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Around the world, hard-won progress on gender justice is being rolled back, and this global backlash has serious consequences not just for rights but also for health outcomes.
What would it take to make gender justice a foundation, and not an afterthought, of global health and other systems? On this episode of #ConsiderThis Melisa Idris speaks with Professor Sarah Hawkes, Head of Global Population Health at Monash University Malaysia and co-chair of the Lancet Commission on Gender and Global Health, and Professor Kent Buse, Professor of Health Policy at Monash University Malaysia. They are both Co-founders and Co-CEOs of Global 50/50, an initiative committed to advancing gender justice in health, law, and finance.
What would it take to make gender justice a foundation, and not an afterthought, of global health and other systems? On this episode of #ConsiderThis Melisa Idris speaks with Professor Sarah Hawkes, Head of Global Population Health at Monash University Malaysia and co-chair of the Lancet Commission on Gender and Global Health, and Professor Kent Buse, Professor of Health Policy at Monash University Malaysia. They are both Co-founders and Co-CEOs of Global 50/50, an initiative committed to advancing gender justice in health, law, and finance.
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00:00Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show
00:14where we want you to consider and then reconsider what you know of the news of the day. My guests
00:19today were speakers at the Precision Public Health Asia 2025 conference. I have Professor
00:26Sarah Hawks, Head of Global Population Health at Monash University Malaysia. She's also
00:31the co-chair of the Lancet Commission on Gender and Global Health. I also have with me Professor
00:37Kent Buse who is the Professor of Health Policy at Monash University Malaysia. They are both
00:44the co-founders and co-CEOs of Global 5050 which is an initiative committed to advancing gender
00:51justice in health, law and finance. Welcome to the show both of you. Thank you so much
00:56for being here with me. I want to begin with the Lancet Commission on Gender and Global
01:01Health if I may, Sarah, with you. Why was this commission necessary at this point in time,
01:08this point in history? I'm just wondering how we should be thinking about the threats to
01:14gender justice and why it's important to address it now. Yes, thanks Melissa. So first of all
01:20just to explain what a Lancet Commission is. So it's a gathering of global experts engaging with a wide
01:29audience globally to try to give a kind of state of the art where are we at, what do we know around
01:36a particular topic. And so we had global experts from I think every continent in the world, 25 of them,
01:44and we engaged with over 100 community groups all around the world from different sectors to really
01:54try to address the question of why now, why here, what are we trying to achieve. And I think we were
02:02driven by a range of conundrums. One was why do people misunderstand what gender is, what's going on
02:11there. And particularly in health, where one would imagine that there would be a widespread understanding
02:19of how gender might affect the human body, but there isn't. But also we were seeing increasing global
02:27pushback on the question of addressing gender as a determinant of health. And we were seeing that
02:36pushback play itself out quite strongly within the political realm of global health organizations
02:43and institutions. And the end result of that was that we were seeing health policies and programs and
02:50plans be gender blind. And we saw that very, very clearly during COVID, for example, that when we did an
02:59analysis of around 500 COVID policies at national level in 76 countries, less than 10% of the policies
03:11took gender into account. So we would really try to explain or understand and then explain what's going
03:19on here. Why is this really fundamental aspect of what it means to be human for all of us? Why is it being
03:26ignored when we know it has very strong impact on people's health and well-being across across the
03:34life course? And the global 50-50 initiative, talk to me about that. What was that meant to address? Why
03:41did you feel the need to set up an initiative that you thought, okay, there's a gap here and I really need
03:47to do something about it? Yeah, just picking up on one thing that Sarah said in terms of sort of
03:52misunderstanding of gender. Yes. And Sarah made the point that I just want to reinforce that gender
03:57is everyone. It's men and women and non-binary. And for a long time as academics, we had understood
04:06that there was evidence that demonstrated that men and women have very different experiences in terms of
04:12the risk factors they face. In most societies, they have different social roles, different economic roles,
04:19and as a function of that, they face different risk factors. They get sick from different things.
04:23Men and women seek care differently. Women will more often seek care than men. And then once they're
04:30inside the healthcare system, men and women again will be treated differently. Often women will be
04:35underdiagnosed or their conditions not taken very seriously. Men, I guess because of the resources in
04:41society are more likely to end up in ICU, you know, when it's a financial sort of question. And so we saw
04:48these huge differences in many areas of health in relation to differences between men and women. And
04:55and to some extent, there are some differences that some people might find sort of counterintuitive,
05:02that there's this sense that gender means women, and that women are disadvantaged in health as they are in
05:07most parts of society. But if you look at the data more granularly, you'll find that in many instances, men
05:13actually have more health, worse health outcomes. And so we had the evidence, and we published it in a high
05:21impact journal. And but as Sarah said, we also were very much aware that the large global health agencies, and
05:28ministries of health, tended to overlook that basic fact, and treat men and women the same, and one homogeneous mass.
05:36And our as academics, we weren't having the impact that we wanted. And so we set up this NGO global 5050
05:43that you referred to. And we can speak more about that if you want. But that's the genesis. Amazing.
05:48And I, that really resonates with me, because more often than not, when you talk about the kind of
05:54misunderstanding of what gender is, I think gender is often conflated with women, with sex. So, and it's often
06:02reduced, particularly in healthcare policies, to women and girls, right, when you think about gender.
06:07I wonder whether, what the real-world consequences are of this conflation in health programs. What is
06:14the impact to men, and boys, and trans people, when gender health programs is just focusing on women
06:22and girls? Okay? I think that's one of the things that the, the Lancet Commission picked up on, because it did
06:27take this quite historical sweep. And I think one of the things that the commission did was to demonstrate
06:33quite persuasively that the public health system looks at the issue from one perspective, and the
06:39for-profit commercial sector actually is much more sophisticated in thinking about the difference
06:45between gender and sex, and the role that it plays in health. But Sarah, I mean, it's really a historical question, isn't it?
06:51Yeah, well, it is, it is. I mean, I think it's, it's historical, it's commercial, it's, it's societal,
06:59and it's a problem with medical training, even. So it's sort of multiple factors as to why there's this
07:07misunderstanding that if you're talking about gender, you're automatically talking about women and girls.
07:13And I think to some extent, as Kent alluded to, you know, that, that's understandable. You've got a,
07:19half the population that generally has less power, people are concerned to empower that 50%.
07:27But the end result is that you end up leaving another 50% out of the, the, the priority setting,
07:34the resource allocation within health. But what we saw on top of that, so the, the, the commission
07:43was not just widely spread geographically, but was a bunch of experts from multiple
07:48disciplines, including historians and lawyers and people bringing very different perspectives to,
07:55to the question you've just asked. And, you know, a large part of what we call the global health system
08:03today, really has its origins in the colonial medical system, and then in a kind of nascent global
08:11system after the Second World War, when all of the systems and ideas and structures were really set
08:18in place, that constitutes what the, the, this, this global health system today. And back in the 50s,
08:27for example, the 1950s, the focus for a lot of these agencies was really on population control.
08:34It wasn't about delivering health for everybody, in the same way that the colonial medical system
08:41wasn't really concerned with the health of the entire population. It was concerned about the people who were
08:48the colonizers. So there have been these, these iterations and evolutions of what the, the health system is
08:56supposed to be about. And for, I would say since the 19, late eight, late 1980s, early 1990s, we've really seen
09:06health systems try to move away from only being focused on population control to being more inclusive
09:16of what health means to everybody. But because it came from that origin, you achieve population control by
09:24focusing on women and girls. Right. You achieve resource mobilization by talking about poor,
09:31vulnerable women. You very rarely achieve resource mobilization by talking about poor, vulnerable
09:38men. And so men and boys have tended to be left out of the entire spectrum of what health services are
09:45designed to do. And then delivery beyond the binary to people who are trans or people who are non-binary,
09:53that's a much newer idea for health services to now be trying, trying to, to struggle with. But the
10:00end result is that in every country in the world, we see life expectancy is much lower for men than it is
10:09for women. We see that men have much more risk exposure to health harming products and health harming
10:19situations than women do. Men are much more likely to smoke or to drink alcohol or to be working in
10:28industries that are harmful to health. They're more likely to be driving cars, buses, trucks, taxes,
10:35so that their rates of risk exposure are much, much higher. But the health system still has this idea
10:42that we need to reach women and girls. And often because what they're trying to do
10:49is to protect the next generation. You're trying to achieve good health and well-being for children,
10:56for example. And so you do that via mothers, not via fathers. So there's a lot to unpack and unpick
11:04there. But the end result is that a lot of people get left out of the system.
11:08Is that why we should be thinking about gender justice as opposed to gender equality? Is that
11:15the justice lens that comes into play? Yeah, for sure. I mean, one, one thing is, is that equality
11:21means everybody the same. And we know that that can't be the case because biologically we're different,
11:27right? So, so that, that comes back to your, what, what you said earlier about the, the conflation of
11:33gender, which is about a, a construction of who we are as a person, socially, politically, legally,
11:41commercially, et cetera. Whereas sex is about the chromosomes you're born with, the, the, the,
11:49your reproductive capacity, how your physiological, um, construction, it can be changed. People who take
11:58hormones will know that you can change what you look like, et cetera, but it, but sex is inherent
12:04to, to who you are. So we will never be gender equal at a health level, but because of the differences
12:12in biology, but we, but, but gender is modifiable. We can change people's social positions. We can make
12:22things better for them, but we can't do that just at an individual level. Gender is about the systems
12:30and structures of society. And so that's what gender justice is, is it, it's saying it's not just about
12:37how you identify as an individual. It's about the systems and structures. Which is wonderful that you
12:44have expanded your global health 50, 50 to now global 50, 50, looking at not just health, but law and
12:52finance as well. Money makes the world go around. So when we think about addressing the entire system to
13:01ensure gender justice, uh, from global 50, 50's perspective, what, what are some things that you
13:07working on to make sure that this isn't just, um, rhetorical, that there are concrete actions being
13:14put in place to ensure that there is gender justice in all systems? I mean, one of the things that we
13:21try to do in global 50, 50 is to, um, situated as an accountability mechanism. And as academics, I guess,
13:29we're quite well, uh, well positioned to do that because we can independently monitor, um, what's
13:37taking place. And so to give you an example, we look at 200 global health organizations annually,
13:44and we, um, look at their gender related policies and practices. And we put out an annual report on
13:51that and we have an annual index. And so we name these 200 organizations and against about 10 criteria
13:59or variables. And, um, that means that women, for example, working in the door with those organizations
14:08can look at the performance of their organizations and say to senior management, Hey, look at, we don't
14:13have a policy on menopause. We don't have a menstrual leave policy or we don't have flexible working
14:19arrangements, but our competitors up the road, they actually do. So there's a, it serves as a mechanism
14:26for, um, redeploying power, I guess, in, in, in that sense to bring about gender justice.
14:33It also means, for example, um, that our index comes known to the donors of some of these organizations
14:40or the boards. And so they then put pressure on their CEOs to make policy changes. So, so for us,
14:48you know, why we're in the business is not just to understand these gender differences,
14:53but actually to try to, um, encourage organizations, the public sector to adopt strategies that might
14:59make for a more gender equitable workplace or to support society to put in place the kind of policies
15:07that are needed to close the gender pay gap, for example. So with, so let's interrogate the role of the
15:13private sector. So corporates, um, do they do well to ensure, um, gender justice in their policies?
15:23I'm just wondering, isn't that the role of regulation? Is it, isn't regulation there to make sure that
15:29they are on track and they are upholding the rules, uh, upholding gender justice policies?
15:35We can, we can sort of answer that in a couple of ways. One is that in our sample of 200 organizations,
15:41we have for profit, not for profits and the for profits generally do better at the policy making.
15:46So they, I guess, have more resources to put in place, the kind of policies that, that we consider
15:50to be useful ones compared to the not for profits, but they don't necessarily do as well in outcomes.
15:56There's that sort of, that sort of paradox, let's say. Where's the gap coming from?
16:03I mean, some of it could be time, you know, if you put in place a policy today,
16:08you won't necessarily get a woman as a CEO for another 20 years, let's say. So that, that's one
16:14factor. The other factor is you can have every policy in the world in your workplace, but unless
16:21you have a culture that supports implementation of the policy and people holding you to account for
16:29the implementation of that policy, then just having a policy doesn't make a difference.
16:35I was also going to come in on the gender pay gap though, to respond to your point about regulation.
16:40So in the 200 organizations that we look at, the jurisdiction where their headquarters makes
16:45a huge difference around gender pay gap reporting. And so those organizations where there are laws in
16:52place that companies over a certain size have to report on it. Of course, all of those organizations do,
16:58but if they're headquartered in other jurist, legal jurisdictions where they're not obliged to,
17:04then they don't. So the law does make a huge difference, as you say.
17:07It makes it trickier and also more opaque. It's easier to hide behind these things, isn't it?
17:13When you're not reporting, yeah. Talk to me a little bit about the anti-gender
17:19political movement that we're seeing lately. How is that, what's behind this resistance,
17:27this pushback, would you say? Yeah, so I think a couple of things. And the commission went into
17:34detail to try to understand where's it come from, where's it going. And just to say, of course,
17:40we're not talking about one unified movement. We're talking about a whole collection of groups around
17:46the world that, some of which are networked, that are really pushing against progressive agendas.
17:54Networked? Yeah, for sure. Meaning these are established with structures and hierarchies?
17:59For sure. Wow. And well-financed. And often, even if they're different groups in different countries,
18:05there's often a single financial link to them, coming from a variety of states, some of them the
18:15usual suspects, the powerful hegemonic states globally, some less clear sources of funding.
18:23But they're, so they're networked in, many of them are networked in many ways, financially, ideologically.
18:31Some of them are kind of standalone groups, but they employ very similar strategies and tactics
18:39to push back against progressive social movements in general, but gender in particular.
18:47And, you know, where does it come from? It's about a regression to a particular ideology. And we've
18:55seen this really culminate in the decisions of governments this year, as well as over the past
19:02couple of years, to deny that gender exists at all. To take us, but you know, we've seen executive
19:09orders coming out of the White House, telling us that there are two sexes and we don't have gender.
19:17We just have male, female sexes. So if you go back to that kind of biological determinism and gender
19:26isn't on the agenda, really, from a health perspective or a, you know, who gets to run,
19:32who gets to be the CEO of a large company, for example, if everything is about biological determinism,
19:40very difficult to change it. Very difficult to say, well, then we'll have, you know, policies or laws
19:47about gender equality, because why bother if it's all about biological determinism?
19:53Right. But there's also, you know, these groups are very linked to, you know, a lot of them are linked
20:00up to anti-immigration ideologies, to right-wing conservative ideologies. There's a regression
20:07back to a sort of authoritarian, conservative, nationalistic ideology of which anti-gender positions
20:16are a part. Right. But anti-genderism has been described as the symbolic glue that holds them
20:25all together, not by me, by other academic scholars. And what, you know, we're seeing a rise of this,
20:35I've just talked about one particular government, but it's all, it's globally. It's global. It's,
20:40we've seen examples of withdrawing, of saying that there's no such thing as gender,
20:47has been other countries, other governments have put those kinds of rules in place. And along with
20:54that, what we're seeing is a push back in many countries to pro-natalism. So we're, you know,
21:02we're seeing people are worried about total fertility rates globally. And so they're pushing,
21:09they're pushing, they're essentially pushing women back into being mothers first and foremost.
21:16Well, you mentioned that they use the same tactics, the same strategies. Are the tactics known? And if
21:24they're known, can we push back or can systems push back against it?
21:29Yeah. So those are two really good questions. The tactics have been pretty well described by a group
21:40that does amazing work based out of the European Parliamentary Forum. And they've done great work.
21:47They put out a report just a couple of weeks ago, in fact, where they reviewed again, the amount of
21:53money that's going to the anti-gender groups and the tactics that they're using. And they use tactics
22:00such as setting up think tanks or getting people into positions of political power. They also, I mean,
22:07they point out it's not just money coming from anti-gender ideologues. They are really good at getting
22:16public money to support the work that they do. So they have a variety of ways of getting funded,
22:23and then a variety of tactics that they use to both put their own ideology forward and discredit
22:30more progressive pro-gender justice movements. That is shocking to me. Yeah, I think it's been shocking
22:37to everybody. And hats off to the people in the European Parliamentary Forum for actually exposing what
22:43what they're doing. So then the question of what do we do about it. To be really honest with you,
22:49I think this is where we as people in progressive social movements, including for gender justice,
22:58haven't been prepared. We haven't got ourselves together. We're networked to some extent, but we
23:05spend a lot of time fighting amongst ourselves, for example. I mean, it's certainly that's the case where
23:12I come from. Perhaps it's the same in Malaysia, too. I would have to agree. You can agree on nine
23:18things, but the one thing you disagree on is what fractures apart. So can I ask Kent, having heard
23:26what Sarah just said, when you think about this region in particular, what is it that you think
23:33needs to be prioritised or highlighted when you think about the barriers and the opportunities for
23:39Southeast Asia, for Malaysia, I would like to say, when we want to make sure that we're working
23:45concretely towards achieving gender justice in all the regions, in all the different sectors and
23:51industries. Yeah, and I think Sarah said that we're as a, definitely as a public health community, but
23:57also as a pro-social justice or gender justice community, not very well prepared. But we're sitting
24:04here, as you said, at this Precision Public Health Conference, and it's surprising how gender blind
24:10the conference is. And it's a real missed opportunity, I think, because one has the opportunity
24:17to demonstrate that gender does make a difference. And if we can convince policy makers and politicians
24:24that gender could make a difference, we could have gender responsive programming, and there could be a
24:29huge benefit for every ringgit invested in health if these programmes were more tailored. And I think
24:36also, you know, given the chair that you're sitting in, we tell a particularly poor story about it as
24:42well. We haven't been able to convince the world very well that gender matters and can make a difference.
24:48And so I think we have an opportunity, given the ascendancy of the anti-gender movement, to try to
24:54remind each other that we need to overcome that one thing that pushes us apart. And I think that
24:59that a country like Malaysia is in a very lovely neutral spot in the middle,
25:07in this disintegrating world order, to be a champion of the middle road, instead of these two extremes of,
25:15well, the two extremes of these movements being anti-anti or pro-pro. So we'd love to work with
25:22partners here in the country and in the region. And we can start on health. Where are the differences?
25:29between men and women? And go on. Well, I was going to say, just to try and bring those two strands
25:34together, not the anti and the pro, but the global 50-50 and the Lancet Commission, for example.
25:43One of the reasons that we set up global 50-50 to do what we do is we're also aware that the more
25:50diversity and inclusivity you have in positions of decision-making power inside an organization,
25:58the more you have diversity and inclusion in terms of who benefits from the activities of that
26:06organization. So a really simple way of putting that is if you give women an equal chance to make
26:12decisions, they are more likely to invest in health, invest in social safety nets, invest in education,
26:22for the benefit of everybody. So that's one of the reasons that we focus on organizations.
26:29It is because the more the more that decision-making just lies with one group of powerful men,
26:39then the less benefit you see accrued across the population, spread across the population.
26:46So I would say that a really great way to move forward in a region like Southeast Asia, country
26:54like Malaysia, is about ensuring everybody has an equal opportunity to succeed in all aspects of life,
27:02including their working life. Thank you both for being on the show with me today. I appreciate your
27:08insights and your time. Thank you. Thanks for having us. That's all the time we have for you on this
27:13episode of Consider This. I'm Melissa Idris, signing off for the evening. Thank you so much for watching. Goodbye.
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