There are different ways in which sex/gender and gender diversity can be considered in health reporting formats: mainstreaming, focus chapters within comprehensive health reports, or focus reports on sex/gender. Different strengths and weaknesses are associated with the different options. When preparing a report, health reporters should discuss the advantages and disadvantages of the different formats in order to make an informed choice. The list of strengths and weaknesses of the different formats compiled here was developed in the AdvanceGender project. It can support health reporters in their decision-making. In addition, advantages and disadvantages of the chosen format should be mentioned in the report.

I. Mainstreaming sex/gender

Sex/gender is a cross-cutting category throughout the report. Each topic is reported on separately by sex/gender (e.g. Health in Germany 2015).

Strengths

1. Sex/gender differences can be vividly illustrated for the selected topics.
2. For the selected topics, sex/gender differences can be presented in interaction with other social categories (e.g. differences in life expectancy between women and men depending on social status).
3. Topic-related research gaps on sex/gender inequities can be revealed in a nuanced manner.
4. There is no Othering or potential stigmatisation of specific sex/gender groups (e.g. migrant women) in a separate chapter of the report.

Weaknesses

1. Implementation often takes the form of a simple comparison between women and men. Heterogeneity within sex/gender groups and gender diversity tend to be neglected.
2. The format offers little space to classify results in a theoretically and empirically sound way.

II. Focus chapter on sex/gender within a comprehensive report

In a larger report, one chapter explores specific sex/gender-related differences or a specific group (e.g. women with a migration background) in more depth.

Strengths

1. The health situation of a sex/gender group or sex/gender-related differences become particularly visible through a separate focus chapter.
2. Sex/gender-related problems and social conditions can be presented in more detail (e.g. labour market segregation and the associated health risks and opportunities).
3. In thematic focus chapters, the results can be classified and interpreted more easily with reference to the comprehensive report (e.g. refugee women in a report on mental health).

Weaknesses

1. There is a danger of Othering a particular group and thus presenting it as different from a general ‘norm’.
2. There is a danger of stigmatising a social group by focusing on their health problems.
3. Sex/gender-related aspects outside the focus of the specific focus chapter are neglected in the overall report.
4. In thematically comprehensive reports, there is often little space to classify individual findings in a theoretically and empirically sound manner.

III. Focus report on sex/gender

Sex/gender in general or a specific group form the central focus of the report (e.g. gender health report, men's health report, transgender health report).

Strengths

1. The health situation of a specific group or sex/gender-related differences become particularly visible in such a focused report.
2. Sex/gender-related problems and social conditions can be presented in more detail (e.g. labour market segregation and the associated health risks and opportunities).
3. There is sufficient room for a theoretically and empirically sound classification of the results.

Weaknesses

1. The preparation of a focus report is resource-intensive, as separate research and evaluations are usually necessary.
2. There is a danger of Othering a particular group and thus representing it as different from a general ‘norm’.
3. There is a danger of stigmatising a social group by focusing on its health problems.

The challenges and recommendations for the selection of suitable reporting formats for the consideration of sex/gender and gender diversity in PHMR formulated here are based on leading discussions of sex/gender-sensitive and intersectional research and reporting, on original research, a desk review, and the structured integration of the expertise of scientists, health reporters and civil society representatives. A Delphi survey showed a high level of agreement with the suggestions developed by the project team.

In the section "possibilities for taking sex/gender and gender diversity into account in PHMR reporting formats", the focus report format received the highest level of approval overall when it comes to the adequate representation of sex/gender and gender diversity in PHMR. In this format, the majority of strengths were rated as particularly important and many weaknesses as rather unimportant.

It was also pointed out that the formulated strengths and weaknesses of the three formats are not set in stone. Many weaknesses can be compensated for, for example, through conscious reflection and an appropriate approach to the conception and preparation of the report. On the other hand, the choice of a supposedly suitable format does not ‘protect’ health reporting from remaining on the surface in terms of content or being perceived as stigmatising by some readers.

Both the strengths and weaknesses of the formats can be reflected upon and addressed. This possibility was frequently pointed out in the case of the weaknesses of reporting formats. For instance, the fact that there is often little space to classify the findings in reports in which sex/gender is a cross-sectional category (sex/gender mainstreaming) was seen as easily changeable.

The experts were also critical of the assessment that focusing on one sex/gender or a specific group (e.g. refugee women) inevitably leads to Othering or stigmatisation.

Additional feedback on the suggestions for the selection of a suitable reporting format, as developed in the project, was the reference to the different socio-economic conditions of PHMR at the different reporting levels (federal, state, municipal). For the municipal level, it was noted that the data is often not very differentiated and that the identification of research gaps also plays a subordinate role. As a result, certain criteria when deciding on a format will be of greater importance here, while others will be less important.

Overall, it can be concluded from the feedback of the experts that sophisticated and convincing reporting on sex/gender and health is possible using different reporting formats, with a slight advantage ascribed to the focus reports. Some interviewees had the experience that reporting formats are often regulated by external conditions and imperatives (e.g. policy requirements, resources, traditions, etc.), but they can then be filled out creatively. Overall, it is important to consciously reflect on the strengths and weaknesses of the chosen format in order to foreground the strengths in the report and to counteract the weaknesses as far as possible.