Opinion: Global health security depends on women

As COVID-19 exposes gaps in the world's pandemic response infrastructure — and challenges our collective social, political, and economic systems — we are faced with an opportunity to tackle the defining issue undermining global health infrastructure: inequality.

Pandemic response efforts are deeply undermined by fundamental gender inequities in the health workforce and wider society. Women represent 70% of the global health workforce, and yet they make up just 25% of global health leadership. In the U.K., the pandemic security response team is entirely men; in its first iteration, the U.S. team was the same.

We know that when women are in positions of global health leadership, women’s needs will be reflected in global health policy. As COVID-19 reshapes our health systems in the coming months, there is an unparalleled opportunity to build gender equity into a system that has long absolved itself of it.

Here are five asks that — if acted upon immediately by governments, private donors, the media, and the research community — could hard-wire gender equality into health systems and ensure health security for us all, now and in the future.

1. Include women in global health security decision-making structures and public discourse

Women account for the majority of the global health workforce but are underrepresented in COVID-19 decision-making bodies, leadership, and media commentaries. Responses to outbreaks are weakened where female talent, expertise, and diverse perspectives are excluded. The current state of global health requires decisive action. That’s why Women in Global Health is doubling down on our Operation 50/50 campaign, which demands equal representation for women in global health leadership because diverse perspectives strengthen health systems and save lives.

We can’t win the fight against this — and other — health challenges by using only half of our global talent pool. The voices of women, especially women from the global south, must be heard.

We ask that World Health Organization member states, international agencies, NGOs, and the media include women — particularly women from the global south — as 50% of global health security decision-making bodies and expert groups.

2. Provide health workers, most of whom are women, with safe and decent working conditions

Women are 70% of the global health workforce but are underrepresented in leadership, clustered into lower-status, lower-paid jobs and commonly subject to harassment. Women are at higher risk of COVID-19 infection, which is compounded by exhaustion and mental stress. Women health workers need safe and decent working conditions to enable them to care effectively for patients, their families, and themselves.

We ask that WHO member states, international agencies and NGOs, and health sector employers provide health workers, most of whom are women, with safe and decent working conditions. This includes protecting workers from harassment and bullying and providing adequate personal protective equipment and procedures.

3. Recognize the value of women’s unpaid care work by including it in the formal labor market and redistributing unpaid family care equally

Women’s unpaid work provides a fragile foundation for global health, including responses to outbreaks and pandemics. Female health workers contribute an estimated $3 trillion to our gross world product, of which almost half is unrecognized and unpaid. Women, more so than men, are recruited for unpaid roles in health and expected to provide indispensable care and domestic work for their families.

We ask that WHO member states, international agencies, and NGOs bring women’s unpaid health and social care work into the formal labor market and help redistribute unpaid family care equally between men and women. This includes paying women fairly for their health and social care work and implementing family-friendly policies — for example, equal paid family leave for men and women — that help redistribute unpaid family care.

4. Adopt a gender-sensitive approach to health security data collection and analysis and response management

Ignoring the gender aspects of outbreaks and pandemics hinders prevention and response management by obscuring critical risk factors and trends.

We ask WHO member states, international agencies and NGOs, and the global health research community to adopt gender-sensitive approaches to health security data collection and analysis and response management — from collecting and publishing sex-disaggregated data to conducting research on the gender-specific impacts of outbreaks, such as increases in gender-based violence and decreased access to sexual and reproductive health services.

5. Fund women’s movements to unleash capacity and address critical gender issues

The response to outbreaks and pandemics is stronger when global movements, including women’s networks, coordinate global and local action. But women’s organizations — especially those based in low- and middle-income countries that are most at risk — are underfunded; only 1% of gender-focused donor aid to civil society went directly to women’s NGOs in low-income countries from 2017 to 2018.

We ask that WHO member states, international donor agencies and NGOs, and philanthropic organizations fund women’s movements and, particularly, women’s organizations in low- and middle-income countries to unleash capacity and address critical issues in global health security.

Global and local solidarity are vital as this emergency escalates. Movements like ours, which works beyond borders, are key to confronting this global threat. As part of this emergency response, it is critical that women are enabled as decision-makers at all levels — from global to community.