Director of Harvard Global Health Institute, Dr. Ashish Jha on gender equity in medicine and health

Leading up to International Women's Day on March 8th, Women in Global Health wanted to highlight how gender equality affects everyone and it is beneficial to all for us to achieve it within global health leadership. Along this thinking, Women in Global Health set out to interview a few Male Champions on their views on gender equality and how they are addressing it within their own networks. Dr. Ashish Jha is the Director of the Harvard Global Health Institute and has researched differences in care by female and male physicians, as well as making a commitment not to have an 'all male panel' in any of his institute's events. Read on to see our conversation with Dr. Jha.

[Women in Global Health]: You’ve written about how female physicians have had lower 30-day mortality rates as compared to male physicians, how can we translate the knowledge or characteristics we have from female physicians to all physicians to decrease our mortality rate among patients, no matter which gender of doctor they are treated by? How can this female physician leadership be promoted?

[Dr. Jha]: Let me share a few thoughts on this: First, the question is, why do women physicians have better outcomes? If you pull together the totality of evidence on this topic it's that women physicians do tend to practice a little differently. What we know is that they tend to be a bit more evidence-based, they stick to clinical guidelines more closely, and there is some evidence that women physicians are more effective communicators. Put all of that together and we believe that is probably what explains the differences. If that is true, which I believe it is, that means there is hope for the rest of us that we can translate those practices into training and learning that can help everyone improve. Of course, these are average differences- we aren't saying that women know how to communicate and men don't, that would be too simplistic. It is that, on average, women seem to be better but there are plenty of men that are very effective communicators. Ultimately, what we need to do is translate this knowledge into better training for every physician with the idea that it would help everyone- patients and physicians, alike. That is the notion behind this study and we have to remember, this study is part of a broader set of work that has found, not many, but some important differences in how men and women practice medicine.

I have had a chance to reflect on this and also speak to a large number of people from all sorts of industries about what this means and how it can be translated to other areas of our economy and society. I think, right now, we don't exactly know, but there is this divide out there that says something about how men and women work differently across lots of factors. Furthermore, it does raise some important questions about the broader role of women in society and how much they have been valued and bring to the table. This notion helps me segway a bit into the second part of this, which is all this evidence emerging within the medical field that women and men are paid differently- even accounting for the number of hours and years, or specialty- women still get paid less. Furthermore, within academic medicine, accounting for all the other factors that we can, women are still less likely to be promoted. Another thing our study does is put to rest any questions about competence and effectiveness which is based on strong empirical evidence that women physicians are doing at least as well as men, if not arguably, better. I think now, we should address that and determine what the mechanisms are for addressing it.

[Women in Global Health]: From an academic perspective, what changes have you seen in the gender equality within high-level research or departmental/institutional leadership? As Director of the Harvard Global Health Institute, how are you implementing institutional change and how are you discussing this issue with other deans within Harvard and your colleagues at other institutions.

[Dr. Jha]: So this is a good news/bad news situation. The good news is we are seeing more women in leadership roles, more women play prominent roles in institutions- the Dean of our school is the first women dean we have had at the Harvard School of Public Health. So we can clearly see these as measures of progress, but if you take a step back and ask "Are we there yet," the answer is "not even close." We still have a lot of work to do as most of the leadership within global and public health is still dominated by men. It is interesting to think about why that is and what little or big things we can do to try to affect that- where the big things we can focus on is having women in senior leadership positions and making sure we do that. Also, there are a lot of little things we can do to promote gender equity- I had a conversation with a colleague that sparked this thinking. About a year ago, I saw a Women in Global Health tweet on all-male panels and I decided that we weren't going to do that anymore. The reason I think we end up with all-male panels is, basically, intellectual laziness. You know, I am a guy and in a leadership position, and I know people start thinking about their friends to be on a panel. It's natural that people will gravitate towards people they know already- and that is why people unintentionally create- even among well-intentioned people- panels and events that really only highlight certain groups. So we made this commitment that we are just not going to do that and we have found it actually easy to stick by because there are lots of really talented, accomplished women. You just can't be intellectually lazy, you have to think about it and the moment you do, it becomes easy to identify women for panels. I mean, I love my friends, I understand, but go do something else with them. If you are going to do something that is professional and intellectual, just take the extra few seconds to ensure you have a diverse set of views.

[Women in Global Health]: Is this something you have encouraged other institutions to take on as well?

[Dr. Jha]: Well we have certainly encouraged it among our colleagues and I talk about it a lot at Harvard- that we are just not going to do that [all-male panels]. Sometimes we will have a panel and someone will say "well, what about this person" and I'll explain to them why we are not doing that. I have found when I explain it to people, everyone gets it just about immediately- people understand why [gender equality] it's important and that it's not difficult to do because there are so many accomplished women to include.

[Women in Global Health]: I think that is so great, this commitment you have made and how you talk about it openly with colleagues that are also on board. We are actually doing a call for commitments through the global health community, talking and asking people to address gender equality at a leadership level or in their own institutions. So, we would love if you could make that commitment as well through our online platform. Are there any other commitments or strategies that you have had time to reflect on that you think would be most effective in bringing about this change?

[Dr. Jha]: Well, beyond the specifics of all-male panels, I think it is important to remind people why gender equity is so important. One of the responses I get that bothers me is when people respond "well, I have daughters," but then what if people just had sons, would that mean we wouldn't be committed to that extent? Of course not! Beyond it being a basic human right argument, it's that it is actually good for all of us- for society. The evidence is that the education of women is good for social development and when you have more diverse leadership structures, boards, and management, organizations tend to function better. This is not a moral issue, so much as an evidence-based one. So within our own institute, we definitely think about these things.

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