Essay about Gender
“First, the majority of the 170 studies identified and reviewed in this report come from the global North and report findings from the global North, many of which are not transferable to settings with different cultures and resource levels. There are major gaps in data and research from all regions but the most serious gaps on gender and equity in the health workforce are in low and middle income countries. This is of particular concern since the most rapid and radical progress is needed in LMICs to reach the SDGs, UHC and health for all targets by 2030.
In addition, widespread gaps in the data and literature were found from countries of all income levels on implementation, application of gender transformative policy measures and what works to change the health systems weaknesses and deficiencies caused by gender inequality. This will be an important focus for the work of the GEH going forward.
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Major gaps and lack of comparable data were also found in countries from all regions. Examples include sexual harassment and gender pay gap data. Despite the prominence the #MeToo movement has given to the issue of sexual harassment in the last year, a disturbing 59 countries still lack legislation prohibiting sexual harassment in the workplace. The #MeToo movement has prompted women in health in some countries to speak about their experience of sexual harassment and abuse at work. Although, from confidential reports, sexual harassment of female health workers by co workers, patients and members of the community appear to be widespread with consequent harm for both women affected and health systems, systematic collection of data and research studies are not common. A supportive legal framework and data collection are the starting points for identifying patterns of and trends in sexual harassment, abuse and violence suffered by female health workers and putting in place prevention measures and support for survivors.
Similarly, with the gender pay gap, data collection is uneven, not always comparable across countries and studies conclude that much of the gender pay gap is ‘unexplained’ by observable factors. Clearly, research is needed to explain the ‘unexplained’ and identify solutions to inequities in pay which have serious lifelong impacts for women’s income, autonomy and well being.
Finally, in the list of deficiencies in the data and literature, studies identified for the review were limited in methodological approaches. Although in many countries female health workers are clustered into different sectors of health and social care by social identities such as race, ethnicity, class, migrant status, very few studies take an intersectional approach to highlight how gender disadvantage in employment can be compounded by other social identities. Some countries are now investigating pay gaps based on disability and race, in addition to gender. It is critical to take an intersectional approach to understand how multiple identities interact with gender in the health workforce to compound inequity.
Three further overarching conclusions from this review also need emphasis. First, is the near universal and pronounced occupational segregation of women and men within the health workforce. This report emphasises that the fast-growing health and social care sectors are important employers of women and critical drivers of economic growth. But although women hold around 70% of jobs in the health workforce they remain largely segregated within it both vertically and horizontally. Vertical segregation, with men holding the majority of higher status, higher paid roles, is a pattern found in most countries. It is particularly acute in the health and social care sector resulting in an estimated gender pay gap higher than the average for other sectors of the economy. It is a paradox that even in female majority health professions, such as nursing, the small minority of male employees often have a ‘glass escalator’ to the top, reaching leadership positions faster than their female colleagues. Women in the health workforce are disadvantaged by being clustered into lower status and lower paid (often unpaid) roles and are further disadvantaged by horizontal occupational segregation resulting from gender norms and stereotypes that brand some jobs in health more suitable for women (nursing) or men (surgery). Women are then triply disadvantaged by social gender norms that attach lower social value to majority female professions and thereby devalue the status and pay of those professions.
Occupational segregation in the health sector is driven by gender inequality and in turn, is the foundation for other gender inequalities identified in this report. Occupational segregation in the health workforce drives the gender pay gap and also makes lower status female health workers, often on insecure contracts and less unionised than men, more vulnerable to sexual harassment, abuse and violence.
There is nothing inevitable about occupational segregation by gender in the health workforce. Education and employment patterns in many countries have changed rapidly over the last 25 years with far more women entering medicine and, in some countries, now forming the majority of medical students. Countries vary, for example, in the percentage of men in nursing. Occupational segregation in health is not fixed over time or across countries and policy measures can be taken to change it. In its next phase of work, the GEH will identify good practice examples to see what lessons can be learned and transferred.
A second and related point is that, despite women being the majority of the global health workforce, their role as drivers of health is often unacknowledged. Trends in applications for medical training show that health as a profession continues to attract women and is likely to remain a major employer of women. The lack of acknowledgement of women’s role, however, contributes to a lack of priority given to addressing gender inequality in the health workforce. This has to change fast with gender transformative policies and measures put in place if global targets such as UHC are to be achieved.
Critical and also largely unacknowledged is the burden of unpaid health and social care work typically done by women and girls caring for sick and disabled family and community members. Women also perform (unpaid) voluntary roles in health promotion and service delivery. This review has focused on findings from the formal labour market and a priority going forward will be to gather evidence on the unpaid health and social care work that forms an insecure foundation for the global health pyramid. Women’s unpaid work must be recorded and valued with measures put in place to enable women and girls engaged in unpaid work to access education, training and the formal labour market where their work would be counted and paid.
Finally, a key conclusion of this report is that gender inequality in the health and social care workforce weaken health systems and health delivery. However, an alternative, far more positive future scenario is possible. Addressing gender inequities in global health and investing in decent work for the female health workforce will have a wider social and economic multiplier, offering a Triple Gender Dividend, comprised of:
Health Dividend: the millions of new jobs in health and social care that must be created to meet growing demand, demographic changes and to deliver UHC by 2030, will be filled. Gender Equality Dividend: investment in women and the education of girls to enter formal, paid work will increase gender equality and women’s empowerment as women gain income, education and autonomy. And in turn, this is likely to improve family education, nutrition, women and children’s health and other aspects of development.
Development Dividend: new jobs created will fuel economic growth. This triple gender dividend will improve the health and lives of people everywhere. The health and social care worker shortage is global and addressing gender inequality in the health workforce is everybody’s business.”