Global women’s health issues: sex and gender matter

Empowering women improves both productivity and health outcomes

Although the terms “sex” and “gender” are commonly used as synonyms, they refer to two distinct concepts. Sex refers to the biological differences between men and women, whereas gender refers to socially defined roles, behaviours and expectations. Being clear about the distinction between the two terms is important, as the contribution to women’s health of sex and gender are likely to be different, and therefore also our solutions for reducing disparities. Sex differences are increasingly recognised as being important for conditions such as cardiovascular disease,1 for example, and while physiological differences in coronary vasculature can contribute to different presentations and manifestations of disease, gender influences health behaviours, risks, and access to health services.2 We argue that taking gender into account, as well as sex, is critical to improving health outcomes.

Gender inequality keeps women poor, makes them more vulnerable to violence as well as to illness, and limits their access to education, health care, and social justice.2 Globally, women and girls are more susceptible to poverty, violence and disability.3 Regardless of their country of residence, Indigenous women across the world experience greater health disparities, and Aboriginal and Torres Islander women are at greater risk of accidents, murder, and intimate partner violence than other Australian women.4 Women are disproportionally affected by conflict, and those who are refugees also experience substantial difficulties and challenges in gaining access to health services, and they consequently have poorer health outcomes.5,6 In recent decades, several health indicators for women have improved, including maternal and child mortality,7 but much remains to be done to reduce health disparities. Women and girls are increasingly susceptible to HIV and AIDS in many countries, and there is a clear association between exposure to violence and infection. In sub-Saharan Africa, women aged 15–24 years are more likely to be HIV-positive than any other age–sex group, and they carry the greatest burden of the disease.8

Disparities are also evident across a range of other health problems, including preventable conditions such as cervical and breast cancer. As the world makes the epidemiological shift in the burden of disease from communicable to non-communicable diseases, the burden of disease in women will also increase.9

The Sustainable Development Goals (SDGs) of the United Nations provide us with stretch targets for improved health and wellbeing, and also require that fundamental social, political and economic factors which contribute to inequity and health disparities be targeted.10 These 17 SDGs and 169 specific targets focus our attention on the critical issues affecting global health and the wellbeing of our planet. Increasing the participation of women in decision-making positions, particularly of women from minority groups, is an important strategy for achieving gender equality (SDG 5). Striving to achieve the aims of the other SDGs without recognising the importance of gender and sex differences will limit the likelihood of success.3

Meeting the targets of the SDGs will require approaching women’s health from a socio-cultural perspective in which gender is assessed as a factor, shifting the focus from discussing only sex-based differences in women’s health. Viewing women’s health from a life course approach, identifying the importance of cultural, contextual and structural perspectives, as well as recognising transitions such as birth, girlhood, adolescence and ageing as periods of vulnerability is important.2 The higher life expectancy of women is frequently associated with poverty, disability and isolation, which necessitate additional health and social services.11,12 Achieving the SDGs will require structural transformations in local communities across the globe, and also in national and international governance. Ensuring that women have access to education is integral to maximising their participation in society and, as a consequence, their health.

Gender inequalities are often regarded as being restricted to low and middle income countries, but disparities are pervasive in all economies, including that of Australia.13 Gender-related violence is widespread globally, and there are more similarities than differences between countries in this regard, motivating global collaborations in potential solutions, such as e-health initiatives, allowing access to confidential resources.14,15 Developing integrated and coordinated strategies is needed to improve women’s health. The Australian Longitudinal Study on Women’s Health, a nationally representative sample of more than 40 000 women in three age cohorts, is generating valuable information that can help guide interventions in women’s health across their lifespan, and not just in Australia, but across the globe.16 This study highlights not only sex-based problems in women’s health, but also important gender-related factors that affect women’s health, such as social circumstances and health-seeking behaviours. It will be a valuable resource for health planning in the future, and will identify important gender-related factors that should be considered by health care policy, practice, education and research.

In July 2010, the General Assembly of the United Nations established UN Women, the United Nations Entity for Gender Equality and the Empowerment of Women. UN Women has successfully focused on problems specific to individual countries and cross-jurisdictional activities, as well as on global activities. Eliminating violence against women, and promoting economic empowerment, leadership and participation across the globe are crucial to improving health and achieving the SDGs of the UN. These structural problems are difficult to overcome, and gender inequities are evident even in Australia.

Developing and evaluating interventions that take both sex and gender into consideration will be important for achieving both the SDGs and the mission of UN Women. Strong, healthy women contribute to a just, cohesive and civil society. As health professionals, it is important that we consider the need for tailored and targeted strategies that meet the needs of women and girls. Just as importantly, we need social, political and economic systems that value women and ensure their maximal participation at all levels of governance and government.