An Elusive Goal? Gender Equity and Gender Equality in Health Policy

Abstract

Variations in the health of men and women are well known: men have poorer life expectancy than women in virtually every country, and there are differences between women and men in patterns of morbidity across the life course. These variations reflect both biology and gender, and health systems play a part through the services they offer.

In recent years a number of national governments and international bodies have paid increasing attention to gender inequalities, and gender mainstreaming has been adopted by as a key policy objective at various levels of governance.

While gender mainstreaming has resulted in some successes, analysis of the depth of change suggests a less optimistic view, reflecting the persistence of barriers to gender mainstreaming in health, which include a lack of resources, uncertainty over the goals of gender mainstreaming, and notional rather than genuine adoption of gender mainstreaming principles. Underlying these barriers however, is the use of bureaucratic and systems-based approaches to gender mainstreaming.

The failure to challenge underlying gender relations of power allows gender strategies to become technocratic exercises which achieve results in terms of the boxes ticked, but not in relation to what matters: the health and health opportunities of both women and men.

Zusammenfassung

Gesundheitliche Unterschiede zwischen Männern und Frauen sind bekannt: Männer haben insgesamt eine geringere Lebenserwartung als Frauen und es gibt Unterschiede zwischen den Geschlechtern in der Morbidität im Lebensverlauf. Hierin spiegeln sich bioloigsche und sozial-kulturelle Geschlechteraspekte wie auch Einflüsse des Gesundheitssystems wider.

In den letzten Jahren haben zahlreiche nationale Regierungen und internationale Organisationen Geschlechterungleichheiten erhöhte Aufmerksamkeit gewidmet und Gender Mainstreaming wurde auf verschiedenen Ebenen als Schlüsselpolitik entwickelt.

Während Gender Mainstreaming in einigen Erfolgen mündete, legen tiefergehende Analysen der erreichten Veränderungen eine weniger optimistische Sicht nahe. Die empirischen Ergebnisse weisen auf die „Hartnäckigkeit“ der Barrieren für die Implementation von Gender Mainstreaming hin. Diese schließen ein Fehlen von Ressourcen, die Unsicherheit über die Ziele von Gender Mainstreaming und die mehr theoretische statt praktische Anwendung von Gender Mainstreaming-Prinzipien ein. Das grundlegende Problem liegt in den bürokratischen und systembasierten Herangehensweisen des Gender Mainstreaming. Damit können die ungleichen geschlechterbezogenen Machtverhältnisse und die männlich dominierten Strukturen der Einflussnahme nicht infrage gestellt werden.

Obgleich verschiedene Strategien Geschlechtergleichheit zu erreichen entwickelt wurden, bestehen weiterhin zahlreiche Barrieren und der Fortschritt ist national wie in internationalen Organisationen langsam. Viel bedeutender als Ressourcenprobleme ist dabei das Unvermögen, durch diese Maßnahmen die grundlegenden Machtverhältnisse zwischen den Geschlechtern infrage zu stellen. Dies führt dazu, dass Strategien zum Erreichen von Geschlechtergleichheit zu technokratischen Übungen werden, die Ergebnisse in Ankreuzfeldern produzieren statt Tatsachen in Bezug auf die Gesundheit und die Gesundheitschancen von Frauen und Männern.

Key words

gender equity - gender equality - gender differences - gender mainstreaming - health policy

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