The covid-19 pandemic has underscored how gender responsive health systems are a crucial path forward, say Peter Baker, Ann Keeling, Arush Lal, Chadia Wannous, and Mahesh Puri

Covid-19 impacts men, women, and non-binary genders differently—and not equally. The virus is not gender blind, but evidence shows that over 80% of covid-19 health policies ignore gender, with serious consequences for everyone’s health and wellbeing. Globally, men compared to women experience a higher severity of illness and mortality from covid-19. The pandemic might therefore be perceived as a “men’s health emergency.” The reality, however, is far more complex.

Women may have lower mortality rates, but they bear the brunt of the major secondary impacts of the covid-19 pandemic, which  have worsened their already weaker social and economic status. The pandemic has led to increases in gender based violence, unwanted pregnancies, stillbirths, and maternal deaths. Anxiety and depression in women have risen, and more girls have been forced out of school and into child marriages. Women have more exposure to covid-19 in the workplace as they constitute 70% of health and social care workers globally, and have faced more challenges returning to work. People of non-binary genders have also experienced the negative effects of sex-specific covid-19 lockdown measures adopted by some countries, and have struggled to obtain appropriate sexual, reproductive, and mental healthcare.

But covid-19 must not become another battlefield in the so-called “gender war.” Positioning one gender or another as the “biggest victim” in a health emergency that affects everyone everywhere is divisive and obscures the fact that all aspects of men’s and women’s health and wellbeing are seriously affected, albeit in very different ways.

Until covid-19, researchers and advocates for men’s and women’s health have generally worked in separate silos. Women’s health advocates have often been cautious about working with men’s health advocates, arguing that political priority for the health of women and girls, particularly sexual and reproductive health and rights, is inadequate and fragile, and fearing that increased attention on men’s health would shift much needed priority and resources. Meanwhile, men’s health organisations, fewer in number, have struggled to carve out a niche in a gender field dominated by women’s health. 

Women’s health advocates have flagged barriers to women’s health driven by systemic gender inequality, gendered social norms, and social institutions led by and favouring men. Men’s health advocates, perceiving that their concerns are often overlooked, have emphasised that “gender” has been incorrectly seen as synonymous with “women.” Men’s health issues have often been marginalised because of a tendency to blame men for “recklessness” rather than acknowledge the role of male gender norms as a social determinant of health. Men’s health advocates have not, however, consistently challenged male power and privilege, nor endorsed calls for more women in global health leadership. Both “sides” have at times positioned men’s and women’s health interests in oppositional ways, rather than acknowledging that they are inextricably linked and mutually dependant. 

Covid-19 has challenged us to think and act differently. This pandemic has shown that not all men and women are equal in their health vulnerability or access to power. Men from groups marginalized by poverty, race, ethnicity, or class are not privileged in health decision making or access to care and may face higher illness severity and mortality. The same is true of women. Resilient health systems must be rooted in gender equity, with diversity and intersectionality as key entry points to reach the most vulnerable of any gender.

Bringing women’s and men’s health advocacy together

As organisations working for men’s and women’s health, we joined the Gender and COVID-19 Working Group to share resources, data, and solutions as the virus took hold. We have understood in a new way that our common interests lie in the development of a gender responsive health system that identifies and meets the health needs of all genders.

A call to action for a gendered, intersectional, and equitable approach to health

By understanding what led men’s and women’s health advocates to work separately in the past, while recognizing the advantages of working together in the future, we will get traction for advancing gender responsive health systems as a crucial path forward. We will therefore adopt a “twin track” approach, working on distinct men’s and women’s health agendas where appropriate, while collaborating on common issues where a gender responsive approach is most equitable and effective. We will strive to engage in an open dialogue on opportunities for active partnership.

We urge the global health community to adopt this genuinely holistic and intersectional approach to health, considering the unique needs of all genders as well as different, socially driven health needs. We also welcome feedback and collaboration to strengthen this approach toward gender responsive health systems.  

We highlight four areas for action:

• Define the features of a gender responsive health system that works equitably in an intersectional way to meet the needs of all genders, focusing on the most vulnerable.
• Build on the learning from covid-19 and previous pandemics to make gender responsive global health security central to future pandemic preparedness and response, while facilitating sustainable and resilient recovery.
• Address underrepresentation of women and people from the Global South in decision making for global health, health research, health systems, advocacy, and in health professions, and support a model of gender transformative leadership in global health, taking a rights based approach to addressing gendered health inequities. 
• Ensure governments meet commitments to disaggregate health data by sex, including access to care. This has not been done by most countries in general, and has undermined the response to covid-19 specifically. Beyond sex, data should be disaggregated by intersectional factors, including gender identity, sexual orientation, age, class, race, ethnicity, caste, indigenous groups, and disability, in order to develop policies and practices that identify and reach the most vulnerable.

The covid-19 pandemic has been a global shock to health, social, and economic systems—and it is far from over. But the crisis creates a new opportunity for men’s and women’s health organizations to come together with the shared goal of advancing gender responsive health systems and global health security. Only by recognizing a gendered and intersectional approach to health can we achieve a just and fair future with health for all.  

Peter Baker, director, Global Action on Men’s Health. Twitter @Globalmenhealth

Ann Keeling, senior policy fellow, Women in Global Health. Twitter @annvkeeling

Arush Lal, board vice chair, Women in Global Health; civil society representative, ACT Accelerator Health Systems Connector; MPhil/PhD candidate, Department of Health Policy, London School of Economics & Political Science. Twitter @Arush_Lal

Chadia Wannous, international health and development, health emergency, and risk reduction expert, and vice president, Women in Global Health, Sweden chapter. Twitter @ChadiaWannous

Mahesh Puri, co-director, Center for Research on Environment Health & Population Activities (CREHPA), Lalitpur, Nepal.

Competing interests: none declared.

Acknowledgement: With thanks to the following people for their contributions: Jeanette H Magnus, director, Centre for Global Health, Faculty of Medicine, University of Oslo, Norway; Ingeborg K Haavardsson, chapter lead, Women in Global Health Norway, and managing director, Centre for Global Health, University of Oslo; Roopa Dhatt, co-founder and executive director, Women in Global Health; Mwende S Muya, chapter development manager, Women in Global Health; Margaret E Greene, senior fellow, Promundo-US, and executive director, GreeneWorks; Amon Ashaba Mwiine, lecturer, School of Women and Gender Studies, Makerere University, Uganda.

Disclaimer: In an attempt to use terminology that is accessible and widely understood, we use terms including “women,” “men,” “female,” “male,” “nonbinary,” and LGBTQI when discussing gender, sex, and intersectionality. We recognise, however, that there is no terminology (including that which we use here) that accurately captures, across context, constructions of gender, sex, and sexuality, without imposing particular histories, ontologies and epistemologies onto subjects who may use different concepts and language in their own understandings and self-identifications.