AdvanceGender

Joint project AdvanceGender

Logo AdvanceGender

Current public health programs focusing on health promotion, prevention and health service delivery are not always equally effective among different population groups characterized by sex/gender. Such differences are often explained by recurring to sex-related differences in terms of disease development, by individual health behaviour such as nutrition or physical activity, and by different needs for health services. This approach is problematic, however, as it follows a dichotomous understanding of sex/gender (“female” and “male”), which insufficiently depicts the complex interplay between health and the socio-structural dimension of sex/gender. To conceptualize the complexity of sex/gender beyond biological characteristics there is an increasing use of theoretical approaches regarding “ intersectionality”. These argue that social and health-related inequalities are formed by multiple interacting structural categories, which might overlap and mutually reinforce one another.
The joint project AdvanceGender uses intersectional approaches to identify, promote and enable sex/gender-sensitive population-based health research and health reporting.

Aim
The aim of AdvanceGender is the development of new methods for sex/gender-sensitive research processes in population-based studies through:

  1. Analysis and evaluation of sex/gender-sensitivity, focusing on specific aspects regarding the research process of population-based studies;

  2. Improvement of the interconnection between data analysis, health reporting and health promotion/prevention;

  3. Development of a sex/gender-sensitive toolkit.

The toolkit will be based on the results of the three research projects of AdvcanceGender and aims to support theory-based sex/gender-sensitive health research.

Theoretical and methodological starting point 
AdvanceGender uses qualitative and quantitative methods to investigate the sex/gender-sensitivity of aspects of the research process in population-based, quantitative studies. Aspects investigated include the recruitment of participants, data analysis, as well as communication of sex/gender in health reporting.

Research projects
AdcanceGender consists of three closely cooperating research projects: (1) The analysis of recruitment and study participation in population-based research (AdvanceRecruitment), (2) the identification and development of sex/gender-sensitive research strategies for intersectionality-based multivariate data analysis (AdvanceDataAnalysis), and (3) sex/gender-sensitive and intersectional health reporting (AdvanceHealthReport).

 

project structure

 

Contact

Spokesperson: Christine Holmberg (christine.holmberg@mhb-fontane.de)
Project coordinator: Philipp Jaehn (philipp.jaehn@mhb-fontane.de)

Funding
AdvanceGender is funded by the initiative “Health Across the Life Span” of the German Ministry of Education and Research (BMBF) (reference no. 01GL1710). The initiative promotes sex/gender-sensitive research projects that aim to maintain and improve health and health services of women and men.

AdvanceRecruitment

AdvanceRecruitment

AdvanceRecruitment (sub project 1) explores the multifaceted processes of recruitment and participation in population-based studies. It is located at the Brandenburg Medical School Theodor Fontane, Institute of Social Medicine and Epidemiology. AdvanceRecruitment aims to refine sex/gender-sensitive approaches for analysis of response in population-based studies. It addresses three research questions:

  1. Are there sex/gender-related differences in participating in population-based studies?
  2. How significant is sex/gender in the recruitment process for and narratives of study participants?
  3. How is sex/gender related to other categories like social class or ethnicity?

To answer these questions, AdvanceRecruitment uses qualitative and quantitative research methods, which are informed by approaches of sex/gender-sensitivity as well as intersectionality.
In a first step, the current practice in health research of reporting sex/gender-related study participation and non-participation in German and international cohort studies will be reviewed.
In the quantitative part, AdvanceRecruitment will use two approaches. A secondary data analysis will be conducted in order to investigate study participation by analysing data of the German National Cohort (GNC, NaKo-Gesundheitsstudie) and population wide surveys of the Robert Koch-Institute. The aim is to explain who participates in large epidemiological studies with a special focus on sex/gender and intersections with other socio-structural variables.
The qualitative part comprises individual interviews with participants and non-participants of the GNC, who will be interviewed for their motivation of non-/participation and their perspective on population-based studies. Document analyses of GNC information material as well as participatory observation in the GNC study sites will complement the sub project.

Research team: Prof. Dr. Christine Holmberg (project head, spokesperson), Dr. Philipp Jaehn (project coordination), Dr. Sibille Merz

AdvanceDataAnalysis

AdvanceDataAnalysis

Within the framework of AdvanceDataAnalysis (sub project 2), led by the Department of Social Epidemiology at the Institute of Public Health and Nursing Research (IPP), gender-sensitive data analysis strategies are developed and tested with special consideration of intersectionality approaches. The starting point is a systematic research on different theoretical concepts and their operationalization within the scope of data analyses in health sciences. The identified concepts and strategies for gender-sensitive multivariate data analyses are further refined and applied in the context of intersectionality-based multivariate data analyses within selected fields, relevant for health reporting. In cooperation with the project partners, the implications of the research results for the practice of intersectionality-informed gender-sensitive health reporting are presented and approaches for further research are elaborated.
More information.

Research team: Prof. Dr. Gabriele Bolte (sub project leadership), Emily Mena

AdvanceHealthReporting

AdvanceHealthReporting

AdvanceHealthReporting (sub project 3) aims to improve health reporting by reviewing international literature and conducting an online survey about current strategies of sex/gender-sensitive health reporting in the OECD- and EU-countries. To capture the diverse social reality in Germany and to consider needs and perspectives of different groups of society focus group discussions are conducted. In a Delphi study, a panel of scientists and experts in health reporting discuss sex/gender-sensitive, intersectional strategies of analysing and reporting health data. Results of the joint project will be compared and interpreted in close cooperation with the other sub projects for a sustainable improvement of health reporting.
More information (in German).

Research team: Alexander Rommel (sub project leadership), Dr. Kathleen Pöge, Sarah Strasser (all unit 24)

Participating institutions

Medical School Brandenburg Theodor Fontane
Institute of Social Medicine and Epidemiology
Hochstraße 15
14770 Brandenburg an der Havel
Germany

 


University of Bremen
Institute of Public Health and Nursing Research (IPP)
Departement of Social Epidemiology
Grazer Straße 4
28359 Bremen
Germany

 


Robert Koch-Institute
Department of Epidemiology and Health Monitoring
Unit 24 Health Reporting
Postfach 650261
13302 Berlin
Germany

Project members

Brandenburg Medical School Theodor Fontane

Prof. Dr. Christine Holmberg (Project Head and Spokesperson)
Tel: +49 (0)3381 41 1281
E-Mail: christine.holmberg@mhb-fontane.de
Prof. Dr. Christine Holmberg is the project head of AdvanceGender. She is professor of Social Medicine and Epidemiology at Brandenburg Medical School Theodor Fontane. Her research focuses are the consequences of medical and statistical technologies on medical practice and experiences of healthy and diseased people. She combines ethnographic methods on experiences of illness and production of knowledge with epidemiological approaches aiming at identifying risk factors and improving health care services. In her publications, she elaborates on how the production of epidemiological knowledge is deeply embedded within societal processes and how society itself as well as experiences of people are shaped by this knowledge. Prof. Holmberg holds a doctoral degree in European ethnology and a master’s degree in public health / epidemiology. She is a professor in epidemiology and public health. Her research profile is founded on her multidisciplinary background. The overarching aim of her work is the integration of social realities and experiences into medical and health research. She is dedicated to the development of novel methods to improve patient-oriented health care service planning.

Dr. Philipp Jaehn (Project coordinator)
Tel: +49 (0)3381 41 1283
E-Mail: philipp.jaehn@mhb-fontane.de
Dr. Philipp Jaehn is a research fellow at the Institute of Social Medicine and Epidemiology at the Brandenburg Medical School Theodor Fontane. He studied Medicine in Heidelberg, Germany and Istanbul, Turkey and holds a medical doctorate degree for his work on the epidemiology of gastrointestinal cancers among resettles from the former Soviet Union. Following this, Dr. Jaehn studied Epidemiology at the London School of Hygiene and Tropical Medicine. His research interests include quantitative research methods, social epidemiology and the epidemiology of non-communicable diseases.

Dr. Sibille Merz
Tel: +49 (0)3381 41 1284
E-Mail: sibille.merz@mhb-fontane.de
Sibille is a Postdoctoral Research Fellow in AdvanceGender at the Institute for Social Medicine and Epidemiology at the Medical University Brandenburg Theodor Fontane. She studied social sciences and cultural studies in Berlin and London and gained her PhD in sociology from Goldsmiths, University of London. In her thesis, she empirically examined the construction of ethnic and racial populations in global clinical trials. Her research interests include the social, ethical and economic dimensions of biomedical research; the construction of difference in biology and medicine, and qualitative methods.


University of Bremen

Prof. Dr. Gabriele Bolte
Tel: +49 421 218 68821
E-Mail: gabriele.bolte@uni-bremen.de
Gabriele Bolte is professor of Social Epidemiology at the University of Bremen and head of the Department of Social Epidemiology, Institute of Public Health and Nursing Research. Her main areas of research are methods of gender-sensitive health research, environmental health inequalities, environmental justice, and intervention-generated inequalities. She holds a Diploma and a PhD in Theoretical Medicine and a Master in Public Health with focus on Epidemiology.

Emily Mena
Tel: +49 421 218-68827
E-Mail: e.mena@uni-bremen.de
Emily Mena is research associate at the Department of Social Epidemiology at the Institute for Public Health and Nursing Research of the University of Bremen. She obtained a bachelors and master’s degree in Public Health. As a lecturer, she works in the fields of Scientific Working Methods and Epidemiology at the Faculty of Human and Health Sciences.


Robert Koch-Institute

Alexander Rommel
Tel: +49 (0)30 18754 3490
E-Mail: RommelA@rki.de
Alexander Rommel, M.A., studied sociology, political science and philosophy and is a senior researcher and project leader at the Robert Koch Institute in Unit 24 Health Reporting. His work focuses on the topics of health and sex/gender, the use of health services, migration and health, and burden of disease. He was one of the coordinators of the reports "Health of Men in Germany" (2014) and "Health in Germany" (2015) which are part of the federal government's health monitoring system.

Dr. Kathleen Pöge
Tel: +49 (0)30 18754 3254
E-Mail: PoegeK@rki.de
Kathleen Pöge is a researcher at the Department of Epidemiology and Health Reporting of the Robert Koch Institute. After her studies in sociology in Leipzig and Paris, she worked in the KarMed-Project and taught at the University of Kassel. For her PhD she conducted a qualitative longitudinal study on the division of work when dual career couples become parents. Her research focuses on sociological gender studies, right-wing extremism and qualitative methods of empirical social research.

Sarah Strasser
Tel: +49 (0)30 18754 3717
E-Mail: StrasserS@rki.de
Sarah Strasser is a scientific project assistant at the Health Reporting Unit of the Robert Koch Institute. She studied Health Sciences at the Charité in Berlin and in Maastricht and works as a midwife. Her research interest focuses on queer-feminist health sciences and health care.

Scientific Advisory Board

Thomas Altgeld - State Assembly of Health and Social Medicine in Lower Saxony, Germany
Ellen Annandale – University of York, United Kingdom
Anne Hammarström – Umeå University, Sweden
Olena Hankivsky – Simon Fraser University, Vancouver, Canada
Petra Kolip – Bielefeld University, Germany
Alan White – Leeds Beckett University, United Kingdom

Publications

Presentations and posters

  • Presentation by Christine Holmberg at the annual conference of the German Society of Epidemiology 2017 in Lübeck, Germany with the title Verbundsprojekt AdvanceGender – Geschlechtersensible Gesundheitsbericherstattung: Methoden für einen geschlechtersensiblen Forschungsprozess in populationsbasierten Studien
  • Presentation by Kathleen Pöge at the 17th biennial conference of the European Society for Health and Medical Sociology 2018 in Lisbon, Portugal with the title Towards gender-sensitive and intersectional Health Reporting in Germany
  • Presentation by Kathleen Pöge at the annual conference of the German Society of Epidemiology 2018 in Bremen, Germany with the title Repräsentation gesellschaftlicher Vielfalt in der Gesundheitsberichterstattung – Perspektiven einer geschlechtersensiblen und intersek-tionalen GBE
  • Poster presentation by Christine Holmberg at the 11th European Public Health Conference 2018 in Ljubljana, Slovenia with the title Developing research approaches to improve gender-sensitive health reporting: concept proposal
  • Presentation by Kathleen Pöge at the 11th European Public Health Conference 2018 in Ljubljana, Slovenia with the title Perspectives of LGBTIQ* migrants, refugees and ethnic minorities for the development of a gender-sensitive and intersectional health reporting in Germany
  • Forum by the study group AdvanceGender at the German Public Health Conference "Poverty and Health", with the title Gender equality: The joint project „AdvanceGender“ – contributions to gender-sensitive health reporting
  • Presentation by Philipp Jaehn at the annual Conference of the German Society for Epidemiology 2019 in Ulm, Germany with the title Practice of reporting study participation in selected German and international population-based studies – Implications for an intersectional perspective
  • Presentation by Kathleen Pöge at the annual Conference of the German Society of Social Medicine and Prevention 2019 in Düsseldorf, Germany with the title Towards sex/gender sensitive and intersectional health reporting. Results of focus groups on sex/gender and sexual diversity
  • Presentation by Alexander Rommel at the annual Conference of the German Society of Social Medicine and Prevention 2019 in Düsseldorf, Germany with the title Sex/gender and health in health reporting – Results of an international comparison
  • Presentation by Emily Mena at the annual Conference of the German Society of Social Medicine and Prevention 2019 in Düsseldorf, Germany with the title Conceptual framework for sex/gender sensitive multivariable data analyses using an intersectional perspective
  • Presentation by Philipp Jaehn, Sarah Cook and Christine Holmberg at the 12th European Public Health Conference 2019 in Marseille about A critical discussion of theoretical foundations and measurement methods of gender roles” as part of the workshop “How to do (and not to do) gender in health research: methods developments and lessons from the field”.
  • Presentation by Emily Mena and Gabriele Bolte at the 12th European Public Health Conference 2019 in Marseille about „Conceptual framework for intersectionality-based gender sensitivity in multivariable analysis” as part of the workshop “How to do (and not to do) gender in health research: methods developments and lessons from the field”.
  • Presentation by Philipp Jaehn, Emily Mena, Sibille Merz, Robert Hoffmann, Antje Gößwald, Alexander Rommel, Christine Holmberg at the 15th annual conference DGEpi 2020  with the title "The intersectionality of non-response in a national health survey in Germany: a multilevel analysis of individual heterogeneity and discriminatory accuracy."
  • Workshop by the Study Group AdvanceGender at the 16th World Congress on Public Health 2020 with the title "Gender-sensitive and intersectional health monitoring and reporting: putting theory into practice"
  • Presentation by Sibille Merz on behalf of the Study Group AdvanceGender at the 16th World Congress on Public Health 2020 with the title " Why should gender-sensitive health reports be intersectional?" as part of the workshop "Gender-sensitive and intersectional health monitoring and reporting: putting theory into practice"
  • Presentation by Emily Mena and Philipp Jaehn on behalf of the Study Group AdvanceGender at the 16th World Congress on Public Health 2020 with the title " Suggestions for a gender-sensitive and intersectional practice of health monitoring and reporting" as part of the workshop "Gender-sensitive and intersectional health monitoring and reporting: putting theory into practice"

Publications

  • Kathleen Pöge, Alexander Rommel, Emily Mena, Christine Holmberg, Anke-Christine Saß, Gabriele Bolte."AdvanceGender – Verbundprojekt für eine geschlechtersensible und intersektionale Forschung und Gesundheitsberichterstattung" in: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2019 Jan;62(1):102-107. (DOI: 10.1007/s00103-018-2855-3).
  • Alexander Rommel, Kathleen Pöge, Laura Krause, Sabine Ludwig, Franziska Prütz, Anke Christine Saß, Sarah Strasser und Thomas Ziese. "Gender and health in the Federal Health Reporting. Concepts and new challenges" in: Public Health Forum, 2019; 27(2): 98–102. (DOI: https://doi.org/10.1515/pubhef-2019-0021).
  • Emily Mena, Gabriele Bolte, ADVANCE GENDER Study Group. „Intersectionality-based quantitative health research and sex/gender sensitivity: a scoping review“ in: International Journal for Equity in Health 2019 Dez;199(2019). (DOI:10.1186/s12939-019-1098-8).
  • Kathleen Pöge, Sarah Mirabella Strasser, Anke-Christine Saß, Alexander Rommel. „Civil society stakeholders’ participation in national health reporting on sex/gender issues: a study protocol for an intersectionality-informed and sex/gender-sensitive approach to focus group research“ in: BMJ Open 2020;10. (DOI: 10.1136/bmjopen-2019-033412).
  • Philipp Jaehn, Julia Rehling, Ronny Klawunn, Sibille Merz, Christine Holmberg, ADVANCE GENDER Study Group. „Practice of reporting social characteristics when describing representativeness of epidemiological cohort studies – A rationale for an intersectional perspective“ in: SSM - Population Health 2020;100617. (DOI: 10.1016/j.ssmph.2020.100617).
  • Philipp Jaehn, Emily Mena, Sibille Merz, Robert Hoffmann, Antje Gößwald, Alexander Rommel, Christine Holmberg, ADVANCE GENDER Study Group. „Non-response in a national health survey in Germany: an intersectionality-informed multilevel analysis of individual heterogeneity and discriminatory accuracy“ in: PLoS ONE; 15(8): e0237349. (DOI: 10.1371/journal.pone.0237349).
  • Emily Mena, Gabriele Bolte, ADVANCE GENDER Study Group. „CART-analysis embedded in social theory: A case study comparing quantitative data analysis strategies for intersectionality-based public health monitoring within and beyond the binaries.“ in: SSM - Population Health; 2021; 100722. (DOI: 10.1016/j.ssmph.2020.100722).
World Congress of Public Health 2020

Gender Sensitive and intersectional health monitoring and reporting – putting theory into practice

Summary of the panel discussion of the joint project Advance Gender at the World Congress of Public Health 2020

To download the whole text, please click here.

Why should gender-sensitive health reports be intersectional? (Sibille Merz)

The status quo of health monitoring and reporting is lacking a theory-based understanding of sex/gender. Current approaches rarely move beyond a binary thinking about sex/gender and are often deficit-oriented. Tenets of intersectionality can inform research activities and health monitoring and reporting. In an intersectional approach, for example, sex/gender is decentred by considering the interaction with other categories of difference such as race/ethnicity or class. Intersectionality-informed and sex/gender-sensitive health reports should focus on the internal heterogeneity of social categories, contextualise social experiences and health outcomes, and draw on a range of novel modelling approaches in data analysis. Last, health reporting opens up a space for the participation of civil society stakeholders and representatives of disadvantaged populations, and can focus much more on resources and resilience rather than exclusively on deficiencies and shortcomings.

Suggestions for a gender-sensitive and intersectional practice of health monitoring and reporting (Philipp Jaehn and Emily Mena)

Two examples were presented that aimed to illustrate novel insights when integrating an intersectional perspective in descriptions of representativeness and data analysis for health monitoring and reporting. Philipp Jaehn suggested that intersectionality-informed assessments of representativeness might aid to identify underrepresented groups in descriptive epidemiological studies more precisely. An intersectionality-informed analysis of representativeness using multilevel analysis of individual heterogeneity and discriminatory accuracy revealed that interventions to increase response should be both population-based and targeted to intersectional groups with high proportions of non-response. Moreover, a data analysis strategy using classification and regression trees (CART) was proposed by Emily Mena. The strategy aims to contribute to an intersectionality-informed and sex/gender-sensitive health monitoring and reporting. The technique is based on the consideration of further categories of difference within sex/gender groups and considers solution-linked sex/gender variables. Preliminary results from a real-world application point out, that the inclusion of solution-linked sex/gender variables into analysis might have the potential to advance intersectionality-informed sex/gender sensitivity in public health monitoring and reporting.
 
Questions from the audience to the presenters:

In what way do the results from the CART analysis differ from sub-strata specific prevalence?

  • Sub-strata specific prevalence does not differ. Emily Mena argued that CART helps to identify the most important variables.

Have you tried to incorporate race in the analysis?

  • Philipp Jaehn reported that race/ethnicity was not part of the analysis, since there were too few observations. Emily Mena included migration background into the analysis.

Comments from Greta Bauer:

Greta Bauer commented that the theoretical concept of intersectionality originated in Black Feminism in the US, starting from the sex/gender approach that already existed. However, intersectionality could also be considered to have started from critical race theory. One could improve research on sex and gender, by decentring the categories, which would allow the understanding that something similar does not have the same relevance for everybody. Furthermore, one can start to get the most out of the complexity within populations, where Bauer sees as a potential for improved health monitoring.

Some interesting tenets of intersectionality might spike the development of novel quantitative methods. For example, recent approaches have focussed on quantifying internal heterogeneity of populations. Greta Bauer points out that looking at populations as heterogenic is crucial, but heterogeneity alone is not intersectionality. The critical focus on social power and social context needs to be kept throughout the process. It is important to consider that the theoretical framework of intersectionality really didn’t start in health research or quantitative research, but comes from black feminist legal theory in sociological theory. It is a travelling theory that moved from discipline to discipline and new challenges arose when intersectionality found entry in a new discipline. Crucially, we need to ask the question how we can be true to the core tenets of intersectionality when we start to use it as a theoretical concept. Greta Bauer recommends Lisa Bowlegs paper for people that are starting to work with intersectionality, because it talks about these core tenets and how to apply them in public health (Bowleg L. 2012. "The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health," American Journal of Public Health, American Public Health Association, vol. 102(7), pages 1267-1273.).

When talking about internal heterogeneity of groups, Greta Bauer re-iterated the importance of understanding statistics from its core as a discipline seeking to find differences between groups and not similarities. This illustrates that statistics were developed by the questions that have been asked to data in a particular time and place. Subsequently, weaknesses arose because researchers omitted asking further questions. Intersectionality can be very important as a corrective by giving rise to new questions that have been neglected in the past. Methods should then follow these new questions. There is a range of statistical methods researchers can choose from. Ultimately, it is important to consider which methods serve us best for a particular aim. Greta Bauer stresses that identifying inequalities in health, for example in descriptive intersectionality-informed analyses, does not give enough information to find solutions. It is necessary to involve new methods that help in identifying factors that drive inequalities and find entry points for interventions.

Comments from Nicole Rosenkötter:
Nicole Rosenkötter commented that the relevance and rationale of the concept of intersectionality is clear and that a good exchange between science and practice is necessary to raise awareness for this concept and make it applicable for practice. The practice of health monitoring and reporting can contribute pragmatic ideas and reflections to guide the translation of intersectionality into its realm. The focus of public health monitoring and reporting is the presentation of facts identified in routinely collected administrative data. In addition, scientific evidence is used to explain identified health inequalities. Nicole Rosenkötter underlines, that in local public health monitoring and reporting, there is awareness of heterogeneity within population groups, but there is often not enough data to analyse it in a detailed way. Instead, other approaches are used. For example, members and stakeholders of civil society are asked to specify health needs and resources that people have in a population. In recent years, intersectoral reporting structures have been developed on the local level. These approaches seek to identify, for example, districts with multiple vulnerabilities (e.g. based on social and environmental data and data on health outcomes) in order to steer resources for their benefit. A further aspect to be considered when thinking about how to implement tenets of intersectionality in public health monitoring and reporting is to understand that public health monitoring and reporting is embedded in a longer process. Hence, it is not only the health report that is crucial, but also the process that follows. Intersectional inequalities that are identified in a health report in a first step need to be used to initiate, for example, round tables to discuss the needs of population groups and how to act on them.

Discussion
Olena Hankivsky asked the presenters to specify possible differences between intersectionality and an eco-social model of health distribution.

  • Philipp Jaehn suggests that both concepts point towards the importance of environment in a socio-historical context, but intersectionality expands eco-social theory by considering that social structures are interlocking and mutually constituting.

How to integrate intersectionality between race and gender using secondary administrative data especially if there is no detailed information on sex/gender or race/ethnicity?

  • Greta Bauer points out, that we should talk more about the use of particular variables as proxies. Administrative data often does not include a specific dimension of sex/gender, while the collection of more sophisticated data is possible when doing primary data collection. The variables that we have in administrative data are often not what we want. Therefore, it is important to be clear of “what we have, what we want, and whether what we have is a reasonable proxy for what we want” (Greta Bauer). Identified shortcomings of the available variables should be stated explicitly and a culture of reporting limitations of administrative data should be strengthened. Such a practice might lead to the collection of data that is more helpful for example to do research on sex/gender or race/ethnicity in the future. Greta Bauer also stresses the importance of collecting data in the conjunction with communities in order to build trust between the people of the community who are described in the data and the government agency that collects the data.
  • Nicole Rosenkötter states that the most pragmatic approach might be to include members and stakeholders of civil society to specify the discussion and to identify the needs of populations. Moreover, including scientific evidence into the health report can help when choosing what messages to include and how to interpret data.

It has become clear that the process behind health reporting is very important, because it facilitates engagement and empowerment. Should we now focus more on this process and not so much on sophisticated statistical methods for analysing data, as we would like to do as epidemiologists?

  • Nicole Rosenkötter answers that it would be a good idea to focus on the process that starts after the health report is published. In addition, one should try to make the scientific evidence available to people who write health reports, so that they can include it. However, Nicole Rosenkötter doubts that it is possible to include new methodological approaches on the regional level, where less resources and less data are available compared to the national level. Nevertheless, on national level, sophisticated analyses can and should be done. These studies are also considered in health reporting at the regional level to explain differences and to explain trends.
  • Greta Bauer adds that there is not a choice to be made between processes and statistical methods. A detailed approach to do statistics works well with community-based processes and the aims of intersectionality. When comparing statistical methods, we can apply an intersectional lens and say what best estimates there are for health conditions of people at different intersections. If we find methods that give us good estimates for small groups, this provides important information for small communities that have been marginalised, and can be used by these communities to address their own health. One could adopt this community-focussed lens toward the methods. Some methods are very complex, but they produce results that can be conveyed to communities in very meaningful ways. These methods are able to handle small groups statistically meaningfully and produce results that are easy to understand. Complex statistics doesn’t mean complexity at that end.

Finally, Olena Hankivsky states that speaking to policy actors about effective messaging is essential. How to translate the complexity into clear messaging?

  • Greta Bauer agrees with that statement. Communities are policy actors. We need to think about the stakeholders before we start to produce results. Stakeholders might be community advocates, policy makers, or practitioners in social service agencies.
    We need to think about the form of the results. This implies that an academic paper is not always useful. We rather need integrated knowledge translation strategies, where people who are going to use the results are involved in the research early on. This also affects the choice of methodology.

Further questions that were posted in the chat but could not be answered:

  • Once the intersectionality is incorporated in the analysis of data as proposed from the theory to include in actions in the promotion and in public health?
  • Which role do power and social injustice play in the work? What are the limitations of the field of epidemiology in terms of advancing in intersectionality? Which tensions occurred, entering the field of intersectionality through categories of sex/gender?
  • How to translate the complexity of [intersectionality] into clear messaging?

Participants of the workshop
Gabriele Bolte and Christine Holmberg chaired the session. Christine Holmberg is director of the Institute of Social Medicine and Epidemiology at Brandenburg Medical School. Gabriele Bolte is director of the Institute of Public Health and Nursing Research (IPP) at the University of Bremen and head of the Department of Social Epidemiology of the IPP. Presentations were given by Sibille Merz and Philipp Jaehn, both research fellows at the Institute of Social Medicine and Epidemiology at Brandenburg Medical School, and Emily Mena, research fellow and lecturer at the Department of Social Epidemiology of the Institute of Public Health and Nursing Research at the University of Bremen.

Members of the panel were Greta Bauer, Nicole Rosenkötter and Olena Hankivsky. Greta Bauer is professor at the Department of Epidemiology and Biostatistics and at the Department of Gender, Sexuality, and Women’s Studies at Western University, Canada. She has recently been appointed Sex and Gender Science Chair at the Canadian Institute of Health Research. Nicole Rosenkötter is a professional in health reporting at the division of health reporting (Centre of Health North Rhine-Westphalia), and former president of the section Public Health Monitoring and Reporting of the European Public Health Association. Olena Hankivsky is Chair in Women’s Health and Director of the Centre for Health Equity at the Melbourne School of Population and Global Health.

For further reading:

Kathleen Pöge, Alexander Rommel, Emily Mena, Christine Holmberg, Anke-Christine Saß, Gabriele Bolte. "AdvanceGender – Verbundprojekt für eine geschlechtersensible und intersektionale Forschung und Gesundheitsberichterstattung" in: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2019 Jan;62(1):102-107. (DOI: 10.1007/s00103-018-2855-3).

Emily Mena, Gabriele Bolte, ADVANCE GENDER Study Group. „Intersectionality-based quantitative health research and sex/gender sensitivity: a scoping review“ in: International Journal for Equity in Health 2019 Dez;199(2019). (DOI:10.1186/s12939-019-1098-8).

Kathleen Pöge, Sarah Mirabella Strasser, Anke-Christine Saß, Alexander Rommel. „Civil society stakeholders’ participation in national health reporting on sex/gender issues: a study protocol for an intersectionality-informed and sex/gender-sensitive approach to focus group research“ in: BMJ Open 2020;10. (DOI: 10.1136/bmjopen-2019-033412).

Philipp Jaehn, Julia Rehling, Ronny Klawunn, Sibille Merz, Christine Holmberg, ADVANCE GENDER Study Group. „Practice of reporting social characteristics when describing representativeness of epidemiological cohort studies – A rationale for an intersectional perspective“ in: SSM - Population Health 2020;100617. (DOI: 10.1016/j.ssmph.2020.100617).

Philipp Jaehn, Emily Mena, Sibille Merz, Robert Hoffmann, Antje Gößwald, Alexander Rommel, Christine Holmberg, ADVANCE GENDER Study Group. „Non-response in a national health survey in Germany: an intersectionality-informed multilevel analysis of individual heterogeneity and discriminatory accuracy“ in: PLoS ONE; 15(8): e0237349. (DOI: 10.1371/journal.pone.0237349)

Emily Mena, Gabriele Bolte, ADVANCE GENDER Study Group. „CART-analysis embedded in social theory: A case study comparing quantitative data analysis strategies for intersectionality-based public health monitoring within and beyond the binaries.“ in: SSM - Population Health; 2021; 100722. (DOI: 10.1016/j.ssmph.2020.100722).