The Gender Lens: Advocating for Equity and Justice 

Editor's note: In the fourth of a series of articles looking at each thematic area of the Alliance’s work, this month we shine the spotlight on our Gender Equity & Justice thematic area, led by Dr. Michele Decker and Dr. Nancy Glass, and explain how the team's work supports health equity.

In many countries, women, girls, and transgender persons face a host of inequities related to their gender. Along with being at increased risk of violent attacks, they may be barred from owning property, inheriting money, pursuing an education, or receiving equal pay for equal work. 

Gender affects almost every aspect of our lives, including our health and well-being. It traditionally refers to socially constructed definitions of masculinity and femininity, most often the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women. The terms “gender” and “sex” are often used interchangeably, yet “sex” refers to biologically defined differences between males and females.  

It is critical to understand and address the disparities in health and development that arise from sex differences vs. gendered experiences. Recognition of the full gender spectrum allows an understanding of a wide range of gender experiences and their health, economic and social implications. Understanding and addressing the negative impact of gender-based inequity, oppression and discrimination is a global priority for advancing development and health. 

The Alliance’s Gender Equity & Justice team is collaborating with partners across sectors for solutions to bolster education, and research as well as clinical decision-making, and to pave the way for gender equity, social justice, and health equity.
— Michele Decker & Nancy Glass

Story illustration and icon for AHW's Gender Equity & Justice thematic priority. © Alliance for a Healthier World

Why is this focus on gender warranted?

Restrictive gender norms, women’s role as caregiver, and men’s role of protector, disadvantage women in earnings, decision making and allocation of resources. Women’s safety in home and work environments is also compromised: An estimated one in three women experience gender-based violence in their lifetimes. Globally, 38 percent of women who are victims of homicide were killed by an intimate partner, while the percentage of men murdered by a partner is significantly lower at 6 percent. Non-fatal physical and sexual harassment and violence, by partners and non-partners, is common globally and affects women’s productivity and personal health, which negatively affects opportunities for education, employment, and leadership, as well as opportunity to raise healthy children. Policies and programs that focus on modifying the prevailing gender norms to expand women’s and girls’ opportunities and ensure their safety are essential in order to advance health equity and social justice globally.

Inclusive definition of gender

The U.S. Department of Health and Human Services is proposing a change in the definition of gender with the effect of erasing transgender persons, thus eliminating protections under the law. The proposed definition would define sex as either male or female, unchangeable, and determined by the genitals that a person is born with. Any dispute about one’s sex would have to be clarified using genetic testing. This change in definition would allow for discrimination and eliminations of protections in employment, housing, health care and education for people that do not neatly fit in the restrictive definition. 

“Nascent epidemiologic and behavioral data suggest an extremely high burden of [gender-based violence] among trans populations, with estimated prevalence ranging from 7%  to 89%  among trans persons in the United States. [Gender-based violence] is associated with poor health outcomes and premature death (Kenagy & Bostwick, 2005),” according to an article in the journal Trauma, Violence and Abuse, co-authored by Nancy Glass. 

Critical need for cross-sector collaboration

The challenges arising from gender inequities cut across many social and economic sectors including health, education, production of goods and services, and government. For example:

  • Women are heavily impacted by environmental conditions that influence the quality and quantity of natural resources such as access to clean water: When there is limited access to clean water in a family’s living environment, the burden usually falls on women and girls to collect it. This is a physically-demanding job, often taking several hours each day, and can risk the personal safety of women and girls when venturing into unprotected situations.

  • Girls who enter into early marriage have less access to education, and they face restrictive opportunities for participating in community-based programs.

  • Women face challenges in gaining food and nutrition security when they are undervalued or hold limited roles in producing, preparing, processing, and distributing food. 

  • Women benefit from access to transformative technology. For example, cookstoves that use clean energy reduce the time-consuming and potentially dangerous process of women and girls gathering biofuel such as wood, dung or crop waste, while also cutting their inhalation of smoke from cooking with traditional cookstoves. 

Image credit: Brunoat /Getty Images ©

Image credit: Brunoat /Getty Images ©

The United Nations’ Sustainable Development Goal 5 calls for gender equality and empowerment for all women and girls. Many additional Sustainable Development Goals include mandates for equity within topics such as food security, energy, and biodiversity. These proposed changes demand that decisions influencing women’s health and well-being are made with the involvement of those impacted, thus including local advocacy organizations to better collaborate across diverse sectors and positively impact the lives of girls, women, transgender individuals, families and communities.  

Our approach to addressing gender-related challenges

Faculty, researchers, and students from many pockets of the Johns Hopkins community, including the Johns Hopkins Center for Women's Health, Sex, and Gender Differences, have been exploring questions about gender, health, and equity in their respective fields.

The Gender Equity & Justice thematic team aims to expand applied global research to advance gender equity and justice across Johns Hopkins as well as expand training in women’s and transgender health to support faculty and students in incorporating gender disparities frameworks and gender analysis in coursework so that a perspective is infused within the diverse fields working towards health equity. 

By integrating the collective expertise within Johns Hopkins and its partners, we become a resource for international agencies, foundations, and governments worldwide. Funded research, targeted events, and dissemination of new knowledge are examples of how we will support evidence-based design, implementation, evaluation, sustainability, and cost-effectiveness of gender-responsive and transformative programs. Additionally, the Alliance’s Gender Equity & Justice team plans to spread these perspectives broadly by providing technical, program, and evaluation assistance to development and humanitarian organizations working toward health equity.

To learn more about the research priorities of the Gender Equity & Justice team, please visit our page on the Alliance for a Healthier World website.


 Michele Decker is the AHW theme co-Leader for Gender Equity & Justice and Associate Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. She directs the Women's Health & Rights Program at the Johns Hopkins Center for Public Health & Human Rights. Read more here.


Nancy Glass co-leads the AHW Gender Equity & Justice theme, and is Professor and Independence Foundation Chair at the Johns Hopkins School of Nursing. She is adjunct professor in the Bloomberg School of Public Health and School of Medicine. She also serves as an Associate Director of the Johns Hopkins Center for Global Health. Her clinical and community-based intervention research aims to improve safety, health, and economic security and address gender inequity in diverse community and clinic settings. Read more here.

Resources & Recommended Reading

  • CNN shares findings from a Johns Hopkins Bloomberg School of Public Health and World Health Organization study that found that gender expectations influence mental and physical health of people across their lifespan

  • Evaluating the communities care program: Best practice for rigorous research to evaluate gender based violence prevention and response programs in humanitarian settings

  • Measuring social norms in practice: Julian Barr, Dr Nancy Glass and Emeka Nwankwo describe how they have measured social norms to track changes in the course of their work.

  • myPlan is an evidence-based tool to help with safety decisions for those experiencing abuse in an intimate relationship.