Looking for Life, Destroying Life: The case for gender equality in global health

Healthcare systems are complicated, fragmented and difficult to navigate. There is no perfect delivery system, and countries around the world have explored many possibilities: single-payer, market and socialized. After spending my entire undergraduate career so far studying healthcare, I, too, do not have a solution to the disaster that is healthcare delivery. But I sincerely believe that there are novel approaches that can be taken to improve healthcare overall that have nothing to do with doctors, hospitals or health insurance. Gender equality, for example, has been shown to be positively correlated with better health outcomes.

Kerala, India is a southwestern coastal state of about 33 million people. As an Indian myself, I have heard my parents speak of the area. I know it was relatively impoverished, however, after much development, the state currently boasts health outcomes that are on-par with high-income countries. It is no coincidence that these health metrics are accompanied by high levels of female empowerment and free family planning services, which include education on breastfeeding, nutrition, immunization for children, prenatal care and more.

In fact, the entirety of India has battled with overt sexism for years. Female infanticide is commonplace, and as a result, India has a sex ratio skewed towards men. Kerala is the only state with a gender ratio that is favorable to women. Additionally, the state has a matrilineal form of inheritance, which means that all wealth and property is passed through the female lineage.Also, much of the economy in Kerala is rooted in agriculture, and women take up a larger portion of the state's workforce than elsewhere in India. The social norms are different there. As a result, people are healthier and more educated (India’s overall literacy rate of 65% pales in comparison to Kerala’s 92%). Now coined as the “Kerala Model of Development,” it is evident that even countries with broken healthcare delivery systems can in fact achieve positive health outcomes by engaging women in the community.

In public health, we heed attention to social determinants of health (SDH). SDH are the conditions in which humans work, live and play. They have enormous impacts on the health of individuals. Examples of these determinants include race, access to healthcare, health behaviors (e.g. smoking, exercising) and, of course, gender. Gender plays a consequential role in health outcomes. I bring up this point to emphasize that being a woman can quite literally define whether or not you will be healthy. And it’s all related! Healthy women mean healthier populations because focusing on reproductive health yields fewer overall birth complications.

Gender equality should be incorporated into all public health decision-making. And, until we do this, we will not be able to achieve what Kerala has already done. A paper published in Health Promotion International actually shows that “health promotion policies that take women's and men's differential biological and social vulnerability to health risks and the unequal power relationships between the sexes into account are more likely to be successful and effective.”