Within the health workforce, men occupy around three quarters of senior roles, yet women make up around 70% of the world’s workers. And while women in health contribute 5% to the world’s gross domestic product — a staggering $3 trillion every year — half of that work goes unrecognised and unpaid.
So found the authors of the WHO’s most recent report on gender equality in the global health workforce, which makes for grim reading. Women in global health are subject to persistent gender inequalities within the workforce which impede their career progression, depress global economic output, and hinder progress towards improving global health, the report found.
But what’s causing gender inequality in the global health workforce? Why does it matter? And what policies could change it?
Equality’s pay offs
Gender biases in societies across the world encourage men and women into different jobs: where men are encouraged into technical, well-paid roles including surgery and management, women are instead led into lower-paid, less secure caregiving roles as community health workers, nurses and midwives.
Those social expectations curtail both men’s and women’s choices: “Just as a woman might benefit from a leadership role, a man might benefit from a caregiving role,” said Dr Geordan Shannon, researcher at the Institute for Global Health, University College London.
Education plays a significant part in that. Girls in low- and middle-income countries often struggle to receive secondary education or reach university, curbing their potential for progression into global health’s higher rungs. Those that do reach the formal global health workforce often face a motherhood penalty.
But gender inequality isn’t purely driven by social factors: across the world, employment rights, equal pay for equal work and protections against harassment are threadbare or non-existent in many legal systems.
Without effective redress for gender-based violence and harassment, pay equality and collective bargaining enshrined in law, women are necessarily held back.
The impact of these inequalities is far reaching, according to the WHO report, impacting the quality of care provided, and the economic potential of the sector at large.
“Gender equality in the global health workforce is both an intrinsic value in and of itself, and something more instrumental,” said Shannon. Helping women to flourish within the workforce is a moral imperative in any fair society, she argued, but it could also improve quality of care and a range of other global development outcomes.
According to the WHO, gender equality in global health would reap a triple dividend.
First, research by the International Monetary Fund, McKinsey and the World Economic Forum in other sectors have found that diversity and gender equality within workforces align with improved productivity and efficiency, which in global health could mean significant progress towards the WHO’s goal of universal health coverage by 2030.
Second, improving women’s working conditions, pay and quality of life in the world’s health systems — which between them employ a significant proportion of the population — could make significant progress towards achieving gender equality in society at large.
Finally, the global health and social sector is projected to create some 40 million new jobs by 2030. Holding back or discriminating against the workers who overwhelmingly fill those roles is also a blow to the world’s economic development.
Data and decisions
Investing in proper data gathering is the bedrock for intelligent policy, but many countries, especially in the global south, remain largely in the dark about the impact of gender inequality within their workforces.
The WHO’s most recent report relies heavily on studies in the global north, the findings of which are unlikely to apply neatly elsewhere. The solutions too are likely to be different.
That said, lack of data is no excuse to delay policy change, said Geordan Shannon. “We don’t need to wait for the full picture of evidence; we have sufficient information on hand to know that gender equality in the global health workforce offers immense rewards.”
The aim, she and others argue, is to stop trying to force women to fit the global health system, and start trying to make the system work for women. According to Roopa Dhatt, co-founder of Women in Global Health, “Policies to date have attempted to fix women to fit into inequitable systems; now we need to fix the system and work environment to create decent work for women and close gender gaps in leadership and pay.”
One vital area that can be addressed now is parental leave and flexible working policies for all, said Sarah Hawkes, Professor of Global Public Health, UCL and co-founder of Global Health 50/50.
“You need strong parental leave policies. Evidence suggests that it’s no good just having the option of paid paternity leave, there’s an argument that it should be mandated, because if it’s just shared then women take most of it,” she said. Simply expanding leave to men is unlikely to dramatically change when social expectations discourage men from becoming primary caregivers to children.
“You also need childcare for people with young children, otherwise women are often the ones forced to fill that role,” Kent Buse, Chief of Strategic Policy Directions at UNAIDS added. “And you need flexible working arrangements for everyone in the workforce, whether you’re a man or woman, to facilitate caring for children or any other family member, or simply to have more of a work-life balance,” he said.
As it stands, research by Global Health 50/50 found that some 200 leading global health organisations differ dramatically in terms of both parental leave and flexible working policies: standardising the most progressive policies would go a significant way in narrowing global health’s gender gap.
Ending the men-lead, women-deliver model is a new era in the fight for gender equality in health. Where previous struggles fought simply to put women’s health issues on the agenda, researchers now stress the need to understand gender as one of the most significant determinants of health, and to understand what gender justice means when women aren’t simply the recipients of care — they’re the vast majority of the global health providers.
According to Geordan Shannon, “It’s not just a women’s issue: it’s about what’s best for everyone.” — Edward Siddons
(Picture credit: Flickr/Ilmicrofono Oggiono)