clip at a Close the Gap event which shows how gender mainstreaming is applicable in situations that many of us deal with on a daily basis and how this can impact on efficiency and quality of public services, benefitting not only the people who use our services, but also our key partners:

(Watch from the beginning to 3:18minutes in for a quick demonstration on how indirect gender approaches can change the way people live).
Back to the event in September: the day was split into two halves – the morning session focused on Culture and the afternoon session on Economy. The format for the day was Open Space Workshops, starting with a short presentation on each of the topics. Participants then identified topics that their group wanted to focus their discussions around. Participants were free to move around the room and join in or leave discussions as desired.
Some of the topics covered during the course of the day included:

• Gender in the Media
  Equal pay for equal work
  Rape Culture
  Part time Work
  ‘Hidden Care’ and the economic ‘value’ of care
  Societal Norms
  Women and Sport
  Success
  Cultural Expectations
  Being non-gender specific (e.g. clothes, toys, activities)
  Women’s Only Groups
  Gender Education
  Welfare Reform

Understanding ‘double standards’
There was a real buzz in the room as each of the groups discussed their topics of interest and it was clear that participants appreciated the opportunity to discuss the issues openly, an opportunity we don’t often get.
All of the event feedback was extremely positive, and there was a real interest from participants in taking this work forward, both in the workplace setting, and in their personal lives. Some of the suggestions included the creation of a Gender Equality Network for D&G, avoiding stereotyping, creating safe spaces for women to talk openly, promoting the White Ribbon Campaign, encouraging managers to see the benefits of a work/life balance, challenging the way gender is represented and considered across society, e.g. across social media, within policies and structures. This list is by no means exhaustive of everything that was covered on the day!
I hope that having a quick read of this sh

ort blog (and hopefully a watch of the gender mainstreaming clip) will be enough to convince a few more people that gender equality really does matter.
If you are interested in being part of future discussions on gender inequality and involved in a Women’s Network then please get in touch.

Lynsey Fitzpatrick is Equality and Diversity Lead at NHS Dumfries and Galloway

Towards a world free of kidney disease….. by Nadeeka Rathnamalala

10^th of March 2016 is World Kidney Day. Many activities take place around the world to raise awareness of risk factors for kidney disease, encourage systematic screening for high risk groups, encourage transplantation and advocacy of governments to take action and invest further in screening and treatment. Despite these efforts especially by organisations like World Health Organization (WHO) and International Society of Nephrology (ISN) we are still not equal in terms of access to treatment.

Sharing my own experience would perhaps shed more light on this. Having done my initial training in general medicine in Sri Lanka I came to the point where I had to undertake further post graduate studies in a subspecialty in Medicine. When I picked renal medicine, the common response from members of my family was “Are you sure?” Kidney disease outcomes were perceived as being worse than cancer due to limited access to dialysis. When I started my training in 2010 there were only 90 functioning haemodialysis machines in government hospitals in Sri Lanka for a population of 20 million (estimated prevalence of Chronic Kidney Disease (CKD) between 4-8%). Haemodialysis had been first introduced to the country in 1983 and attempts to introduce Chronic Ambulatory Peritoneal Dialysis (CAPD) had not been successful as the cost was much greater than the cost of in centre haemodialysis given that no plants for PD fluid production were in the region. Live donor transplantation was an available option but limited by long waiting lists in the government sector and availability of donors. I went through my training attending on patients who would present breathless with fluid overload due to ad hoc haemodialysis. The limited dialysis slots had to be prioritised according to the severity of symptoms. When I came over to the UK to complete my training in nephrology I was amazed by the free and unlimited access to renal replacement therapy. What was more they were transported back and forth from the dialysis centre at no personal cost!

On my return to Sri Lanka in 2013, to take up my first job as a consultant I was hit hard by the reality. I was appointed to be the only nephrologist in the southern province of the country to provide care for a 2 million population. I was to be based in the tertiary care centre in the region with 7 haemodialysis machines and facilities to perform a live donor transplant every fortnight. I also had funds to have a further 10 patients on CAPD. The hemodialysis machines were working around the clock and at any given time a couple of machines would be having technical faults leaving me with five functional machines at a given time. The total number of patients registered in the clinic was just above 1000 (at least 150 end stage renal disease requiring dialysis) and there would at least be another 5 to 8 in patients requiring dialysis in the hospital. The way I could prioritise was to give preference to the patients with acute kidney injury (with the hope they would recover) and those awaiting live donor transplantation. Everyone else who did not have a plan but were in end stage renal failure had to be fitted in to the left over slots. Despite our best efforts many patients lost their lives due to inadequate dialysis.

That is the heart sinking story of kidney disease in the developing world. 80 % of the dialysis population is in Europe, North America and Japan while the rest of the 20 % is distributed in the vast regions of South America and Asia. These figures are a reflection that dialysis is a luxury mostly the rich can afford. Though disparities in renal care are greater in the developing world, there is data to support inequalities in provision of care to the more disadvantaged populations in developed countries. For example, in the United States ethnic minorities have a higher incidence of end stage renal failure while in Australia figures show that aboriginal Australians are 4 times more likely to die of CKD than the non indigenous Australians.  

Concerted effort on prevention and early detection would be the way forward to minimise these disparities in the future. World kidney day is a global awareness campaign that aims to do just that. This year the theme is “kidney disease and children – act early to prevent it” and aims to highlight the importance of protecting kidneys from an early age. We hope to have a booth in DGRI on 10^th March to hand out leaflets and badges to join in this world wide effort of raising awareness of kidney disease. We hope that staff as well as visitors will take the time to come visit us and support the world kidney day initiative.

Dr Nadeeka Rathnamalala is a Locum Consultant Nephrologist at NHS Dumfries and Galloway

LGBT History Month by Laura Lennox

Good things to have come out of Dumfries, Scotland:

• Calvin Harris, superstar DJ
• LGBT Charter of Rights    
• Big Burns Supper                                  
• Please feel free to add more in the comments section at the end…..                      

February is LGBT History Month. LGBT stands for Lesbian, Gay, Bisexual and Transgender. LGBT History Month takes place in Scotland every February. It’s an opportunity to celebrate the lives and culture of LGBT people as well as the chance to raise awareness of the continual need to ensure all LGBT people feel valued, supported and included.

Our Speech and Language Therapy Adult Service in NHS Dumfries & Galloway are currently undertaking the LGBT Charter of Rights. The LGBT Charter of Rights is a programme created by LGBT Youth Scotland. It developed from the findings of a group of young people in Dumfries (Phoenix LGBT Youth) who began exploring relevant topics to LGBT people and included education, social and health issues. It emerged that people who are LGBT still face discrimination and prejudice due to barriers in these areas. The LGBT Charter of Rights is a way to target these inequalities by providing a means for groups and organisations to change their policies and practice to work towards a fairer and inclusive society for people who are LGBT.

The training we received from LGBT Youth Scotland focused on health & wellbeing issues in particular, based on the Life in Scotland for LGBT Young People: Health Report (2012). Just over half (56.5%) of LGBT young people (13-25yrs) feel safe and supported by the NHS in terms of their sexual orientation or gender identity. Women within the LGBT population (43.1%) and transgender young people (48.1%) are even less likely to feel supported by the NHS. What really stands out is the fact that 40.1% of LGBT young people consider themselves to have mental ill health. These facts and figures are unfortunately understandable when you consider any person who faces continual discrimination and prejudice for just being who they are.

Our Call to Action: As a National Health Service, we are required to demonstrate our commitment to equality and diversity in accordance with the Equality Act, 2010. Ensuring our legislation and policies meet the needs of the LGBT population is a part of this ongoing process. But it is much more than this. We, as individual staff members within the organisation, have a responsibility to actively take steps to identify and break down these barriers within our own practice and our own services to ensure that people who are LGBT are treated equally and fairly. For more information on how you can begin then please follow this link: https://www.lgbtyouth.org.uk/charter-general    

Thank you.

Laura Lennox is a Speech and Language Therapist at NHS Dumfries and Galloway

 

Prioritisation in NHS Scotland by Ewan Bell

I have to make it clear from the outset that the views expressed here are my own – these are my personal views.  They are nothing to do with being Associate Medical Director in NHS Dumfries and Galloway and do not reflect any local management or Board view! I’m writing this as an avid armchair follower of politics, current affairs and economics! I should also stress that I am a member of no political party.

To put my views in context, I should state that I believe that there are 2 fundamental and essential pillars of a fair society;

• Equality of opportunity; in real terms this means free access to education and zero tolerance of discrimination
• Free healthcare; people should not suffer or die because they can’t afford to pay for health-care

I am a passionate believer in the concept of the NHS and free health-care for all. My mum and dad tell me stories about how their grand-parents couldn’t afford to go to see the Doctor. In my view this is unacceptable, incompatible with a fair society and must remain in the past. 

On one hand we have increasing costs due to advances in health-care technology, changing demographics, increased expectation and the costs of prescribing. And on the other hand we have limited resources. Demand will always outstrip capacity. Just about every health-care system in the world is wrestling with this challenge, no matter whether they are publicly or privately funded. There will never be unlimited resources, or indeed adequate resources, to provide all health-care, free of charge, for all people. So how should we, as a society, respond to this challenge?

Let’s consider an analogy.  All households have a defined income. We might moan about it and complain, but there’s not much we can do about it. So how do we respond to this? Most organised households will budget and align expenditure with income. There are fixed essentials, such as tax, national insurance, council tax and rental (or mortgage) payments, over which we have little control. But there are other outgoing costs which can be varied and influenced by the household (maybe not enthusiastically), such as, for example, food, clothes, heating, alcohol, etc. If times are hard, then a household will pull back to the fixed essentials and moderate spending in other areas, or to put it another way, the household will prioritise its spending.

If we apply this approach to health-care, then we need to start debating and defining the essentials of health-care and what can we pull back from. In other words, we really are going to have to start discussing what we should be focusing our limited resources on and what we should stop doing, as not all interventions are equal.

I suppose this goes back to my initial views on the pillars of a fair society. To maintain free health-care for critical, core services in the NHS, we are going to have to start redefining what health-care means and acknowledge that we can’t continue to provide the current range of interventions and services, if we want a sustainable NHS for the future.

So, what are the essentials and what should we stop doing?

Dr Ewan Bell is a Consultant Biochemist and Associate Medical Director for NHS Dumfries and Galloway

 

 

 

 

 

 

Gender Equality is Everyones Business by Luis Pombo

What’s the issue with gender?

Gender can be an elusive concept but since it is so embedded in the fabric of our identities, and day to day life and culture, we perceive its nature to be as natural as the air we breathe. In other words the very nature of gender makes it almost impossible for us to think about it as what it really is; a code.

When we wake up in the morning, we do not usually think about gender, or how we are going to make our behaviour fit within the limits of the gender identities we have grown into, or how others expect this to be the case. Any alteration to the rules, any breaking of the code, will attract other people’s attention and sometimes their censure.

But what is gender?

Is it about what sex we are?…Identifying as a woman or a man? Being male or female? Being masculine or feminine? Behaving masculinely or femininely?…

Sex and gender are sometimes used interchangeably despite having different meanings; sex is about biology and gender is cultural.

A very useful gender definition is the one adopted by the World Health Organisation:

Gender refers to the array of socially constructed roles and relationships, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis. […] Gender is an acquired identity that is learned, changes over time, and varies widely within and across cultures. Gender is relational and refers not simply to women or men but to the relationship between them.

 

Gender goes beyond identifying ourselves as men or women or being masculine or feminine; gender is a whole acquired identity and in the process of acquiring that identity we also acquire notions of power, influence, privilege, expectations and restrictions of what we can expect in life. We learn what is acceptable and unacceptable according to our acquired gender role and we also learn to accept these standards and not to challenge them due to their perceived naturalness.  In a way, it is a kind of code that we all generally share and agree to abide by; a code that cannot be challenged or changed straightforwardly and without consequences for the challenger.

To understand this we need to have a look at how we, humans, ‘get’ our gender.

“It’s a girl!”

As soon as we are born, or now with the help of scans even before then, a name is assigned to us, “appropriate” clothes are bought for us and our bedrooms are decorated according to what gender we are expected to grow into; images of footballs, Spiderman or Disney Princesses will feature in our lampshades, duvet covers and curtains, and toys will follow. A trip to any shop selling baby equipment, clothes or toys shows how entrenched such views are and how much is marketed in terms of learned gender norms.

As we grow, we see our parents and other people around us performing gender and the understanding that we get from those performances is reinforced by other similar consistent messages coming from the behaviour of other people, and from popular culture – songs, music videos, games, books, celebrities, films, cartoons, etc. –

After two years of a constant exposure to fairly consistent gender messages, we start internalising them and by the age of 3 we already know whether we are a boy or a girl. Moreover, by the age of 5 our ideas of gender stereotypes are well developed and by the age of 7 they are fully fixed.

So what?!

There would not be anything wrong with all this except that when we internalise our gender identities we also internalise other notions which will expand or limit our opportunities and expectations according to notions of relative power which, by the way, historically have been imbalanced and which informed a way of thinking and acting that resulted in inequalities some of them still happening these days.

For example:

• 2300 years ago, Aristotle thought that: “The male is by nature superior, and the female inferior, and the one rules and the other is ruled; this principle, of necessity, extends to all mankind.”
• Women were first allowed to inherit property in the UK only 133 years ago.
• Women were allowed to vote in the UK only 87 years ago; 39 years ago in Portugal; maybe this year women will be allowed to vote for the first time in the history of Saudi Arabia and there are no prospects of women being allowed to vote in Vatican City in the foreseeable future.  
• Out of 196 countries in the world today, only 17 have a woman president or prime minister.
• Out of 650 seats in the House of Commons, 191 are occupied by women. That’s 29%; compared with Rwanda 63.8% and Bolivia 53.1%.
• Women are portrayed in media and advertising as sexual objects which fit the male gaze; women’s bodies are objectified in everyday life.

• Children’s toys ………Dolls like Monster High are highly sexualised.

• It becomes natural for Young men to see pornographic images of women and to objectify them.
• Men feel pressure to be macho and not be emotional
• Men learn to direct emotions towards anger / Use of violence and link to masculinity is internalised / Power is constructed as a capacity to dominate and control
• Many expectations of masculinity are impossible to attain, six-packs, rich, decided, etc. 
• Men are in general at greater risk of suicide
• Men are subject to violence from other men if they don’t conform to the stereotype
• Poweris constructed as a capacity to dominate and control others.

• At least 85,000 women are raped on average each year in the UK.

• 72 million children around the world are not in school; girls are the majority.
• 759 million adults around the world cannot read or write; the majority are women.
• 25% of girls in relationships in the UK reported physical violence.
• 60,080 domestic abuse incidents were reported to the Police in Scotland in 2012/13; 45,916 (76%) were women abused by a man.
• 45% of women in Europe have suffered from men’s violence.
• In 2013, the gender pay gap in Europe is 2%. Women would need to work an extra 59 days in a year to match the amount earned by men.

• In the UK, men earn 17.5 % more than women on average per hour.

• Globally, 603 million women live in countries where domestic abuse is not yet considered a crime.
• Over 60 million girls worldwide are child brides, married before the age of 18.
• FGM (Female Genital Mutilation) is most commonly carried out when a girl is 5-8 years old but it can happen from infancy to the age of 15. More than 125 million girls and women alive today have been cut and at least 23,000 girls under 15 could be at riskof FGM in England and Wales.
• 1 billion women in the world will experience physical or sexual violence in their lifetime.
• Prostitution is still seen by some as “work” or as a “career” and some men (we are talking about millions here) feel entitled to buy sex.
• And this list could continue…!

Rewriting the Code

There is hope! … And everyone can make a difference, however ‘small’

We have to bear in mind that gender norms and parameters are not fixed and can be changed.

If we start looking at the ‘taken-for-granted’ reality of our everyday life with more inquisitive eyes and start spotting the gender rules we all follow we will be better prepared to start challenging and rewriting them.

A practical way of challenging these norms is by example; for instance, at home men could take responsibility for or share traditional ‘female’ tasks like doing the laundry, ironing, or cooking. At the same time, traditional ‘masculine’ tasks like mowing the lawn or doing home repairs could also be shared. These behaviours will be seen and adopted by the couple’s children and part of the norms will start being rewritten. 

Parents could buy gender neutral clothes and toys for their children and encourage gender neutral play; parents could also avoid encouraging boys to be strong and girls to be gentle as the stereotypes dictate. Comments like “Don’t kick the ball like a girl”, “Stop being such a wee girl”, “Stop crying, be a man” should be avoided.

We could also choose deliberate challenging behaviours in our professional worlds; e.g. a male colleague may offer to be in charge of the teas and coffees prior to a meeting or tidying up afterwards. What is more, people could deliberately look at what kind of language they use and favour gender neutral language like: ‘chair’ instead of ‘chairman’, ‘humankind’ instead of ‘mankind’, etc.

Developing our understanding of the restrictions imposed by gender norms and challenging the expectations associated with them can be the start of a process to rebalance the position of women and men in society, to develop a more equal and fairer society that can be enjoyed and built by both women and men equally for the benefit of all. 

Authors

Luis Pombo – Research and Information Officer, Domestic Abuse and Violence Against Women Partnership

With

Kerry Herriot – Development Officer, Domestic Abuse and Violence Against Women Partnership

Jo Kopela – Health and Wellbeing Specialist, DG Health and Wellbeing Team

Lynsey Fitzpatrick – Equality and Diversity Lead, NHS Dumfries and Galloway @lynseyfitzy

We would like to take this opportunity to warmly invite any NHS or Dumfries and Galloway Council staff to the second of our joint NHS/Council interactive events exploring the issue of gender equality. Through film, discussion, evidence, the influence of the media and the impact of privilege in society, we will continue to raise awareness and develop a shared understanding of how everyone can contribute towards promoting gender equality. This event is taking place on Monday 9^th November 2015 at 2pm at Garroch Training Centre, Dumfries. If you would be interested in coming along, please contact Lynsey Fitzpatrick on 01387 244030 or at lynsey.fitzpatrick@nhs.net

 

 

 

All Men (& Women) are created equal? by @lynseyfitzy

Since taking up the post of Equality Lead at the end of October 2012, I’ve heard various comments such as “What does THAT involve?” and “Surely that’s a made up job?”.  If only.  If only it wasn’t the case in Scotland that only 0.3% of apprenticeships go to people with a disability or that women are paid 14% less than men in full time work.  But possibly the worst comment I have heard so far is “people need to have a sense of humour about some things”.  I’m sure those people that have suffered discrimination would be delighted to hear that all this could be resolved if they simply lightened up and learned to laugh about it….

With the ongoing work around person-centred care and  patient experience, equality and diversity couldn’t be more relevant, after all, each and every one of us has at least one ‘protected characteristic’ and we are all at risk of being discriminated against at one point in our lives.  Most of us will at some point have to engage with health services and I’m sure that none of us would like to be treated less favourably because of one of our protected characteristics.

After attending the Patient Experience event in September 2013, where I couldn’t help but think that equality and diversity is at the heart of so much of this work, I came across the following articles by columnist Ian Birrell who has a disabled daughter and writes passionately about discrimination. He cites an example of a patient with Downs Syndrome being made “not for resuscitation” without any discussion with loved ones as it was just assumed by medical staff that his life held no quality. He also quotes some frightening statistics about disabled patients being left to die as it was considered “the kind thing to do” by medical staff. Two of his articles can be read here and here.

It would be easy to think that we work in a place where discrimination like this doesn’t exist, and I often hear the words “I treat everyone the same” as if this excuses someone from needing any further training or development on equality issues.  One thing which is clear though is that treating everyone the same or basing decisions on our personal assumptions is not equality and, as these articles highlight, can be dangerous.  People (staff and services users) should be treated as individuals, with a range of different needs.  Some of the complaints which I have been involved in since October 2012 could easily have been avoided if those involved had taken the time to consider the needs of the individual rather than a ‘one size fits all’ response.

At the recent Big Burns Supper event held in Dumfries, I had the wonderful opportunity to see a one man show called “If These Spasms Could Speak” which was about the way in which disabled people experience the world and how they feel about their bodies.  The show is by Robert Gale, a disabled actor, and had rave reviews when it was shown at the Edinburgh festival (There are clips on You Tube for anyone that might be interested in finding out more, one of which can be viewed here).  Despite the spasms which are probably the first thing people notice, and are so very aware of, the first thing that Robert sees when he looks in the mirror is a “cute face” despite the attitudes of others to his own physicality.  However, one of the funniest, yet probably most worrying parts of the show is when he describes visiting his brother in hospital and a young doctor proceeds to ask him personal inappropriate questions, assuming that he “must be somebody’s patient”.  This highlighted the way in which non-disabled people often view those with disabilities, in this case Robert’s own cerebral palsy and speech impediment.

Not only is it good practice to consider equality from a moral viewpoint, but by law we have had to become more pro-active about eliminating discrimination, advancing equality of opportunity and fostering good relations.  One of the ways in which NHS Dumfries and Galloway have done this is to come up with a set of equality outcomes, which you can read more about here.  We are also in the process of reviewing our equality impact assessment policy and toolkit, again something which is required to be completed by law but something which is often seen as something which is a bit of a nuisance.   If the fear of being personally fined if there was ever a claim against us isn’t enough, then think of it this way.  You have gone to all the bother of writing a policy/coming up with a strategy/started the process of service change (delete as appropriate).  Surely it makes sense to ensure that you have considered and consulted as many different people and groups of people as possible.  This can only improve your service or your policy and make it better than it already is, and may save you having to go back and make changes at a later date.

This is not to say that there isn’t already lot of good work being done out there.  For example, we have several areas within our Board currently undertaking the LGBT Charter Mark.  As an employer we are signed up to the disability two ticks symbol and each of our directorates have developed their own action plans on how equality and diversity can be mainstreamed into day to day business.  There is a lot of good work being done out there and a lot of our staff willing to consider people as individuals with a range of needs and requirements which they are more than willing to try and accommodate.

But, for the time being anyway, it looks like I do have a ‘real’ job as equality and diversity is no laughing matter….

Lynsey Fitzpatrick is Equality and Diversity Lead for NHS Dumfries and Galloway