Introduction to Gender Equality and Social Inclusion (GESI)

Original Editor - User:Robin Tacchetti based on the course by Linda Thumba
Top Contributors - Robin Tacchetti, Amanda Ager, Tarina van der Stockt, Kim Jackson and Lucinda hampton

What is Gender and Social Inclusion

Gender Equality and Social Inclusion (GESI) are two intertwined concepts that help improve access to goods and services for all including the excluded, women and the poor. GESI promotes inclusive policies and focuses on increasing the power of the excluded, women and the poor.

Gender Equality

The goal of gender equality is that men and women have equal resources, opportunities, human rights and socially valued goods. The world bank defines gender equality as, “ Gender equality or equality between different groups of women and men refers to the equal enjoyment by groups of females and males – of all ages and regardless of sexual orientation or gender identity – of rights, socially valued goods, opportunities, resources and rewards. Equality does not mean that women and men are the same but that their enjoyment of rights, opportunities and life chances are not governed or limited by whether they were born female or male." The world bank further classifies gender by the following:

Gender is:

• About women, girls, men, and boys, and the associated norms, behaviors, and roles as well as the relationships among these groups. Gender is considered to be a social construct and its definition can vary among societies and change over time. CIWA wishes to adopt a gender-inclusive approach that recognizes that some people prefer to use non-binary terms to identify themselves.

Gender is not:

• Only about women and girls: Men and boys should also be part of the GESI equation
• Only women’s responsibility: For real change to happen, everyone needs to be involved
• A Western or foreign concept: Gender equality is a global goal articulated in national, regional, and international commitments and treaties to which many countries worldwide are signatories
• An attempt to take away the rights of men and boys: Human Rights are universal, which means that they apply to all human beings
• Only an issue for gender specialists: Relying solely on gender specialists cannot tackle the main drivers of gender inequality and social exclusion. Everyone needs to be involved and committed to equality and inclusiveness. https://www.ciwaprogram.org/about/

The video below by the World Health Organisation director Director-General Dr Tedros discusses gender equality for women and girls: inequalit

Social Inclusion

Social inclusion aims to keep vulnerable groups from being excluded from a specific circumstance. Vulnerable groups include the elderly, people with disabilities, religious minorities, women, girls, LGBTQ, etc. The world bank defines social inclusion as, “ In every country, some groups confront barriers that prevent them from fully participating in political, economic, and social life. These groups may be excluded not only through legal systems, land, and labor markets, but also discriminatory or stigmatizing attitudes, beliefs, or perceptions. Disadvantage is often based on social identity, which may be across dimensions of gender, age, location, occupation, race, ethnicity, religion, citizenship status, disability, and sexual orientation and gender identity (SOGI), among other factors. This kind of social exclusion robs individuals of dignity, security, and the opportunity to lead a better life. Unless the root causes of structural exclusion and discrimination are addressed, it will be challenging to support sustainable inclusive growth and rapid poverty reduction.”

This video by Healthwest TV speaks to the importance of social inclusion:

GESI and Healthcare

There is a link between social norms and biological factors that affect the health status of women and men. Despite gender equality being a basic human right, it continues to be a leading determinant of health inequality. Gender determines health responses, care practices, health behaviours, and essentially outcomes. To combat these health inequalities, the World Health Organisation (WHO) and the United Nations have pushed countries to introduce gender issues into their health systems

Women have a higher risk of morbidities due to their reproductive roles, nutritional inequality and their lower status in society. In addition, child marriages are more prevalent in girls (5 times higher), and women are the majority of the victims of sexual abuse and domestic violence. Lastly, poor access to potable water and sanitation affects women more as they manage household water supply. Lastly, women are at a higher risk for anxiety, depression and cancer. Men are perceived as strong and not needing care.

GESI and Physiotherapy

GESI affects healthcare across the spectrum including physiotherapy. Studies have determined that there are three areas physiotherapists where GESI has been an issue:

1. gender in clinical practice
2. gendered organizational aspects
3. gendered socio-cultural norms and ideals

Gender in Clinical Practice

The following studies demonstrate how gender can impact physiotherapy practice:

• Back and neck pain study: When addressing patients in a rehabilitation setting, therapists' message to patients is expressed differently based on gender-specific stereotype.
  • Women hear “be careful” in regards to pain, while men were supported in “heavy work leads to pain.”  
  • Men were also not given as many exercises as women as they were considered to be strong.
• CP study: Interventions for children with cerebral palsy were related not only to their gross motor function but to their gender
• LGBTQ study: LGBTQ patients felt physiotherapists' interactions were uncomfortable with them in regards to touch, physical proximity, observation of their body or undressing.
• Transgender study: Transgender community felt the physiotherapists had a lack of knowledge about transgender-specific health issues

Gender Organisational Aspects

Research in this category depicts a broader area and refers to the general make-up of the organization and the organizational ladder. The studies have been summarized below:

• Men typically have more power at the organizational level
• Workplace tools and instruments are often designed with males as the norm leading to disadvantageous outcomes for females.
• This can lead to increased sick leave and a high risk of musculoskeletal disorders for women
• Working life can affect women more than men
• More women than men end their careers due to sick leave, mental health, and musculoskeletal issues

Gendered sociocultural norms and ideals

This last aspect refers to understanding how traditionally women have been depicted as weaker and more prone to illness than men

Implications for Physiotherapist in Practice

Stenberg et al., 2020 recommended physiotherapists should be aware of

“1) What patients say and how they act, and how this can be influenced by gender;

2) How we interpret what we have seen and heard (from our patients) based on our gender norms, assumptions and gender stereotypes; and how we act based on those interpretations;

3) What gender and power regimes we can see and identify in organizations; and how do they influence our work, working conditions as well as the patient’s reality and health; and

4) What gendered societal and cultural norms influence us as physiotherapists and our patients.”

In addition,Stenberg et al., 2020 recommends gender awareness training in PT schools and gender awareness/sensitivity related to decision-making for assessment and interventions. More research is needed in this arena to help physiotherapists with gender equality and social inclusion.

Resources

• What Does Gender and Inclusion Mean for Clinical Practice?
• RELAB-HS: Rehabilitation Through a Gender Lens
• USAID: Gender and Social Inclusion Assesment

or