A One Health Gender Equality and Social Inclusion (OH GESI) Framework to strengthen equity goals of One Health implementation tools

Abstract

There is a persistent lack of gender and social inclusion in widely used One Health assessment, planning and implementation tools, underscoring the gap between high-level One Health policy commitments to equality and inclusion and real-world practice. Most One Health tools, including those produced by international agencies with high-level commitments, do not adequately address gender equality or social equity. To tackle this issue, the authors developed the One Health Gender Equality and Social Inclusion assessment framework (OH-GESI), which evaluates how tools support gender equality, empowerment, and social inclusion in One Health. The framework assesses approaches along a continuum—from ignoring inequalities, to being sensitive or responsive, and ultimately to transforming root causes and structural barriers. Application of OH-GESI to tools inventoried by the One Health High Level Expert Panel (OHHLEP) revealed major shortcomings in addressing gender and inclusion, while also pinpointing areas for improvement. The framework provides practical guidance for OH tool developers, users, and stakeholders, encouraging deeper integration of intersectional gender and social analysis into One Health practices. By aligning with the equity principles in the One Health Joint Plan of Action and OHHLEP's core definition, OH-GESI aims to help organizations, governments and stakeholders translate equity and inclusion commitments into meaningful action.

Highlights

• •Gender and identity-based discrimination shapes human, animal, and environmental health outcomes.
• •Most One Health tools fail to address gender equality or social inclusion.
• •OH-GESI framework assesses tools across a five-stage equity continuum.
• •OH-GESI guides tool developers from gender-blind to transformative practice.
• •Framework aligns with One Health Joint Plan of Action equity principles.

List of abbreviations

AMR	Antimicrobial Resistance
CDC	Centers for Disease Control and Prevention
FAO	Food and Agriculture Organization
GBV	Gender based violence
GESI	Gender equality and social inclusion
JPA	Joint Plan of Action
OH	One Health
OH-GESI	One Health Gender Equality and Social Inclusion Framework
OHHLEP	One Health High Level Expert Panel
TPZG	Tripartite Zoonoses Guide
UNEP	United National Environmental Program
WHO	World Health Organization
WOAH	World Organization of Animal Health

1. Introduction

The world is currently experiencing a polycrisis – new and re-emerging infections, climate change, and biodiversity loss are accelerating, while persistent poverty, hunger and energy scarcity afflict billions of people. Political polarization and declining multilateralism are inhibiting effective intersectoral and international responses [1]. Inequality and structural unfair power dynamics contribute to and exacerbate the harms of the many crises currently facing the world. The implications for the health and wellbeing of people, animals, plants, and ecosystems are growing in severity. These issues overlap sectors and mandates and therefore require intersectoral responses [2] that also address inequalities and exclusion. One Health has been defined by One Health High Level Expert Panel (OHHLEP) as an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent. The approach mobilizes multiple sectors, disciplines, and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for healthy food, water, energy, and air, taking action on climate change and contributing to sustainable development [3].

The definition includes five foundational principles: equity, parity, transdisciplinarity, socio-ecological balance and stewardship. These principles have been taken up by the signatories to a Quadripartite One Health agreement that convened OHHLEP, namely the World Health Organization (WHO), United Nations (UN) Food and Agriculture Organization (FAO), World Organization for Animal Health (WOAH) and UN Environment Program (UNEP), in 2022. With the support of OHHLEP, the Quadripartite agencies published a One Health Joint Plan of Action (JPA) [4] and an accompanying Guide for implementation at the national level [5]) that articulate comprehensive principles of gender and social equity and inclusion but fall short on specifics for implementation. Of the six Action Tracks of the JPA, only Action Tracks 2 (Reducing the risks from emerging and re-emerging zoonotic epidemics and pandemics) and 5 (Curbing the silent pandemic of antimicrobial resistance) explicitly address gender and inclusion. Likewise, the approach to gender, intersectionality and inclusion is weak in the JPA theory of change, and monitoring and evaluation guidance.

The OHHLEP Theory of Change states that “Inclusiveness across all segments of society (such as by gender, ethnicity, Indigenous peoples, and disadvantaged and marginalized groups) is core to the approach, and the scope reinforces the universal human right to equitable access to a clean, healthy and sustainable environment” [6].

These influential international guidance documents demonstrate high awareness of the importance of gender equality and social inclusion (GESI) for One Health, and commitment to them in One Health implementation, but provide insufficient operational guidance. Principled stances on GESI are an important step in addressing inequalities and discrimination on the basis of gender and other social identifiers such as age, ethnicity, religion, sexual orientation, disability, indigeneity, or other social group identity factors, but are insufficient to respond to the rampant patterns of domination, exploitation and oppression of weaker social groups by those with power. Stronger guidance is required for effective One Health implementation that promotes and sustains GESI.

Feminist scholarship documents how women have faced centuries of marginalization and how men have been granted dominant positions in society and households. Women, and people with non-binary gender identities who are situated at the intersection of poverty and ethnic minority status experience intensified harm through multiple, reinforcing layers of exclusion and oppression [7], [8]. Restrictive gender norms that entrench male dominance over the lives of women and gender-diverse people — in both private and public spheres — continue to operate globally. The advent of democratic governance and universal suffrage in many countries has not been sufficient to rebalance power. For example, UN Women projects that, with current efforts, it will take many centuries to achieve gender equality worldwide [9]. Given global structural barriers to equality and inclusion, One Health implementation cannot be pursued without attention to gender equality, intersectionality, social inclusion and empowerment of people whose voices are currently not heard, let alone valued. Discrimination and exclusion based on gender and other identities are recognized social determinants of health; they also determine animal health and welfare, and how the environment is perceived, used and managed. The urgency of this work is underscored by the current moment of reconfiguration of global health policies, driven by the prioritization of national interests over collective ones, the politicization of international public health, and increased defense spending at the expense of health and foreign aid budgets. These processes—evident in vaccine nationalism during the COVID-19 pandemic [10] and the United States withdrawal from the WHO—demonstrate the structural limitations of multilateral cooperation in times of crisis [11] and raise questions about who will participate in One Health governance in the coming years, and under what kinds of motivations and logic they will do so. The commitments to gender equality and social inclusion are being rolled back, highlighting the importance of institutionalizing GESI considerations within international One Health frameworks [12].

Despite longstanding and unfair social norms and values surrounding gender identity or belonging to a minority group, there is considerable evidence showing how gender and social equality in education and political empowerment have a positive impact on social well-being and human health indicators as well as for environmental sustainability [13], [14], [15], [16], [17], [18]. Likewise, recent One Health literature has shown that large gender gaps in educational attainment and political empowerment were strongly and negatively correlated with life expectancy, environmental health, and ecosystem vitality [19].

Several authors have highlighted the need for strengthening gender equality and social considerations in One Health policies, programs and projects [19], [20], [21], [22]. The deep structural and systematic discrimination experienced by women, people of non-binary gender, people with disability, Indigenous people and other socially marginalized groups affect not only their health, but how they interact with social structures, other people, plants, animals and ecosystems, and, in turn, how One Health interventions affect these interactions and relationships and vice versa [21]. As a matter of human rights, failure to systematically integrate a gender and social equity lens in One Health undermines the validity of assessments and plans and jeopardizes One Health implementation success and sustainability.

Why is there such a disconnect between the good intentions of the commitments to equality and fairness in global institutions, global frameworks and One Health implementation? Apart from the persistence of patriarchal discriminatory structures and policies, part of the answer may rest with the dismal lack of gender and inclusion integration among the tools widely used for One Health assessment, prioritization and implementation. OHHLEP examined gender and inclusion considerations in their inventory of One Health tools [23]. Among fifty tools examined, only four were found to have addressed gender, intersectionality and social inclusion to a significant extent, and an additional five tools to some extent. Thirty-one tools failed to mention gender or social equality or inclusion (ten tools could not be assessed). Without better guidance and tools for integrating gender equality, intersectionality and social inclusion, One Health implementation will continue to fall short of the aspirations and commitments reflected in its principles.

In this paper, we sought to provide guidance to improve the integration of gender equality, intersectionality and social inclusion in One Health implementation, and among One Health tools in particular; to provide greater insight on how the tools contribute to wider goals of gender equality and inclusion; and to draw on existing gender equality scholarship to inform One Health implementation, particularly improvements to existing One Health tools and the development of new ones.

2. Methods

2.1. Data

We sought to deepen our understanding of how One Health tools addressed gender, intersectionality and social inclusion considerations. We used the list compiled by the OHHLEP inventory of One Health Tools [23], and the gender and inclusion ratings originally assigned to those tools. The methods used to assemble the OHHLEP inventory and to categorize tools according to the extent of integration of gender equality and social inclusion considerations were previously reported [23]. Table 1 details the tools and their gender and inclusion rating. Our analysis focused on the nine tools that were found by OHHLEP to integrate gender and social inclusion to some, or to a significant degree. We excluded tools that did not mention gender or inclusion and those that were excluded from the original analysis.

Table 1.

Gender and social inclusion ratings of Fifty One Health Tools (reproduced from Behravesh et al. 2024).

Degree of gender and social inclusion integration	Name of One Health Tool	Contributing Organization
Present to a high degree (4 tools)	Global Environment Outlook Report (GEO) & Integrated Environmental Assessment	United Nations Environmental Program (UNEP)
	Joint External Evaluation (JEE) of the IHR	WHO
	One Health - Assessment for Planning and Performance (OH-APP)	DAI (for USAID Preparedness and Response Program)
	Strategic toolkit for assessing risks (STAR)	WHO
Present to some degree (5 tools)	Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA): Toward an Integrated Approach	UNEP
	Health Emergency and Disaster Risk Management (HEDRM) framework	WHO
	Tripartite Zoonoses Guide (TZG) Joint Risk Assessment Operational Tool (JRA OT)	WHO, FAO, WOAH
	Response preparedness (REPREP) programme	WHO, FAO, WOAH
	WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human health sector	WHO
Could not assess (10 tools)	Electronic Integrated Disease Surveillance System (EIDSS)	Defense Threat Reduction Agency (DTRA)
	State Parties Annual Reporting Tool (SPAR)	WHO
	One Health Monitoring Tool (OHMT)	FAO
	FAO Progressive Management Pathway for Antimicrobial Resistance (FAO-PMP-AMR)	FAO
	Data Reporting Tool (DaRT) for Multilateral Environment Agreements (MEAs)	UNEP
	Stepwise Approach to Rabies Elimination (SARE)	CDC, Global Alliance for Rabies Control (GARC)
	European Joint Program (EJP) Decision Support Tool	European Commission
	Progressive Pathway for Emergency Preparedness (PPEP)	FAO
	CADRI (Capacity for Disaster Reduction Initiative) Digital Tool	United Nations Development Programme (UNDP)
	The Epidemic Intelligence from Open Sources (EIOS)	WHO
Absent (31 tools)	All other tools 31

2.2. Gender analysis and One Health frameworks

In searching for an appropriate intersectional gender analysis framework to apply to One Health tools, in December 2024, we performed a purposive scan of Google scholar and PubMed databases with the search terms One Health and gender or equity or equality or inclusion, as well as social equity, analysis, social analysis or intersectional. We supplemented this with literature known by us or recommended to us by others in the field, up to August 2025. In December 2024, we conducted a search for publicly available guidance documents pertaining to gender mainstreaming and intersectional gender analysis on the websites of the Quadripartite organizations (WHO, FAO, WOAH and UNEP) as well as UN Women. The most helpful resource documents are listed in Supplementary material. We found no suitable existing gender framework or gender analysis tool that would reveal the strengths, weaknesses and gaps within and among the One Health tools. This led us to develop a novel gender and social inclusion analysis framework specifically designed to assess and strengthen One Health tools.

The design of the framework was informed by the literature scan, the guidance documents from the Quadripartite agencies and UN Women, and gender analysis frameworks familiar to us. We drew upon two approaches in particular, the social relations gender analysis approach of Kabeer (1994) [24] and the gender equality continuum of the Interagency Gender Working Group (IGWG) (2017) [25] Boriani et al. (2025) [26]. These frameworks address gendered power dynamics, the intersection of gender and other identity factors that form the basis of discrimination, and different types of gender and social equality differences, such as individual or household level factors, socially defined roles, access and control over resources, decision making autonomy and bodily integrity and structural barriers to equality (policies, institutions and social norms). Both approaches use a continuum to assess the level of action on gender equality, from blind (does not address gender inequality and social exclusion), to actions that tackle the root causes and structural barriers to equality and are therefore transformative. Informed by these, we developed a One Health Gender Equality and Social Inclusion Framework (OH-GESI) for assessing One Health tools.

OH-GESI was also informed by the gender and social equality and inclusion content of the One Health tools themselves, since any new gender and social analysis framework intended for One Health tools would need to be relevant to these tools. Starting with the four tools rated as best by OHHLEP regarding integration of gender and social equality and inclusion (Table 1), we sought specific gender and social analysis, intersectionality or social equality and inclusion elements of that could be modeled by other tools or generalized. We also analyzed the international organizations gender mainstreaming and intersectional gender analysis guidance documents described in Methods (list in Supplementary material). We identified over thirty elements, questions and recommendations that were applicable to One Health tools. We then grouped similar elements together and arrived at fourteen distinct elements that map onto the intersectional gender and social analysis continuum to create the OH-GESI framework.

The OH-GESI framework was then applied to the nine One Health tools described above. This was done by word searching each document for the words in each of OH-GESI criteria, as well as validating the word search results by reading the sections of the documents that addressed gender and social inclusion, to ensure that content that may have been worded differently was not excluded.

3. Results

There are very few published One Health GESI or intersectional gender analysis frameworks. Only one publication by Galié et al. (2024) [20] was found using our search terms. This paper offers guidance for integrating gender equality and equity considerations in One Health research, but did not provide sufficiently detailed or specific guidance to be used to differentiate between One Health tools and frameworks, or to provide operational guidance beyond what is already covered in the JPA and its Guide. We were referred to Emdin et al. (2025) [27] who build on Galiès work, with a goal of enhancing the gender-responsiveness of AMR research in livestock systems but encountered the same limitations. Garnier et al., (2025,) [28] take a gender and inclusion lens to strengthen the operationalization of the Guide for Implementing the One Health JPA at national level using 32 yes/no questions along the five steps suggested to implement one health approach, and it was very helpful for strengthening gender equality and social inclusion considerations when using the Guide or other similar national-level implementation tools. However, the scale of analysis is not aligned with that of most One Health tools.

We examined the gender and social analysis guidance tools produced by the Quadripartite organizations or UN Women (list in Supplementary Material). Although none of these excellent tools were suitable for our analysis of One Health tools, their guidance informed the development of OH-GESI and the selection of elements.

3.1. A new One Health Gender Equality and Social inclusion Analysis Framework (OH-GESI)

The OH-GESI framework analyses how One Health tools address different dimensions of gender equality and inclusion, gender and social group differences regarding agency and bodily integrity, representation, access to resources and information, decision making power, and harmful social norms, policies and institutional structures that perpetuate inequalities.

OH-GESI has five stages, on the continuum from gender and social inclusion blind to gender and social inclusion transformative, with each stage building on the previous one. See Fig. 1. the five stages One Health Gender Equality and Social inclusion Analysis Framework (OH-GESI).

Fig. 1.

One Health Gender and Social inclusion Analysis Framework for One Health Tools (OH-GESI).

3.1.1. Stage 1. Gender Equality and Social Inclusion (GESI)-Blind One Health Tools

One Health tools that are GESI-blind fail to address the culturally defined set of economic, social, and political roles, responsibilities, rights, entitlements, obligations, and power relations associated with being female, male or non-binary, Nor do they address the dynamics between and among different genders, or consider similarly defined roles, entitlements and power relations associated with different social groups based on age, ethnic, religion, sexual orientation, disability, indigeneity, or other relevant social identity factors that form the basis of discrimination and exclusion.

3.1.2. Stage 2. Gaining an understanding of gender and social inequality and exclusion in One Health

Stage 2. One Health tools contain elements that contribute to understanding gender and social equity, diversity and context but stop short of exploring the implications of, or reasons behind, any differences that may be observed. The elements in this stage include:

• •Data collection disaggregated by gender
• •Data on intersectional social factors collected
• •Data on gendered roles, norms, traditions
• •Data on gendered access to resources and information

3.1.3. Stage 3. Ensuring Gender and Social Group Representation and Voice in One Health

In Stage 3, OH-GESI includes elements that not only capture data to describe the differences between different genders and social groups (as in Stage 2) but go beyond to enhance GESI with representation and voice. These key aspects contribute to building agency for people whose perspectives are often excluded from decision making. Elements in this section include all from Stage 2 plus:

• •Women, men and people who identify as non-binary, represented among stakeholders (and/or women's groups)
• •Women, men and people who identify as non-binary, from different marginalized social groups and People with disability included among stakeholders

Tools that meet the criteria for Stage 2 and 3 are considered to be “gender sensitive” because they contribute to exposing and describing social and gender inequalities in One Health, and to improving representation and voice, but stop short of advancing actions that help redress inequalities and exclusion, such as adopting GESI-explicit goals. GESI-sensitive One Health tools acknowledge power dynamics between genders and social groups in One Health implementation and recognize different needs of people of different genders and of different social groups who experience discrimination. However, these tools do not address root causes of inequality and exclusion, nor do they respond to the power imbalances, other than to try and integrate an understanding of these dynamics within tool design or One Health implementation.

3.1.4. Stage 4. Improve agency and bodily integrity in One Health

Stage 4 captures the elements of tools outlined in previous stages, plus elements that contribute to agency and empowerment of women, people of non-binary gender and people from marginalized or excluded social groups and people with disability through an intersectional lens. They include elements from the previous stages and:

• •Gender equality and social inclusion expertise mobilized to develop and implement the tool.
• •Include women, people of diverse genders and identities as well as socially marginalized groups in decision making and governance structures.
• •Improve access to knowledge and resources for all gender groups, socially marginalized people, Indigenous people and people with disability.
• •Address risks of gender-based violence, hate-motivated violence and other negative unintended consequences of One Health implementation, ideally with an intersectional lens.
• •Monitoring and Evaluation Framework, and the monitoring of OH tool implementation performance, tracks advances on gender equality and social inclusion.

Negative unintended consequences of One Health implementation might include gender-based or hate-motivated violence, excess care load for women and girls, and/or worsening exclusion, vulnerability or marginalization of people belonging to particular social identity groups or levels of ability. One Health tools that include safeguards against gender-based violence and other unintended harms for stakeholders are found among the tools we examined. The requirements of some funders of One Health may include stipulations for the safeguarding of stakeholders and community members against violence. Tools that address these elements are more gender and social inclusion responsive. They begin to expose and redress inequalities facing women, gender-diverse people and people from vulnerable groups and under-represented parts of society.

3.1.5. Stage 5. Empowerment and transformation for equality and inclusion in One Health

Stage 5 encompasses One Health tools that have elements to support empowerment and transformation of gender norms and unequal power dynamics that affect vulnerable and underrepresented groups, while strengthening systems that support GESI. They support the empowerment of people who are discriminated against by ensuring that they have decision-making roles in One Health governance, oversight and implementation. These OH tools interrogate harmful gender and societal roles, norms and power dynamics, or explicitly include approaches that promote GESI by interrogating One Health policies and institutional aspects in One Health from a GESI lens. Tools at this stage may link to other policies and structures that promote equality and inclusion (national gender and social equality and poverty alleviation strategies, Indigenous self-governance, human rights, Sustainable Development Goal targets, or similar). In other words, One Health tools at Stage 5 support and make explicit a fundamental aim of addressing root causes of inequality and exclusion with policies, action plans or laws.

Elements in this stage include those from all the previous stages plus:

• •Gender equality and social inclusion as explicit goals or principles of the tool.
• •Inclusion of linkages or alignment to national gender, equality and inclusion policies, action plans and/or laws.
• •Budget allocation for gender equality and social inclusion activities.
• •Measurement and accountability which includes specific tracking advances on gender equality and social inclusion

3.2. Application of OH-GESI Framework to OH tools previously compiled by OHHLEP

We applied OH-GESI to the nine tools that had previously been rated by Behravesh et al., (2024) as having addressed gender and social inclusion to some, or to a significant degree(Table 2).

Table 2.

Analysis of nine One Health tools using the One Health Gender and Social Inclusion Framework (OH-GESI).

Continuum	Gender and Inclusion Sensitive						Gender and Inclusion Responsive				Gender and Inclusion Transformative
Framework section	2. OH tool helps understand gender and social diversity and context				3. OH Tool includes, enables representation		4. OH Tool contributes to improved agency and security of people of all genders, abilities and vulnerable or underrepresented groups				5. OH Tool contributes to empowerment and transformation for equality
Framework Elements	Data disaggregated by gender	Gender and Intersectional factors data collected such as disability, ethnicity religion, Indigeneity, sexual orientation age,	Data on gender, disability and other social group identity roles, norms, traditions	Data on access to resources and information by gender and other social group identifiers	All genders represented among stakeholders	All genders, disabilities vulnerabl and underrepresented groups included among stakeholders	Data on decision making power dynamics between genders and social groups	All genders, disabilities vulnerable and underrepresented groups representation in leadership	Gender and social inclusion expertise involved in design and or application of the tool	Addresses risks of and or safeguards against negative unintended consequences like GBV and hate motivated violence	Gender equity and social inclusion are a goal or principle of the tool	Linkages or alignment to national gender and social equality and inclusion policies, action plans and or laws	Budget allocated for gender equality and social inclusion	Measurement and accountability include specific tracking advances on gender equality and social inclusion
DAI- USAID One Health Gender analysis framework	X	X	X		X	X	X	X	X	X	X	X	X	X
JEE Third Edition	X	X	X	X	X	X	X	X		X		X	X	X
STAR	X	X				X			X
GEO Integrated Environmental Assessment guidelines	X	X	X	X				X	X					X
Environmental Impact Assessment and Strategic Environmental Assessment (SEA): Toward an Integrated Approach		X			X	X					X
HEDRM Health emergency and disaster risk management framework					X	X		X		X	X
Tripartite Zoonoses Guide (TZG) Joint Risk Assessment Operational Tool (JRA OT)	X
Response preparedness (REPREP) programme					X
WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human health sector					X

The tools included between one and thirteen of the fourteen elements of our gender and social analysis framework. Two of the tools ranked much more strongly than the remaining tools (with twelve and thirteen elements each) namely the DAI-USAID One Health Gender Integration Toolkit [29] and the JEE Third Edition [30]. UNEP Integrated Environmental Assessment Guidelines [31] scored well with seven elements, and the remaining tools included five or fewer OH-GESI elements.

Six of the tools included elements from Stage 2 (gender and social diversity and context). Seven tools included elements from Stage 3 (gender and social representation). Five tools included elements from Stage 4 (agency and safety). Five tools contributed elements from Stage 5 (Empowerment and transformation for equality).

The two most highly ranked tools included elements from each of four stages of the framework. Six tools included at least one element from the gender and inclusion responsive and transformative Stages 4 and 5 of the OH-GESI framework. Five tools included elements only from Stages 2 and 3, the gender and inclusion sensitive part of OH-GESI.

4. Discussion

This study reexamined the GESI analysis in OHHLEP’s inventory and analysis of One Health tools (Behravesh et al. (2024). Our results were mostly consistent with OHHLEPs simpler analysis, with some revealing differences. The two most highly ranked tools in our analysis were also highly rated in the OHHLEP inventory paper [29], [30] (DAI International-USAID One Health Gender Integration Toolkit and JEE tool). However, with OH-GESI, the UNEP Integrated Environmental Assessment Guidelines [29] and the WHO STAR [32] were shown not to have integrated GESI as well as the top two tools. OH-GESI revealed that three tools addressed only one of a possible fourteen elements, and might therefore be considered as quite weak relative to the others, from a GESI perspective (namely Tripartite Zoonoses Guide [33]; Risk Assessment Operational Tool [34]; Response Preparedness Programme [35]; and, WHO Implementation Handbook for National Action Plans on Antimicrobial Resistance [36].

Our analysis of nine tools for implementing the One Health approach using the OH-GESI framework, deepened our understanding of a significant and worrying gap between the global One Health discourse on gender equality and social inclusiveness and its actual operational application via One Health tools. It also showed how a strong gender and social analysis tool strengthens understanding and insight on GESI in One Health, and how to strengthen it. Although several of the tools refer to gender equality and social inclusiveness as goals, principles or considerations, few incorporate concrete mechanisms to guarantee equity, agency, or representation. According to Measure Evaluation (2017) [37], measurement of gender and inclusion-sensitive indicators is essential to define and assess results, and for results to be relevant to all genders and groups in society. Our findings highlight the need for stronger GESI analysis and integration in One Health tools and implementation.

Works by Galiè et al. (2024) [20] and Merridale-Punter et al. (2024) [38] highlight how gender and other social inequalities are not only reflected in quantitative data, but are in fact rooted in social, institutional, and cultural structures, often more so in rural contexts in low- and middle-income countries. The FAO report on status of women in the agrifood systems (2023) noted that women play vital roles in agricultural and food systems, yet face marginalized positions and inferior working conditions, unpaid care responsibilities compared to men, often in unstable, informal, low-skilled jobs on and off-farm. Deep-rooted discriminatory social attitudes remain the core barrier to GESI, changing slowly despite evidence showing women's empowerment and inclusiveness benefits society [39]. These differences are important considerations when implementing One Health interventions with these communities.

Gannaway et al. (2022) [40] states that despite the existence of advanced gender policies in Rwanda, women continued to be excluded from livestock vaccine value chains as a result of multiple barriers such as restrictive cultural norms, limited access to credit, technology, and training, as well as the need for spousal consent to start a business. Gender inequality influences exposure to and perception of zoonotic risk (Oruganti et al. 2023) [41]. In South Africa, men in constant contact with livestock face greater zoonotic risks, while women, responsible for collecting water and firewood, are more exposed to vector-borne diseases because of differences in routes of exposure to pathogens. These differences give rise to the way men and women interpret and prioritize health risks. One Health tools and frameworks that recognize this unbalanced reality for women and men of different social groups are necessary for effective One Health practice.

Cataldo (2024) [42] contends that intersectional gender analysis is both ethically and methodologically essential to prevent and mitigate health risks at the human-animal-ecosystem interface. Examples such as the intersectional gender equality framework designed by Emdin, et al. (2025) [27] were produced an to assess the use of antibiotics, exposure to antibiotics, and AMR outcomes in livestock systems. The framework provides valuable theoretical reflection and identifies the key questions that should guide an intersectional gender analysis. However, the OH-GESI framework supports a more detailed analysis needed for One Health tools.

The OH-GESI framework responds to an important gap in One Health implementation. The need to strengthen GESI considerations among tools published and used by Quadripartite and other international agencies cannot be overemphasized. Countries are using such tools to advance One Health, and risk perpetuating the lack of attention to these core considerations. For example, Canadas One Health Approach Risk Assessment Guidelines [43] are regrettably gender blind, although they do address the inclusion of Indigenous perspectives. This might not have been the case had their model, the Tripartite Zoonoses Guide Joint Risk Assessment Operational Tool, provided better guidance regarding GESI considerations and methods for gender and social analysis.

There is an urgent need to improve the integration of gender analysis and inclusion considerations in One Health, including in the many tools used. When empowered and meaningfully engaged from the outset, women, youth, People with disabilities, and people from vulnerable and underrepresented groups, including Indigenous people, can lead on One Health action to great effect [44], The Quadripartite have set the right tone with their strong commitment to GESI in the One Health JPA and Guide for Implementation. They can draw on the strengths of some existing One Health tools that integrate GESI well. Nevertheless, there is a need to accelerate the development of additional GESI analysis tools and methods, and to make GESI considerations a requirement of operationalizing One Health. To fail to do so will not only perpetuate inequalities faced by women, youth and vulnerable and under-represented groups; it will impede the effectiveness of One Health action by neglecting the value and benefits of mobilizing, including and building ownership by these groups.

5. Conclusion

OH-GESI responds to a critical gap between high-level commitments to gender equality and social inclusion in One Health, and the lack of sufficient attention to these issues in implementation. This leads to One Health tools and implementation that ignore or perpetuate gender and social inequalities and exclusion and present important barriers to achieving the goals of One Health. OH-GESI provides practical guidance to agencies, governments, researchers, educators, non-governmental, community and civil society groups who are developing or using One Health tools. It does so in a stepwise manner, highlighting how to strengthen One Health tools to be more than gender sensitive, toward tools that support One Health practice that is responsive, or even transformative, in the face of inequalities and exclusion. With this framework, users may strengthen the integration of gender and social equality and inclusion considerations, work toward meaningfully integrating gender and social equality and inclusion goals and outcomes into their One Health practice and contribute to wider national and international goals of equality and inclusion. The more groups and agencies do this, the more One Health implementation will approach the high-level principles of the OHHLEP definition, theory of change and JPA. In addition, One Health implementation will be based on more robust information and reach more people equitably, aligning with the sustainable development goals of Agenda 2030. OH-GESI provides solid and reproducible framework to achieve this and may inform strengthening of gender and social inclusion considerations in One Health assessment, planning, and implementation.

OH-GESI is a tool to help improve One Health tools, but may also inform One Health policies, programs and projects design, implementation, monitoring and evaluation. It may enhance recognition of inequalities, address representation and support One Health tools, plans and implementation on a pathway toward improving agency and empowerment for women, gender non-binary people, and other socially vulnerable and under-represented social groups. By taking a stronger gender and inclusion perspective, One Health tools can contribute to the transformation of gender and social standings toward equality, thus better embodying the principles of the JPA and the OHHLEP definition of One Health.

Authors' information

All authors are members of OHHLEP (2024–2026). N.C.B and D.C. conducted the analysis regarding gender equality and social inclusion considerations in the OHHLEP Tools Inventory paper (Barton-Behravesh et al., 2024) [23].

CRediT authorship contribution statement

Natalia Cediel-Becerra: Writing – original draft, Visualization, Funding acquisition, Formal analysis, Data curation, Conceptualization. Dominique F. Charron: Writing – original draft, Methodology, Formal analysis, Data curation, Conceptualization. Maxine Whittaker: Writing – review & editing, Visualization, Methodology. Salome A. Bukachi: Writing – review & editing, Visualization, Methodology.

Funding

This research was partially funded by Vice-rectoria de Investigación y Transferencia at Universidad de La Salle under a scientific mobility scholarship to travel to University of Guelph in 2024.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

Natalia Margarita Cediel Becerra reports a relationship with Universidad de La Salle that includes: travel reimbursement for mobility scholarship. “Given my role as guest editor for One Health Journal (NMCB), had no involvement in the peer review of this article and had no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to another journal editor.” The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A. Supplementary data

List of Intersectional gender analysis guidance from UN Women and Quadripartite Agencies that informed development of OH-GESI

Data availability

Data will be made available on request.