Health Security

Health security emergencies and infectious disease outbreaks have considerable social and economic costs. Sex, gender and other social determinants influence pathways of transmission and the impacts on men and women, and on particular groups in society, compounding or exacerbating existing vulnerabilities and putting them at greater risk of adverse health outcomes.

The characteristics of infectious diseases and outbreaks interact with sex, gender roles and other social determinants at an individual and population level in ways that may impact the risk or impact of health security threats. The third Asia Pacific Strategy for Emerging Disease and Public Health Emergencies (APSED) III (2017) includes a commitment to strengthening existing surveillance systems by reviewing and identifying data and information that can be used during different phases of an event, including gender-specific surveillance data (76). Mainstreaming gender in emerging disease programs is identified as common practice as part of APSED (77). Experience indicates that monitoring the interaction between gender and infectious diseases during an outbreak can lead to important insights into transmission patterns and to strategies for outbreak prevention and control (77).

Health security emergencies and infectious disease outbreaks have considerable social and economic costs, both directly and in terms of the flow-on effects and disruptions in domains such as trade, travel, education and food security. These complex pathways of transmission and impacts may put men and women or particular groups in society at greater risk and may compound or exacerbate existing vulnerabilities (see also Section 4). For example, males and females differ in the outcome of influenza A virus infections, vaccination and antiviral treatments, with both sex (i.e. biological factors) and gender (i.e. sociocultural factors) impacting exposure, severity and health care response and treatment outcomes (78). Pregnant women are also at increased risk for influenza-associated illness and death, and the fetus may also be negatively affected by maternal exposure (82).

More generally, health services, such as for SRH and NCDs, may be disrupted or paused as the health system and health workforce mobilizes to address the emergency outbreak. In post-disaster contexts for example, women’s access to reproductive healthcare may be significantly hampered, as occurred after Typhoon Hayian in the Philippines (83). Multiple studies from the region have demonstrated that in post-disaster contexts women and girls face heightened risks of sexual and gender-based violence, increased vulnerability to sexual exploitation and trafficking. After two 2011 cyclones in Vanuatu, the Women’s Centre in Tanna recorded a 300% increase in reported violence cases (84). A similar trend was documented in Whakatane, New Zealand following 2004 floods (85). Finally, occupation may also play a role. Women make up a greater proportion of frontline healthcare workers, and thus may be more exposed to disease outbreaks as well as have insufficient training and resources to effectively protect themselves and the patients and communities they serve.

References

76. Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III): Advancing implementation of the International Health Regulations (2005). Manila, Philippines., World Health Organization Regional Office for the Western Pacific, 2017.
77. Taking sex and gender into account in emerging infectious disease programmes: an analytical framework. Manila, Philippines, WHO Western Pacific Regional Office, 2011.
78. Morgan R, Klein SL. The intersection of sex and gender in the treatment of influenza. Antiviral strategies, 2019, 35:35–41.

82. Sonja A. Rasmussen, Denise J. Jamieson, Joseph S. Bresee. Pandemic Influenza and Pregnant Women. Emerging Infectious Disease journal, 2008, 14(1):95.
83. Barmania S. Typhoon Haiyan recovery: Progress and challenges. The Lancet, 2014, 383(9924):1197–1199.
84. Aipira C, Kidd A, Morioka K. Climate Change Adaptation in Pacific Countries: Fostering Resilience Through Gender Equality. In: Leal Filho W, ed. Climate Change Adaptation in Pacific Countries. Springer International Publishing, 2017:225–239.
85. Houghton R. ‘Everything Became a Struggle, Absolute Struggle’: Post-flood Increases in Domestic Violence in New Zealand. In: Enarson E, Chakrabarti PGD, eds. Women, Gender and Disaste: Global Issues and Inititatives. Los Angeles, London, New Delhi, Singapore, Washington DC, Sage, 2009:99–111.