Principle 2

Gender equality

"Equality of treatment and opportunities between women and men must be ensured and fostered in all areas, including regarding participation in the labour market, terms and conditions of employment and career progression. Women and men have the right to equal pay for work of equal value."

- Principle 2 of the European Pillar of Social Rights

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Gender equality as a determinant of health

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Gender equality is vital for health and wellbeing. When all genders are treated equally and have equal access to care, opportunities and pay, societies become healthier, happier and more inclusive.

To reduce inequalities between genders, it is important to ensure access to (health) services and tackle gender-based violence, stereotypes and traditional gender roles. LGBTI* people face a unique set of (health) challenges, making it essential to integrate LGBTI considerations into gender policy.

* LGBTI people are people who identify as lesbian, gay, bisexual, transgender or intersex)

Gender and health

Gender has a strong correlations with health. For example, men tend to view their health more positively and are less likely to seek medical care or support. Women, on the other hand, live longer but spend 25% more of their lives in poor health.  

Some health inequalities between genders stem from different health behaviours. For instance, men tend to smoke or drink more and engage more in risky behaviour, while women are more likely to take part in health-promoting behaviours, such as healthy eating.

Other inequalities stem from social factors. For instance, women are more likely to report poor mental health, partly due to the mental pressure caused by their burden of care for others. They also face more interpersonal and domestic violence, and are less likely to be diagnosed by a doctor in general. Traditional masculinity norms can create unique mental health challenges for men, discouraging emotional openness and reinforcing stigma around men’s mental health, leading to higher rates of suicide amongst men.

Gender-based health inequalities become even more complex when considering LGBTI people, including trans and intersex people, who face unique challenges, such as social exclusion, discrimination and barriers to accessing healthcare.

The topic of gender equality is further complicated by intersecting factors, such as migrant background, racism, disability, and lower socioeconomic status.

Access to basic needs, such as healthcare, education, and fair job conditions, helps promote mental and physical health benefits for all.

Gender and health

Gender, poverty and health equity

Social, political, and economic factors cause health inequalities, with poverty playing a crucial role. Financial insecurity has represented 35% of health inequalities, and poor quality housing and neighbourhood environment represented 29%.

Women are more likely to work in part-time or low-paid jobs without social protections, which limits their economic security and career opportunities. Many women take on unpaid primary caregiving roles to support children and elderly family members, making it hard to work full-time, advance in their careers, save for retirement, or achieve financial stability to live healthy lives.

These issues affect women and gender minorities even more if they face additional challenges. Factors like migrant or refugee status, racial minority background, disability, single motherhood, LGBTI identity and age all actively impact socioeconomic factors and health equity, and even more when combined with gender.

For instance, migrant women and those from racial minority backgrounds often face language barriers, racism or lack of legal status, making it hard to access essential services and find employment. Single mothers often juggle caregiving and earning a livelihood, leading to financial instability. LGBTI individuals, especially transgender women, face social exclusion and discrimination, making it hard to find secure employment.

In later life, gender pay gaps become pension gaps. In the EU, women’s pensions are 26% lower than men’s while they live longer and in poorer health.   

Gender, poverty and health equity

LGBTI and health

LGBTI* communities often experience worse health and social outcomes compared to others. This includes higher levels of mental ill health, due to factors such as stigma, discrimination, social rejection, violence, economic inequalities, and barriers to accessing healthcare and employment.

Many health professionals want to support their LGBTI patients but often lack the necessary resources and training to do so. Medical school curricula often overlook LGBTI health, and ongoing training opportunities may be limited. As a result, healthcare providers face difficulties offering proper support, leaving many in the community to rely on informal networks for guidance on inclusive healthcare and social services.

Recent data shows that LGBTI people across Europe often struggle to access healthcare. For example, in Montenegro, 69% of LGBTI people would not seek specialised support or mental health counselling, while 37% indicate that they have no trust in the public healthcare system.

Trans-specific care encompasses a diverse spectrum of resources, adapted to each person's unique needs and identity. However, challenges such as long waiting times, workforce shortages, lack of staff confidence in providing treatments, and legal restrictions can make it more difficult to access these treatments in many countries.

LGBTI communities also face stigma and inequalities related to sexual health and HIV/AIDS care, requiring inclusive sexual health services and support.

*LGBTI stands for lesbian, gay, bisexual, transgender and intersex.                 

LGBTI and health

Gender, NCDs and healthy ageing

Gender (in)equality plays an important role in how different genders experience non-communicable diseases (NCDs). Men are more likely to take part in behaviours which influence the development of NCDs, such as alcohol consumption or unhealthy food choices, while women, especially in older age, have shown higher rates of biological risk factors, such as obesity and high blood pressure, and are more likely to suffer from cardiovascular diseases.

Different genders also age differently. Women usually live longer than men but may suffer more from age-related conditions like osteoporosis and dementia. Men might not live as long, but have significant levels of social isolation and loneliness as they age, which can impact mental wellbeing.

Healthy ageing strategies must be based on gender-sensitive and age-specific data and should suggest actions for specific cultural and socioeconomic contexts.

Gender, NCDs and healthy ageing

Gender-sensitive workplaces and fair job opportunities

Employment conditions and workplace environments significantly influence our health. Men face higher levels of work-related injuries as they more often take up jobs with physical hazards, as well as chemical and biological exposures, especially in industries involving heavy machinery and manual labour. This exposure can lead to higher health problems and mortality rates.

Women and gender minorities face barriers such as the gender pay gap, limited job opportunities, and lack of representation in decision-making roles. These challenges can adversely affect health and wellbeing, as they reflect systemic disadvantages in accessing higher-paying jobs. Also, when women are not present in decision-making roles, important gender-specific health needs may be overlooked.

Women's employment rates are influenced by (child)care responsibilities. Flexible work arrangements, for all genders, can alleviate these inequalities by challenging traditional caregiving roles, promoting better work-life balance, and improving overall health.

Informal work, such as domestic work and sex work, affects different genders, and migrants, in different ways. This contributes to socioeconomic vulnerabilities of certain groups, leading to poor health outcomes due to stigma and inadequate access to healthcare and social services.

Gender-sensitive policies are necessary for creating healthy workplaces. Measures like paid parental leave, flexible work hours, menstrual leave, menopause policy and anti-sexist workplace policies enhance work-life balance, reduce stress, and support mental wellbeing.

Gender-sensitive workplaces and fair opportunities
About principle 2

What does the EPSR Action Plan say?

The EPSR Action Plan sets out several overarching goals for EU Member States for principle 2:

  • Ensure access to affordable and quality healthcare for all, including by proposing new tools to better measure and eliminate barriers that disproportionately affect women and marginalised groups.

  • Reduce the gender employment gap by 50% compared to 2019 by increasing the provision of formal early childhood education and care, among other things.

  • Reduce the gender pay gap by implementing pay transparency measures and enforcement mechanisms.

  • Improve work-life balance through policies promoting accessible childcare, flexible work, and equitable parental leave.

  • Combat gender-based violence and counter gender stereotypes by implementing the Gender Equality Strategy 2020-2025.

  • Increase women’s representation in political and economic decision-making and leadership.

Where are we now?
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Where are we now?

The Social Scoreboard measures progress on the principles of the EPSR. Linked to the principle on gender equality, the Scoreboard outlines that in the EU:

  • The gender employment gap was 10.2% on average. Employed women were more likely to work part-time, with the gender employment gap in part-time work being 20.2%.  

  • In 2023, the gender pay gap in the EU was 12.7%, meaning women earned on average 12.7% less per hour than men in the same position.

Other sources tell us that:

  • In 2021, more than two out of every three (68.3 %) non-fatal accidents at work in the EU involved men. (Eurostat)

  • Among the economically inactive population, 19% of women and 3% of men were not able to seek employment due to providing care to adults with disabilities or children. (Council of the European Union)

  • In 2022, women aged 65 and above received on average 26% lower pension income than men. (Council of the European Union)

  • 1 in 3 women has experienced physical or sexual violence in her lifetime. (EU Commission)

  • 46% of LGBTI people are never open to medical staff or healthcare providers about being LGBTI. (FRA)

  • In 2023, 19% of lesbian, gay and bisexual people, 35% of trans people and 32% of intersex people felt discriminated against at work. (FRA)

What are public health actors doing?
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What are public health actors doing?

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The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 2.

Open Window to Families (UVAF) - Andalusia, Spain

Founded in 2012 in Andalusia, Spain, the Open Window to the Families (UVAF) initiative promotes family wellbeing and gender equality by challenging traditional gender roles. The Andalusian Regional Ministry of Health and Consumer Affairs (CSJA) developed UVAF to support diverse family structures for healthier dynamics.

UVAF provides educational materials on positive parenting and guidelines for sharing household and childcare responsibilities. It encourages men to take a more active role in family life and offers free online courses and audiovisual materials on gender equality, shared responsibilities* and evolving masculinity**.

The initiative focuses on emotional wellbeing, offering resources to help parents and children manage emotions and strengthen relationships, especially during difficult times like separation or divorce. Aligned with the Andalusian Public Health Act, UVAF promotes health equity by addressing gender roles and socioeconomic factors.

UVAF advocates for positive, non-violent parenting and aims to create nurturing environments for children. UVAF has provided essential resources to Andalusian families, promoting positive parenting and shared responsibilities for a healthier, more equitable future.

Other recent work by CSJA included the development of a comprehensive resource guide to better equip healthcare professionals and NGOs in facilitating access to healthcare for migrants and refugees. This tool promotes a gender-sensitive approach by acknowledging the systemic disadvantages faced by migrant women in accessing healthcare. It aims to standardise care and improve coordination across health centres, ensuring better health outcomes for migrants and refugees.


*Shared responsibilities means that both partners or parents equally contribute to family life, including household chores and childcare. This promotes fairness and reduces the burden traditionally placed on women.
**Evolving masculinity refers to the shift of understanding and expectations of what it means to be a man in society today. Men are increasingly encouraged to embrace roles and behaviours which are traditionally associated with femininity, such as nurturing or caregiving.

Open Window to Families

Menstrual leave - Spain

Spain introduced menstrual leave to address menstrual symptoms that affect work performance. The law allows individuals with significant pain related to menstruation to take paid leave for up to three days, extendable to five days with a doctor's note. This initiative is part of broader legislation advancing sexual and reproductive rights, including gender identity and access to abortion.

Menstrual leave promotes workplace inclusivity by acknowledging and accommodating real physical and mental challenges, promoting workplace inclusivity and gender equity. It addresses conditions like endometriosis or premenstrual dysphoric disorder (PMDD), which can cause severe cramps, migraines, anxiety, physical discomfort, reduced cognitive and executive function, and even thoughts of suicide.

By recognising such conditions, menstrual leave policies validate the experiences of affected individuals and affirm the seriousness of their needs. This ensures they receive essential support to manage their health effectively while staying engaged in their professional and social life. Such measures promote inclusivity and environments where individuals can thrive despite health challenges related to menstruation.

Menstrual leave

Austrian Action Plan for Women’s Health - Austria

The Austrian Action Plan for Women's Health by the Austrian National Public Health Institute (GÖG) aims to improve women's health through collaboration. This plan, aligned with WHO's Strategy on women's health and well-being in the WHO European Region (2016), sets 17 goals and 40 measures to reduce health risks for women. The implementation of the Women's Health Action Plan also addresses the United Nations 2030 Agenda (including Sustainable Development Goal 5 - Gender Equality and Goal 10 Reduced Inequalities).

Annual Women's Health Dialogues and regular focal point meetings drive the plan’s implementation, fostering nationwide coordination among organisations and experts. The Action Plan focuses on health promotion, research, policies and addressing socioeconomic determinants across the lifespan of girls and women, especially for marginalised groups like migrant women and those affected by poverty or violence. Key areas include health literacy, sexual and reproductive health, mental health, and women-related diseases.

The plan has made significant progress, promoting health literacy and creating a victim protection toolbox. It has led to reports, such as the Women’s Health Report 2022 and Contraception Report 2024, highlighting the need for more comprehensive data on women’s health issues, including menstrual health, menopause, and the impacts of stress and violence. The plan calls for healthcare systems to be more inclusive of women's health and for increasing research on women-specific conditions.

It has gained legislative support, established expert networks nationwide, and is one of the Agenda 2030 success stories, adapted to emerging health challenges. Moving forward, efforts will focus on enhancing data collection, strengthening international partnerships, and updating strategies to meet evolving healthcare needs.

Austrian Action Plan for Women’s Health

D.i.Re, Anti-violence network - Italy

The Italian Anti-Violence Network, D.i.Re – Women on the Net Against Violence, comprises 87 organisations in Italy managing 106 anti-violence centres and over 60 shelters, supporting around 21,000 women annually. Various anti-violence centres, municipal social services, law enforcement, public health services, and educational institutions collaborate through a multisectoral approach.

In 2006, 57 local organisations created the Charter of the National Network of Anti-violence Centers and Women's Homes, leading to the Network's formal constitution. D.i.Re uses local experiences to drive national political action and promote cultural change to combat male violence against women.

D.i.Re’s efforts include:

  • Increasing visibility of male violence against women.
  • Changing societal perception to recognise this violence as a crime against humanity.
  • Promoting awareness through various initiatives.
  • Conducting research and continuous training for anti-violence centres.

Additionally, D.i.Re engages with national and international institutions to influence legislation on women's rights, drawing on extensive knowledge and experience from other women’s rights centres across Europe.

D.i.Re, Anti-violence network

Men's Sheds

The Men's Sheds initiative supports men’s mental health and wellbeing in local communities. It started in Australia in the 1990s and has spread to Ireland, Canada, the United States, Iceland, Japan, Denmark, Sweden, Norway, Finland, Spain, Kenya and South Africa.

Men’s Sheds help tackle loneliness among men and challenge societal stigmas about men’s mental health. They provide a safe environment where men can gather, participate in various activities, learn new skills, and make lasting friendships.

In Ireland, 450 Men's Sheds serve as dedicated, friendly, and inclusive spaces for men to engage in craftwork and social interactions. They also provide valuable health information and serve as platforms for open discussions, improving overall health and wellbeing.

Read more about Men’s Shed Ireland in EuroHealthNet Magazine.

Men’s Sheds

Centre for Transforming Sexuality and Gender (CTSG) - Brighton, UK

The Centre for Transforming Sexuality & Gender (CTSG) at the University of Brighton researches and addresses health and social inequalities. With a focus on sexuality, gender, and social change, CTSG produces impactful research with community partners to influence practice and policy.

CTSG has strengths in interdisciplinary research around 3 key areas: 1) LGBTQIA+ lives and communities, 2) health, care, and wellbeing, and 3) gendered inequalities. The centre promotes anti-racist and gender-inclusive research practice across all fields.

CTSG played a key role in the EU-funded Health4LGBTI pilot project, which aimed to reduce health inequalities faced by LGBTI people. This project trained medical professionals to better understand LGBTI health needs, promote inclusive attitudes, and improve healthcare. Led by Verona University Hospital in Italy, partners included the University of Brighton, Poland's National Institute of Public Health, and EuroHealthNet.

The Health4LGBTI project:

  • Raised awareness about health inequalities and barriers faced by LGBTI individuals.
  • Increased understanding of reducing these inequalities, especially from multiple forms of discrimination.
  • Equipped European health and social care professionals with the tools, skills, and knowledge to overcome these barriers.

To collaborate with the CTSG on research or to study for a PhD with us, please contact: ctsg@brighton.ac.uk or Professor Nigel Sherriff n.s.sherriff@brighton.ac.uk

Centre for Transforming Sexuality and Gender

Future Generations Commissioner Equality Strategy 2023 - 2027 - Wales, UK

The Future Generations Commissioner for Wales, who helps public bodies in Wales consider the long-term impacts of their decisions, developed a comprehensive Equality Strategy for their office, ensuring they are also walking the talk on creating a more equal and diverse nation.

The strategy uses an intersectional approach to equality and aims to foster an inclusive culture, with specific action plans for gender equality, anti-racism, LGBTI support, and disability inclusion.

Aligned with the Well-being of Future Generations (Wales) Act 2015 and Equality Acts 2006 and 2010, the strategy aims to create a diverse, inclusive, and equitable workplace, enhancing staff contributions to wellbeing goals.

The strategy promotes several objectives:

  • Promoting fair working environments, recruitment, retention, and progression.
  • Analyse workforce data to address gaps.
  • Support staff development.
  • Ensure equality in policies and practices.
  • Provide regular training on equality and diversity.
  • Foster a discrimination-free workplace.
  • Promote shared learning and accessibility.
  • Commit to equality pledges and action plans.
  • Encourage understanding and respect for diverse backgrounds.
Future Generations Commissioner Equality Strategy 2023 – 2027
What EU tools are out there?

EU tools that help implement Principle 2

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 2.

More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.

EU Gender Equality Strategy 2020-2025
EU Gender Equality Strategy 2020-2025

The EU’s Gender Equality Strategy 2020-2025 sets out a vision, policy objectives and actions to make concrete progress on gender equality in Europe and towards achieving the Sustainable Development Goals. Measures include:

  • Enforce pay transparency measures to ensure that women and men receive equal pay for the same work and for work of equal value.
  • Transpose and implement EU rules on work-life balance for women and men's work in practice and equal uptake of family leaves and flexible working arrangements.
  • Invest in childcare services and implement the EU Child Guarantee to provide high-quality and affordable services.
  • Adopt EU-wide targets on gender balance in all work sectors, in corporate boards and politics.

Key initiatives under the strategy include:

EU Work-life Balance Directive
LGBTIQ Equality Strategy 2020-2025
European Care Strategy
The Istanbul Convention
EU Pay Transparency Directive
Read about EU funding and contact points

Available resources

For more supportive policy instruments on the topic, consult our other flashcards:

More information about the EU institutions and programmes is available on EuroHealthNet’s Health Inequalities Portal.

Available EU funding

Available EU funding

Contact points for further assistance

The following contact points and resources may be useful:

Contact points for further assistance

Technical resources

Technical resources
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Have your say

Would you like to share promising policies or practices carried out by your public health institute, which support the implementation of this EPSR principle?

Feel free to reach out to our EuroHealthNet colleague Silvia Ganzerla.

What's next?

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