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Breaking gender equality barriers in women’s global healthcare leadership

  • The global COVID-19 pandemic has further revealed the gender inequality of women in global health leadership roles.
  • Dr Sonya G Smith from the American Dental Education Association and Dr Jeanne C Sinkford, Dean Emerita and Professor Emerita at Howard University College of Dentistry, USA, have evaluated the disparity faced by women in this sector.
  • Although women make up most of the health and social sector workforce, bias, discrimination, stereotypes, and systemic barriers often prevent women from entering global health leadership roles.
  • A gender transformative leadership approach which incorporates gender mainstreaming is needed to break down barriers and accelerate gender equality in the global healthcare sector.

It’s undeniable that the COVID-19 pandemic placed an enormous amount of strain on healthcare workers around the world. While highlighting strengths in our healthcare systems, it has also brought to our attention disparities in global health leadership. For example, women in global healthcare decision making are under-represented. During the pandemic, only 10% of the World Health Organization’s (WHO) board members were women, and 11% of countries had no woman at all within their COVID-19 task forces. As we strive to achieve the UN gender equality goal, it is important to have gender equality at the most senior level of global healthcare leadership.

Gender inequality in leadership

Dr Sonya G Smith, Chief Diversity Officer at the American Dental Education Association in Washington DC, and Dr Jeanne C Sinkford, Professor Emerita and Dean Emerita, Howard University College of Dentistry, USA, highlight this gender inequality in their recent evaluations of the global health and social care workforce. They analysed a range of sources (including data from the UN and WHO) which indicated global gender inequality in our healthcare systems. Globally, women make up 70% of the workforce in the health and social care industry, but hold only 25% of leadership positions. Of the more than 100 roles appointed at CEO and board level in 2020, none were filled by women. The researchers found there is particular marginalisation of woman from developing countries, with only 5% of CEOs being female and from low–middle income regions. Through their assessment of the role of women working in our healthcare systems, Smith and Sinkford also investigated the barriers which prevent them from undertaking leadership roles in equal proportions to men.

Globally, women make up 70% of the workforce in the health and social care industry, but hold only 25% of leadership positions.

Barriers against women

The Women in Global Health Ecological Model gives a clear overview of the five key factors which may prevent women from entering or advancing in global health leadership. The first factor relates to public policies which lack support for gender-specific issues such as pay gaps, parental leave, childcare, sexual harassment, or eldercare. Smith and Sinkford believe establishing policies in these areas will not only serve to support women in the workplace but will also impact on gender equity in society.

2018 Global female and male distribution of healthcare professionals.
Source: The World Health Organization National Health Workforce Accounts Data (NHWA) portal. Updated December 2021. Accessed May 13, 2022.

Further barriers relate to community attitudes such as cultural norms which place limitations on women’s right to work. In some countries there are still laws preventing women from taking on employment unless agreed by their husband or older male family members. Cultural beliefs and stereotyping can also give rise to institutional and interpersonal barriers such as workplace bias, harassment, and discrimination. An example of this bias would be perceiving women as intellectually inferior, often witnessed in fields where fewer women currently occupy leadership roles.

Globally, women undertake the majority of social and healthcare roles but are under-represented in global healthcare decision-making.

The final factors are individual barriers which include work-based situations that are more likely to be experienced by women such as ‘likeability bias’ and ‘imposter syndrome’. Likeability bias refers to women being liked by colleagues due to their stereotypical female traits such a being kind and caring, but this often make them less likely to be promoted into leadership roles. Imposter syndrome is when a person has chronic self-doubts about their work role irrespective of their ability, and this can lead to women in particular turning down leadership roles through fear of under-performance.

Women in the global health ecological model. Source: Women in global health. women in global health – ecological model 

Achieving gender equality

Smith and Sinkford acknowledge that achieving gender equality within global health leadership is a complex issue. There are interconnected factors relating to culture, society, economics, and politics which have a significant impact on the gender-equality landscape. Smith and Sinkford believe a more gender transformative leadership (GTL) approach is needed. GTL focuses on eliminating power imbalances by disrupting the current system of thinking and then reframing roles. This approach could help to remove systemic bias and discrimination towards women in the global health workforce.

The fight for reform must continue at all levels, as health equity and equal opportunity belong to all women, men, and nonbinary persons around the world.

Another key tool to support GTL is gender mainstreaming, which aims to achieve equality through developing gender-inclusive policies. Gender mainstreaming focuses on addressing gender inequality to help counter historic inequality for women in relation to health. It also aims to reduce stereotyping and bias relating to gender. Smith and Sinkford’s research revealed a need for more analysis that incorporates gender mainstreaming. This includes collecting data for all gender identities to assist with monitoring and future planning. The researchers also emphasise the importance of collecting and using data to help provide global recognition for women working in global health and social care. Increasing women’s visibility within the sector may help them to gain recognition for their efforts and assist with career advancement.

2021 Gender representation – global health organisation boards.
Reproduced with permission from: Global Health 50/50. Boards for all? A review of power, policy and people on the boards of organisations active in global health. Cambridge UK, 2022.

Smith and Sinkford believe training is vital for GTL and gender mainstreaming to be adopted and implemented at all levels within the health sector. They also note the importance of specifically designing leadership development programmes for women, as well as mentoring and networking schemes led by women in senior positions to coach and support more junior women within the sector. Smith and Sinkford insist the fight for reform must continue at all levels, as health equity and equal opportunity belong to all women, men, and nonbinary persons around the world.

Did any of the findings from your recent evaluations of the health and social care workforce come as a surprise to you?

Yes. According to the 2021 Global Health 50/50 Report, 58% (80/138) of global health organisations have never had a woman CEO, and 51% (70/138) have not had a woman Chair of the Board.

Based on your research, what steps should healthcare systems be taking to break down barriers and help women to enter leadership roles?

In the article, we provide ten recommendations. Two of these are:
• conduct gender analysis and related policy/programmes audits and design GTL approaches to address structural barriers to change
• collect and analyse gender identity and sex disaggregated data and conduct gender analysis for all gender identities to assist with strategic planning, monitoring, and policy and programme development in support of gender equality and GTL approaches.

Which topic areas do you feel are still under researched in relation to gender inequality in the health and social care sector?

Future research on barriers and solutions to inequality in global health leadership should include the experiences of gender identities beyond persons whose sex at birth are male and female. Additional research is also needed on workplace violence and sexual harassment in global health organisations with a gender analysis focused on intersecting identities.

Do you have further research planned in this field?

Yes. In terms of a comparative analysis, we are looking at the different barriers and experiences of women in various healthcare sectors in global leadership roles, and strategies for overcoming them.

Related posts.

Further reading

Smith, SG, Sinkford, JC, (2022) Gender equality in the 21st century: Overcoming barriers to women’s leadership in global health, J Dent Educ, 86:1144–1173.

Dr Sonya G Smith

Dr Sonya G Smith is the Chief Diversity Officer at the American Dental Education Association. Prior positions include Associate Vice Chancellor, University of Tennessee Health Science Center; Associate Vice Chancellor for Academic Affairs/Chief Student Affairs Officer and Associate Professor, College of Public Health, University of Nebraska Medical Center.

Dr Jeanne C Sinkford

Dr Jeanne C Sinkford is Senior Scholar-in-Residence Emerita, American Dental Education Association and Professor Emerita and Dean Emerita, Howard University College of Dentistry. She is the first woman dean of a US dental school. She is a renowned scholar and champion of women and under-represented populations in the health professions.

Contact Details

Sonya G Smith, EdD, JD MEd, MA
American Dental Education Association
655 K Street NW
Suite 800, Washington, DC
20001, USA


Cite this Article

Smith, S, Sinkford, J, (2023) Breaking gender equality barriers in women’s global healthcare leadership. Research Features, 146. Available at: 10.26904/RF-146-4042070407

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(CC BY-NC-ND 4.0) This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Creative Commons License

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