In line with the public health action cycle, health reporting can, in addition to the presentation and interpretation of results, identify specific needs for action at the health policy level and derive recommendations for action based on this. This can facilitate the development and implementation of targeted projects and interventions aimed at health promotion, prevention and care that can counteract sex/gender-based inequity.

In light of missing data and research gaps on particular population groups or on specific topics, the derivation of recommendations for action can be a challenge. Transparency in the definition of recommendations for action, the involvement of external expertise, and feedback with policymakers or the public can help to meet this challenge, but might also create additional challenges during implementation.

The following suggestions were developed in the AdvanceGender project to address the challenges in developing practice-relevant recommendations for action.

I. Determine recommendations for action

1. The background of a health report (e.g. self-initiated or commissioned by policymakers) can influence recommendations for action and should therefore be communicated.
2. It should be explained which sex/gender-based and intersectional inequities the recommendations address, and where data gaps may exist.
3. Recommendations should be justified and the decision-making process should be made transparent.
4. Already-existing recommendations for action to achieve sex/gender-related and intersectional equality (e.g. health targets) should be examined on the basis of empirical results and supplemented if necessary.

II. Involve external expertise

1. External experts and relevant stakeholders can evaluate recommendations for action to see if they differentiate sufficiently in terms of sex/gender and intersectionality.
2. External experts and relevant stakeholders can formulate their own recommendations for action, which are integrated into the health report and identified as such.

III. Feedback with policymakers and the public

1. The publication of health reports and related recommendations should be accompanied by appropriate public relations and outreach work.
2. Public relations should go beyond unidirectional formats (e.g. press releases) and be dialogical, by discussing recommendations for action with relevant stakeholders (e.g. community and civil society stakeholders, politicians) in terms of their relevance and feasibility.

For dialogical forms of communication, public events (e.g. health policy hours, lectures and roundtable discussions) and complementary closed events (e.g. briefings) can be organised.

The challenges and suggestions for the development of practice-relevant recommendations for action formulated here are based on leading scientific debates on sex/gender-sensitive and intersectional research and reporting, on original research and a desk review. In addition, the expertise of scientists, health reporters and civil society representatives was included in a structured way. A Delphi survey showed a high level of agreement with the recommendations developed by the project team. For the area "practical recommendations for action for health equity", we have provided important information that should be taken into account during implementation.

Recommendations for action should be formulated on the basis of the results. Some experts argued that such recommendations should be an integral part of PHMR. Since the clients of PHMR are often also the addressees, the possibility of their influencing the content should be discussed. Transparency in the definition of recommendations for action can help counter this.

External experts can be involved in order to concretise recommendations for action. However, it is important to check who can be considered for this and what resources are available for this process. Our interlocutors pointed out that there could be a danger of giving too much space to particular interests, such that it might be better to build consensus with external experts. This could be supported by early participation in the reporting process (see also recommendations on the "participation of civil society stakeholders in health reporting").

The suggestions for increased communication with policymakers and the public were welcomed in principle, but interlocutors pointed out the additional resources required for this, especially for new formats such as dialogical forms of communication.

The experts pointed out in several instances that the recommendations are sensible and can be implemented in principle, but that they require appropriately qualified staff and resources that will be continuously involved in the process.