Gender plays a key role in driving health outcomes for everyone - men, women, and people with non-binary gender identities.
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.
Ultimately, gender inequality and patriarchal norms and structures hurt everyone, driving poor health outcomes for all populations.
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. According to Global Health 50/50 (housed within our Centre), 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, 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 COVID-19
COVID-19 is providing a stark example of how gender can determine health outcomes. In nearly every country where sex-disaggregated data is available, the majority of deaths are in men. Gender and sex are playing a crucial role in determining who is at risk of infection, severe illness and death from COVID-19, from differences in women’s and men’s bodies due to their sex (biology) to our gendered social environments, structures and norms. Global Health 50/50, housed at this Centre, is playing a key role in tracking differences in COVID-19 infection, illness and death among women and men through the COVID-19 Sex-Disaggregated Data Tracker.
Gender and NCDs
The non-communicable diseases (NCDs) carry the highest burden of morbidity and mortality globally. Globally and at regional and national levels, sex-disaggregated data highlight that the distribution of NCDs varies by gender. For example, while some of the major physical NCDs (chronic lung conditions, cardiovascular disease, and many cancers) are more frequently diagnosed in men, several conditions are rising at a faster rate in women than men.
Gender, either acting alone, or through its intersection with other social stratifiers (age, socioeconomic status, sexual orientation, disability, ethnicity, etc), influences NCDs through: rates of exposure to health-harming products (e.g. tobacco, alcohol, poor diets) that drive many NCD outcomes; patterns of care-seeking (or risk reduction); pathways of care received within health systems; and the extent to which organisational and institutional policies and programmes are gender-responsive to both patients and providers.
Why do we see these gendered differences in NCD rates across time and place? These diseases are increasing rapidly owing to changes in patterns of consumption, urbanisation, means of production, and decreasing opportunities for physical activity. For example, in industrialised high-income settings, sex-differences in two of the major NCD risk factors (tobacco smoking and drinking alcohol) have been converging for many decades – and risk intersects with socio-economic position and gender in many countries. Additionally, evidence shows that while men in many settings are more at risk of heart disease, lung disease and cancers owing to their higher rates of tobacco and alcohol use, women are more likely to be misdiagnosed in health care settings and receive less effective and high quality care and treatment. Understanding the role that gender plays in NCDs can mean examining determinants as diverse as the impact of household gender norms on risk of lung disease in women (who are exposed more to solid-fuel cooking with its associated risks of particulate air pollution), to the impact of commercially-driven norms of masculinity which continue to exert detrimental effects on patterns of smoking tobacco in men (including young men in low- and middle-income countries).
Our work in the Gender Centre finds that gender, as a key, modifiable social construct, exerting significant effects on determining sex-disaggregated differences in NCD rates, and driving health care responses, is nonetheless largely absent from consideration in policies and programmes. Continuing to ignore gender in NCD responses is likely to result not only in missing NCD control targets, but is also likely to mean that the global health community will not keep its commitment to leave no-one behind in ensuring health and wellbeing for all.