A Fireside Chat: The 5 'C's for Women's Leadership in Global Health - Lived Experiences

This week Women in Global Health’s Executive Director Roopa Dhatt and Board of Directors Member/Senior Fellow Ann Keeling sat down to discuss questions on women’s leadership in global health posed to WGH for a presentation. We recorded the conversation and decided to turn it into a blog. This conversation spans a generation and reflects a multitude of lived experiences.

Roopa is an Indian-American, early career global health advocate who entered the space as a youth leader She is now practicing international health and is a primary care physician, in addition to leading WGH.

Ann has over 35 years’ experience in human and social development working for UN, Commonwealth and governments of UK, Papua New Guinea and Pakistan. Ann was Head of Gender Equality for the UK government, CEO of the International Diabetes Federation and founded the NCD Alliance.

Question: How has your experience in global health been different because you are a woman?​

Roopa: Speaking as a medical practitioner and a global health advocate with social identities of being a woman, a woman of color and an immigrant, my reflections are shaped both by my personal journey and the journeys of the people I have met. Foremost, I feel I can empathize with the women and girls who are the most marginalized in global health and understand some of the gendered and cross-cultural issues they face. I am more convinced them ever before, that a diverse world needs diverse thinking. The dominance of one group in decision-making in global health leads to group thinking which fails to recognize and challenge the social determinants of health for women and girls – specifically, the gendered determinants of health - and fails to recognize the health needs of women and girls. The upside of being a woman in global health is being able to bring issues to the decision-making table that always should have been a priority, but simply weren’t because the needs of women both as patients and as health workers were not considered important.

Ann: Agreed! We have been working on global health for decades but to give an example, it is only in the last couple of years that menstruation as a political, economic, social and a health issue has been put onto the global health agenda and spoken about publicly. I am delighted to see groups advocating on menstruation and leveraging action. I can’t think why we didn’t make menstruation central to reproductive health and rights a long time ago. We all know women and girls menstruate but the taboos surrounding menstruation have kept millions of girls out of school and until recently, meant that supply kits for refugees did not include sanitary protection. If men menstruated it would be revered and not treated as a cause for shame. As women in global health we have an opportunity to flip the narrative and bring different perspectives that will strengthen global health for all genders.

Roopa: At the same time, the downside for women in global health is that we face the paradox of being the majority of global health and social care workers, but being in the minority in decision-making. Leadership in global health still has a male face despite health being an increasingly feminized profession. Women can expect to face additional barriers, micro aggressions, unconscious biases etc. that keep us in second place. And the gender disadvantage is multiplied many times for women of color, some religions, transgender women and for women from the global South. We don’t start with a level playing field and women who question the status quo risk being branded troublemakers. We believe, based on individual reports, that female health and social care workers commonly face sexual harassment and violence from male colleagues, community members and even their patients. This creates a toxic working environment for women in global health that their male colleagues rarely face.

Ann: I’ve just read the report just out from the UK House of Commons on ‘Sexual Harassment in the Workplace.’ [1] It estimates 40% of working women in the UK experience unwanted sexual behaviour at work despite it being unlawful. It generally isn’t reported, is often regarded as a ‘normal’ part of office culture and many male managers seem genuinely unaware – that in itself is a compelling argument for gender parity in leadership. Even in UK there is no reliable data and the burden of calling abusers and employers to account falls on the victim. Ensuring zero tolerance of sexual harassment in global health is essential if, as you say, we are to level the playing field at work between women and men. It is also essential to fill the 40 million new health and social care jobs needed to reach Universal Health Coverage. We need women to fill those jobs and that won’t happen if they battle sexual harassment and violence as an everyday reality at work.

Roopa: The #MeToo movement has taken the lid off this particular Pandora’s box and the secrets mainly shared by women are now becoming public knowledge. It’s also true that we have very little research and data on incidence in the global health and social care sector. Although there has been push back and we are told uncertainty has been created for some men who now feel unsure how to behave with female colleagues. But that uncertainty cannot compare with the stress and suffering women have endured and continue to endure as a result of workplace sexual harassment and violence. The two aren’t equal in the balance. I’m encouraged that these issues are out in the open now. Momentum has been building to advance gender parity in global health leadership and gender equality in global health. Awareness is growing that gender equality brings smart global health. We are gaining ground and bringing both men and women with us. This is the very best time as a woman to be working in global health.

Question: What one piece of advice would you give another woman looking to enter the global health field?

Roopa: Go for it! We can’t wait for someone else to step forward and bring change so be the change you want to see.

Ann: As Helen Clark said, know that there will be no red carpet laid out for you when you take up a leadership role and second, join Women in Global Health to advocate for change and for support and inspiration.

Roopa: Tips that I have learned along the way or that have been passed along: 1) Be a part of a community – join a group or network that can support your journey; 2) Build relationships that matter – invest in professional relationships, they help you grow and find opportunities; 3) Explore your interests- don’t be afraid to diverge from the classic path; 4) Integrity matters – stay true to your values; 5) Most importantly, take care of yourself—resilience is a learned practice and much needed in this space!

Question: How can we advocate for ourselves as women leaders?

Ann: We must advocate for ourselves as individuals and advocate for all women as a group to have equal access as men to leadership opportunities.

Roopa: We must be evaluated on our merit, but we know that access to opportunities is a much bigger issue of privilege and power.

Ann: As women we must recognize there are deeper power dynamics, patriarchal culture, policies, practices of the organizations and systems in which we work. We need to be both competent and have the courage to speak out, put forward ourselves and other women, while working with others, men and women to address the root causes of inequity.

Roopa: The more I work in global health, especially in gender, in addition to viewing everything through a gender lens, I have learned to also look through the political lens. The spaces we operate in are always political – learn how to read the political dynamics. An organization not only has a unique culture and set of values, but it likely operates by a set of gender norms and bias, which affects all people. Be aware and responsive-- take advantage of opportunities to challenge gendered norms and expectations when possible.

Ann: Keep trying! Learn how to stand up again and again, when you are knocked down.

Question: How can we serve our fellow women as mentors and role models? Roopa: I believe we can serve both MEN and women by being role models and mentors. It is essential that men also see women in positions of leadership and that women’s leadership becomes normalized and accepted by all genders as something unremarkable.

Ann: We need to distinguish between mentoring and championing. It’s common for men in leadership to champion the careers of younger men, which rarely happens for women. Men champion men in their own image, younger versions of themselves, and do it in the name of mentoring. I have frequently seen senior men make contacts for other men, put a word in for them when they apply for promotion and encourage them to apply for promotion while no-one encourages their better qualified female colleagues. For me mentoring is more about guidance and identifying skills gaps, rather than advocating for career advancement. I am concerned that mentoring schemes for women will focus on guidance and building skills but will not help women advance if the male to male version of mentoring continues to be one group of men championing younger men to succeed them.

Roopa: It is critical when we think of mentoring that we don’t try to change ourselves as women to fit into systems designed for men. It’s not women that have to change, it’s the power dynamics of the patriarchal systems designed to exclude women. This is a very important message when we are mentoring both men and women. When you find yourself excluded don’t ask ‘what’s wrong with me?’, instead ask ‘what’s wrong with the system and how does it need to change?’ We must aim not only to join the system but also to transform it so it is fairer, merit based, diverse and therefore better. We also need to engage men in senior roles to mentor early career women as well as men.

Ann: When I started in my career overseas with the UK government there were almost no women in senior jobs to be role models for me. The British government had a ‘marriage bar’ until the early 1970s meaning women in the overseas service had to resign when they married. We understood that to be one of the few women, like Margaret Thatcher, who made it into leadership, we had to be better than all the men around us and play by men’s rules. We have come a long way in the last 40 years and as you say, we now aim to change the system and not just join it. As role models we can best inspire both women and men by demonstrating the four ‘Cs’- Competence, Commitment, Courage and Change.

Roopa: And I would add a fifth ‘C’ – Compassion. And say that those five ‘Cs’ are what we are looking for in all leaders, all genders, to drive global health leaving no-one behind.

References

[1] House of Commons Women and Equalities Committee ‘Sexual harassment in the workplace’

Fifth Report of Session 2017–19, HC 725 Published on 25 July 2018 by authority of the House of Commons www.parliament.uk/womenandequalities