Copyright Lancet Ltd. Nov 18-Nov 24, 2006The strong links between health and development have been increasingly articulated by leaders in health policy and economic development: investments in health systems help to reduce poverty and promote sustainable development, while national development contributes to improved public health.1 The connection between health and development is clearly articulated in the Millennium Development Goals, which provide a global framework for current development efforts.
Gender-the social, cultural, and political constructs that prescribe feminine and masculine roles and which often lead to power imbalances between women and men2-also strongly affects health and development. Gender-related disadvantages, in addition to undermining human rights and social justice, contribute to poverty and poor health. Health policies and social systems that ensure women's equal access to information and services not only contribute to their wellbeing, but also affect economic growth and reduction of poverty by raising productivity, improving efficiency, and enabling the female half of the population to reach its full potential.3
Most developing countries are currently implementing complex processes to improve the efficiency, equity, and effectiveness of the health sector. Central elements of these reform programmes in the health sector include ensuring fairness, access, quality, and the social right to health protection.4 There is much debate, however, over the effect of health-sector reform on the most vulnerable segments of the population, particularly women.5
Gender imbalances contribute to women's and men's different positions as users and providers of health care.4 Women's needs as consumers of health care are often neglected. As providers of health care, women have a vital but often understated role in both the private and professional spheres. A disproportionate burden of informal health care in households and communities is provided by women. The hierarchical health workforce is also predominantly female, yet men continue to dominate positions of influence and power.4 Given the profoundly important roles of women as consumers and providers of health care in all developing countries, health-sector reform cannot succeed if it is gender blind.
Mexico is engaged in a dynamic process of health-system reform. The Seguro Popular health-insurance scheme addresses women's health problems, such as maternal mortality, HIV/AIDS, cervical and breast cancer, and gender violence.6 The programme has also responded to the problem of gender inequality by: increasing health-care coverage for poor women (especially female heads of households, who are enrolling at an accelerated rate); expanding the range of services offered; broadening the definition of family so that more female family members are eligible; and increasing attention to community health promotion and disease prevention (Aurora del Rio Zolezzi, National Program for Women and Health, Mexico City, personal communication).
Along with Seguro Popular, the current administration in Mexico also started the innovative National Program on Women and Health (PROMSA), which is implemented by the National Center for Gender Equity and Reproductive Health and aims to integrate a gender perspective in all national policies and programmes across the health sector. PROMSA focuses on three main areas: meeting women's health-care needs throughout life, addressing the challenges women face as health-care professionals, and as caregivers in the family and community. This pioneering programme seeks to redress gender exclusion and discrimination in the health sector by making the invisible visible. PROMSA works in close collaboration with those engaged in the process of health-sector reform, and although improvements are evident, the integration of a gender perspective is a challenging and slow process. Its success, however, is essential if Mexico is to break down conditions of gender inequality, poverty, and poor health.
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Mexico's health-sector advances, including Seguro Popular, show critical initial stops toward gender equality in health care. But much remains to be done to achieve the ambitious goals set by this administration-ie, that by 2015, all Mexican health programmes and services will be designed, budgeted, and evaluated with a gender perspective. Continued progress will require strong leadership and support at the highest levels. Without the vision, political will, and accompanying resource allocation of the current administration, gender mainstreaming will not be possible. The foundation has been laid, but only with sustained efforts will gender equality in Mexico's health sector be attained.
| [Sidebar] |
| Published Online |
| October 25, 2006 |
| DOI:10.1016/S0140-6736(06)69527-5 |
| [Reference] |
| We declare that we have no conflict of interest. |
| 1 Sachs J. Macroeconomics and health investing in health for economic development. Report of the commission on macro economics and health Geneva: World Health Organization, 2001. |
| 2 Gomez E. Equity, gender, and health policy reform in Latin America and the Caribbean. Washington, DC: Pan American Health Organization, 2000. |
| 3 Freedman LP, Waldman RJ, de Pinho H, et al. Who's got the power? Transforming health systems for women and children. Task Force on Child Health and Maternal Health. New York: Millennium Development Project, 2005. |
| 4 Standing H. Gender and equity in health sector reform programs: a review. Health Policy Plan 1997; 12: 1-18. |
| 5 Doyal L. Gender and health sector reform a literature review and report from a workshop at Forum 7. Geneva: Global Forum for Health Research, 2003. |
| 6 Frenk J. Bridging the divide, global lessons from evidence-based health policy in Mexico Lancet 2006: 368: 9640 -71 |
| 7 Programa Mujer y Salud. Vision statement 2006. http://www.mujerysalud.gob. mx/contenido/vision.html (accessed Oct 9, 2006) |
| [Author Affiliation] |
| *Ana Langer, Jennifer Catino |
| EngenderHealth, NewYork, NY 10001, USA |
| alanger@engenderhealth.org |
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