Lancet series on gender equality, norms and health

One of the United Nation’s ‘Sustainable Development Goals of 2030’ is gender equality. The focus is on equitable access to economic independence, technology, education, as well as general and reproductive healthcare for all.

The Lancet recently published a series of five papers on ‘Gender Equality, Norms, and Health’. The series provides in depth analysis about health inequalities related to gender, with calls to action for governments and institutions, leaders in the health sector, researchers, and the community.

Gender inequity and restrictive gender norms (ie, the often unspoken rules that govern the attributes and behaviours that are valued and considered acceptable for men, women, and gender minorities) are determinants of health. However, the relationship between gender and health is complex because gender interacts with other social determinants (including race, class, age, and ability), and these interactions are commonly multiplicative rather than additive. The series illustrates several examples of this. Families living in poverty are less likely to seek treatment for daughters for communicable diseases, and adolescent women in developing countries are at particularly increased risk of maternal mortality due to inadequate access to healthcare.

Gender norms result in differential exposure to disease, disability, and injury. Men are more likely to experience work-related and road accidents, as well as traumatic injuries. They are more likely to experience substance abuse and develop lung cancer, due to a perceived sense of masculinity related to alcohol, smoking, and risk-taking behaviour. Health promotion activities aimed at dispelling these stereotypes are essential in reducing harm to the individual and burden on healthcare systems.

As physiotherapists, it is important to be aware of our own gender biases in how we interact with our patients, as well as the systemic gender bias in our healthcare systems. The series provides evidence that women around the world receive poorer pain management, are screened for disease less often, receive less aggressive treatment, and substandard follow-up. It is our role as physiotherapists to advocate for adequate assessment and treatment of women in pain, and promote appropriate screening for neglected conditions such as heart disease in women.

Research supports the notion that more equal and diverse societies result in better health outcomes and life expectancy for both men and women. This should inform the design and implementation of healthcare programs worldwide. Increasing equitable gender representation in positions of leadership and governance, as well as integrating modules of sex and gender-based medical concepts in medical and public health training would contribute to the United Nation’s goal of gender equality.

Researchers also need to consider gender bias in health research at various stages. Sampling, design and analysis of randomised controlled trials as well as population-based surveys needs to ensure equitable representation, unbiased framing of survey questions, and consideration of gender as a significant variable in health research.

A podcast of Lancet Executive Editor Jocalyn Clark talking with Gary Darmstadt (Stanford University, USA), the lead author of the Lancet series on gender and health, is available here.

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