Abstract
BACKGROUND: Critical gender analysis is increasingly recognized as essential to improving the quality and equity of health research. This study aims to analyze the scientific evidence on the effectiveness of interventions to reduce health inequalities in Europe and identify the level of gender innovation as a quality criterion. METHODS: An umbrella review was conducted to gather recent scientific evidence on community and/or health sector interventions in Europe aim at reducing health inequalities. Fourteen health science and social science databases were searched from 2016 to 2024. Seventeen qualitative and quantitative reviews were analysed to describe interventions effectiveness, examine the inclusion of sex and gender categories, and assess the gender approach in the reviews. An adapted version of the SGAT-SR instrument and a gender innovation classification system were used for the last two analysis. PROSPERO registration number: CRD42022286792. RESULTS: The 17 systematic reviews analysed encompassed 338 interventions. In 35% of the reviews, sex or gender categories were used incorrectly. 52.9% of the reviews omitted gender in their analyses (gender-blind) yet concluded that the outcomes of health promotion and disease prevention programs were effective. Only one review identified effective interventions and was found to be gender-transformative. CONCLUSIONS: The degree of gender innovation in systematic reviews was considered insufficient or questionable. The scientific community does not currently consider the inclusion of gender as scientific, methodological (and therefore social) requirement that should be addressed with the same level of rigor and excellence as ‘traditional’ epidemiological considerations in systematic reviews. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12939-026-02801-6.