Why gender and health?
Image: Dogoyaro, Nnebuife Kwubei, Nigeria (2019)
Gender matters in global health
Gender inequality hurts everyone. Patriarchal norms and structures shape institutions, drive poor health outcomes for all populations, determine career pathways and narrow workplace norms.
Although they interact with one another, gender and biological sex are different. Gender is not equivalent to women and girls, or men and boys, but encompasses people of all genders and sexual orientations. It is socially constructed and influenced by laws, politics, policies, communities, families and individuals. It shapes how we behave, act and feel.
Gender determines our positions and roles in society. It impacts health and wellbeing, influencing both our own individual behaviours -what risks we take with our health, what risks we face and whether or not we seek health care – and how the health system responds to our needs when we are sick or need care and support.
Gender and health outcomes
The consequences of inaction on gender are grave: For example, a baby girl born in 2017 can expect to live 4 years more than a baby boy born on the same day. In some countries that life expectancy gap is 11.7 years or more. Men’s shorter life expectancies are driven, in part, by:
- their higher rates of consumption of tobacco and alcohol
- their likelihood of death from violence (including in peacetime)
- deaths from road injuries, and deaths by suicide.
Girls and women might live longer, but they suffer longer with chronic diseases. Pregnancy complications and unsafe abortions remain a significant cause of death in many settings, with one third of girls married before they are 18. Further, married women in 27 countries still require their husband’s consent before they can access contraceptives.
Yet too many global health organisations continue to fly gender blind. Only 35% of organisations define what they mean by gender. 2 in 3 organisations fail to take a gender-responsive approach to their programmes. And the majority still do not disaggregate their programmatic data by sex. A focus on gender is often still equated to working with women.
This not only wastes precious resources, but also exacerbates inequalities in health outcomes among women, men,transgender and non-binary people. Unless organisations take a fully gender-responsive approach that seeks to transform harmful gender norms, global health will fail to tackle the root cause that is driving poor health outcomes for women, men, non-binary and transgender people.
Gender and career progression
Gender norms continue to determine career trajectories in global health. Health is delivered by women and led by men. This in turn drives an unconscionable gender pay gap that our 2021 Report found to be as much of a problem in global health as in other sectors. The health sector ought to lead on justice and fairness, but instead male privilege pervades, and is compounded by geographical under-representation. In our sample, just 5% of global health leaders are women from low- and middle-income countries. We do not yet see representative diversity in global health leadership, or sufficient attention from organisations to address this.
Our vision of a more equitable, inclusive model of gender and health
Gender equality will lead to equal opportunities for people of all genders, everywhere. And health policies and programmes that place gender equality at their core will lead to better health outcomes. Gender inequality is not inevitable.
But to sustainably improve health and well-being for all people, global health must move beyond the symptoms of gender inequality to address the root causes – this is the basis of a gender-transformative approach. To radically improve health and opportunities, organisations must seek to transform the power dynamics and structures that reinforce geographic and gendered inequalities. They must attend to their intersections with race, class, and the many other inequalities that determine our health and opportunities. These are the norms, attitudes, behaviors and systems that lie beneath the visible gender gaps.
To do so, they must start with the way they function themselves.
For definitions of gender and equality-related terms terms, see our glossary.
Global health today: a snapshot
Spheres of power in global health have long been dominated by men from high-income countries. Two years ago, we reported that power imbalances resulting from systemic patriarchal, colonial and imperial norms pervaded the global health system. In our 2022 Global Health 50/50 report, Boards for all?, we find that in the corridors of power and the rules determining who is given a platform to govern, considerations of gender and diversity are all too often lacking. Through an examination of the demographics of over 2,000 board members of the most influential organisations active in global health, the report warns that global health is not living up to its name.
Image: The Well, Sudipto Das, India (2018)