Abstract
Introduction
As described in the literature, multiple complex factors contribute to women and men health inequalities (social status, education, sanitary needs, etc.). Though sex and gender are well-known determinants of health, they are rarely considered as parameters to improve population health.
Policy context and objective
The interplay between sex, gender and other related factors are rarely considered by health operators and even more seldom incorporated in health policy. The French National Authority for Health (HAS) analyzed the last 5 years of public health legislation in France, along with other related topics (norms, data, clinical trials, guidelines, and professional practices), using a gender mainstreaming approach. The purpose is to raise awareness on the importance of biological and gender identity – whether assigned or chosen – and encourage all stakeholders (including users) to integrate sex and gender in all areas of health research, policy, and practice through national capacity building.
This work is not specific to a specific sex or gender population, as rigid binary assumptions are not considered suitable. Thus, the targeted population includes women and men, but also intersex and transgender people of all ages.
Highlights
The analysis showed that health and welfare systems in France, along with its operators, tend to reproduce stereotypical habits and patterns of discrimination. Sex and gender-inclusive healthcare is found lacking at one end of the spectrum, with excessive targeting at the other. Typically, policies focus on female reproductive capacities, with little attention given to the increased mortality rate known in the male population. Differences for intersex and transgender people are misunderstood making their consideration incomplete to non-existent. Further, a lack of patient understanding of gendered attitudes and behaviors only compounds the problem.
The analytical report proposes 10 recommendations aimed to reshape health policy conception, implementation, and evaluation. Institutional actors are invited to co-construct initiatives in partnership with the associative world; and evaluations should investigate whether such initiatives are resulting in targeted goals, and not creating – nor further widening – existing inequalities.
The report encourages the design of public health instruments that are sex- and gender-inclusive in areas such as:
- Epidemiological and sociological data collection and use
- Administrative norms
- Clinical trial design
- Professional education
- Methodological and best practice guidelines
In addition to the recommendations outlined in the report, the HAS is committed to playing a proactive role in working towards sex and gender equality within its scope of action. The report thereby includes 8 institutional strategic engagements geared to towards this objective.
Transferability
The report includes examples of comparative data on international health policies and outcomes as a mean to positively influence debate and progress at the national level in France. As seen in the literature, no country has fully attained sex and gender health equality.
Conclusions
This report calls for action to raise awareness on making health and welfare systems more gender equitable, inclusive, and fair. Building health policies that are more inclusive in its global design and more targeted in its implementation requires the involvement of all stakeholders.