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Key messages

Policy issues

• Data on mortality, morbidity and use of health services reveal some important differences in health experiences between women and men.
• Health systems can make important contributions to gender equality and gender equity by addressing gender in a variety of ways.
• Identifying gender inequalities and addressing gender equity are also central to good stewardship of health systems.

Policy approaches/options

Gender equality and gender equity can be addressed by using various approaches, including legislation, organizational processes and information gathering.

• Regulatory approaches at national level might address patients’ rights or create a duty for public-sector organizations to address gender equality. Such a duty would require health ministries to consider the ways in which health systems can reinforce inequality, and to work towards the promotion of gender equality.
• Organizational approaches designed to address gender equity focus on the use (in health systems) of various tools to highlight gender inequalities and pinpoint solutions. For example, gender budgeting is an organizational approach that focuses on government expenditure and makes the gender impact of budgetary decisions explicit.
• Informational approaches focus on the role of data in providing knowledge about gender inequities. For example, gender-sensitive health indicators are intended to identify key differences between women and men in relation to health and in the social determinants of health, in order to support policy change.

All approaches need to be evaluated in terms of their possible benefits, costs and the barriers that might make introducing change difficult. Benefits, for example, include increasing the visibility of gender issues, improvements in population health and in efficiency and value for money in terms of services. Costs can include the increased resources needed for training, monitoring, evaluation and the collection of any new data that might be required. Barriers may include a lack of understanding of the issues and a lack of political will. Factors that might facilitate change could include gender ‘champions’ and prior experience (at local or national level) of gender equity reforms in other policy arenas.

Facilitating implementation

All approaches require financial and human resources, political commitment, a long-term approach, transparent decision-making processes, gender-disaggregated data, training and the involvement of stakeholders. A strong stewardship function within the health system can help to take this forward.

However, it is also the case that small changes can help to bring about further change. For example, a requirement for gender-disaggregated reporting of key health data can help generate evidence about the gender gap in health, which can, in turn, support the case for other changes.

Once gender-disaggregated data have become routinely available over time, trends can be observed that help make the case for gender-related budgeting, which can begin with relatively modest goals – assessing the difference between women and men in terms of the use of specific health services, for example – before moving on to strategies that begin to challenge such differences or address gender equity across the system as a whole.