Advancing Women's Leadership in Global Health

Women in Global Health was present that the World Congress on Public Health in Melbourne earlier this month. Our workshop and panel on "Advancing Women's Leadership in Global Health", facilitated by Mariam Parwaiz from the WGH Communications team and Rangi de Silva from Global Ideas, marked the first time we brought a non-binary perspective to our event, and we applied the gender lens to the Congress and the work they do. Read our workshop facilitation below.

The objectives of the WCPH workshop were to discuss barriers public health practitioners face in their roles due to their personal gender, to apply a gender lens to discussing these barriers, to reflect upon our own gender biases, and to discuss potential solutions to the barriers. The WGH mission is to improve global health through gender equal, gender responsive leadership, through the utilisation of advocacy, capacity building, research, policy recommendations, networking, and mentorship opportunities. A workshop such is this one was designed to raise awareness of the issue as well as increase capacity of people to work in this area.

To illustrate the need for our work, here are some recent statistics. You will know that women make up about 70% of the health workforce globally, and in public health as you can see from this Congress, it’s slightly higher than that. Yet in the highest echelons of global health leadership, the numbers are flipped. Only 11 of 33 WHO Executive Board members are women. 27% of Ministers of Health from around the world are women, 26% of World Health Assembly Chief delegates are women, and only 3/10 women work in the Director General’s office. Hence our call for greater gender equality in global health leadership.

Definitions

Before we get into the workshop part of this session, a few definitions to make sure we all are on the same page. What is gender? It is a social construction of characteristics, such as norms, roles, and relationships of and between groups of women and men. It varies from society to society and can be changed. Gender norms and behaviours are taught – e.g. how to interact with the same or opposite sex within households, communities, and workplaces. It is different to biological sex. So for example, biological females menstruate, that’s a physiological design. Whereas, in most parts of the world, women do more housework than men, there is no biological reason for women doing more housework, it’s just a social construction.

Gender equality is about equal rights, responsibilities, and opportunities for all genders, not based on biological reasons. It does not however mean that men and women become the same. Instead it’s about recognising the diversity of genders, and taking the interests, needs, and priorities of both women and men into consideration. Therefore, it’s not just a women-only issue, but should concern men as well as women.

A critical aspect of promoting gender equality is the empowerment of women, with a focus on identifying and redressing power imbalances. Achieving gender equality requires women’s empowerment to ensure that decision-making at private and public levels, and access to resources are no longer weighted in men’s favour, so that both women and men can fully participate as equal partners in life. Gender equality is a human rights issue, it is a part of the 5th Sustainable Development Goal, and thus a precondition for, and an indicator of, sustainable, people-centred development.

Continuum

This framework is from the Interagency Gender Working Group and categorises how policies and programmes treat gender norms and inequalities in their design, implementation, and evaluation.

The term “gender blind” refers to policies and programmes which are designed without prior analysis of the culturally-defined set of economic, social, and political roles, responsibilities, rights, entitlements, obligations, and power relations associated with being female and male, and being gender blind ignores the power dynamics between and among men and women. In essence, gender blind programmes/policies ignore gender considerations altogether. In contrast, “gender aware” programmes/policies deliberately examine and address the anticipated gender related outcomes during both design and implementation. An important prerequisite for all gender-integrated interventions is to be gender aware. The ultimate goal is gender equality and better outcomes.

The continuum moves from exploitative gender programmes and policies to accommodating to transformative. Transformative gender programming attempts to promote gender equality by fostering a critical examination of inequalities, and gender roles, norms, and dynamics; by recognising and strengthening positive norms; and by promoting the relative position of women and marginalised groups, and transforming the underlying social structures, policies, and broadly held social norms that perpetuate gender inequalities. There was a fantastic panel yesterday afternoon on gender transformative theory, practice, and knowledge translation in public health. I hope some of you had the chance to attend.

Think about the policies and programmes that exist in your country or your area of work. Where do you think they sit along this continuum? Maybe some policies more gender aware than others?

Barriers

Having considered the gender continuum, we have to consider the barriers and discrimination women face in public health and public health leadership. Michael Moore, in his opening address challenged the next generation of public health professionals to take the leadership of public health into the future. Think about what barriers do you think exist for early career public health women in this room, women like myself and like a lot of yourselves, the barriers that exist for many women at this Congress and in your respective workplaces from taking the baton of public health leadership?

This framework shows the five different levels of barriers that women face. You will have seen similar frameworks, and it’s just one way of trying to understand and solve these barriers.

Firstly, are the structural barriers. These are related to the laws and logistical aspects of how a society works. So take for example the issue of parental leave for childbirth. In most countries, there are laws about maternity leave, but they may not apply to women doing contractual or consultancy work, which can be the case in public health. Many countries do not have paternity leave, the societal understanding being that women are solely responsible for childcare.

Social and political barriers relate to institutional mindsets. This is closely related to structural barriers. Social and cultural norms define gender norms and expectations. This can play out within institutions people work in, so if you’re in academia you might notice that women make up 50-60% of the student population yet female professors, even in public health, are not at 50%. Social and political barriers relate to stereotypes, gender bias, gender discrimination, and ultimately are about a lack of respect for all genders that are not masculine.

Economic and financial barriers relate to unequal access to capital, and getting paid less for same work. Many female workers work in female-dominated occupations and these tend to be lower paid. Women are under-represented in the higher-level jobs. We could talk about the gender pay gap all day but essentially women are more likely to be clustered in the bottom or middle of an organisation; the job’s women do are not recognised or seen as valuable as non female-dominated jobs; and women contribute more to childcare and family care, which means they tend to be in part-time positions which tend to be more in the lower paid occupations and positions.

Psychological barriers can also be described as personal mindset or even internalised discrimination. It’s about how women tend to look at themselves and how we look at others around us.

Lastly are the physical barriers, so these are biological, physiological issues that men and women face differently. These biological differences have an affect on how they can function in their workplaces, at home, and in their communities.

Now, bear in mind that some examples of barriers will fit across different categories and that’s absolutely fine. Also, gender does not exist in a silo. It intersects with ethnicity, class, religion, sexual identity, and much more. Women of colour and indigenous women face multiple barriers that are compounded by layers of gender, ethnicity, history of colonisation, class, religion, and so on.

Discussion

The presenters outlined structural barriers. I’ve already mentioned the laws around maternity and paternity leave. Related to that are laws around “care work” and if looking after elderly parents or other family members, is recognised is work or not. Many women in public health are juggling their paid work with unpaid, under-recognised care work, which is not shared equally between men and women. You’ll know of women from your own workplace, or perhaps you are one or have been in this situation. This links with women’s abilities to earn similar amounts as men, which then contributes to economic inequality.

I think examples of social and politics barriers are plentiful. Social norms about women and what they can and cannot do continue to be prevalent. In academia, I hear of women still being asked personal questions like when they are planning to have children and if they will take time off for it, as if their ability to be an academic and a mother may conflict with each other!

Unfortunately I have many examples of social barriers from my own life experience. I know in situations my views have not been taken seriously because of my gender. For example, I was at a public health meeting once not that long ago where there was a discussion happening about a particular issue, and I raised a point. I was immediately shot down by the chair of the meeting. Some time later, in the same meeting, the same chair, who happened to be a man, made exactly the same point I had made earlier and credited it as his own idea! No one raised an eye and I felt so uncomfortable having been discredited earlier that I did not have the courage to speak up again. These small instances, or microaggressions, affect a person’s mindset. I have not felt comfortable speaking to that chair again and I try and avoid that particular public health group, even though I’m extremely passionate about public health.

For economic and financial barriers, nursing is a classic example of a female-dominated profession, it’s not seen as valuable as other work that is of equal value. The fact that women work part-time as I’ve just said contributes to the economic inequality. It’s closely related to structural barriers, for example, what areas that governments put money into. We all know that public health is often underfunded and undervalued by governments, and it’s a female dominated industry. Obviously that’s not the only reason why public health is underfunded but there are certainly some unconscious biases happening here!

Psychological barriers are quite interesting because we often don’t even realise we view the world in a certain way. There is a riddle, which goes like this “a father and son are driving a car and they get into a car accident. The dad dies and the son gets rushed to the hospital. The surgeon says “I cannot operate, this is my son”. Who is the surgeon?” The answer is the surgeon is the mother. I recently asked my medical and surgical female colleagues this riddle and some of the female surgeons said that they automatically thought the surgeon was the father even though they themselves are surgeons! This is how psychologically women are made to feel less important than men.

Physical barriers include things like pregnancy, only biological females can get pregnant, menstruation and access to or lack thereof to pads and tampons and safe facilities to change these in workplaces or communities. It’s not always easy or possible to change these physical barriers but there certainly are ways to accommodation for them.

Life course approach

In this workshop, we are taking a life course approach. I imagine most of you are familiar with this but just briefly – we are going to think about barriers women face as they progress through life. So growing up as a child, then pursuing university education, being a young professional, a senior professional, becoming an expert in a particular field, ageing, and of course considerations about having a family along the way. Some barriers women will face throughout their lives, others they may only face once or twice. And of course, barriers that we all face in our childhood can have a significant long-lasting impact later on in our life or even throughout our lives. For example, not having access to primary education because one is a girl will lead to further barriers in life.

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