Unveiling the Layers: Gender as a Crucial Social Determinant of Health

Session Report

Tanu Paliwal

A Four Week Online Certificate Training Course on Healthcare & Gender Equity: Emerging Dimensions, Policies, Impact & Way Forward was organized by the Gender Impact Studies Center (GISC), at the IMPRI Impact and Policy Research Institute, New Delhi and Center for Ethics (CFE), Yenepoya (Deemed to be University), Mangalore. 

Day 1 of our event featured Prof Vibhuti Patel, Visiting Distinguished Professor at IMPRI, as the last speaker delivering an insightful presentation on “Gender as a Social Determinant of Health.” Prof Patel’s discourse explored the intricate relationship between social determinants of health and gender equity, dissecting the five levels at which gender operates as a social determinant.

Levels of Gender as a Social Determinant:

1. Gender Unequal: This level perpetuates gender inequality by favoring one gender over the other, reinforcing unbalanced norms, roles, and relations.

2. Gender-Blind:Ignoring gender norms and relations, this level overlooks differences in opportunities and resource allocation for women and men.

3. Gender-Sensitive:Recognizing gender norms and relations, but without addressing the resulting inequalities, indicating a basic level of gender awareness.

4. Gender-Specific:Considering the specific needs of women and men, this level facilitates the fulfillment of their desires.

5. Gender Transformative:Addressing the root causes of gender-based health inequalities, this level includes strategies to foster progressive changes in power relationships between women and men.

Intersectionality in Access to Healthcare:

Prof Patel underscored the influence of class, caste, ethnicity, and location in accessing healthcare services. Political factors and the state’s attitude, especially viewing women in the context of reproductive and child health, contribute to disparities. The neglect of girls in the 0-14 age group and elderly women further accentuates gender imbalances.

Beyond the Biomedical Approach:

To truly understand living and working conditions, public services, infrastructure, and individual behavior, Prof Patel advocated transcending the biomedical approach. A patriarchal mindset, deeply ingrained in societal structures, determines these aspects, leaving young adults and elders vulnerable. The absence of a gender-sensitive approach perpetuates stereotypes, but positive shifts in gender sensitization to challenge these norms are observed.

Pandemic Impact and Vulnerable Groups:

Examining the pandemic’s impact, Prof Patel highlighted discrimination against children, adolescents, and girls. She argued for considering child rights as an emergency during the pandemic, emphasizing that all issues couldn’t be deemed non-essential. Persons with disabilities were brought into focus, urging a convergence of medical and social models to create empathetic environments.

Empathy for Intersex Individuals and Persons with Disabilities:

Intersex individuals and persons with disabilities often face abandonment by their families. She stressed the importance of not viewing persons with disabilities as worthless, emphasizing their unique value. The ecosystem theory was proposed for the medical profession, understanding individuals’ life experiences in society.

Vietnam’s Resilience and Challenges:

Reflecting on Vietnam’s experience after gaining independence in 1975, Prof Patel shared the challenges faced due to constant bombing, leading to a significant percentage (40%) of the population becoming disabled. The resilience of the people in the face of such adversity underscored the importance of enabling environments for flourishing lives.

Gender-Responsive Approaches and Seven Key Strategies:

Seven approaches to address gender-based health inequalities were outlined:

1. Normative Framework: Transform and deepen the normative framework for women’s human rights.

2. Legal Instruments:Create, implement, and enforce formal international and regional agreements, codes, and laws to change norms violating women’s health rights.

3. Showcasing Good Practices:Amplify the voices and replicate models where good practices are happening.

4. Inclusive Discussions: Include healthcare professionals beyond doctors, such as volunteers and informal care providers, in discussions.

5. Holistic Solutions:Recognize the limitations of biomedical approaches in addressing mental health issues and involve communities, families, and councils.

6.Data Collection:Ensure the collection of disaggregated data by sex and socioeconomic status, including women in clinical trials and health studies.

7.Institutional Ownership:Gender mainstreaming in government and non-government organizations should be institutionally owned, adequately funded, and effectively implemented.


Prof Vibhuti Patel’s presentation unveiled the intricate dynamics of gender as a social determinant of health, emphasizing the need for comprehensive, inclusive, and transformative approaches. The seven key strategies provide a roadmap for creating a healthcare system that addresses the unique needs of women, transgender individuals, and persons with disabilities, fostering a more equitable and just society.

AcknowledgementTanu Paliwal is a research intern at IMPRI.

Read also : Gender Implications of Health Policies

Breaking Barriers: Integrating Gender Perspectives in Medical Education


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