Mainstreaming Gender can make Health Systems more Resilient

By Yarrow Global

Health systems resiliency is becoming a central concept in Global Health. Still missing from this concept is a true integration of gender. Recently, Yarrow Global Consulting put on a panel to explore the connection between gender and health systems resiliency. Sumegha Asthana, Co-Founder of Global Women in Health Chapter India facilitated a conversation with Dr Revati Phalkey, Head of the Climate Change and Health Unit at the UK Health Security Agency, and Dr Kathryn Bowen, Associate Professor in the Fenner School of Environment and Society at Australian National University. These are the key takeaways.

By Yarrow Global

Health-related risks from climate change are on the rise. Global hunger is increasing, with especially damaging effects on malnutrition and stunting of children. More than 1 billion additional people are at risk of mosquito-borne diseases, such as Zika, dengue, and malaria as natural systems degrade. Outbreaks of viruses and infections like cholera and typhoid are increasing with flooding and hurricanes. And wildfire smoke in places like Australia and the USA are making people more susceptible to the impacts of COVID-19 and respiratory diseases. One conservative estimate says that between 2030 and 2050, the number of additional fatalities due to climate-related diseases and death, such as malnutrition, malaria, diarrhea and heat stress could rise to 250,000 per year. These deaths would disproportionately affect low-middle income countries. And because the majority of the world’s poor are women, who also face higher risks from the impacts of climate change, this would also disproportionately affect women.

“Health systems are nested in environmental systems,” Dr. Kathryn Bowen, Associate Professor in the Fenner School of Environment and Society at the Australian National University said. Climate change won’t necessarily bring anything new, but it will “exacerbate current underlying health issues of concern.”

Climate change also increases the challenges facing health service delivery, especially in Low- and Middle-Income Countries. Increasing temperatures are already putting stressors on energy infrastructure, causing increased black-outs and increasing energy demand for cooling systems. Flooding and wildfires will force hospitals to shut down or relocate. Already, over 25% of global health care facilities lack basic water services, 20% have no sanitation service and 33% do not segregate waste safely. Fully 90% of hospital wards could be at risk from overheating due to their design, while 10% of UK hospitals are in areas of significant flood risk.

On top of that, the healthcare system too will have to reduce its own footprint; the climate footprint of global health care is equivalent to 4.4% of global net emissions – around twice as high as the aviation sector’s footprint.

“Achieving Universal Health Care and the Sustainable Development Goals at the same time as we struggle with a rise in global population and healthcare needs will mean a scaling up of functions while maintaining a low carbon footprint,” says Dr Phalkey. ”This will be the main challenge of healthcare systems in the future.”


According to the WHO, a “Climate Resilient Health System” can anticipate, respond to, cope with, recover from and adapt to climate-related shocks and stress, so as to bring sustained improvements in population health, despite an unstable climate.

But dimensions of resilience differ for environmental, ecosystems, human, socio-economic and health systems. In the panel talk, Dr Phalkey pointed out that parallel transitions are happening in interrelated fields with regards to resiliency. First, the concept of health systems strengthening is evolving. Understanding the health of populations as part of wider systems, including climate and environmental systems, is gaining importance as a central aspect in health care delivery. Especially after the Ebola outbreak most projects around infectious diseases adapted a systematic approach to understanding and combating the epidemiological effects of infectious diseases.

Secondly, the concept of resiliency is being adapted to areas outside of just ecology, where the term was first coined. It is being adapted to the area health as a way of showing, for example, the ability to respond to different kinds of shocks and stressors. Dr Phalkey noted that more equal societies are more able to absorb such shocks. A key factor that resilient systems share is the integration of feedback loops and learning capabilities, meaning that if one element changes, the rest of the system adapts.

As practitioners look at how to break down concepts of health systems resilience and make them easier to implement and measure, the difference in concepts has proven to be a challenge. Institutions have created resiliency guidelines and toolkits in the last several years. For example the WHO Operational Guidance of Resilient and Sustainable Healthcare Facilities helps operationalise this concept and ease application in practice with checklists. The US Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI), the Pan American Health Organization’s Smart Hospitals Toolkit, Canada’s Health Care Facility Climate Change Resiliency Toolkit, and the World Health Organization (WHO) Climate Change and Health Diagnostic are all toolkits that help organizations and stakeholders operationalize climate resiliency, but many still differ in how they understand and define resiliency.

What comes out of considering resiliency more broadly is that the idea that “it’s not sufficient anymore to look at just humans or the environment,” says Dr Phalkey. “It’s a fundamental look at how we are connected.” And although gender should be a fundamental part of these considerations, say both Dr Brown and Dr Phalkey, it is not.


Human resources, gender-blind financing and programming, and a lack of clear mechanisms for accountability, says Dr Phalkey, are just some of the challenges to creating more equal health systems. “It’s about societal change”, she says. For example, “It’s not enough to have women in leadership roles, you want equal representation throughout.”

This is backed up by the recent 2021 Global Health 50/50 Report finding that action to dismantle gender inequality inside organisations and apply a gender lens in health programmes remains scarce. Even though women make up 70% of the global health workforce, they occupy only 25% of senior roles. The gender pay gap is also higher in global health than other sectors, hovering between 36-29%. Women in health contribute 5% to global GDP of which 50% is unpaid.

Of course, gender is not just women. But even basic data on women’s access to and participation in healthcare systems is scarce; information on other genders is practically non-existent. The current COVID-19 pandemic exemplified this. The 2021 Global Health 50/50 Report found that even though gender influences everything from who gets tested for COVID-19 to risk of severe disease and death, the vast majority of activities to address the health impacts of COVID-19 ignored the role of gender. Support across a range of WHO-recommended areas for pandemic responses – including vaccine development, prevention, access to treatment and care, health workforce protection, and surveillance – was largely gender-blind. The COVID-19 pandemic also had a disproportionate health and economic impact on gender equality, leading to what some are calling the “pink recession.”

Ultimately, segregating based on gender shouldn’t really be the point, notes Dr Phalkey. In an ideal world gender should be integrated in all aspects of healthcare planning, research, and implementation so that gender-specific programming isn’t necessary. Rather than adding it as a separate field or pillar, gender should be thought of as an overarching framework, where gender connects disparate parts of systems. But until then, a lot of decision-making in healthcare will continue to be gender-blind.

COVID-19 has already caused over 3 million deaths, and trillions of dollars in economic losses. It also increased lack of access to essential highly gendered healthcare services, such as immunization, prenatal and child health services. While the pandemic is forcing people are accept the interconnection between the environment and human health systems, we need to also accept the connections between human health systems and gender equality. By mainstreaming gender in health systems, we can both help create more equitable health systems and make them more resilient.

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Banner Photo: A Yarrow plant grows on an alpine field. Photo courtesy of Sony2k

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