For #TheRightBalance in global health the structural matters

For #TheRightBalance in global health the structural matters

The pursuit of gender equality in global health cannot stop even during a pandemic

For #TheRightBalance in global health the structural matters

By Lavanya Vijayasingham, PhD 

The pursuit of gender equality in global health cannot stop even during a pandemic. Even amidst the urgency of Covid-19 response, WHO’s chief scientist Dr Soumya Swaminathan, the Lancet’s Dr Jocalyn Clark, and South Africa’s Western Cape Government Health Emergency Medical Service’s Medical Director Dr Shaheem DeVries spoke with the UN think tank for global health (United Nation University-International Institute for Global Health) Director Professor Pascale Allotey to discuss how to advance gender equality in global health.  

This conversation, convened by Health Systems Global, drew upon the panel’s experiences and thoughts in their careers as policymakers, researchers, research editors and front-line medical professionals. Overall, the panel members highlighted three main levels of influence- individual, organizational and structural factors. At an individual career level, each of the panel members reflexively drew on their upbringing, life roles, early career exposures, including the roles of their parents in raising them in feminist households, with freedoms to pursue professional opportunities without any gender-based cultural restrictions.  

“You don’t need to be a woman to be a gender champion” 

Reflecting on her own career, Dr Swaminathan spoke of the value of the early career support, mentorship and advice she received from male supervisors, to “be bold, and speak up as the technical expert”, as a way to manoeuvre the covert and sometimes, overt biases of a room full of male colleagues, superiors and policy-makers. She observed through the course of her career, that women appeared less confident in applying for new or higher roles and sees benefit in support that encourage confidence building and professional exposure in the early career phase.  

Dr Swaminathan noted, that “you don’t need to be a woman to be a gender champion” and placed importance in engaging men in the pursuit of advancing gender equality, and more broadly to champion those with lesser levels of opportunity. Dr Shaheem, the only man on the panel, echoed this point, and reflected on how gender was not a concept he engaged with until he became a medical professional, and grew to more strongly become a gender champion after the birth of his daughter- the world must see her as equal, and as she is.  

Addressing individual AND organizational and structural factors 

A word of caution was raised by Dr Clark- to address the individual level alone is problematic. When the onus to change and source of the issue is placed on women, they will fail to address the larger systemic and organizational factors that are at the root of the broad issue. Gender inequality, imbalance and unequal treatment in the professional progress and leadership in global health emerges from widespread and crosscutting gender bias. Women have been consistently viewed as less than men in society. Dr DeVries similarly noted- gender transformation is a question of power – “if we keep playing the same game, we will play into the same issues”.   

To advance gender equality within global health, we will also need to consider and intervene at organizational and structural levels, such as the dynamics of the economy and labour market. In research publications, Dr Clark noted that it was gratifying to see the visibility of gender equality in discourse across Global Health journals. Journals are beginning to see themselves as part of the problem. She emphasized global Health journals should be leveraged as platforms to campaign for change.  

Changing our understanding of organizations, strategy and participation 

Within scholarship on gender inequality, Dr Clark suggests drawing from broader disciplinary bases, particularly using feminist thinking, a critical lens, and highlighting global south perspectives. Power is unequally distributed, and research must expose the unequal playing field. Similarly, Dr Swaminathan suggested that focus of research must include on areas that empower women- such as product development that meet the needs of women, encourage the upward promotion and progress of women into leadership and positions. 

For global health institutions, Dr DeVries called for the need to revisit and redress the way we understand organizations, strategy and participation. Framing structure as the way we are social, speak, use language and perceive the world, he noted, “you cannot fit women into a structure that is made for men”. He figuratively contended that the problem was not about how many seats at the boardroom table’, but the problem is the board room itself.   

For more action-oriented steps within global health organizations, Dr Swaminathan suggested that the use of digital platforms could perhaps provide more opportunities for women to be heard. The lessons being learnt in the current context, where many are ‘working from home’ could be used to implement long-term flexible work arrangements, gender training and online learning to change the culture and thinking around gendered dynamics. She further hoped that the new ways of work using online platforms within domestic spaces, which have been a new experience to many during the pandemic, have instilled more sensitivity in everyone in terms of the care and domestic responsibilities that we all need to share.  

A window of opportunity? 

The pandemic’s monopoly of global news cycles is perhaps a window of opportunity, a catalyst or entry-point for advancing gender equality in the post-COVID-19 era of global health. The visible impact of the gender inequalities through the health, economic and social consequences of the pandemic is pronounced. Women are more prone to non-standard work and work within informal work settings that often mean daily or piece-meal wages, without enough social protection to buffer financial risks in times of crisis, such as a pandemic.  

Stay-home messaging and lockdown policies have also led to increase reports of gender-based violence, where at-risk women are being confined to domestic spaces in close proximity with perpetrators without means for alternative shelter or extraction. Correspondingly, the UN Secretary General Antonio Guterres made a landmark call for a strong focus on women and girls in the global COVID-19 response. Building on conversations such as these, and the pressing need of the moment, we must work to be responsive towards deeply ingrained forces, stimulate wider outreach and buy-in to ‘unbias’ the culture and achieve long-term solutions at individual, organizational and structural levels. 


This blog post was first published on the HSG Getting the Balance Right website. 


Image credit: Toby Phillips Photography 

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