Dear G7 Leaders, Investing in Women as Change Agents in Health Will Drive Better Health, Economic Gr

“Girls and women are powerful agents of change but cannot realize their full potential due to the discrimination and violence they face worldwide…… This is not a women’s issue; it is everyone’s issue. The Council urges G7 Leaders to be as brave as girls and women are every day.”

Call to Action and Recommendations of the G7 Gender Equality Advisory Council, August 2019[1]

This weekend, 24-26 August 2019, the Leaders of the G7 countries, seven of the most powerful industrialised economies in the world[2], are meeting at the G7 Summit in Biarritz, France. Women in Global Health are addressing the following letter to the Leaders of the G7:

23 August 2019

Dear G7 Leaders

Women in Global Health here. While we have you all together in Biarritz this weekend we have one important question:

Will you take the one action that will strengthen health for everyone everywhere, empower women and drive economic growth, all at the same time?

You will? Great! That action is investing in decent jobs for women in the health workforce.

Just about every country in the G7 and beyond is struggling to keep up with rising demand for health and social care workers. People are living longer (something we can be proud of), the burden of disease is changing and demand for health and social care services is rising. The health sector is growing fast globally and 40 million new jobs are set to be created by 2030. And all of you will be familiar with Universal Health Coverage (UHC) as G7 countries prepare for the September UN High Level Meeting on UHC. UHC stands to change the lives and life chances of billions of people who currently lack access to quality health services they can afford. To make this a reality, however, low -and middle- income countries must fill 18 million health worker jobs by 2030.

So what does this have to do with women?

Well, women hold 70% of health worker jobs globally and that percentage is set to rise as more young women graduate from medical school. Nursing and midwifery, of course, have long been female majority professions, with less than 20% men globally working in them. Although women are often spoken about as victims or beneficiaries in global health, they are, in fact, drivers of health systems, delivering health services to around 5 billion people. If enabled, women will fill the majority of those 40 million health and social care jobs and women will deliver UHC.

But there is a catch – channelling women into health workforce jobs on the same basis as now will not solve the problem. Why not?

The gains to be made by women in the health workforce are largely untapped because they tend to be clustered into lower status, lower paid roles and hold only 25% senior roles. Some women are then further disadvantaged on the basis of their race, class or other social factors. Health systems are weakened by loss of talent and diverse perspectives. As outlined in a recent WHO report[3] health is delivered by women but led by men and the women who manage health systems have the least say in their design and delivery. That has to change and we know how to fix it.

Currently, gender norms and stereotypes about jobs affect the roles women and men occupy in health (occupational segregation). Men dominate higher status sectors and roles in health. Women hold 90% of long term care roles but are less than 4% of CEOs of Fortune 500 Healthcare companies. Men tend to be surgeons while women are nurses. Female majority professions are generally given lower social value and money follows status. The Gender Pay Gap in the health sector is 26-29% (in favour of men), higher than the average for other employment sectors. This pay gap results in lifetime economic disadvantage for women and leads to greater poverty in older age for many. The gender norms, discrimination and bias that drive women’s underrepresentation in senior roles in health and therefore the gender pay gap, are persistent and will not just equalise without action. Many countries still lack the equal pay legislation to underpin gender equality and only a minority collect and publish Gender Pay Gap statistics. Male health workers are more likely than female health workers to be organised in trade unions that bargain collectively on pay and employment rights. Again, all of this has to change if health systems are to draw from the entire talent pool and women are to benefit equally with men from the work they do.

But perhaps the greatest gender inequity of our current global health system is its dependence on the unpaid work of women and girls. It is estimated that around half the US$3 trillion contributed by women to global health is unpaid work and not included in employment statistics or gender pay gap analysis. This is work caring for sick and disabled family and community members which takes girls out of education and women out of paid work. It also includes unpaid work done by female community health workers employed by governments, NGOs and international agencies. Global health systems are subsidised by the unpaid work of women of some of the poorest women on the planet, which makes a weak and inequitable foundation for something as important as the health of humanity. Converting unpaid health and care work into paid jobs in the formal sector will benefit women and girls and will also drive economic growth.

Finally, you may be surprised to learn that many women health workers experience sexual harassment from male colleagues, patients and members of the community. As in other employment sectors, such harassment is often not recorded, reported or addressed. Women fear retaliation, stigma and not being believed, especially where male colleagues are in more powerful positions. This harassment affects women’s careers and leads to attrition, stress and loss of productivity, damaging both individual women health workers and health systems. Many countries still lack laws and social protection that are the foundation for gender equality, dignity and safety at work. This is an issue we can and must fix to build strong health systems and ensure essential health worker roles are filled.

Women in Global Health congratulate the G7 on establishing the G7 Gender Advisory Council and we give our full support to the Council’s Biarritz Partnership for Gender Equality and Call to Action, especially the call for governments to enact legislation to underpin gender equality. As noted above, this will be critical for gender equity and the health workforce. Unless targeted measures are taken now, it may take over 200 years to achieve gender equality at work. We ask the G7 to champion laws and policies at home and globally that address the underlying causes of gender inequity (gender transformative policy change) in the health workforce. Adding jobs to the health workforce under current conditions will not solve the gender inequities that exacerbate the health worker shortage and impact negatively on health systems performance. We must address work policies and culture, create decent work for women and close gender gaps in leadership and pay.

Finally, we appreciate this is a busy weekend but have written this letter because health is the basis of all human life and we believe the right investments can have a huge multiplier effect that we call the ‘triple gender dividend’. The global health and social care worker shortage is significant and growing and threatens to undermine important progress made in global health. Women hold the majority of jobs in the health and social care sectors. Creating decent jobs for women would significantly contribute to health for all by 2030 and help reduce the global health worker gap (dividend one). Investing in women to enter those formal sector jobs in health would increase gender equality as women gain more income and autonomy (dividend two) New jobs created in health would fuel economic growth and strengthen health systems and outcomes, all contributing to achieving the Sustainable Development Goals by the 2030 end date (dividend three). Every government can realise this triple gender dividend.

Health is a human right that all governments have a responsibility to deliver to their citizens. The benefits to be gained by investing in the female health workforce present an unmissable opportunity in the G7 and beyond. Addressing gender inequities in the health workforce is essential to strengthening health systems everywhere to meet current and future demand - and that makes it the business of the G7 and everybody’s business.

Thank you for listening. Women in Global Health stand ready to support.

Yours faithfully,

Roopa Dhatt and Ann Keeling

Women in Global Health

[1] Recommendations of the G7 Gender Equality Advisory Council for advancing gender equality and the empowerment of girls and women, Biarritz Partnership for Gender Equality, August 2019

[2] G7 countries are Canada, France, Germany, Italy, Japan, United Kingdom and United States of America. The European Union will also attend the G7 Summit in Biarritz which is being hosted by the Government of France.

3] Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health Workforce. WHO March 2019 (produced by the Global Health Worker Network’s Gender Equity Hub co-chaired by WHO and Women in Global Health)