Health inequalities: Gendered puzzles and conundrums. The 10th Annual Sol Levine Lecture on Society and Health, October 6, 2008

Abstract

Introduction: I never met Sol Levine. I deeply regret this not only because of the possible close synergy between his work and my own, but also because of his concern for social justice, and his ethical stance. How to be ethical is often not obvious especially in the globalized and interacting world in which we live. I think I would have learned a great deal had I met him and interacted with him not only about the complexities of ethics in public health, but also about the subtle interplay between ethical concerns and social justice concerns (Kawachi, 2002; Levine & Scotch, 1981). I would certainly have loved to have been able to pick his brain in the last few years as I co-coordinated the Knowledge Network on Women and Gender Equity (WGEKN) for the WHO’s Commission on the Social Determinants of Health, since a focus on social determinants of health was clearly the anchor for all his work. In that WGEKN work – pulling together a network of people, data, policy and program examples, and experiences – we ran into many gendered puzzles including the hardy perennial (biology versus social causes; nature versus nurture) that is still unresolved because the biological knowledge frontier is such a moving target. And we also confronted a number of challenges – conundrums for action. Probably one of the most important is this one – in instances where we appear already to have a lot of (if not adequate) knowledge about gender inequality and inequity in health, why is it still so difficult to get forward movement (Sen, Ostlin, & George, 2007)? In my own work, these challenges have appeared not only at the macro level (as in the WGEKN work) but also in the context of the work that my team and I have been doing over the last 8 years to attempt to improve women’s health and tackle gender inequity in health in a very poor and backward part of Karnataka state in southern India, where I live (Sen, Iyer, & George, 2007). We are confronted constantly with the ‘why’s’ and the ‘why not’s’ – why is there so much gender inequality and injustice in health, and why is it so difficult to change even when we think we know what needs to be done? In the process of probing these questions, I have also learned some things about hubris and humility, and about the links between ethics and gender justice.