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.

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.

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.

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.

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.