Elsevier

Social Science & Medicine

Volume 51, Issue 6, 15 September 2000, Pages 931-939
Social Science & Medicine

Gender equity in health: debates and dilemmas

https://doi.org/10.1016/S0277-9536(00)00072-1Get rights and content

Abstract

Gender equity is increasingly cited as a goal of health policy but there is considerable confusion about what this could mean either in theory or in practice. If policies for the promotion of gender equity are to be realisable their goal must be the equitable distribution of health related resources. This requires careful identification of the similarities and differences in the health needs of men and women. It also necessitates an analysis of the gendered obstacles that currently prevent men and women from realising their potential for health. This article explores the impact of gender divisions on the health and the health care of both women and men and draws out some of the policy implications of this analysis. It outlines a three point agenda for change. This includes policies to ensure universal access to reproductive health care, to reduce gender inequalities in access to resources and to relax the constraints of rigidly defined gender roles. The article concludes with a brief overview of the practical and political dilemmas that the implementation of such policies would impose.

Introduction

Gender equity is increasingly identified as one of the goals of health policy at both national and international levels. However the precise meaning of the term is not always clear. Are there any examples of it in the real world? Would we recognize them if we saw them? In attempting to answer these and other questions this paper will address some key policy concerns. It will also identify some of the underlying theoretical and conceptual issues that need resolution if anything resembling gender equity in health is to be realised.

In recent years there has been a shift away from talking about ‘women’ to talking about ‘gender’. Instead of focussing on women as an underprivileged group, the emphasis is now on the social construction of gender identities and on the nature of the relationships between women and men. This shift is evident in academic discourse where ‘gender studies’ is increasingly replacing ‘women’s studies’ as the framework for generating new knowledge. It is also apparent in many policy settings where the language of gender equity is increasingly heard. However closer examination reveals a distinct lack of clarity about how such a goal should be defined or about how it might be achieved.

Section snippets

Gender equity: the politics of confusion

The essential contestability of the term ‘gender equity’ can be illustrated through an examination of debates at the recent UN conferences in Cairo and Beijing. Participants in these debates could be loosely categorised into three major groups. Each would claim to represent the interests of women but all perceive gender equity in very different ways (Baden & Goetz, 1998).

First, there is a loose grouping of individuals who could be called traditionalists, many but not all of whom would ground

Defining the problem

Any attempt to promote gender equity in health must begin with a clear definition of what is being sought. The most obvious goal might seem to be equality in health outcomes between men and women. However this is clearly unachievable. Because individuals (and groups) begin with very different biological constitutions, any attempt to equalize male and female life expectancy or morbidity rates is doomed to failure. Instead, policies in pursuit of gender equity must focus not on health outcomes

Nature or nurture?

This investigation will require an examination of both the biological (sex) and the social (gender) dimensions of difference as well as the relations between them. There are, of course, a variety of philosophical problems awaiting the unwary who talk in any simple way about separating these two domains. Indeed much recent work in gender studies has been concerned in one way or another to demonstrate their intrinsic interconnectedness (Butler, 1993). Some of this has been extremely valuable in

The biology of risk

In biomedical theory and practice the analysis of maleness and femaleness starts (and usually ends) with sex differences in reproductive systems. This is also a useful starting point for thinking about equity in public policy since it is an area in which women start off at a considerable disadvantage in comparison with men. If they are to realize their potential for health, most women require access to the resources necessary to control their fertility and also, intermittently, to those which

The hazards of female gender

All societies are divided in two along a male/female axis. This means that those falling on opposite sides of the divide are seen as fundamentally different types of creatures with different duties and responsibilities as well as different entitlements (Charles, 1993, Moore, 1988). Though the precise formulation of these definitions varies between societies, there is also a surprising degree of consistency, with those who are defined as female having primary responsibility for household and

Male gender: a mixed blessing?

Thus far, relatively little attention has been paid to the impact of gender on the health of men. Indeed this is part of a much broader pattern whereby men’s lives have not usually been seen as gendered at all. This has now begun to change with the creation (mostly in the developed countries) of the sociology of masculinities, men’s studies and associated men’s movements (Brod and Kaufman, 1994, Connell, 1995, Hearn and Morgan, 1990, Mac an Ghaill, 1996). A major focus of many of those working

Sex, gender and diversity

We have now explored the biological and the social commonalities that identify men and women as separate groups. But of course this does not imply homogeneity within each group. Hence socio–economic, cultural and age differences among women and among men also need careful exploration in order to assess their implications for the promotion of gender equity in health.

Despite the fact that they share the same biology, it is clear that women’s reproductive health status is profoundly affected by

Policies for gender equity: a preliminary agenda

It can be argued that universal access to high quality reproductive health care is the single most important element that must be included in any global strategy for gender equity. In the richer parts of the world this has largely been achieved and its impact on women’s capacity to realize their potential for long and healthy lives is very obvious. In the UK the gap between male and female life expectancy is now around 7 years, but in India it is less than 2 years while in Bangladesh men live

Health and the politics of gender

Concerns about health and masculinity have recently come to the fore both in academic and policy arenas and also in the popular press. While these debates are taking place mainly within the developed countries they do have a broader significance for the gender equity debate. A number of different positions can be identified and these will be examined in turn.

The first argument could be characterised as ‘back to the future’. The supporters of this position claim that in many societies, changes

The way forward: dilemmas and constraints

The first dilemma is whether we can improve the health of women without men losing out. And if we cannot, what implications does this have for the equity debate? If improvements in women’s health necessitate them receiving a fairer share of available social resources, then men may have to get less and this will sometimes have a negative impact on their health. Men on the edge of poverty for example, might be dragged down below subsistence if their income had to be shared equally with their

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