Characteristics of successful programmes targeting gender inequality and restrictive gender norms for the health and wellbeing of children, adolescents, and young adults: a systematic review.

BACKGROUND: In the context of the Sustainable Development Goals and the shifting global burden of disease, this systematic review analyses the evidence from rigorously evaluated programmes that seek to transform the gendered social norms undermining the health and wellbeing of children, adolescents, and young adults. The aim of this study was threefold: to describe the landscape of gender-transformative programmes that attempt to influence health-related outcomes; to identify mechanisms through which successful programmes work; and to highlight where gaps might exist in implementation and evaluation. METHODS: We systematically reviewed rigorous evaluations published between Jan 1, 2000, and Nov 1, 2018 of programmes that sought to decrease gender inequalities and transform restrictive gender norms to improve the health and wellbeing of 0-24 year olds. We included rigorously evaluated health programmes that met the Interagency Gender Working Group definition of gender-transformative programming, regardless of where in the world they were implemented and what area of health they focused on. FINDINGS: Among 22 993 articles identified by our search, 61 evaluations of 59 programmes met review criteria. Programmes were concentrated in sub-Saharan Africa (25 [42%]), south Asia (13 [22%]), and North America (13 [22%]) and mainly measured health indicators related to reproductive health (29 [48%]), violence (26 [43%]), or HIV (18 [30%]). Programmes most frequently focused on improving the individual power of the beneficiaries, rather than working on broader systems of inequality. 45 (74%) of the evaluations measured significant improvements in health-related and gender-related indicators; however, only ten (16%) showed evidence of, or potential for, broader norm change. These ten programmes worked with sectors beyond health, included multiple stakeholders, implemented diversified strategies, and fostered critical awareness and participation among affected community members. INTERPRETATION: This review can accelerate efforts to improve global health by leading to more strategic investment in programmes that promote gender equality and target restrictive gender norms among young people. Such programmes can lead to a lifetime of improved health and wellbeing by challenging not only attitudes and behaviours related to gender at an early age, but also the gendered systems that surround them. FUNDING: Bill & Melinda Gates Foundation.

The global environmental injustice of fast fashion.

Fast fashion, inexpensive and widely available of-the-moment garments, has changed the way people buy and dispose of clothing. By selling large quantities of clothing at cheap prices, fast fashion has emerged as a dominant business model, causing garment consumption to skyrocket. While this transition is sometimes heralded as the "democratization" of fashion in which the latest styles are available to all classes of consumers, the human and environmental health risks associated with inexpensive clothing are hidden throughout the lifecycle of each garment. From the growth of water-intensive cotton, to the release of untreated dyes into local water sources, to worker's low wages and poor working conditions; the environmental and social costs involved in textile manufacturing are widespread.In this paper, we posit that negative externalities at each step of the fast fashion supply chain have created a global environmental justice dilemma. While fast fashion offers consumers an opportunity to buy more clothes for less, those who work in or live near textile manufacturing facilities bear a disproportionate burden of environmental health hazards. Furthermore, increased consumption patterns have also created millions of tons of textile waste in landfills and unregulated settings. This is particularly applicable to low and middle-income countries (LMICs) as much of this waste ends up in second-hand clothing markets. These LMICs often lack the supports and resources necessary to develop and enforce environmental and occupational safeguards to protect human health. We discuss the role of industry, policymakers, consumers, and scientists in promoting sustainable production and ethical consumption in an equitable manner.