Connie Musolino and Kristen Foley
More consistent understanding of gender as a social construct by people across the health sector can help lead to better policies and programs and, ideally, healthier, more equitable populations, authors of a Lancet Commission report say.
Recognising why and how there’s been a coordinated backlash led by right wing forces can help people working in health to counter it, ensuring people continue to access health services, and work toward gender justice.
Those messages, distilled from a variety of experts, were conveyed at the Australian launch of the Achieving gender justice for global health equity: the Lancet Commission on gender and global health report last month.
The launch at the Stretton Health Equity and the Fay Gale Centre for Research on Gender at the University of Adelaide on Kaurna Country, Adelaide on 20 June, featured members of the academy, government, and civil society.
They included Lancet Australian Commissioners Professor Fran Baum (University of Adelaide), Professor Sharon Friel (ANU), and Professor Emerita Raewyn Connell (University of Sydney).
They were joined by the Co-Chair of the Lancet Commission, Professor Sarah Hawkes (Monash University Malaysia), to outline the opportunities it presents to advance gender justice in global health systems. A suite of health and gender activists and scholars explained the current state of gender rights in Australia.
They connected key challenges between both local and global health organisations to the political histories which make dismissal and backlash about gender justice possible, and why this matters.
The Lancet Commission was started in March 2020 at the beginning of the Covid-19 epidemic. The Commission was assembled as a multi-disciplinary group of experts working at the intersection of gender and health.
Over the past five years the commission has worked with academics, health workers, policy makers, community and civil society, to produce new research, evidence and recommendations on achieving gender justice.
Their report represents a significant advancement of consensus building regarding how gender and gender justice should be conceptualised and defined. It notes while gender is often discussed in global health, action on gender justice remains a major challenge.
Reasons why include that there is no shared understanding of gender and related terms, leading to disagreement, misinterpretation, discrimination, and frayed collaborations. In research and health data systems, the Commission found that gender and sex are often conflated, which ignores and masks the multiple dimensions of gender and its interactions with sex.
In addition, gender often becomes a shorthand for women and girls, excluding the needs of trans and gender diverse people, as well as how gender relates to the health of boys and men.
The report provides a thorough and thought-provoking history of the political and cultural foundations of how ‘gender’ definitions and knowledge developed and has been operationalised in Global Health systems.
Prof Connell told the launch audience of the long progress made through the 20th century on making gender visible as a social construct. That means the biological divisions between female and male could be understood in relation to gender, rather than a proxy for them.
This is important because it makes new conversations about health possible, such as the way that gender stereotypes shape ideas, desires, and actions. An example is the trope that men are ‘emotion-less’ while women are ‘emotional’, which can shape how men and women might access health services and how they are treated during them.
Further, LGBTQIA+ people might be alienated from health services altogether because they do not conform to gendered stereotypes that tacitly guide treatment approaches.
The overarching aim of the Lancet Commission was to identify ways in which health practitioners, policy makers, researchers, and civil society can use more inclusive understandings of gender to improve health policies and programmes.
The Commission’s vision of a gender justice approach “recognises the diversity of needs and experiences, calls for the inclusion of all people, and aims to achieve both equity and equality for all”.
The report illustrates this through gendered analysis of case studies from around the world, including of alcohol policies in Kenya, gender and tobacco use, the 2022 World Health Assembly disagreement over the use of gender and related terms, and the current anti-gender movement in the US.
The Commission and the report launch were timely as speakers detailed how well-funded international far right networks have supported a rollback in gender and queer rights across the world.
This political shift has incredibly significant consequences not only to funding of global health organisations and their scope: it also threatens to reverse decades of progress through reversing equal opportunity and reproductive rights legislation.
Prof Barbara Baird (Flinders University) outlined the fight for reproductive justice in SA as part of the SA Abortion Action Coalition which resulted in some of the most progressive policies on abortion rights and access in the world.
Baird argued that we cannot be complacent as recent anti-abortion campaigns have gained strength (and funding) from international movements.
Holley Skene, CEO of SHINE SA, recalled working at the interface of inclusive and equitable sexual and reproductive primary health care in South Australia.
Holley discussed the importance of gender and sexuality inclusive care for capturing people who do not find mainstream services accessible and safe, and how services which reinforce the gender binary exclude many members of our community.
Prof Fran Baum chaired a panel discussion about the report’s main findings. Panellists were Professor Megan Warin (University of Adelaide), Dr Jared Dmello, (University of Adelaide), Professor Sarah Hawkes (Monash University, Malaysia), Dr Connie Musolino (University of Adelaide), and Professor Sharon Friel (ANU). The panellists brought a gender justice lens to topics such as; fatness, epigenetics and mother blaming, especially for poorer and marginalised women.
They also covered the history of women’s health centres in Australia; the role of social movements, solidarity and coalition-building across sectors; how commercial actors can employ gender to sell health-depleting products, including the aggressive gender marketing of alcohol and tobacco to women in middle and lower income countries because they are a ‘growth’ market.
They also explained why the deletion of trans and gender diverse people from decades of data sets in the USA is such a concerning event, because not only will it directly impact services, it excludes gender from understandings about health and equity.
Launch delegates were urged to bring a gender justice lens to all our work, whether that be via gender-responsive health promotion, advocacy, surveillance and monitoring, service provision, or cross-sectoral partnerships.
Photo by Jo-Anna Robinson: Back row, from left: Professor Megan Warin, Professor Sharon Friel, Dr Jared Dmello, Dr Connie Musolino, Professor Barbara Baird, and Holley Skene.
Front row from left: Professor Emerita Raewyn Connell, Honourable Catherine Branson AC SC, Professor Sarah Hawkes, and Professor Fran Baum.
Dr Connie Musolino is a Research Fellow at the Stretton Health Equity, The University of Adelaide
Kristen Foley is a social scientist at the Centre for Public Health, Equity and Human Flourishing at Torrens University Australia
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