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This Policy Brief tackle the issue of the process of implementation of gender equality measures in research organisations considering different strategies and actions – and how to overcome the resistance to change.

The state of men’s health, particularly the high levels of premature mortality amongst men, remains a cause for concern across much of the globe; though the reasons for this premature mortality may vary significantly in different countries and across different continents. Aggregate rates for mortality or longevity have to be treated with some caution as they can hide significant health inequalities across geographical areas and regions or across different groups of men in relation to social class, ethnicity, sexuality and other demographic factors. There is much then that the public health community could do to address these inequalities. This chapter begins by mapping the current issues in relation to men’s health, inequalities and public health and describes where discourses on ‘masculinities’ can fit into these debates. The authors then discuss the implications of this for men in the Global South, in particular approaches taking a gender relations or gender transformative position in dealing with issues such as reproductive health, sexual health and men’s violence. The chapter then moves on to consider the nuances of framing men’s health as an intersectoral endeavour. The authors unpack how a broader focus on men’s health can be embedded into public policy spaces both within and outside of the health sector through the adoption of Health in All Policies (HiAP) and gender mainstreaming approaches. In doing so, discourses of masculinities can be used to refocus men’s health discussions on issues relating to equity (where issues of social justice and fairness come into play) within a public policy space. The development of sex-specific health policies is a controversial part of current debates relating to men and public health responses. Case studies featuring the experiences of two countries that have developed and implemented men’s health policies, Ireland and Australia, are therefore explored in order to illustrate what lessons have been learnt in transitioning from policy development to implementation.

Purpose: Gender-based violence (GBV) is a global health and human rights issue with individual and social determinants. Youth are considered high risk; national influences include norms, pol- icies and practices. By age, nation, and region, we contrast key GBV indicators, specifically intimate partner violence (IPV) and forced sexual debut among adolescent and young adult women using Demographic and Health Surveys across low- and middle-income countries.

Methods: National prevalence estimates were generated among adolescents (15e19 years) and young adults (20e24 years) for lifetime and the past-year physical and sexual IPV among ever-married/ cohabitating women (30 nations) and forced sexual debut among sexually experienced women (17 nations). Meta-analyses provided regional estimates and cross-national comparisons, and compared the past-year IPV prevalence among adolescent and young adult women to adult women.

Results: An estimated 28% of adolescent and 29% of young adult women reported lifetime physical or sexual IPV, most prevalent in the East and Southern Africa region. Regional and cross-national variation emerged in patterns of violence by age; overall, young adult women demonstrated higher risk for the past-year IPV relative to adult women (meta-analysis odds ratio, 1.20; 95% confidence interval, 1.10e1.37) and adolescents had a comparable risk (meta-analysis odds ratio, 1.07; 95% confidence interval, .91e1.23). Forced sexual debut was estimated at 12% overall, highest in the East and Southern Africa region.

Conclusions: GBV is pervasive among adolescent and young adult women in low- and middle- income countries. The unique risk to youth varies across nations, suggesting an ageeplace inter- action. Future research is needed to clarify contextual determinants of GBV. Findings provide direction for integrating youth within GBV prevention efforts. 

Current findings offer pragmatic guidance in considering and responding to GBV among youth. In some settings, such as India, Bangladesh, Bolivia, and Peru, youth are disproportionately affected by IPV, suggesting that GBV efforts should target youth specifically both for prevention and for survivor support. Else- where, in both the East/Southern and West/Central regions of Africa, home to the highest observed prevalence of lifetime IPV among adolescents and young adults, no differences in risk were detected based on age. Forced sexual debut was also most prevalent in these regions. In such settings, national responses may consider pursuing more general prevention and support efforts, ensuring the inclusion of youth but not targeting them specifically. Together, findings emphasize the need for practi- tioners and policymakers to consider both the unique risk to youth and the overall prevalence of GBV, in prioritizing inter- vention and support efforts. 

Age-related vulnerabilities, such as relative inexperience and limited social standing, may in some settings interact with gender-based vulnerability to heighten risk for violence. In Bangladesh for example, adolescents demonstrated a threefold increased odds of IPV relative to their adult counterparts. Bangladesh is distinct in having one of the highest rates of child marriage globally; [39] the IPV heightened risk observed may reflect gender-based power inequities that are reinforced by young age [15]. In other settings, gender-based vulnerabilities and broader indicators of social and political un- rest may overshadow age-related vulnerabilities. For example, the highest IPV prevalence was identified in the DRC, although youth were not found at significantly elevated risk. The DRC’s extensive genocide and protracted conflict, with sexual violence endemic as weapon of war [40], may overshadow young age in imparting risk for violence. 

In Uganda, biomass smoke seems to be the largest risk factor for the development of Chronic Obstructive Pulmonary Diseases, but socio-economic factors and gender may have a role. Therefore, more in-depth research is needed to understand the risk factors. The aim of this study was to investigate the impact of socio-economic factors and gender differences on the COPD prevalence in Uganda. Chronic obstructive pulmonary disease (COPD) is a major health problem in low- and middle-income countries (LMICs).1 In 2010, COPD was the fourth leading cause of death globally, and it was expected to be the third by 2030.2,3 Unfortunately, the prediction has been overtaken by reality: at this moment, COPD is the third leading cause of mortality worldwide.4,5 Approximately 90% of COPD deaths occur in LMICs.6 Despite these high numbers, COPD is an unknown disease in most of the rural areas of sub-Saharan Africa, both in terms of public awareness and in public health planning. The people are unaware of the potential damage to respiratory and non-respiratory health caused by tobacco and biomass smoke.7,​8,​9 Biomass fuel use is the third largest contributor to the global burden of disease. Worldwide, around 3 billion people, most of them living in LMICs, rely on the use of open fires and burning of biomass fuels (wood, animal dung, crop residues, straw and charcoal) for cooking and heating in poorly ventilated conditions.14 Solid fuel burning is incomplete and produces high levels of household air pollution with a range of more than 250 health-damaging pollutants, including carbon monoxide, nitrogen and sulphur oxides, as well as a variety of pollutants, irritants, carcinogens, co-carcinogens and free radicals.

A substantial difference in the prevalence of COPD was seen between the two ethnic groups: the prevalence of COPD among non-Bantu people was 20% (20.3% men and 19.7% women) and among Bantu people it was 12.9% (10.5% men and 14.9% women). Interestingly, additional analyses showed substantial differences between the two ethnic groups in SES. Bantu refers to a primarily large and complex linguistic grouping of people in Africa. Their cultural pattern is extremely diverse and are the most prosperous. They occupy the southern and western parts of Uganda.19,29 In general, non-Bantu people are the poorer ethnic group, and they inhabit a geographical area stretching semi-arid eastern and northern parts of Uganda.19,29Compared with the Bantu people, non-Bantu smoked more (57.7% vs 10.7%, P<0.001)), were less educated (no education 28.5% vs 12.9%, particularly women: 51.6% vs 17.1%, P<0.001) and lived more in tobacco-growing areas (72.0% vs 14.8%, P<0.001). After adjustment for these socio-economic factors in the multivariable model, the association between ethnicity and COPD remained significant, in contrast to the single socio-economic risk factors (tobacco smoking, education and living in tobacco-growing areas). An explanation for this could be that ethnicity was associated with a combination of all these socio-economic factors, and that this combination was more important than any single factor. As such, ethnicity could be seen as a variable indicating SES.