key: cord-0747476-53igktw4 authors: Hawkes, Sarah; Allotey, Pascale; Elhadj, As Sy; Clark, Jocalyn; Horton, Richard title: The Lancet Commission on Gender and Global Health date: 2020-08-04 journal: Lancet DOI: 10.1016/s0140-6736(20)31547-6 sha: 5efd96836bded32959dde580688e9907c97dfb74 doc_id: 747476 cord_uid: 53igktw4 nan Gender inequalities drive inequities in health and well being. From determining our chance of being born 1 to the predominantly maleled delivery of our funerals, 2,3 gender interacts with, and frequently amplifies, other inequalities such as race or poverty in shaping our entire life experience. The global goal of equality on the basis of gender is an integral part of other global struggles for inclusive, rightsbased, respectful, equitable systems, structures, and communities. Gender is a social construction-influencing, and in turn influenced by, the distribution of power and resources, divisions of work and labour, distinctions between production and reproduction, and expec tations and opportunities available to all people in all societies. 4 Gender intersects with other social factors to drive health inequities. 5 This is evident in the COVID19 pandemic in which severity of illness and death rates are higher in men than in women but women face heightened vulnerabilities because they form the bulk of frontline health and care workers, and bear the greatest burden of domestic violence, household and childcare responsibilities, mental health, and economic impacts of the pandemic. 6 Gender is embedded within and across organisations, systemic structures, and institutional norms, including in science, medicine, and health. 7 Deepseated gender biases were documented in The Lancet's 2019 theme issue on advancing women in science, medicine, and global health, #LancetWomen, 8 which explain, for example, the persistent imbalance between the 70% of health workers who are female and the 70% of health care leadership who are male. 9 Gender is a crosscutting issue with an impact on the health and careers of women, men, transgender people, and people with non binary identities everywhere. The global health system has been aware of the relation between gender and health for decades, and scholarship in the area is widespread. In the 2019 Lancet Series on gender equality, norms, and health, the role of norms as a bridge to improved equity and health was highlighted. 10 By taking a gender lens to sexual and reproductive health and rights, policies and programmes are likely to have a greater impact than those that remain "genderblind". 11 And evidence shows that intersectional approaches in global health can uncover the interlocking disadvantages for people of different ethnicities, and for groups that vary on the basis of abilities, sexuality, class, and geography, among other social stratifiers, in addition to gender. 5 Despite this body of knowledge, however, con sideration of gender in global health is neglected. Gender is everywhere in global health discourse and promises, but nowhere in action or accountability plans. As Clark and Horton wrote: "Gender now runs the risk of being treated like motherhood and apple pie-a common good no one would disparage, but neutered of its radical political nature. 12 Or, as Geeta Rao Gupta and colleagues have argued, gender is "everyone's problem but no one's responsibility". 13 This represents a massive missed opportunity. The world's community is not on track to meet the Sustainable Development Goals (SDGs) for health or for gender equality. 14 COVID19 could widen the gaps. Now is the time to leverage the benefit of addressing gender and global health targets simultaneously. The underlying cultural, social, political, legal, and economic drivers that create disadvantage are not immutable. With this in mind and building on the journal's past commitments to gender equity, The Lancet announces a new Commission on Gender and Global Health. This Commission has been set up with the explicit and uncompromising aim to move beyond the evidence to catalyse action. For change to happen, academic evidence is necessary but insufficient: the world does not need another report on the evidence and extent of a socalled gender problem in health. The Commission was borne of a collective and strategic understanding of the need to mobilise individuals and institutions to redress imbalances in the gender-health relationship, producing a politically informed, globally relevant, and intersectional feminist strategy for structural change in global health. The Commission is cochaired by three of us (SH, PA, ASE) along with 25 other independent Commissioners (appendix) who bring a wide range of expertise and experience-from people working with community health groups to those working on the global governance of the corporate determinants of health, through to human rights scholars and practitioners-and representing a range of global health topics and disciplines, geographies, and genders. The Commission will privilege a diversity of voices and scholarship. We plan to establish a programme of public engagement, seeking dialogue across a range of views and voices to understand the complexity of defining and addressing gender, intersectionality, and health. We are grateful for seed funding from the Wellcome Trust, The Ford Foundation, the United Nations University-International Institute for Global Health, and University College London. We plan to have our first Commissioners' meeting in late 2020, and a 2year timeframe for the Commission's work. The gender-health relationship is complicated and multidimensional, but with 10 years left in the SDG agenda and as the world begins to exit from the pro found disruption of COVID19, now is the right time to unpick the complexity and identify solutions for gender responsive change within systems and sectors. The change needed to reach a goal of gender equality and health equity is substantial, structural, and systemwide, and the voices demanding this change have never been louder. The Lancet Commission on Gender and Global Health aims to contribute to that change and deliver on the action agenda on gender and health. United Nations University-International Institute for Global Health ASE); and The Lancet Why is son preference so persistent in East and South Asia? A crosscountry study of China, India and the Republic of Korea Death and bereavement across cultures Redoing gender: how women in the funeral industry use essentialism for equality The state, gender, and sexual politics Gender and health: relational, intersectional, and biosocial approaches COVID19: the gendered impacts of the outbreak The Oxford handbook of global health politics Feminism is for everybody Global Health 50/50. Global Health 50/50 annual report 2020: power, privilege and priorities Disrupting gender norms in health systems: making the case for change Questioning gender norms with men to improve health outcomes: evidence of impact A coming of age for gender in global health Gender equality and gender norms: framing the opportunities for health The Sustainable Development Goals Report