Lessons from the first book about women's leadership in global health

Women represent the majority of people working to improve the health of communities – but most leadership positions in global health organizations are still held by men.

That's the confounding question at the heart of a newly published book called Women and Global Health Leadership: Power and Transformation, described as the first book about women's leadership in global health. A collaboration of 28 authors and 11 interviewees from 17 countries across six regions, the book not only examines barriers and facilitators to women's global health leadership, but also showcases the journeys of women leaders across global health sectors, offering practical advice to increasing women's representation in global health at different levels.

We spoke with one of the book's editors, Dr. Rosemary Morgan, Associate Scientist at the Johns Hopkins Bloomberg School of Public Health, about the lessons the book offers and her hopes for a transformation in global health leadership.

Why is it that when it comes to leadership positions in global health we have a governance system that privileges men? And what can we do to redress the imbalance?

Dr. Morgan: You're right that in the global health system and organizations, men dominate in leadership positions despite women being the majority of those on the ground. Women, for example, deliver approximately 75 percent of the work, but only represent 25 percent of the leadership. The 'why' is a bit complex. Why do we have this governance system that privileges men? I would say it's due to historical reasons that we still see reflected today. It hasn't been that long, in the overall scheme of things, that women have even been in the workforce. The workforce was also originally developed for men, with men as the main laborers and in leadership positions, while their wives or partners were at home looking after children and taking care of the domestic space. We still see that legacy today. Another layer to it is gender bias – things that are seen as feminine have been traditionally devalued. Who is considered a good leader? What traits do they have? Good leaders are often seen to be dominant, aggressive and assertive – which are very masculine traits. And the flip side to that is when women do demonstrate these characteristics they are often penalized because women are not supposed to be these things. This legacy is perpetuated within our current systems and structures.

What are some of the barriers and facilitators to women's global health leadership?

Dr. Morgan: There are quite a few barriers which are highlighted in the book. There are, of course, existing gender stereotypes and biases. I already mentioned that masculine traits are often seen as leadership traits. I think that's a clear gender bias. But you have also more tangible things like pay gaps, which we see across all sectors. Another barrier for women's leadership is the dual care responsibility. Women are often responsible for the majority of care in the home, in addition to their work. Over the years we've seen a shift of more women entering the workforce, but at the home, we haven't seen the same shift in domestic care responsibilities being equally shared by men and women. I think that's very much a barrier. And it’s important to note that these gender norms are also upheld by both men and women.

Many of the systems out there to support women entering leadership actually come from an understanding that women are the problem. We, as women, have to change ourselves to be good leaders, we need to demonstrate these more masculine traits. And women are being forced to fit into a system that wasn't built with women in mind, for example, by thinking of dual care responsibilities and catering for these. Often the question is 'what do we need to do to get women to act more like men, basically, to be more assertive? What's the type of training do we need to provide to get more women into leadership positions – public speaking, self-assertion, self-esteem?' However, we need to realize that there are different types of leadership which are effective and transcend the more hierarchical top-down dominant form.

For the most part, a lot of the women that have succeeded in this space have been helped by having the right qualifications and getting the right training. Or they might come from more privileged backgrounds. And they had the help to be able to do it. I think that having supportive spouses or partners and being able to pay for domestic support and childcare are also helpful. And it is important for us to consider who may be excluded from this. Who, for example, is able to pay to obtain the right qualifications? Who's able to pay to have help or has supportive families to help with childcare? And who doesn't? These are also important barriers and facilitators to women entering leadership positions, which are often not talked about.

The book features a number of interviews with prominent women leaders in global health. What lessons can be drawn from their journeys?

Dr. Morgan: Firstly, I think hearing from women leaders and their stories is so important and can be such an influential tool for our learning. We can learn about different pathways, different barriers, and different facilitators. I think one of my biggest takeaways is that nobody follows the same path. A lot of the women we interviewed took different paths. Some worked within the system, while others worked more outside the system, but all made their own path and pushed against some of these constraints. A common theme that came through for me was the importance of having support of spouses or partners, and support of family. Having those structures at home does really help.

Also, we need to recognize that leadership happens at different levels. When we talk about global health leadership, people often think about global health governance, such as the World Health Organization or big multilateral organizations. One thing we really wanted to show in the book was that leadership happens at all levels. That you can be a leader in your community, within your organization or project, or within your home. We wanted to span different sectors including governance, academia, and civil society.

One of the other things we also learned is the importance of women supporting women. We need to use our networks to bring others along and make space, that was a strong thing that came out for me.

What are some of the pragmatic solutions to increasing women's representation in global health at different levels?

Dr. Morgan: The last chapter in the book really goes into this. How do we shift how we characterize women's leadership, not just women's leadership, but shift mindsets about who makes a good leader. This shift in thinking is not just about parity of numbers – getting more women represented in leadership positions – but also shifting normative beliefs and actions.

We also need to think about women in global health as being change agents, drivers of health, not only service users and beneficiaries. That diversifying who's at the table, who gets a seat at the table, who gets to be in leadership, benefits everybody.

Also, recording and valuing unpaid health and social care work. This is an important point because this type of work often falls exclusively on women, which leads it to be devalued or de-prioritized. The more we value this work, to the more we value the contributions of those who do this work.

Finally, we need to stop fixing women, we need to stop thinking that women are the ones that have to change, that have to conform. No, we need to change the systems and structures to make space for different leadership styles. We need to adopt more gender transformative strategies and address the biases within the environments we work in.

In one sense, the book is also intended as a primer to support other women in their efforts and struggles to succeed in global health in a highly unfair and unequal world. What personal advice would you have for women currently studying global health or who are early in their careers?

Dr. Morgan: One piece of advice I have is that we often compare ourselves to others and others' successes and achievements. That doesn't do us a lot of favors because we all take different paths, we all have different challenges. We need to recognize that what we often see are people's successes and we don't know everything that came before – all the challenges, barriers, and bumps in the road. We also need to recognize the importance of supportive networks. For example, the Women in Global Health network is such a strong network that really is bringing people together to amplify voices and give people opportunities. Also, the importance of being champions. We all hold gender bias and women can sometimes be just as if not more harmful to other women than men in the workforce. Sometimes we need to turn the lens inwards and unpack our own gender biases. Finally, I think really showing up in spaces, showing up, being present when you can, is important.

You're also hoping that organizations can use this book to help inform the development of institutional policies and procedures to support women in leadership positions across academic, health workforce, and global health governance systems. Could you be specific about the changes you’d like to see in these areas?

Dr. Morgan: Well, of course we want to see equal representation, but that doesn't happen overnight. We need the systems to change. We often talk about integrating gender into our programs, but we also need to integrate it into our institutions. We need to create enabling environments , and that means thinking about and changing the processes, systems, and structures within our work environments to ensure that they address gender bias and are more inclusive.

This includes integrating this lens into our policies. For example, making sure that our recruitment policies and procedures are unbiased. Do we have clear sexual harassment policies and procedures in place? Do we have safeguarding procedures and policies in place?

It's not just about gender parity. It's also about diversity – of both women and men – and taking a more gender transformative approach. What does that mean? It means leadership that seeks to address gender inequities and harmful power dynamics to ensure that we are not perpetuating and reinforcing them.