Women Leaders in Global Health: Fixing the system, not fixing women

This week, more than 850 participants from around 90 countries will meet in London at the second annual Women Leaders in Global Health (WLGH) conference on November 8-9, 2018. Women in Global Health will be leading several sessions at the conference and the title of one of those sessions sums up our message:

“Can we flip the coin? Moving from recognising power and privilege imbalances in global health leadership to doing something about it.”

Women hold over 70% of jobs in the global health and social care workforce but only 20% of leadership roles. Women deliver global health and men lead it – and that is not okay.

Women are often told to be patient because ‘women are in the pipeline’ and it won’t be too much longer before women and men are equally represented in global health leadership. But how long is too long? In 2017, The World Economic Forum (WEF) estimated it will take 217 years to close the economic gender gap between men and women, forty years longer than WEF estimated in 2016. None of us alive today will live to see that happen, and neither will our grandchildren. That is too long.

We cannot wait for global health to correct its own course. Nothing will change without addressing the power and privilege that produce and reproduce inequality. This week we will consider who makes the rules, who benefits from those rules, and who holds the mic - and follow the money.

We cannot understand the present without knowing where we have come from in global health. There are many historical examples of women playing leading roles as healers, keepers of knowledge about traditional medicines and remedies, and birth attendants. But when medicine was professionalised, it was appropriated as a male-only space and formal barriers were erected to keep women out. Worldwide, women had to fight for the right to study and practice medicine, travelling to other countries to be educated and even impersonating men.

In England, the exclusion of women from medicine dates back to 1540 when the King granted a charter to the company of Barber-Surgeons, banning women from the profession. That is indeed a long time ago.

In the USA, the first woman, Elizabeth Blackwell, qualified as a doctor in 1849 but over a century later in 1969, women were still only 9% of total US medical school enrolments. That figure had increased to 20% in 1976 and is now around 50%. The cohort of women who entered medical school in 1976 would now be in their sixties (around retirement age), and late in their careers. The small percentage of women who were able to enter medical school at that time clearly limits the number of women in senior posts today.

Formal discrimination against women in medicine is still very recent history in some countries. The first female doctors in Haiti and El Salvador, for example, graduated in 1940 and 1945 respectively. Discrimination is always hardest fought at the intersections of gender and other identities such as race, caste and class. It took until 1947 before the first black woman was able to even register as a doctor in South Africa.

It was not the case that women did not want to practice medicine: formal discrimination meant they simply had no way into the system. If they received access to the system, formal and informal discrimination and bias meant many women were prevented from getting to the top due to a ‘leaky pipeline’. As a result, most mid- and late-career women in medicine today started their careers in global health with little to no female role models. And just as important, men starting out in medicine also lacked female role models, which further normalised the stereotype of leadership having a male face.

Women at work hear a lot of advice – dress this way, smile, find a mentor, lower your voice, and lean into work systems and cultures largely designed by men for men. Women learn early on that their subordinate position is their fault and they must change to fit in. Many men never consider that their privilege derives largely from an accident of birth, by virtue of the sex and other identities they were born with. The men who were 80% of the US medical school intake in 1976 may never have considered how much easier their career progression would be with so much female competition eliminated from the race.

So this week Women in Global Health are not in London to ask how we can advance our own careers in global health. We are asking: how we can address power and privilege imbalances in leadership to transform global health? We are asking leaders in global health of all genders, to do things differently and be Gender Transformative Leaders. We are bringing women from all backgrounds and all walks of life to the table who use their voices for smarter, more sustainable global health decisions. Let’s stop trying to fix women and instead, fix the global health system to fit all genders so we have better global health for all.

References:

World Economic Forum, The global gender gap report. 2017

Ellis, Harold (October 2001). "The Company of Barbers and Surgeons". Journal of the Royal Society of Medicine. 94 (10): 548-549. doi: 10.1177/014107680109401022. ISSN 0141-0768. PMC 1282221

Walsh, Mary Roth. Doctors Wanted: No Women Need Apply: Sexual Barriers in the Medical Profession, 1835-1975 (1977)

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