It is time to deal with the persistent gender leadership gap in global health. Here’s what we know: when disaggregated by sex, there are many fewer women than men in positions of leadership within the global health arena. We also know that women carry the highest burden of disease and that they comprise 65 to 85 percent of both the formal and informal health workforce.
The World Health Assembly, for example, has roughly 25 percent of leadership positions occupied by women, which is also the same low percentage that made up female African ministers of health in 2014. If women make up the majority of the health workforce but the minority of its leadership, then there is something in the trajectory from working in health to leading in health that is hindering women’s progress. We need to address that “something.”
If you adopt a simplified version of Robert Kaplan’s take on what you really need to lead as believing in something, being able to act, and adding value to others, then women are ceaselessly and relentlessly leading in the global health arena. Community health workers and nurses, for example, are largely women who are constantly closing the effects of the gaps in human resources for health and adding health value to their communities. They are constantly influencing society members toward accomplishing good health. So basically, women are leading, even though very few of them are in formal leadership positions.
Global health systems are complex adaptive systems and require leadership that is transformational and not transactional. The effectiveness of a leader is in part due to the prescriptive, socially constructed expectations of men and women. Yet the fundamentals of transformative leadership — relationship-oriented, encouraging participation, nonhierarchical, enhancing other people’s self-worth, and interested in sharing power and information — are socially “feminine” characteristics. Most women grow up being socialized to embody these traits. When they display them in the public space, at work and in boardrooms, we do not call them leaders. We say they are just being women, because that is what women do.
On the other hand, when a man erases transactional fundamentals of a trade of promotion or salary for performance, or a “punishment” of demotion or firing for poor performance that are “masculine” expectations and adopts transformational fundamentals, he is lauded and applauded. He is praised for being a good leader. This is one way in which we are diluting the leadership contributions of women in global health. We fail to give them the authority that comes with leadership positions, even when they are already manifesting leadership in the roles they play in global health.
When we do put them in spaces of authority, women are often offered salaries that are significantly less than if a man had been appointed to the same position. Mothers even suffer a “motherhood-wage penalty” compared to non-mothers. At times, global health institutions have gender-blind policies that ignore childbirth and caregiving life cycle events that differ between men and women, leaving qualified leading women to choose between advancing their careers and their home lives. Anne-Marie Slaughter was the first female director of policy planning at the state department, and she had to grapple with such gender-blind policies.
In the leadership context, gender parity means leadership representation of every type of woman using their unique value add to improve global health. I’ve walked into meetings and have had conversations about Africa’s health systems and how to make them better — and I was not represented at the decision-making table. I am black, I am a woman, and I am African.
There is nothing wrong with differences based on sex, or having a particular skin color — the issue is when these differences are assigned unequal value and women are considered the inferior sex, the weaker sex; or an African or black woman is considered less than a European or white woman. We have to pay attention to the interactions between gender and other forms of identity, and we have to pay attention to interactions between gender and organizational processes.
There are differences in the career capital that different men and women have access to and these differences are influenced by factors such as differing traditions, attitudes, and behaviors; different types of education, training, and laws; differences in employment conditions and trajectories, rights and benefits; child care provisions; and/or equal opportunities policies. Acknowledging these differences and harnessing them for context- sensitive leadership is one possible way of cracking doors to empower women to be successful global health leaders.
We need multicultural global leaders who exhibit this trait via the leadership skills they exhibit. So in addition to mentoring up-and-coming women leaders, coaching them is particularly important. Coaching is based on skills improvement — enabling women to use and improve their skills. There is no final destination to the influence of gender in leadership because gender is not a static notion. A crucial step is to acknowledge the ever-changing notions of gender-influenced leadership trajectories and career progression.
We need to get to the point where global health leadership mirrors the health workforce population and health needs, with many women and many different kinds of women in leadership positions. It’s time to pay attention to the leadership processes and experiences that women are already manifesting, and bring those to the forefront as evidence to advocate for putting more women in power.
Let us be proactive about removing barriers and obstacles that prevent women from striving for and thriving in global health leadership. This means confronting daily prejudices, biases, or discriminations at the individual level, in the law, and in the media. And maybe it means young women like me, who strongly believe in our role in making universal and equitable health systems a reality, will speak up and act to ensure the global health arena accommodates our choices, our qualities, and our experiences. We have waited too long.