Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA.
Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C., USA.
J Glob Health. 2020 Jun;10(1):010702. doi: 10.7189/jogh.10.010702.
Many global health organisations have adopted formal strategies to integrate gender in their programming. In practice, few prioritise the issue. Institutions with considerable global power therefore largely overlook fundamental drivers of adverse health outcomes: gender inequality and harmful gender norms. We analyse the factors shaping attention to gender in organisations involved in global health governance.
Drawing on scholarship from the fields of organisational behavior and management, sociology, international relations and the policy process, we undertook a thematic analysis of peer-reviewed scholarship and organisational documents. We also conducted 20 semi-structured interviews over Skype with individuals working at the cross-section of gender and health.
In seeking to reform the policies and practices of global health organisations, gender proponents confront patriarchal organisational cultures, hostile political environments and an issue that is difficult to address as it requires upsetting existing power structures. Proponents also face three linked challenges internal to their own networks. First, there is little cohesion among champions themselves, as they are fragmented into multiple networks. Second, proponents differ on the nature of the problem and solutions, including whether reducing gender inequality or addressing harmful gender norms is the primary goal, the role of men in gender initiatives, which health issues to prioritise, and even the value of proponent cohesion. Third, there are disagreements among proponents on how to convey the problem. Some advance an instrumental case, while others believe that it should be portrayed as a human rights issue and using any other argument undermines that fundamental justification.
Prospects for building more gender-responsive global health organisations will depend in part on the ability of proponents to address these disagreements and develop strategies for negotiating difficult organisational cultures and political environments.
许多全球卫生组织已经采取了正式策略，将性别问题纳入其规划中。但实际上，很少有组织对此给予优先重视。因此，拥有相当全球影响力的机构在很大程度上忽视了导致健康状况不佳的根本驱动因素：性别不平等和有害的性别规范。我们分析了参与全球卫生治理的组织中关注性别问题的因素。
借鉴组织行为学和管理学、社会学、国际关系和政策过程等领域的学术研究，我们对同行评议的学术研究和组织文件进行了主题分析。我们还通过 Skype 与从事性别与健康交叉工作的 20 人进行了半结构化访谈。
在试图改革全球卫生组织的政策和实践时，性别倡导者面临着父权制的组织文化、敌对的政治环境以及一个难以解决的问题，因为这需要打破现有的权力结构。倡导者还面临着他们自己的网络内部的三个相互关联的挑战。首先，拥护者本身之间几乎没有凝聚力，因为他们分散在多个网络中。其次，倡导者对问题的性质和解决方案存在分歧，包括减少性别不平等还是解决有害的性别规范是主要目标，男性在性别倡议中的作用，优先考虑哪些健康问题，甚至拥护者凝聚力的价值。第三，倡导者之间在如何表达问题上存在分歧。一些人提出了工具性的论点，而另一些人则认为这应该被视为一个人权问题，任何其他论点都会破坏这一基本理由。
建立更多关注性别问题的全球卫生组织的前景部分取决于倡导者解决这些分歧的能力，并制定策略，以应对困难的组织文化和政治环境。
