What population is lacking in public health leadership and what are some solutions?

Women in Global Health's Co-Founder and Communications Director, Caity Jackson, was invited to speak at the European Public Health Association's Annual Conference this November, on the plenary panel 'A paradox of public health leadership: towards resilience in the context of vulnerability'. During her presentation, she presented the scenario at play when looking at the global health workforce and leadership.

"We have been talking about leadership, but we haven’t touched upon its image, what do the people in leadership look like? and this is important to note because this has consequences to the next generation of public health leaders."

The above graph is what the public global health workforce looks like. At the bottom of our global workforce, we have an incredibly high concentration of women- with a global estimate or average of 75% women. At the top of the career ladder, we have the complete opposite with the majority of top leadership positions occupied by men. When women in global health was founded in 2015, only 23% of chief delegates at the World Health Assembly were women. That’s less than a quarter. Now it is 32% and you might think hey, we’re getting better, but the work is not done. This number might have increased, but it still fluctuates year to year and at the 2017 World Health Assembly there were still 2 all-male panels. We still have a lot of work to do.

Now many sectors have a problem engaging both genders in an equal way. We have traditionally male-dominated fields like tech and STEM working incredibly hard to attract women and to make progress but healthcare is a surprising sector to be experiencing this inequality because it is so completely flipped, with women dominating the workforce. Sania Nishtar, one of the final candidates for the WHO DG position phrased it perfectly when she stated as ‘it isn’t just a glass ceiling, but a whole pipeline, which is leaking women all the way to the top’.

Now why is the field of global public health leaking women throughout its leadership pipeline? There are a multitude of possible answers to this but at Women in Global Health we like to talk about visibility..

Have you seen many all female panels at a conference? Doubtful. But male panels are frequent and infamous and being rightly called out because they happen in excess. I’m very happy to be sitting on a gender equal panel here and that matters. Role models matter. The fact that the newly announced leadership at WHO was 62% women matters. If I walk into a room and I see only men, I don’t think the room is for me, I must be mistaken, why would I aim to be in a place where I don’t see myself represented?

Visibility also tends to have a domino effect: we can talk about promotions, about sponsorship, about awards. For example we co-wrote a commentary in The Lancet recently about public health awards and over a 10 year period, less than 20% of public health awards have been given to women. Only 19% to be exact! Awards bring visibility and visibility brings promotion and support and so the dominos continue.

To end the session on a positive note, Caity went on to list a few simple solutions, challenging the global health community to think critically about the issue and how it can be solved:

1. DIVERSITY

Sustainable health solutions, resilient communities, they require diverse leadership. We often talk about leadership as “seats at a table”. In the business world, it has been researched that the more diverse a board is, the more diverse the people in those seats, the more profit the company makes. If the community you are rolling out your program in or your solution to is a diverse community, your program will fail if you don’t have the same diversity at the leadership table, especially women, and especially under-represented populations.

"We need strong responsive health systems and this means making the most of the leadership talent pool."

2. Gender disaggregated data

Data is SUCH an important component of healthcare. We love it and we need it. We look at the results from a program evaluation and it appears beneficial! We all celebrate that there has been a positive correlation from our implementation, right? But have we looked at how that implementation affected all genders? Perhaps our intervention actually only benefited one and it needs to be re-assessed but unless we disaggregate this data, we will never know. It is key to have a clearer picture of what our data means and how it affects us differently.

3. Enabling environments

This is a simple phrase that encompasses a lot of things. Creating enabling environments means looking at your work place or organization and assessing how you make it possible for all genders, for all people, to succeed. This can be as simple as revising your hiring practices to hide the names on CV’s. Stanford did research on gender biases in hiring practices where they took one CV and duplicated it exactly, everything was the same except they changed the name of the applicant from John to Jennifer. Hundreds of scientists were then sent one of these CVs and the group overwhelming found Jennifer to be less competent than John, despite them being the same CV! Enabling environments can also mean implementing practices so that meetings make sure to hear from all voices or institute techniques for everyone to contribute to a document or project. It can also mean making sure that promotions are equally distributed. McKinsey and Lean In published a great collection on gender in the business sector where it was found that women negotiate their salaries just as often as men but they just don’t get what they ask for as often, so there is a lot of room for improvement within the working environment.

"In conclusion, governance is a core pillar of health systems and greater parity and gender responsive, transformative leadership are essential in our efforts to strengthen health systems and meet the gender- and health-related SDGs."