If politicians have the will to address gender inequality in global healthcare provision they will reap huge financial awards, as well as moral and social victories, says the Rt Hon Helen Clark, former New Zealand PM and UN development programme administrator

As a former prime minister and former minister of health, I am fully aligned with the premise of this publication—namely that advancing health is a political choice. Heads of state and government can choose to prioritise the right to health, healthy environments and universal health coverage, heeding the evidence that investing in health is both the right thing to do and the smart thing to do.

The returns on such investments are incontrovertible. Every dollar invested in vaccines over a decade, for example, is estimated to return $44 in benefits.

Similarly, it is a political choice for government leaders to convene ministers and hold them accountable for implementing policies in their respective sectors to protect and promote health. It takes political courage to address the drivers of ill health—often in the face of powerful interests, whether they be commercial or cultural.

I commend the G20 for the wise and strategic choice of prominently positioning health in this year’s G20 Osaka agenda, articulated by Prime Minister Shinzo Abe as part of the human-centred future society, Society 5.0.

The gender lens

At their G20 summit, I urge leaders to make another wise and strategic choice: to embrace the opportunity to agree to grow their health investments exponentially by filtering them through a gender lens.

Investing in gender equality in the health sector means delivering not only more health for the funding provided, but also shaping a more just and inclusive future.

It is widely appreciated that gender equality in the workplace could add a further $28 trillion to the annual global gross domestic product by 2025. The G20 deserves recognition for embracing this evidence and committing to mainstream gender across its agenda, as does France, which holds the presidency of this year’s G7 summit to be hosted by President Emmanuel Macron in Biarritz.

What is less widely appreciated is that gender is among the most powerful determinants of health. Gender influences the distribution of power and privilege and defines roles considered appropriate for women and men respectively in societies. Gender norms shape health outcomes through differential exposure to health risks, health-seeking and health-harming personal behaviour, and the gendered provision of health services.

We see the dramatic influence of gender norms on the high rates of smoking, alcohol consumption and early death among men. We see the pernicious impact of gender inequality experienced by the hundreds of millions of women and girls who are unable to protect their own health. We also see it reflected in rising numbers of adolescent pregnancies, disproportionately high rates of HIV among young women and endemic gender-based violence.

Delivering sustainable impact

Global health organisations—which include the international development organisations of some G20 countries—are meant to guide the global response to such challenges of health inequity. Global organisations too can make the political choice to commit to gender equality and apply a gender lens to health. But, too often, organisations opt to remain blind to gender. A narrow focus on the health of women and girls, without confronting systemic issues of power, will not deliver sustainable impact. A health response that does not address the drivers of disproportionately high rates of ill health among men will not deliver healthy societies. 

Equality Works, the recent report published by Global Health 50/50, reveals the extent of gender blindness in global health. It looks at the gender-related policies and practices of 200 global organisations active in health from a range of sectors. Although stated commitments to gender equality have increased over the past year since GH5050 issued its inaugural report—from 50% to 75% of organisations sampled—far fewer define gender in a way that is consistent with global norms (33%).

Approximately 60% of organisations mention gender in their strategy documents. Seventy-seven organisations (41%) focus primarily on the health of women and girls, yet the majority of these organisations (61%) do not mention gender. Furthermore, fewer than half disaggregate their programme data by sex, which identifies where resources can deliver the most effective and equitable returns in improving people’s health. 

I encourage the G20 and the G7 to bring together the Sustainable Development Goals on gender (SDG 5), health (SDG 3) and strong institutions (SDG 16) during their discussions in Osaka and Biarritz, and beyond at the United Nations High Level Meeting in September.

Even more importantly, leaders should take those discussions home and commit to mainstream gender across domestic health programmes; to apply a gender lens in G20 and G7 development cooperation policies and programmes, including but not limited to the health sector; and to use the findings of the GH5050 report to encourage global health organisations to be more gender-responsive so as to reap the gender and health dividend that the Sustainable Development Goals promise.

First published in Health: A Political Choice, an official Global Governance Project publication, edited by John Kirton and Ilona Kickbusch. Read your copy here www.bit.ly/2019UHC

Helen Clark is patron of the Helen Clark Foundation, and a member of the Advisory Council, Global Health 50/50. She served as the 37th prime minister of New Zealand from 1999 to 2008, and was the administrator of the United Nations Development Programme from 2009 to 2017.