Achieving gender justice for global health equity: the Lancet Commission on gender and global health

Abstract

Section snippets

Executive summary

Achieving gender justice in global health—which we define as encompassing the realisation of universal rights in relation to health equity and gender equality, while also addressing the drivers of gender-based discrimination and exclusion—would yield positive benefits for all people by improving health outcomes, reducing health inequities, and ensuring more inclusive and equitable global health workplaces and workforce governance. Despite these potential benefits, gender has become a divisive

Part 1: Challenging entrenched biases in understandings of sex and gender in global health

Global health as a field exhibits three persistent biases in relation to gender that have resulted in misunderstanding and in misdirection of action. In this part, we set out these biases and present alternative evidence and framing in recognition of the fact that how gender and health are defined and expressed has implications for how change is directed in policy and practice.

Part 2: Towards comprehensive understandings of gender, gender justice, and global health

One commonly held view treats gender as a direct expression of bodily difference. Human bodies are generally specialised as female or male in reproductive function, and some genetic and anatomical differences and bodily processes (eg, the menstrual cycle) are associated with this specialisation. Although health services seek to address the health concerns of all people, bodily differences are generally addressed by specialised fields of women's health (which is often focused on obstetric and

Part 3: The history of a global field—colonialism, imperialism, and beyond

The history of gender and global health is entangled with the history of empires, colonialism, capitalism, imperialism, and the global economy. These histories have a deep and continuing influence on the global health sector, including how gender is framed, understood, acted upon, and contested within global health spaces. Our review of these histories builds on two parallel processes of research, which were necessarily limited in scope because of the constraints of the Commission format. The

Part 4: Power, and how power is wielded to oppose gender justice

How can the contestations and divisions in the global health system be overcome to achieve a shared vision of gender justice for health? To identify strategies and pathways towards progress, paying attention to power is essential: what power means, how it is distributed, how it is used to shape views and actions, how powerful forces contest progress towards gender equality, and how power can be used to fight back.Power in its various guises has been used to shape social, economic, and political

Part 5: Knowledge needs for the future

In developing our vision of gender justice in global health, we reflected on why progress has not been made, which involved identifying misconceptions about what gender is and about the role of gender in health outcomes. We have outlined how achieving gender justice in global health requires acknowledgment of the history of the gendered global health system and the impact of power and politics on the construction of, and opposition to, gender justice within the system. All these forces

Part 6: Practical actions for gender justice in health

In this final part, we move from knowledge to action to realise the gender-justice dividend. We outline previous strategies that have successfully disrupted inequitable systems of power and challenge the activities of the opposition. Crucially, we need to ensure that sufficient resources are available to enable these efforts. Additionally, routine accountability systems need to be established and strengthened to hold actors and institutions within the global health system to account for

Conclusion

Over the 5 years of the Commission's work, the importance of achieving gender justice for global health equity became ever more apparent. We witnessed the role of gender in driving inequitable health, social, and economic outcomes during the COVID-19 pandemic; the stalemate at the World Health Assembly in 2022 and in other international forums; the rise in situations of armed conflict and associated gender-based violence; the struggle to retain rights in relation to reproductive autonomy, with

Declaration of interests

FEB reports royalty payments from Oxford University Press for books, is an unpaid member of the Cancer Council South Australia, and is a former co-chair of the People's Health Movement Global Steering Council and a current member of its Advisory Council. ACH and VZ report consulting fees from University College London. EN reports funds from University College London (paid to their institution) and is a former member of the UK National Institute for Health and Care Research Expert Advisory

Acknowledgments

The Commission was funded by the Wellcome Trust (WT564580, to the Institute for Global Health, University College London, UK), the Ford Foundation (137700, to United Nations University—International Institute for Global Health, Kuala Lumpur, Malaysia), and Global Health 50/50. Staff members of Global Health 50/50 are authors of the report; other staff members were also involved in data collection, analysis, and writing. The United Nations University—International Institute for Global Health