Responsible welfare and gender inequalities in health: a model for a fair system

The issue of gender inequalities in health represents a critical challenge on both a global and national scale. These inequalities are not only attributable to biological factors, but also to socio-cultural, economic and systemic influences. In low- and middle-income countries such as Nigeria, Kenya, India and Bangladesh, women consistently perform worse than men on the Universal Health Coverage (UHC) index. This is due to structural barriers, including limited autonomy, restricted mobility and financial exclusion. In a similar vein, while Italian women enjoy a higher life expectancy than their male counterparts, they are subject to a greater number of years spent living with chronic illness or disability. Moreover, they encounter specific obstacles when attempting to access health and social services. The present article puts forward the Responsible Welfare model as a novel, transferable approach to addressing these disparities, involving an integrated, multi-actor, gender-sensitive welfare system. Following an exposition of the theoretical framework and methodology, the article undertakes a comparative analysis of gender health inequalities across Italian regions and internationally, with a particular focus on developing countries. The findings emphasise that gender health disparities are a social construct and context-dependent, yet modifiable through inclusive, localised, and collaborative policies. The study posits that Responsible Welfare, with its emphasis on personalisation, proximity, shared responsibility, and systemic integration, has the potential to serve as a response not only to national inequalities, but also as a reference model for countries seeking to advance SDG 3.8 and reduce gender-based health disparities. The article concludes with the presentation of concrete policy recommendations aimed at the promotion of equitable and sustainable health systems that leave no one behind.