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Efforts to promote gender justice in global health have been obstructed by powerful political, economic and ideological interests, according a paper released this month by the journal The Lancet. The report, by the Lancet Commission on gender and global health, warned that without urgent reforms to make health systems more equitable and inclusive, the world will remain far from achieving gender equality or health equity for all.
The Commission, composed of academics, health professionals and civil society leaders from around the world, described gender justice as essential for improving health outcomes and reducing inequities across populations. It defined gender justice as the realisation of universal rights in health and gender equality, while addressing the structural forces — such as patriarchy, colonialism and capitalism — that perpetuate discrimination.
Despite its potential to benefit everyone, the concept of gender has become a point of international dispute. The report noted that gender-related terminology and policies are increasingly contested in national and global health forums. Anti-gender movements — often backed by religious or conservative organisations — have actively undermined inclusive policies, framing gender justice as a threat to cultural values or national sovereignty.
“Gender is weaponised, manipulated, and instrumentalised in ways that impact health outcomes and the distribution thereof,” the Commission said, adding that it was being misrepresented as an imperialist agenda and stripped of its central role in health equity. “Framing anti-genderactivities as anti-imperial, anti-colonial, and as a form of resistance to global elites further unites many movements across the globe,” it stated.
It also warned of corporate actors exploiting gender norms to promote harmful products like tobacco and alcohol, contributing to poor health outcomes.
The report highlighted how gendered power dynamics are embedded across all levels of the health sector, from workforce structures to data systems. Women make up the majority of the global health workforce but remain underrepresented in leadership roles and there are large gender pay gaps across most regions.
The Commission called for clear definitions and accurate use of sex and gender in research and policy, stressing that these are distinct concepts with different implications for health. It also urged stakeholders to adopt gender-responsive policies across all areas of health, from clinical care to workforce planning and regulation.
Critically, the authors found that gender is often treated narrowly as an issue concerning women and girls, ignoring how it affects men, boys, transgender and non-binary people. They advocated for a more relational and inclusive understanding of gender as a structure that impacts everyone’s health and wellbeing.
These tensions are not confined to the health sector. In the UK, more than a thousand people marched through Cardiff city centre this weekend to protest a ruling by the Supreme Court that defined “woman” and “sex” in the Equality Act 2010 as referring to biological sex only. The judges maintained that the ruling does not remove protections for transgender people, but campaigners at the trans liberation march described it as a dangerous step backwards for gender equality and legal recognition.
To push back against growing resistance to gender equality, the Commission urged greater investment in gender justice, stronger accountability for decision-makers and the integration of gender analysis in health surveillance, programme design and funding decisions.
The world is not on track to meet the Sustainable Development Goals for health and gender equality, the report stated. But implementing the Commission’s recommendations could lead to a “gender-justice dividend” — not just better outcomes for marginalised groups, but measurable health benefits for all.