journal of men's health
Volume 5, Issue 3 , Pages 189-191, September 2008

Mainstreaming men into gender sensitive health policies

Gender Equality Unit, Ministry of Social Affairs and Health, Finland

Article Outline

 

Finland was the president of the European Union during the second part of 2006. At the time, one of the Finnish national priorities in gender equality policy was that ‘gender equality issues would also be assessed from the male viewpoint’. As part of the presidency program, Finland organized an expert conference entitled ‘Men and Gender Equality. Towards Proggressive Policies’ [1], which included a session on gender mainstreaming in health policies. This editorial draws from discussions and presentations in that session, but also goes beyond them.

Our analysis before the session was that gender differences in health and wellbeing have not been at the forefront of gender equality policies. The aim of the session was to discuss ways of strengthening the gender perspective in health policies and practices as well as the relation of health and gender equality policy. ‘Women's health’ or ‘men's health’ can be seen as being located somewhere in between or at the margins of these two policy areas.

It is safe to say that both the importance of health in gender equality policy and that of gender in health policy have now been recognized – at a general level. For example, the Roadmap for Equality between Women and Men 2006–2010, which outlines EU action in gender equality, calls for the recognition of the gender dimension in health, although only as a part of one out of six priority areas [2]. Both the EU Health Strategy for 2008–2013 [3] and the Health Programme 2008–2013 [4] mention the importance of integrating the gender dimension within them.

At a very basic strategic level everything seems to be in order. Those working with gender equality just need to also think about health and those dealing with health need only to integrate the gender perspective into their work. But how does this interconnection work in practice? Which sector will do the work that will deliver the actual results? I believe that the health sector has better possibilities for making changes that can have effects on real flesh-and-blood men and women, as it is directly connected to relevant legislation, institutions, training of professionals etc. From gender equality policy we can expect to receive useful strategies, methods and tools.

Gender equality policy is horizontal in its nature: it is related to all policy spheres, of which health is just one. Because it is impossible to harness the deep expertise of every policy field within those institutions that are responsible for gender equality, the strategy of gender mainstreaming has been invented. Its impact for gender equality policy has increased, especially after the adoption, in 1995, of the Beijing Platform for Action [5], which is perhaps the single most important policy document in gender equality policy globally. Gender mainstreaming refers to the idea of integrating the gender perspective into all processes in all areas, by the actors normally involved in them. It is a tool or approach that has been in development in various organizations with varying levels of success for more or less a decade now. It seems that the goal of integrating the gender perspective into health can be translated one level down the ladder of abstraction into using the tool of gender mainstreaming in health policies.

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Men's health and gender mainstreaming 

The observant reader will notice at this point, that I have used the term ‘men's health’ only twice in this editorial, whereas gender mainstreaming has already been mentioned several times. This is deliberate and comes from the belief that a very good strategy for promoting men's health is to integrate it into the gender mainstreaming effort. There are three basic arguments for this. First, within the context of gender equality policy, there are some reservations about tackling problems pertaining to men. This is shown, for example, in the UN and EU agreed conclusions on men and gender equality, which both stress the notion that participation of men must be consistent with the empowerment of women, and that resources for gender equality initiatives for men should not compromise similar resources for women [6], [7]. This means that integrating men within the umbrella of gender runs a lesser risk of seeming to threaten these resolutions, and the sentiments behind them, and simultaneously increases the potential allies for those who work for men's health.

The second reason concerns the fact that gender mainstreaming is a process that has already been going on for some time and is part of the accepted language. For example, the World Health Organization (WHO) has prepared a strategy for integrating gender analysis and actions in its work [8] and it also has a department of gender, women and health (the name of the department points to one of the risks of the gender mainstreaming strategy: sometimes ‘gender’ is interpreted to only refer to women and consequently men's gender-specific needs receive insufficient attention). The use of existing tools as well as reference to already accepted documents reduces the need to reinvent the wheel and struggle to legitimize work for improving men's health.

Third, there are some disadvantages to looking at men's health and looking at women's health as separate issues. One of the problems is losing sight of the interconnections: the effects of men's health behavior and situations on the health of women, and vice versa. A recent report by the WHO evaluating intervention program that work with men and boys asked: ‘how can programmes take a more relational perspective, integrating efforts to engage men and boys with efforts to empower women and girls?’ [9] Perhaps the most intuitive example of these interconnections comes from the area of sexual health. Sexually responsible action reduces the partners’ risk of contracting a venereal disease. Thus, it is not effective, for example, to only address women about the issue. Too little gender-sensitive work focuses on both genders simultaneously; usually it is either women or men. The inherent logic behind gender mainstreaming, looking at both women and men, will hopefully moderate this challenge over time.

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The next step: from sex-disaggregated data to policy change 

In the expert conference session [1] it was agreed that the level of progress in integrating the gender perspective in health policies is still relatively limited. It seems, however, that the overall problem of unjustified gender differences has been identified and also acknowledged. Alan White showed very convincingly how men's health is not driven solely by their biology, and that lifestyle is implicated in the majority of health conditions in men (see [10]). In the conference, Marita Sihto summarized the current situation as follows:

[T]here is a gap between gender health and the policies, strategies and action plans on how to tackle these differences. It is common that when […] relevant evidence-based data exists, there is still a long way to go to develop strategies and action plans and implement gender-related policies.

My own experiences in working for gender mainstreaming with the Finnish health policy sector support this observation. The situation concerning the data and indicators has improved and they are now usually routinely available in a sex-disaggregated form. What is lacking is the next step. A discussion about what explains gender differences in health and what to do with them is often very limited or missing altogether in key policy documents.

Policy documents draw their analysis and understanding of the overall situation especially from research. In order to take the next step from sex-disaggregated data towards policies that reduce the imbalances shown by the data, a new kind of research is needed. That is, research on the impact of gendered norms and expectations on lifestyle and health behaviors. Lifestyle is a vital determinant of health and gendered norms affect lifestyle decisions. Therefore, research with a social sciences and behavioral approach to gender and health is especially needed. It would also be useful to include this kind of research more strongly in the organizational structure (i.e. departments, units, teams) of the institutions supplying the policymakers with data and analysis.

Some relevant theoretical perspectives for research can be drawn, for example, from the research field of men and masculinities. The current consensus there is that masculinities (yes, a plural) are best understood as historical and contextual, instead of a single monolithic, set of rules for all men. This means that there is room for change. Also, it would be crucial to investigate the intersectionality of masculinities with other important social categories, such as class [11]. Research on gender and health behavior could then be used in actual programs aiming for change. Indeed, the WHO's report mentioned earlier states that ‘Programmes with men and boys that include deliberate discussions of gender and masculinity and clear efforts to transform such gender norms seemed to be more effective than programmes that merely acknowledge or mention gender norms and roles.’ [9]

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References 

  1. Varanka J, Närhinen A, Siukola R, editors. Men and Gender Equality. Towards Progressive Policies. Conference proceedings: 2006 Oct 5–6, Helsinki, Finland. Helsinki: Ministry of Social Affairs and Health; 2006.
  2. Commission of the European Communities . A Roadmap for Equality between Women and Men 2006–2010. COM (2006) 92. Brussels: COM; 2006;Available at: http://europa.eu/scadplus/leg/en/cha/c10404.htm
  3. Commission of the European Communities . White Paper. Together for Health: A Strategic Approach for the EU 2008–2013. COM (2007) 630. Brussels: COM; 2007;Available at: http://europa.eu/scadplus/leg/en/cha/c11579.htm
  4. European Parliament and European Council. Establishing a second programme of Community action in the field of health (2008–13). Decision No 1350/2007/EC of the European Parliament and of the Council. Official Journal of the European Union, Publ. No. L 301/3 (October 23, 2007). Available at: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2007:301:0003:0013:EN:PDF.
  5. United Nations . Department of Public Information. Beijing Declaration and Platform for Action: Fourth World Conference on Women, Beijing China. New York: United Nations; 1996;Available at: http://www.unesco.org/education/information/nfsunesco/pdf/BEIJIN_E.PDF
  6. United Nations . Commission on the Status of Women. Forty-eighth session; 2004 Mar 1–12. The role of men and boys in achieving gender equality. Agreed conclusions. New York: United Nations, Division for the Advancement of Women; 2004;Available at: http://www.un.org/womenwatch/daw/csw/csw48/ac-men-auv.pdf
  7. Council of the European Union. 2767th Employment, Social Policy, Health and Consumer Affairs Council meeting, Brussels 30 Nov and 1 Dec 2006. Council Conclusions on men and gender equality. Brussels, Belgium: Council of the European Union. Available at: http://www.eu2006.fi/news_and_documents/conclusions/vko48/en_GB/1164987131570/_files/76348606395122256/default/91959.pdf.
  8. World Health Organization . Strategy for integrating gender analysis and actions into the work of WHO. Geneva: World Health Organization; 2007;Available at: http://www.euro.who.int/document/gem/final_strat_sep07.pdf
  9. Barker G, Ricardo C, Nascimento M. Engaging men and boys in changing gender-based inequity in health: evidence from programme interventions. Geneva: World Health Organization; 2007;Available at: http://www.who.int/gender/documents/Engaging_men_boys.pdf
  10. White A, Holmes M. Patterns of mortality across 44 countries among men and women aged 15–44 years. jmhg. 2006;3(4):139–151
  11. In:  Kimmel MS,  Hearn J,  Connell RW editor. Handbook of Studies on Men and Masculinities. London: Sage; 2005;

PII: S1875-6867(08)00151-6

doi:10.1016/j.jomh.2008.07.004

journal of men's health
Volume 5, Issue 3 , Pages 189-191, September 2008

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