Breaking gender equality barriers in women’s global healthcare leadership


Although women make up most of the health and social sector workforce, bias, discrimination, stereotypes, and systemic barriers often prevent women from entering global health leadership roles.


Dr Sonya Smith from the American Dental Education Association and Dr Jeanne Sinkford, Dean Emerita and Professor Emerita at Howard University College of Dentistry, USA, have evaluated the disparity faced by women in this sector.


Read more about their work in Research Features


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Although women make up most of the health and social sector workforce, bias, discrimination, stereotypes, and systemic barriers often prevent women from entering global health leadership roles. Dr Sonya Smith from the American Dental Education Association and Dr Jeanne Sinkford, Dean Emerita and Professor Emerita at Howard University College of Dentistry, USA, have evaluated the disparity faced by women in this sector.


It’s undeniable that the COVID-19 pandemic placed an enormous amount of strain on healthcare workers around the world. While highlighting strengths in our healthcare systems, it has also brought to our attention disparities in global health leadership. For example, women in global healthcare decision making are under-represented. During the pandemic, only 10 % of the WHO’s board members were women, and 11 % of countries had no woman at all within their COVID-19 task forces. As we strive to achieve the UN gender equality goal, it is important to have gender equality at the most senior level of global healthcare leadership.



Dr Sonya Smith, Chief Diversity Officer at the American Dental Education Association in Washington DC, and Dr Jeanne Sinkford, Professor Emerita and Dean Emerita, Howard University College of Dentistry, highlight this gender inequality in their recent evaluations of the global health and social care workforce. They analysed a range of sources, including data from the UN and WHO, which indicated global gender inequality in our healthcare systems. Globally, women make up 70% of the workforce in the health and social care industry, but hold only 25% of global health leadership positions. Of the more than 100 roles appointed as CEOs  and board members at global health organizations in 2020, none were filled by women. The researchers found there is particular marginalisation of woman from developing countries, with only 5% of CEOs being female and from low–middle income regions. Through their assessment of the role of women working in our global healthcare systems, Smith and Sinkford also investigated the barriers which prevent them from undertaking global health leadership roles and achieving parity to men.


So, what are the barriers against women?


The Women in Global Health Ecological Model gives a clear overview of the five key factors which may prevent women from entering or advancing in global health leadership. The first factor relates to public policies which lack support for gender-specific issues such as pay gaps, parental leave, childcare, sexual harassment, or eldercare. Smith and Sinkford believe establishing policies in these areas will not only serve to support women in the workplace but will also impact on gender equity in society.


Further barriers relate to community factors such as cultural norms which place limitations on women’s right to work. In some countries there are still laws preventing women from taking on employment unless agreed by their husband or older male family members. Cultural beliefs and stereotyping can also give rise to other factors, including both institutional and interpersonal barriers such as workplace bias, harassment, and discrimination. An example of this bias would be perceiving women as intellectually inferior, often witnessed in some of the STEM fields where fewer women currently occupy leadership roles.


The final barrier are is individual factors which include work-based situations that are more likely to be experienced by women such as ‘likeability penality’ and ‘imposter syndrome’. Likeability penalty refers to women being liked for stereotypical female traits such a being kind, gentle, and caring, but often not being viewed as effective or good leaders because of these traits. Imposter syndrome is when a person has chronic self-doubts about their professional and intellectual capabilities or feel they are not enough irrespective of their ability or achievements. These self-doubts can lead to women in particular not pursing or turning down leadership positions because they believe that they lack the qualifications or the talent to do well in the role.


So how can we achieve gender equality?

Smith and Sinkford acknowledge that achieving gender equality within global health leadership is a complex issue. There are interconnected factors relating to culture, society, economics, and politics which have a significant impact on the gender-equality landscape. Smith and Sinkford believe a more gender transformative leadership – or GTL – approach is needed. GTL focuses on eliminating power imbalances by disrupting the current system of thinking and then reframing roles. This approach could help to remove systemic bias and discrimination towards women in the global health workforce.


Another key tool to support GTL is gender mainstreaming, a strategy that aims to achieve equality through developing gender-inclusive policies. Gender mainstreaming focuses on addressing gender inequality to help counter historic inequality for women in relation to health. It also aims to reduce stereotyping and bias relating to gender. Smith and Sinkford’s research revealed a need for more analysis that incorporates gender mainstreaming. This includes collecting data for all gender identities to assist with monitoring and future planning. The researchers also emphasise the importance of collecting and using data to help provide global recognition for women working in global health and social care. Increasing women’s visibility within the sector may help them to gain recognition for their efforts and assist with career advancement.


Smith and Sinkford believe training is vital for GTL and gender mainstreaming to be adopted and implemented at all levels within the health sector. They also note the importance of specifically designing leadership development programmes for women, as well as mentoring and networking schemes led by women in senior positions to coach and support more junior women within the sector. Smith and Sinkford insist the fight for reform must continue at all levels, as health equity and equal opportunity belong to all women, men, and nonbinary persons around the world.


Smith goes on to describe their research in her own words, explaining that some of the findings came as a surprise: “According to the 2021 Global Health 50/50 Report, 58% (80/138) of global health organisations have never had a woman CEO, and 51% (70/138) have not had a woman Chair of the Board.”


She further explains two key recommendations from their research that healthcare systems should be taking to break down barriers and help women to enter leadership roles:  


“Firstly, to conduct gender analysis and related policy/programmes audits and design GTL approaches to address structural barriers to change;

and second to collect and analyse gender identity and sex disaggregated data and conduct gender analysis for all gender identities to assist with strategic planning, monitoring, and policy and programme development in support of gender equality and GTL approaches.”


Lastly, Smith tells us which topic areas are still under researched in relation to gender inequality in the health and social care sector:


“Future research on barriers and solutions to inequality in global health leadership should include the experiences of gender identities beyond persons whose sex at birth are male and female. Additional research is also needed on workplace violence and sexual harassment in global health organisations with a gender analysis focused on intersecting identities.

In terms of a comparative analysis, we are looking at the different barriers and experiences of women in various healthcare sectors in global leadership roles, and strategies for overcoming them.”


More on Smith and Sinkford’s research can be found in the September 2022 edition of the Journal of Dental Education.


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