The evidence is clear and unequivocal: societies with higher levels of gender equality are safer and more prosperous. Better places for everyone to live.

但卫生部门扮演什么角色在promotion of such equality? Do health systems help or hinder progress? And what is the responsibility of the health system to support gender equality and social justice?

自2012年以来我们研究了这些问题，专门关注冲突后的环境，其中丰富的捐助者资源和更多可延展的社会规范可能会带来独特的变革机会。然而，对于所有情况，这些都是重要的问题。我们如何看待卫生系统为研究人员和政策制定者提供了启发式框架，从而塑造了他们对这些系统的期望以及政策的方向和资源分配。

Such research is inherently challenging. What are we trying to explain? Is our outcome of interest – our dependent variable – gendered variation in health outcomes, the effectiveness of the health system, or both? In many low and middle-income countries, little data exists for either measure.

我们如何处理这项研究？社会上的性别不平等明显影响健康结果。卫生系统在解决不平等与卫生之间的联系中有什么作用？卫生系统是社会机构，嵌入其本地环境中。怎么办gender normsmanifest themselves, and how we measure gender equity within health systems themselves? And can we distinguish weak and under-resourced systems from gender inequitable ones?

Assessing gender equity

To navigate these challenges, in our paper性别盲we built on earlier研究和adopted a benchmarking approach, which identified the attributes of a gender equitable health system. We then established benchmarks for each of the WHO health system building blocks to assess if these health systems were gender equitable.

Through an iterative review of peer reviewed research, grey literature, and available health data, we analyzed health systems in four post-conflict contexts – Mozambique, Timor-Leste, Northern Uganda, and Sierra Leone – against those benchmarks.

在各种情况下，妇女报告说，文化和社会信念阻碍了她们获得医疗保健的机会，而提供者经常遭受患者的口头和身体虐待。

在这四种情况下，卫生系统反映并加强了有害性别规范。在各种情况下，妇女报告说，文化和社会信念阻碍了她们获得医疗保健的机会，而提供者经常遭受患者的口头和身体虐待。妇女面临着全面生殖健康服务的障碍。人力资源策略没有纳入性别。

卫生系统还未能承认或解决地理障碍，从袋装支付，药品库存或缺乏对妇女影响不成比例的诊所中的卫生工作者的性别影响。

Our research convincingly demonstrated that health system engagement is gender blind. Once policy makers implement programming in the area of maternal health and sexual violence programs, they check the ‘gender’ box. Health researchers and policy makers reflect little on gender dynamics within the health system because they regard health systems as technical institutions.

But health systems are embedded in and shaped by their socialcontext。它们反映了社会内部的不平等和权力关系。他们可以抵抗更广泛的努力来促进性别平等。

The bricks and mortar of health systems

We build on health systems研究，使用“砖和砂浆”类比。卫生系统的参与通常关注卫生系统的“砖”（正如WHO Building Block命名法清楚的那样）。改善砖块对于性别公平的卫生系统至关重要：他们需要熟练的人员，融资，有效提供服务以及获得药品。

But social institutions like health care are held together by the interaction between people and systems that are shaped by social norms such as gender. In many settings, women and girls are viewed as objects to dominate, limiting their life chances. The same beliefs shape the behavior of men and boys. Gender norms can be harmful for everyone and they are part of the mortar that holds together the bricks of the health system.

For health systems to ensure sustained improvement in health outcomes, our evidence suggests that it is the responsibility of health systems to confront gender and the cultural context of gender norms.

Throughout their life span, individuals interface with the health sector more than any other social institution. Health workers are respected members of the community who are accustomed to having difficult conversations about health determinants. They understand the social and cultural dynamics of their communities and confront on a daily basis the health impacts of gender norms.

But more research is clearly needed onhowhealth systems can best support gender equity. We know that societies with higher levels of gender equality are more peaceful and prosperous. But we know less about how gender inequitable societies transform into more equitable ones or the potential role of the health system and health workers in that process.

我们希望我们的研究能够激发进一步的讨论和经验，分享卫生部门如何有意义地促进变革以改善卫生系统，并使他们能够更好地满足他们所服务的所有社区的需求。