Written by Gita Sen, Piroska Östlin, and Asha George, this 2007 Final Report to the World Health Organization Commission on Social Determinants of Health posits that gender inequality is a profound and pervasive social determinant that damages global health and undermines health systems.

It argues that gender power relations constitute a root cause of health inequity, systematically disadvantaging individuals through four key intermediary factors: (1) structural determinants, such as the unequal burden of unpaid care work; (2) discriminatory social norms and values; (3) differential exposures and vulnerabilities; and (4) the intrinsic gender politics of health systems and research.

The analysis concludes that tackling these drivers requires a multi-sectoral approach. The report proposes seven strategic, evidence-based pathways for action—spanning from legal reforms and education to health system transformation and strengthened research—to dismantle systemic inequities and build effective, equitable health outcomes for all.