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Achieving gender equity in global health will require reimagining of how health systems operate, including who leads and the traits they possess, who is valued within the health system and how they are remunerated, and what inclusivity means in terms of knowledge production and its impacts.
The world is not on track to achieve the United Nations (UN) Sustainable Development Goal (SDG) 5 of achieving gender equality and empowering all women and girls by 2030. Following the adoption of the SDGs in 2015, institutional support for women’s leadership and gender equality in global health gathered momentum. It led to the establishment of initiatives such as Women in Global Health (WGH), Global Health 50/50 and the Women Leaders in Global Health Conference. These initiatives marked a critical step towards empowering women in global health. However, with data such as women making up 70% of frontline health workers but only occupying 25% of senior leadership positions in global health, much work remains for our sector to achieve the targets of SDG 5. Under new leadership, the world’s largest global health state actor, the United States, has “cancelled” all federal diversity, equity and inclusion initiatives and withdrawn from the World Health Organization. While this recent chaos threatens the progresses made so far, it also offers an opportunity to examine how global health systems can become environments that support diversity, equity, and inclusivity and identify concerted actions for achieving SDG 5. Achieving universal health coverage is only possible through achieving gender equity.
We cannot achieve gender equity by merely treating it as an “add-on” to existing systems and processes. The perpetual gender disparity fundamentally requires reimagining global health systems and a move away from “add women and stir”. Add-ons are easily removed. To achieve gender equity in global health, a gender perspective must be mainstreamed into the core of all health policies, regulations and programs from the outset, including planning, implementing, resource allocation and evaluation.
Why women in leadership
The feminist method highlights “those people and processes lost in gaps, silences, margins, and peripheries”, calling for the dismantling of systems that perpetuate inequality and invisibility. This approach seeks leadership spaces that are diverse and inclusive, empowering individuals from all backgrounds to contribute and lead. In the global health arena, this leads to the question: who has power, and who does not?
Arguments for gender parity in leadership span from the obvious notions of equality to ensuring intersectional representation in leadership. There is increasing evidence on the benefits of women in health leadership. A recent review of 137 studies found that women leaders had a positive influence on financial performance, risk, stability, innovation, engagement with ethical initiatives, health, organisational culture and climate outcomes, and influence on other women’s careers and aspirations.
Early data shows that women in leadership roles are more likely to practise gender mainstreaming than men. For example, a study from Norway found that increasing women’s representation in council municipalities led to increased childcare coverage, allowing more women to participate in the paid workforce. However, the benefits of gender mainstreaming extend beyond gains for women. A study from India found a positive relationship between women in state legislation roles and infant survival, where “a 10-percentage point increase in women’s representation resulted in a 2.1 percentage point reduction in neonatal mortality.” However, more research is needed on women’s leadership, including to better understand the benefits of women in leadership on policies, programs and plans.
The role of global health institutions
It is imperative to consider the meaning of “equity” when it comes to representation in global health. In 2019, 24 million of the 28.5 million nurses and midwives globally were women. However, women continue to be under-represented in leadership roles. For example, at the 77th World Health Assembly, women made up 30% of chief delegates. Notably, the board members representing the Western Pacific Region, of which Australia is a member, are solely men.
Intersectionality in health leadership
While women are under-represented in global health leadership, taking an intersectional lens to the data further reveals that some women are less represented than others. The 2024 Global Health 50/50 report found that people from low-income countries, particularly women, remain largely excluded from leadership roles globally. Shockingly, only 2% of non-profit board seats and 0.4% of for-profit seats are held by women from low-income countries, while 17% and 30% respectively are held by men from the United States.
The systems that converge to create global health have largely been designed by men from high-income countries. We must ask the critical question: how can representatives from high-income countries drive the global health agenda when low and middle-income countries (LMICs) represent almost 82% of the world’s population? Significant data gaps impede exploration of this question and, indeed, many aspects of intersectionality in global health – from the health workforce to the populations they serve.
Equality starts at home
In Australia, as per the Workplace Gender Equality Agency (WGEA) dataset (2020-2021), women represent less than 20% of Chief Executive Officer (CEO) roles and only 33% of key management roles despite comprising 51% of the workforce. Serving from 1997 to 1999, Judith Whitworth was the only woman to serve as Chief Medical Officer – the highest health adviser to the Australian Government – since the role was established in 1982. With the search for a new leader for the Australian health sector, and aligning with the Australian Government’s 2024 Gender Equality Strategy Priority Area 5, there is an opportunity to course correct.
We know people of non-European and Indigenous background make up make up 21% of the population, yet occupy just 4.7% of high-level leadership roles; however there is insufficient data to stratify this by gender, cultural background or sector. The statistics for First Nations Australians are not celebratory either, who form 3% of the population, but only hold 0.4% of senior leadership roles. Health sector workforce data are routinely not collected, and when available, not reported.
Reimagining health systems
The “add women and stir” approach to global health will fail to achieve SDG 5 in our sector. Recent world events demonstrate the fragility of the global health system and the speed at which it can change, and so, now is the time to fundamentally reimagine our health systems to embrace true diversity. We must question the origins and beneficiaries of current systems, recognising that systems created by and for men alone are unable to accommodate diversity, equity or inclusion simply by adding women. Initiatives that aim to prepare women for leadership, perhaps well intended, suggest the participant is deficient and requires support to be fit to lead. We need to move away from the idea that individuals or demographic groups are deficient and instead recognise that deficient systems fail to accommodate humans in all their diversity, overlooking a range of experiences, insights and expertise. Here we propose three key areas to be reimagined.
We need to reimagine who and what makes a leader. Deeply held social norms shape how we perceive who can be a leader, and the typical behaviours of leaders. Today, nearly half of the world’s population still believe that men make better leaders than women. Inclusivity is a mindset; transformation of norms, gendered and otherwise, requires significant disruption of commonly held attitudes, beliefs and perceptions at all layers of the health system. Transformative leadership is collaborative, purposeful, accountable and conscientious; every decision is underpinned by a mission to enable everyone to thrive. Transforming norms would make this every leader’s responsibility and not just the remit of activists on the sidelines.
We need to reimagine who is valued. The gender bias underpinning our current systems value women’s contributions less than those of their male counterparts. The professional hierarchies and sociocultural norms that exist in the health sector result in half of women’s caregiving roles being unpaid, leading to an estimated financial loss of US$1.5 trillion annually for women. By valuing caregivers, our health systems will also better value the populations they serve, as frontline workers are the most common interface for health access.
We need to reimagine what inclusivity means. Inclusivity impacts all aspects of access to care, including proximity to health care, affordability and policies that make care accessible in terms of, for example, disability or language. Inclusivity means patients or clients feel accepted, welcomed and valued in their interactions with the health service, which links to reconsidering how knowledge is valued. Relaxing our reliance on positivist epistemologies and appreciating mixed and plural methodologies will mean evidence derived from global health research is inclusive. Prioritising women’s physiology in studies on disease and pharmaceuticals will create the necessary data to optimise interventions that impact women’s health and wellbeing. The global gender-specific data on SDGs stood at 56% in 2024, however pervasive data gaps that continue to exist effectively render whole populations invisible. Inclusive leadership will transform how knowledge is produced, by whom, who it affects, who is valued and what they are worth.
As we commemorate International Women’s Day, at a time when progress hard-won over decades appears to be threatened, we urge the health sector to follow the UN Women Australia 2025 theme: March Forward. We ask that we expand the responsibility of diversity, equity and inclusion from activists and hold all researchers, policy makers and practitioners accountable to mainstreaming these values across every undertaking. As we march forward, systematic data will be needed to highlight both the real-world impact of inclusive leadership in global health and the real-world impact of its opposite. Gender inequity affects everyone’s lives. Now is the time to show the gains and demand more; gender equal, inclusive and diverse health systems create better outcomes for everyone: for those leading it, for the people working in it, and most importantly, for the populations they serve. The responsibility of achieving this lies with all, not just women.
About the authors
This article was developed stemming from ideas shared at the Women in Global Health Australia Seminar titled “Reimagining Systems to Elevate Women in Global Health Leadership” . Women in Global Health is a women-led grassroots advocacy group that promotes women in global health leadership.
Rachel Hammersley-Mather is an epidemiologist with Field Epidemiology in Action and a PhD candidate at the Australian National University focusing on women’s experiences in Field Epidemiology Training Programs. She serves as a committee member of Women in Global Health Australia.
Adeline Tinessia is a research officer at the University of Sydney, and a secretariat member of Women in Global Health Australia.
Parveen Fathima is a senior research fellow in infectious diseases epidemiology at the University of Sydney, and a secretariat member of Women in Global Health Australia.
Sara Davies is a professor of international relations at the Griffith Asia Institute, Griffith University, specialising in global health governance and gender equity.
Meru Sheel is associate professor in infectious diseases and global health expert at the University of Sydney working extensively across the Asia-Pacific region. She is an advocate for women and diversity in leadership and Chair of Women in Global Health Australia
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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