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Unequal, Unfair, Ineffective and Inefficient - Gender Inequity in Health: Why it exists and how we can change it
September 2007
Gita Sen, Piroska Östlin, Asha George
Women and Gender Equity Knowledge Network
Gender differentials in health related risks and outcomes are partly determined by biological sex differences. Yet they are also the result of how societies socialise women and men into gender roles. For example, in many societies, practices around sexuality sometimes include ritual (and painful) 'deflowering' of brides and sanctioned marital rape. In some settings, being a man means being tough, brave, risk-taking, aggressive and not caring for one's body. Norms of men and boys as being 'invulnerable' also contribute to an unwillingness to seek help or treatment when their health is impaired. This report shows that addressing the problem of gender inequality in health requires actions both outside and within the health sector. It is critical to develop skills and capacities among health professionals at all levels of the health system to understand and apply gender perspectives in their work. This must be matched by efforts to monitor quality of care, for example by incorporating gender into clinical audits. Broader strategies to tackle the social biases that generate differentials in health related risks and outcomes are also essential. One approach is to work with boys and men to transform harmful masculinist norms, high risk behaviours, and violent practices. Another priority is to create, implement and enforce formal international and regional agreements, codes and laws to change norms that violate women's rights to health.
Background
Gender inequality damages the health of millions of girls and women across the globe. It can also be harmful to men’s health despite the many tangible benefits it gives men through resources, power, authority and control. These benefits to men do not come without a cost to their own emotional and psychological health, often translated into risky and unhealthy behaviours, and reduced longevity. Taking action to improve gender equity in health and to address women’s rights to health is one of the most direct and potent ways to reduce health inequities overall and ensure effective use of health resources. Deepening and consistently implementing human rights instruments can be a powerful mechanism to motivate and mobilize governments, people and especially women themselves.
Gender relations of power constitute the root causes of gender inequality and are among the most influential of the social determinants of health. They determine whether people’s health needs are acknowledged, whether they have voice or a modicum of control over their lives and health, whether they can realize their rights. This report shows that addressing the problem of gender inequality requires actions both outside and within the health sector because gender power relations operate across such a wide spectrum of human life and in such inter-related ways. Taking such actions is good for the health of all people - girls and boys, women and men. In particular, inter-sectoral action to address gender inequality is critical to the realization of the Millennium Development Goals (MDGs).
Like other social relations, gender relations as experienced in daily life, and in the everyday business of feeling well or ill, are based on core structures that govern how power is embedded in social hierarchy. The structures that govern gender systems have basic commonalities and similarities across different societies, although how they manifest through beliefs, norms, organisations, behaviours and practices can vary. The report shows that gender inequality and equity in health are socially governed and therefore actionable. Sex and society interact to determine who is well or ill, who is treated or not, who is exposed or vulnerable to ill-health and how, whose behaviour is riskprone or risk-averse, and whose health needs are acknowledged or dismissed.
However gender intersects with economic inequality, racial or ethnic hierarchy, caste domination, differences based on sexual orientation, and a number of other social markers. Only focusing on economic inequalities across households can seriously distort our understanding of how inequality works and who actually bears much of its burdens. Health gradients can be significantly different for men and women; medical poverty may not trap women and men to the same extent or in the same way. The standard work on gradients and gaps tells us easily enough that the poor are worse off in terms of both health access and health outcomes than those who are economically better off. But it does not tell us whether the burden of this inequity is borne equally by different caste or racial groups among the poor. Nor does it tell us how the burden of health inequity is shared among different members of poor households. Are women and men, widows and income-earning youths equally trapped by medical poverty? Are they treated alike in the event of catastrophic illness or injury? When health costs go up significantly, as they have in many countries in recent years, do households tighten the belt equally for women and men? And are these patterns similar across different income quintiles? This poses a challenge for policy to ensure not only equity across but also and simultaneously within households. The right to health is affirmed in the Universal Declaration of Human Rights and is part of the WHO’s core principles. This report is grounded in the affirmation of equal and universal rights to health for all people, irrespective of economic class, gender, race, ethnicity, caste, sexual orientation, disability, age or location.
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