Health equity isn't just about medicine—it's a matter of social justice.
The World Health Organization reports that deep-seated gender biases in health research and policy institutions combine with a lack of well-articulated evidence to downgrade the importance of gender perspectives in health. This means that unless public health changes direction, it cannot effectively address the needs of those who are most marginalized—many of whom are women 1 .
This article explores how the groundbreaking work "Engendering International Health: The Challenge of Equity," edited by Gita Sen, Asha George, and Piroska Östlin, provides a powerful framework for understanding and addressing these critical disparities.
Health equity is defined as the state in which everyone can attain their full potential for health and well-being. It is not merely the absence of disease, but the absence of unfair, avoidable, or remediable differences among groups of people 2 . Our health is determined less by our genetic code and more by the conditions in which we are born, grow, live, work, and age—what health experts call the social determinants of health 3 .
"Where we are born, grow, live, work and age, and our access to power, money and resources influence our health outcomes more than genetic influences or healthcare," states a WHO World Report on Social Determinants of Health Equity 3 .
These determinants include factors like access to quality education, safe housing, and meaningful employment opportunities. They are shaped by political, legal, and economic systems that distribute power and resources unevenly, often along gender, racial, and class lines 2 3 . For example, discrimination embedded in institutional processes can lead to groups being underrepresented in decision-making or underserved by health systems 2 .
| Social Determinant | Privileged Scenario | Marginalized Scenario | Health Impact |
|---|---|---|---|
| Education | Higher education access | Limited or no schooling | Impacts health literacy & access to health information |
| Income & Employment | Stable, living-wage job | Unstable, low-wage work without benefits | Determines ability to afford healthcare & nutritious food |
| Geographic Location | Urban area with multiple health facilities | Rural or remote area with limited services | Affects access to preventative care and emergency services |
| Gender Norms | Equal decision-making power | Limited autonomy over body and resources | Influences access to sexual/reproductive healthcare |
| Social Discrimination | Member of dominant social group | Faces racism, sexism, or other structural discrimination | Leads to chronic stress and barriers to care |
"Engendering International Health" argues that the conventional, biology-only approach to health is dangerously incomplete. The book's central premise is that gender biases in health research and policy combine to downgrade the importance of gender perspectives, preventing public health from effectively addressing the needs of the most marginalized 1 .
This is not just about women's reproductive health. It's about how gender roles and power dynamics influence every aspect of health for people of all genders.
The book provides evidence from both low- and high-income countries, showing that a gender analysis is essential for effective health policy 1 .
As one review noted, the essays describe how research and policy have historically taken a "one-size-fits-all" approach, failing to address the different needs and challenges of women's health vis-à-vis that of men 9 . This lack of attention has had dire consequences for the efficacy and equity of health programs worldwide.
While not a single laboratory experiment, the creation of "Engendering International Health" itself serves as a crucial case study in how to conduct a comprehensive, gender-sensitive analysis of global health inequities.
The work deliberately moves beyond a narrow focus on biological sex differences. It examines how gender intersects with other social determinants like class, race, and geography to compound disadvantage 1 .
The research presents evidence from both low- and high-income countries, rejecting the notion that health equity is only a concern for the developing world 1 .
The book analyzes how health research and policy institutions themselves often reinforce gender biases through their structures and priorities 1 .
Going beyond criticism, the work details concrete approaches and agendas for incorporating gender and equity analysis into the heart of international health policy debates 1 .
The analysis revealed that health inequities are not natural or accidental; they are the result of how society allocates resources and opportunities, reinforced by political choices 3 . The findings demonstrate that:
Women of working age lack equal economic opportunities due to structural discrimination 3
Inequities are worsening in many contexts with income inequality nearly doubling 3
Gender biases in health systems make services inaccessible to many
"[This book] will be helpful for researchers, policymakers, and activists interested in designing policies and strategies to reduce inequities and promote women's health and rights."
Since the publication of "Engendering International Health," the field has continued to evolve. A 2025 bibliometric study analyzing thousands of health equity publications revealed how research trends have shifted, particularly after the COVID-19 pandemic 8 .
The study also identified Artificial Intelligence (AI), racial disparity, and machine learning as the most prominent emerging topics in health equity research, pointing to significant future opportunities, particularly in low- and middle-income countries 8 .
Tackling health inequity requires a diverse set of conceptual and analytical tools. The following "toolkit" outlines key resources and methods used by researchers and policymakers in this field.
To make health inequalities visible by breaking down data by sex, income, education, ethnicity, etc.
Example: Monitoring differences in maternal mortality rates between racial groups to target interventions 2 .
To systematically examine how gender roles and power relations affect health policies and outcomes.
Example: Used to redesign a health program to ensure it is accessible and acceptable to women, men, and gender minorities.
An economic method to assess how health interventions affect different social groups, focusing on equity impacts.
Example: Evaluating whether a new vaccination program reduces or widens health gaps between rich and poor communities 6 .
A global network to strengthen capacity, generate evidence, and develop best practices for monitoring health inequalities.
Example: Provides standardized tools and resources to help countries track and respond to growing health gaps 7 .
The evidence is clear: achieving health for all requires a deliberate focus on equity. As outlined by the WHO and supported by the work of Sen, George, and Östlin, this involves evidence-informed action on multiple fronts 2 3 :
This includes pooling financial resources to enhance redistributive capacity and striving for Universal Health Coverage (UHC) to protect people from financial hardship 2 .
Actively address the root causes of inequity, such as sexism, racism, ageism, and ablism, through legislation, policy, and changes in social norms 2 .
Governments must use progressive taxation to fund universal public services like education, social protection, and health 3 .
Ensure that women and other underrepresented groups are in leadership positions and decision-making processes at all levels 2 .
The challenge is immense, but the path forward is known. As the editors of "Engendering International Health" have compellingly argued, integrating a rigorous gender and equity analysis into the heart of health research and policy is not an optional add-on—it is the cornerstone of creating a truly healthy global society 1 .