Ten asks: Doing things differently in gender equality and global health
19 September 2018
‘Good health is essential for sustained economic and social development and for poverty reduction. This requires universal health coverage, underpinned by a strong health system..’
UN Secretary General August 2018 [1]
As momentum builds on addressing Non-Communicable Diseases (NCDs) and Tuberculosis (TB) – it is important to also look at the foundation that will support the achievement of the SDG 3 Health and Wellbeing targets, including Universal Health Coverage (UHC). If the World Health Organization (WHO) is able to achieve its Triple Billion Goal [2] – one billion more people benefiting from UHC, one billion more people better protected from health emergencies, and one billion more people enjoying better health and wellbeing – #HealthforAll could be realized by 2030.
Global health: Doing things differently
21st century global health challenges, however, require us to do things differently. The World Bank and WHO estimate that 40 million new jobs in global health and social care must be created by 2030 to meet rising demand. [3] 18 million new health and social care jobs are needed in low income countries alone, where the burden of disease is greatest and health worker shortages most severe, to meet SDG and UHC targets. There is a lead time for creation of such skilled jobs and in some low income countries the pipeline of youth, particularly girls, finishing secondary school is insufficient to feed into the tertiary training needed. We can harness IT, robotics, e-health, new medicines, better medical devices and task shift to release capacity but most health prevention and care will continue to be delivered by human beings. Without people to fill those new jobs the post 2015 global health goals will not be achieved and a global scramble for health workers is likely with low and middle income countries losing skilled health workers to richer parts of the world.
Although women are often portrayed as victims in global health, they comprise over 70% of the global health and social care workforce. [4] Women currently deliver health and social care to around 5 billion people and their work contributes around 5 % global GDP (approximately US$3 trillion). [5] Remove women from the global health system and there is no system. But the irony is that in this majority female profession, men hold an estimated 75% of global health decision making roles. [6] Men lead global health and women deliver it. It is also ironic that the gender pay gap in global health (estimated at 26% for high income countries and 29% for upper middle income countries) is higher than the global average for all other employment sectors. [7] In other words, the men who reach the top in global health reward themselves well compared to the women segregated into the lower paid, lower status and less secure parts of the profession. And to compound that inequality, around half the work women in health and social care remain unrecognized and unpaid, seen as a natural extension of the caring role socially assigned to women everywhere. And the burden of that unpaid care work impacts their own health, income and life chances.
The 40 million new health and social care jobs needed by 2030 will not be created without urgent and serious investment in the female health and social care workforce. Doing things differently does not mean creating more jobs on current terms and putting more women into underpaid or unpaid roles in health and social care systems overwhelmingly led by men. Business as usual will not achieve the transformation needed to deliver #HealthforAll. Currently global health is flying on one wing, not drawing its leadership from 100% of the talent pool. Evidence from other sectors show that diverse leadership teams are likely to be more innovative and more successful. We have untapped potential in global health. Quality and outcomes suffer because the women who deliver health and social care are too often unable to contribute diverse ideas and perspectives from their professional experience and lived experience as women. As women form the majority of medical and allied health graduates in an increasing number of countries, we cannot afford to lose female health workers due to the pressure of insecure job terms, discrimination, harassment or violence. New and existing health and social care jobs must be created as decent work for women where women and men enter leadership posts based on merit. Gender equality must be a goal in health outreach, programs and delivery, as well in leadership at all levels.
Realizing the triple gender dividend in global health
Since our formation in 2015, Women in Global Health, has advocated for gender equality in global health leadership at all levels. In 2017, recognizing the crucial role of the health workforce in health systems and achieving UHC and the SDGs, WGH formed the Gender Equity Hub with WHO, under the umbrella of the Global Health Workforce Network. The Gender Equity Hub, convenes a critical group of partner organizations and experts to
‘accelerate large-scale gender-transformative progress to address gender inequities and biases in the health and social workforce through evidence and data, policy tools, advocacy and implementation.’
A report issued by the UN Secretary General [8] recognized that
’…..as 70 per cent of the global health workforce is female, creating jobs in the health sector is an investment in women’s empowerment and gender equality.’
We welcome this statement. Investment in the female health and social care workforce must be an urgent priority. For example, in case of NCDs and TB, a recent focus of the UN, both shift the focus to the primary health care level, where prevention and management is generally carried out by female nurses and community health workers. Moreover, investment in the female health and social care workforce has a wider multiplier effect, offering a Triple Gender Dividend comprised of:
1. Health Dividend: since expanding women’s work in health and social care is the only way to fill the millions of new jobs that must be created to meet growing demand and reach UHC and health related SDGs by 2030;
2. Gender Equality Dividend: investment in women and the education of girls to enter formal, paid work will increase gender equality and women’s empowerment as women gain income, education and autonomy. And in turn this is likely to improve family education, nutrition, women’s and children’s health and other aspects of development.
3. Development Dividend: New jobs created will fuel economic growth.
This gender dividend, if realized, will improve the health and lives of people everywhere. The health and social care worker shortage is global. This is everybody’s business.
We are delighted to see growing commitment to invest in the health workforce, including women, but IS THE TIDE TURNING? Will greater investment in the female health and social care workforce be agreed on? Such commitments must then follow through into the “Working for Health” five-year action plan for health employment and inclusive economic growth, created by ILO, OECD and WHO and into national health workforce plans. [9]
Ten asks: doing things differently in gender equality and global health
Finally, we have 10 asks for UN Member States and international organizations:
1. Change the narrative: women in global health are change agents and drivers of health, not victims.
2. Shift the mind-set: take advantage of 100% of the talent pool, especially women, all genders, marginalized groups and people from diverse backgrounds.
3. Include voices from the South: especially women from the South, as central to global health decision making.
4. Record and value unpaid health and social care work by girls and women in order to move that work into the formal labor market.
5. Adopt gender transformative strategies with programs and policies that are enabling for all genders in global health work and organizations. Focus on changing the environment, not on fixing women to fit into unequal organizations and cultures.
6. Root out inequity: address the power relations and structures that promote inequity in our work and organizations, especially all forms of discrimination, harassment and violence, which commonly affect women.
7. Close all gender gaps including the gender data gap, gender pay gap, and gender leadership gap.
8. Customize policy solutions to fit the societal and cultural context, but do not comprise on the goal.
9. Support collective action through movements and partnerships, to accelerate progress, particularly on employment rights such as parental leave to enable all parents to take paid work.
10. Understand that gender equality in global health is everyone’s business: this is not a ‘women’s issue’, it applies to all sectors, countries and people.
Business as usual will not achieve the transformation in global health needed to kick start long term change. Too much is at stake and the price is too high – in addition to the human cost of preventable death and suffering, the World Bank estimates gender inequities cost US $160 Trillion in wealth and social capital. [10] To do things differently and deliver #HealthForAll, we must invest urgently and seriously in the female health and social care workforce.
Acknowledgements: We would like to acknowledge the global health civil society and workforce organizations also voicing the importance of addressing the gender dimensions of the health workforce, RinGS, FIP, Intrahealth International, Frontline Health Workers Coalition, JPHIEGO, HRH2030, Nursing Now and many other members of the Gender Equity Hub, Global Health Workforce Network.
References
[1] UN General Assembly 73rd Session Report of the Secretary General ‘Implementation of the Third United Nations Decade on the Eradication of Poverty (2018-2027)’ 8 August 2018
[2] WHO Draft thirteenth general programme of work 2019–2023, Accessed at: http://www.who.int/about/what-we-do/gpw13-expert-group/Draft-GPW13-Advance-Edited-5Jan2018.pdf
[3] WHO- Global Strategy on Human Resources for Health Workforce 2030 (2016). Note: Health workers data refers to physicians, nurses, midwives and a limited group of other health occupations, based on WHO databases.
[4] Improving employment and working conditions in health services – ILO 2017. Accessed at: https://www.ilo.org/wcmsp5/groups/public/—ed_dialogue/—sector/documents/publication/wcms_548288.pdf
[5] Langer, Ana et. al. (2015). Women and Health: the key for sustainable development. The Lancet , Volume 386 , Issue 9999 , 1165 – 1210
[6] Women in Global Health 2018
[7] This refers to an unadjusted gender wage gap. Data available from 40 countries (27 high-income; eight upper middle-income; four lower-middle-income; one low-income); latest available data: 2011–13. Source: ILOSTAT based on national labour force surveys and official estimates of each country.
[8] UN General Assembly 73rd Session Report of the Secretary General ‘Implementation of the Third United Nations Decade on the Eradication of Poverty (2018-2027)’ 8 August 2018
[9] Working for Health: A Five-Year Action Plan for Health Employment and Inclusive Economic Growth (2017–21), WHO, 2018. Accessed at: http://apps.who.int/iris/bitstream/handle/10665/272941/9789241514149-eng.pdf?ua=1
[10] Globally, Countries Lose $160 Trillion in Wealth Due to Earnings Gaps Between Women and Men, World Bank 2018. Accessed at: https://www.worldbank.org/en/news/press-release/2018/05/30/globally-countries-lose-160-trillion-in-wealth-due-to-earnings-gaps-between-women-and-men
