Q&A on Gender’s Impact on Healthcare Systems with Sally Theobald and Sarah Hawkes

Sarah Hawkes is Professor of Global Public Health at the Institute for Global Health at UCL.

Sally Theobald is Chair in Social Science and International Health at the Liverpool School of Tropical Medicine and part of the ReBUILD and RInGS consortium. 

C4D: How does gender play a role in health?

Sarah Hawkes (SH): Unlike biological sex, gender is socially constructed – it’s the rules, norms, customs, laws and social ideas about what it means to be male or female in any society. For health, gender impacts very much on risk behaviors. Individual risk behaviors are shaped by the broader context including gender roles and relations – whether it’s socially allowable to smoke, drink, drive, or have sex outside marriage, or whether its environmentally, economically feasible to avoid unhealthy exposures. People’s chances of reaching healthcare are also driven by gender constructions [with men less likely than women to seek medical advice]. And then how you are treated within the health system is driven by gender norms as well.

Sally Theobald (ST): As gender is a social construct, it’s fluid, amenable to change. We need to understand how gender plays out in different contexts, to shape the experience of women, men, boys, girls and people of other genders in specific contexts. War is an example of how gender roles and relations can change. If you look at the Second World War in the UK, it was a real time of gender change, with women taking up productive work in the labour force for the first time as men were fighting. 

SH: And that had an impact on women’s health: the relative empowerment that women achieved through having a regular wage, in a particular social context, led many women to adopt risk behaviors which had previously been associated with being male. Specifically smoking – women’s tobacco consumption rate in the UK went up the moment they went into the workplace in the 1940s. There have been similar patterns of risk behavior associated with product consumption – alcohol, processed foods, tobacco – around the world, wherever you have large proportions of the population moving into paid employment. People with money and relative autonomy make decisions on what to spend it on, and they are proactively encouraged to spend it on products which are bad for their health.

Video: Sarah Hawkes addresses preconceived notions of gender and calls for bringing men and boys into the analysis, and Sally Theobald outlines the gender impact on areas from seeking healthcare to human resources, remuneration and promotion within healthcare systems.

C4D: What are the key areas for change with the EU’s updated Gender Action Plan? 

SH: The GAP, which every EU Delegation has at their fingertips, offers an opportunity to think holistically and constructively about how to have a gendered response to strengthening health systems. Whilst it has a pillar which is about physical and psychological wellbeing of girls and women, there is enormous evidence that if you are concerned with sexual and reproductive health and rights, it’s more effective and equitable to also include men and boys in that process, rather than thinking you can achieve that by focusing on women alone.

This should all be within a thoughtful multi-sectoral framework, based on the 2030 agenda, which talks about an indivisible tapestry of all the goals interacting. We can’t just focus on the gender goal and the health goal. To truly improve health outcomes for everyone, we have to look across, at the multi-sectoral influences on a broad set of health risk behaviors in their broader social and environmental context These are increasing in countries which are developing economically, where there are rapid periods of industrialization and growth, but without state capacity to regulate the private sector - that is having an enormous impact on health outcomes. 

If you can’t implement the Framework Convention on tobacco control, or guarantee clean air, or regulate the salt content of food, there are gendered elements of consumption which drive the largest burden of disease, predominantly in low and middle-income countries. The GAP should allow everyone to look across all sectors and say what is driving health outcomes in the future, and how can we get multi-sectoral action, and regulate the environment to control for risk exposures.

C4D: What role do data collection and indicators play in this?

ST: Indicators are crucial to measure progress. There are beautiful gender policies which evaporate in practice; we need a process and a plan with indicators to ensure gender mainstreaming has “teeth”. We can look at opportunities for partnership across and between sectors. EC Delegates need to talk to civil society organisations and colleagues, to look across sectors and ask what the meaningful data may be in a particular context. Obviously sex disaggregation is important – and using that data to enable change, to look at ways to shift health services, to look at prioritization within health systems, so they are more responsive to the needs of women, men, boys and girls. 

We see a focus on women and girls because of their specific vulnerabilities, but their experiences are not in isolation and we need to look at the interplay, and also the vulnerabilities of men and boys. Data collection and indicators can help us with that. It’s also about being creative and looking at the range of sources. Sometimes it’s about qualitative data and capturing voices, experiences, the realities of marginalized groups, which can bring the context alive.

SH: Health outcomes are shaped by social determinants, an indivisible tapestry. It’s both our challenge and our opportunity and we need to build strategic partnerships for change. Joint Programming and joint indicators will all facilitate that. It takes time to develop partnerships, but it’s worthy of investment. The more we build those bridges, the more we support the development of gender responsive health systems.

This interview summarises thematic discussions held during the 2016 edition of the annual Health Seminar, organised by the DEVCO Health Team and attended by EU experts from HQ and EU Delegations around the world.