In commemoration of the International Women’s Day on 8 March 2019, I was invited to a webinar on The Future of Women, Gender, and Health. Co-hosted by St. Luke’s Medical Center College of Medicine-William H. Quasha Memorial and the Likhaan Center for Women's Health, Inc. The conversation had a panel from the Philippines, India and the United Kingdom.[1]
We were asked to reflect on the question: “How would you diagnose the state of women, gender, and health in the Philippines, regionally and globally today, and how should its future look like?" It was a big question that needed to be asked. I offered three points from a broad governance and policy perspective, exploring how gender inequalities rooted in structural and well-entrenched power imbalances impact policy and policy making.
THE CRISIS
First the crisis. In October 2020, the World Bank’s Poverty and Shared Prosperity report highlighted the convergence of three forces- a pandemic with its associated global economic downturn, armed conflict and climate change. The Human Development Report 2020, on the other hand, highlights the social and planetary imbalances that exacerbate each other, citing that in this proposed new ecological epoch- the Anthropocene- the dominant risk to our survival is ourselves. And not to forget the global crisis of trust in leaders and democratic institutions. The convergence of these forces has led to an intensified global emergency with profound impoverishing effects for both people and planet, except for the world’s richest, who hit a record high with their wealth increasing 27.5 percent from April to July 2020.
These converging forces interact with intersecting inequalities and reinforce patterns of disempowerment and different types of exclusion and marginalisation of specific groups such as women, children, indigenous communities, persons with disabilities and people in all their diversity, with non-conforming gender identities. These intersections across multiple levels of society create interdependent forms of privilege and oppression. Let’s take the negative effects of environmental degradation. The impact of climate crisis for instance fall heavily on women – 80% of those displaced by the climate crisis are women. There is also clearly a direct correlation between unjust planetary destruction and its impact on women and indigenous communities.
Unequal access to and distribution of resources heighten vulnerability to gender-based violence, food insecurity, diseases and health challenges, among others. For example, in more than 90 countries, female farmers lack equal rights to own land. The lowest rate of land ownership (14-16%) by women are in countries where more than half of the women are living off the land. In India for example, 85% of rural women work in agriculture but only 13% own any land. This results in disproportionate burden of malnutrition, not only for the women but their children and increased vulnerability to risks of childbearing and child birth for instance. Prevailing inequalities within and between countries, with deep roots in colonialism and racism, means that people who have more, capture the benefits of nature and export the costs. Such is the existential threat to small island developing states in the Caribbean and the Indian Ocean and large ocean nations in the Pacific. On the other hand, laws that criminalise same sex intimacy, criminalise the LGBT+ identity. This leaves LGBT+ people vulnerable to violence, abuse and harassment. I argue that all these converging forces and intersecting inequalities are in themselves public health issues.
RESILIENCE
Our fragmented world is aching to recover… and expected to be resilient.
Usually taken in the context of economic and environmental recovery, resilience often refers to the capacity of individuals, societies and the planet to cope, to bounce back, to rebound. The second point is on this mainstream discourse on resilience, which ignores the underlying causes of vulnerabilities. Rather, it’s about bouncing back to the status quo without addressing its flaws; it’s about negating instead of contributing to just, structural transformation; it's also about transferring the burden of resilience to those who have less and in the margins. For example, the women who are displaced by the climate crisis are expected to be resilient, to cope amidst their poverty.
As we talk about recovery, the invitation is to deconstruct our notion of resilience and think about a kind of governance and policy response that is committed to addressing all forms of vulnerability within the context of the differential impact of the crisis. This brings us to the third point.
GOVERNANCE FOR RESILIENCE
So what does the future look like for women, gender and health?
Resilience and just transformation are political, systemic processes. When we talk about a resilient public health care system whose interest are being served? Who are authorised to make decisions on global and national health policies? Will the opportunities for women to engage in policy processes continue to be unequal in this increasingly highly profitable no-touch future? Beyond the applause, what institutional reforms are on the table to compensate the “heroes of the times” more equitably, relative to the mega profits of big business. In the UK, a 1% pay rise for NHS staff was announced recently with nurses leaders raising the prospect of strike action.
Five years ago, civil society across the Commonwealth drafted the Malta Declaration on Governance for Resilience that called for building resilience with active, not superficial community engagement and participation in decision-making processes, where women and communities, especially those less heard are part of co-creating solutions rooted in local knowledge and local ownership.
We need different agendas promoting the specific health needs of women, men and people with non-conforming gender identities. But we must also have a common governance agenda, which is to promote policies, approaches and investments that aim to transform structural gender inequalities and power dynamics; a common global and public health agenda that is underpinned by social justice[2] and cognisant of planetary pressures.
In building a resilient future where both people and planet thrive in their diversity we must…
Persist
· in amplifying the voices of women and people in all their diversity who are less heard
· in reframing and re-writing narratives that perpetuate systemic oppression.
· in engaging constructively in policy processes where you are and where it matters
Resist
· all forms of oppression and violence
Insist
· on holding political leaders and institutions to account
· that the culture of impunity has no place in society, if both people and planet are to thrive
· on NOTHING ABOUT US WITHOUT US
[1] The panel included Dr. Junice Melgar, Executive Director, Likhaan Center for Women's Health Inc., Professor Sarah Hawkes, Professor of Global Public Health, Director, Centre for Gender and Global Health, University College London, Co-Founder and Co-Director, Global Health 50/50, Dr. Winlove Mojica, Board Member, Philippine LGBT Chamber of Commerce and Ms. ElsaMarie D’Silva, Founder & CEO, Red Dot Foundation, India . It was convened and moderated by Renzo Guinto, MD DrPH, Associate Professor of the Practice of Global Public Health, Inaugural Director, Planetary and Global Health Program, St. Luke’s Medical Center College of Medicine-William H. Quasha Memorial.
[2] Pascale Allotey and Michelle Remme, Gender equality should not be about competing vulnerabilities, April 2020
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