Public health monitoring and reporting (PHMR) provides up-to-date information on the health situation of the population for many different users. It thus supports the planning, implementation and evaluation of health policy measures. Data sources for PHMR are health surveys, epidemiological studies, registry data, routine data and official statistics.
PHMR aims to contribute to evidence-based discussions, freedom of information and political decision-making. It should therefore reflect the health of the population and the differing needs of population subgroups in a differentiated and nuanced way. Paradigmatic in this sense is the development of sex/gender-sensitive health monitoring and evaluation. This goes beyond a pure comparison of the sexes/genders to illuminate the social context of observed differences and phenomena and offer explanatory approaches for sex/gender-related differences. PHMR is thereby guided by good practice guidelines, its findings are reported in a sex/gender-sensitive way, and it addresses sex/gender-specific topics in thematic focus reports.
There are various challenges in the implementation of sex/gender-sensitive health reporting. For example, statistical comparisons between men and women run the risk of painting a picture of sex/gender groups is too homogeneous. There is currently no existing analytical framework to map the diversity within the sexes/genders and to communicate risks in a nuanced way. Additionally, well-founded explanations for sex/gender-related differences are rare. A comparative perspective between women and men also neglects gender diversity and thus, for example, the health needs of intersex and transgender people. Finally, agenda setting and the formulation of needs for action in PHMR are mostly done from a scientific perspective. The experiential and expert knowledge of, for example, civil society representatives regarding the specific health issues affecting their communities has so far only been included to a limited extent.
In order to address the challenges of implementing sex/gender-PHMR, the AdvanceHealthReport focused on the development of PHMR in three major ways. First, in order to get an overview of existing strategies and best practice models of health reporting on sex/gender, a desk review of international approaches was conducted. The identified reports were examined to explore how they include sex/gender in their analyses, whether they take intersections with other social categories into account, and to what extent explanations of observed sex/gender-related differences are offered. Second, in order to test methodological approaches to enable better representation of different user groups and include civil society representatives, AdvanceHealthReport project members conducted a range of focus groups with civil society representatives. Each group was thematically structured around a specific intersection of sex/gender with other social categories (e.g. migration), and was focused on the group’s specific health needs. Third, a Delphi survey was conducted wherein experts from academia and PHMR provided information about their experiences with sex/gender-sensitive health reporting, as well as important reflections on how the findings from the international desk review and the focus groups could be translated into PHMR practice.
The suggestions for sex/gender-sensitive and intersectional PHMR in this toolkit are therefore based on leading scientific discussions on sex/gender-sensitive and intersectional public health research and reporting; on a desk review of international approaches to health reporting; on the expertise of civil society stakeholders and scientists from different disciplines and thematic fields; as well as on the expertise of health reporters with extensive experience at the federal, state and municipal levels. Intersectional PHMR as outlined here is to be understood as intersectionality-informed PHMR. By this we mean that the different dimensions of intersectionality are implemented to a greater or lesser extent, with specific dimensions given more weight than others. Such an approach to PHMR is informed by, rather than being fully in line with, the principles of intersectionality. Underlying decisions about which dimensions are considered and which are not should be made transparent.
The Delphi survey of scientists and PHMR experts showed a high level of agreement with the recommendations developed in the AdvanceHealthReport project. Participants rated many recommendations as "very important" or "important". Most participants also rated the practicability of the recommendations for PHMR practice as "good". Finally, they made important recommendations for their adaptation and improvement.