Why diversity is critical to health decision-making

The overwhelming majority of healthcare workers are women, yet they are still excluded from leadership and decision-making roles – this must change if health systems in Australia and the region are to reach their full potential, Meru Sheel writes.

Never has closing the gender gap in health leadership and decision-making been more important. The COVID-19 pandemic has highlighted the critical role women play in health and medicine, especially on the front line. Yet a pay and leadership gap plagues the health sector, limiting the potential of national healthcare systems to deliver the best health outcomes.

A 2019 World Health Organization (WHO) global report assessed data from 104 countries and found that women make up 70 per cent of workers in the health and social sector. Despite this, women in the sector earn 28 per cent less than men overall, and 11 per cent less when occupation and working hours are taken into consideration. Women often undertake more unpaid work, so the true pay gap is likely to be greater still.

While the report presents important data that is critical to guiding policy reforms, it comes with its own limitations. It categorises the health workforce into nursing and midwifery personnel, pharmacists, dentists and physicians – which would capture the majority of workforce. But it’s also possible that a meaningful proportion of the public health workforce may not be accurately represented, including epidemiologists, speech pathologists, social workers and aged care workers, who might be task shifting.

Further, due to poor quality data in many countries in the Asia-Pacific region, gender data on the National Health Workforce Accounts Data Portal is limited, meaning it is hard to get a complete picture of the current situation.

The comparatively low COVID-19 hospitalisation and death rates in Australia and the Pacific can be linked to strong public health responses and responsive health systems. In all of this, women have been at the front line in everything from contact tracing to vaccine delivery, but have been seen all too infrequently in leadership positions at the decision-making table.

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A very early review of the pandemic decision-making reported some disheartening statistics. Of 115 identified COVID-19 decision-making and expert taskforces across 87 countries, 85.2 per cent of committees had a male majority. These numbers are clearly a symptom of defects in governance, policies, and culture.

Addressing the root causes of bias, discrimination, racism, and exclusion is crucial to changing these outcomes.

If the saying ‘culture starts at the top’ holds true, then it’s important to look at what leadership looks like at the global level. Even in 2022, less than 10 per cent of the 34-member WHO executive board, a body that is critical for governance and finance-related decisions about global health, were women.

There is limited data on gender diversity in health leadership in Australia and the region, but there is certainly no shortage of capable, collaborative, and empathetic women who can lead public health at the local, national, and international levels.

There are multiple causes and barriers that prevent the inclusion of women in health leadership and decision-making, one of which is that the traditional model is a ‘tap on the shoulder’, with quite often a focus on inviting ‘known’ experts. All too often this amounts to men inviting other men into decision-making processes, creating a cycle that makes women and experts from diverse backgrounds less visible.

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There is no shortage of women in the health sector with stories of being excluded, discriminated against, stereotyped, and questioned on their expertise and ability to lead. There is also no shortages of examples of how women are ‘breaking the bias’ in health leadership and building a sustainable future, but it’s not easy. While targeted coaching and mentoring for women is helpful, greater efforts must be made to fix the long-term features of a system that limits their growth.

There are some crucial steps that need to be taken to close this gap. Corporations must be bold in holding themselves and others to account when progress towards gender equality is not sufficient.

On the eve of International Women’s Day, the Snow Medical Research Foundation suspended its relationship with a decorated Australian university for not meeting the Foundation’s vision of equality and diversity.

This act of leadership, even though perceived by some as reactive, is not only important to hold others to account, but sends a strong and timely message that failing to address gender equality and diversity is no longer acceptable.

Open and transparent processes when forming expert groups and committees are essential too, and the sector needs more sponsors and advocates that support the visibility and growth of women and people from diverse backgrounds, ensuring they have seats at the decision-making table. Further, the sector needs solutions that are context-specific to support gender responsive leadership.

It is just as important to note that inclusive leadership must also extend beyond gender, to include people from diverse geography, sexual orientation, race, socio-economic status, and disciplines within and beyond health. All of these factors offer unique perspectives, creativity, innovative solutions, while bringing diverse skills to decision-making, and ultimately improving health outcomes.

The diversity gap global health leadership and decision-making is real and, unless that changes, it will continue to limit the ability of the health system and society to perform to the fullest. With this crisis far from over, the next one potentially just around the corner, there is no time to waste.