About Time: Gender Equity In Global Health Starts In The C Suite

At PATH, we are striving to recognize the challenges of balancing work and family and we are piloting innovative approaches to flexible work schedules. We are also encouraging women to take on leadership roles, adopting better models for supporting women in recruiting and hiring practices, and creating more space for discussions about bias and assumptions. And while we are doing better as a result, I’ll be the first to admit that PATH still has much work to do.

Jo Addy, a veteran corporate strategist and international economist, is a member of PATH’s board of directors. Photo: PATH/Stefan Bosch

One thing I did say was that I am fully committed to achieving gender equity— in pay, in leadership, and in power. As a longtime activist in the gay rights movement, and as someone who has spent a significant part of my career using my law degree to work to advance human and civil rights, I believe that the gender imbalance in global health is an injustice that we have a fundamental responsibility to correct.

But, I believe that as important as it is to achieve gender parity when it comes to pay and access to opportunity, something much bigger is at stake.

It’s matter of life and death

In global health, gender equity is quite literally a matter of life and death. Deep discrimination is an inherent part of everyday life for most vulnerable and poor women around the globe, and gender-based violence is common. Gender-based harassment and intimidation are routine in health systems that are run by men where the majority of patients and workers are female — the norm in most of the world. Gender-based bias and cultural assumptions about the roles of men and women even affect how research is conducted, how we treat diseases, and who receives medical care. Here in the United States, and in many countries around the world where PATH works, deeply entrenched racial bias compounds the impact of all these issues for women of color. The result is that millions of women and girls suffer and die needlessly every year.

Coumba Dado Diouf leads a meeting in a neighbor’s home on the proper use of bednets. She is one of PATH’s community champions in the fight to eliminate malaria in Senegal. Photo: PATH/ Gabe Bienczycki

Our ultimate goal must be to look at how gender affects the entire global health agenda — how assumptions, biases, and cultural norms influence the decisions we make about what research to fund, what diseases we focus on, and how we provide health care.

Cervical cancer is an example of how the gender imbalance at the top almost certainly skews global health priorities. This is a cancer that is highly treatable if detected early enough through regular screening, and one that can be prevented with a vaccine for the human papillomavirus. But every year, half a million women die from this disease. Most of these deaths occur in low- and middle-income nations, where vaccines are lacking and screening and treatment programs are rare — rare because the people who decide where to focus global health efforts haven’t chosen to prioritize research, prevention, or treatment of cervical cancer. And rare because in many communities, one of the most common effects of systemic gender inequality is that women are relegated to the back of the line when it comes to receiving medical services.

It’s certainly reasonable to wonder if the situation would be different if more women and people of color where among the leaders at the table when decisions are made about what diseases to tackle and which to ignore. And it’s probably safe to assume that if there were more equitable representation by gender and race, we would have a global commitment to achieve a significant reduction in the incidence of cervical cancer in the world, and black women in the United States wouldn’t be more than twice as likely to die from cervical cancer than white women.

Around the world, women and girls suffer and die disproportionately for a wide range of reasons that are a direct result of gender norms. It’s a list that includes female infanticide, female genital cutting, early and forced marriage, polygamy, sexual assault and rape, HIV (the rate of infection is now higher for women than men), and even things as seemingly straightforward as being young (pregnancy is one of the leading causes of death for adolescent girls) and growing old (older women have less access to retirement benefits, health care, and social services than men).

PATH staff and youth advocates from around the world at the 2016 Women Deliver conference. Photo: PATH

Another one is menstruation. In Nepal in early January, a 22-year-old woman named Guari Kumari Bayak died while observing a traditional practice that requires women who are menstruating to sequester themselves because they are considered impure. She died of asphyxiation caused by the small fire she lit to stay warm in the tiny hut meant for goats where she went to sleep. Dozens of women and girls have died in Nepal in recent years because of this custom, even though the Nepalese government recently outlawed the practice.

Gender bias in research hurts women in the world

The impact of our assumptions and attitudes about gender affect even the most fact-based and supposedly unbiased of human endeavors — scientific research. There’s a growing body of evidence that suggests that research led by men is assumed to be more credible than research led by women, and that men have a higher chance of being hired by universities than women. According to a study published in Nature in 2013, in most scientific fields, men earn more than women in comparable jobs and receive larger research grants. And research by two Montana State University social psychologists even found that men are biased against studies that suggest they have bias.

Not only does gender bias affect who does research and how much credit and compensation they receive, it has a significant impact on the quality of the research itself. According to a study of gender bias in medical research published in the Journal of the Royal Society of Medicine, women’s diseases tend to receive less research funding, fewer women are included in research studies, and gender-based data are often not reported, which means doctors make treatment decisions for women based on data that are only scientifically valid for men. As that study concluded, “the evidence basis of medicine may be fundamentally flawed because there is an ongoing failure of research tools to include sex difference in study design and analysis.”

How to address all this? By continually challenging our assumptions about every aspect of global health work. This means asking ourselves and each other a lot of questions. Questions such as how a given treatment, technology, or disease might affect women differently than men, or girls differently than boys. Or if culture constrains women’s choices or their ability to access and use health solutions. When it comes to research, we need to look at the role gender plays in decisions about what we choose to study, how women and girls respond to being research subjects, and who is included, who is excluded, and why.

Source : https://medium.com/@SteveDavisPATH/about-time-gender-equity-in-global-health-starts-in-the-c-suite-142545db8191

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