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 are health surveys, epidemiological studies, registry data, routine data and official statistics. PHMR aims to contribute an evidence-based discussion, freedom of information and political decision-making.
Therefore, PHMR should reflect the health of the population and 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, illuminates the social context of observed differences and phenomena, and offers explanatory approaches for sex/gender-related differences. PHMR is thereby guided by good practice guidelines, reports its findings in a sex/gender-sensitive way and addresses sex/gender-specific topics in thematic focus reports.
Challenges remains in the implementation of sex/gender-sensitive health reporting. For example, statistical comparisons between sexes/genders run the risk of painting a picture of women and men that is too homogeneous. There is no analytical framework to map the diversity within the sexes/genders and to communicate risks in a nuanced way. Also, 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 inter- 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 about specific health issues affecting their specific communities has so far only been included to a limited extent.
In order to address the challenges of implementing gender-sensitive health monitoring, AdvanceHealthReport has focused on the development of health monitoring 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 has been 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 on how to enable better representation of different user groups and include civil society representatives, 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 their 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 health monitoring in this toolkit are therefore based on leading edge scientific discussion 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 a PHMR is informed by, rather than being fully in line with, the principles of intersectionality. Underlying decisions about which dimensions were considered and which were 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 project. Participants rated many recommendations as "very important" or "important". Most of them also rated the practicability of the recommendations for PHMR practice as "good". Finally, they made important recommendations for their adaptation and improvement.