2019 ended on an exciting, galvanizing note for women in global health. In November, established and emerging leaders gathered in Kigali, Rwanda for the third Women Leaders in Global Health (WLGH) Conference. This event anticipated the upcoming anniversary of the Beijing Declaration and Platform for Action—in writing, a standard-bearer for global commitment to women’s rights—and convened over 1,000 attendees from 81 countries. Hosted by the University of Global Health Equity, the conference included panel discussions, interactive workshops, and skills sessions, all aimed at providing attendees with the opportunity to collaborate toward gender equity in health leadership. Programs also encompassed discussions of yet-to-be-fulfilled aspirations of the Beijing Platform for Action, including specific measures for health promotion and disease prevention regarding women’s tobacco use.

Here are some key insights:

Barriers to Women’s Leadership

• “Women make up 70% of the health workforce globally but only 25% of leadership.” – Jeannette Kagame, First Lady of Rwanda. According to Filomina Steady, Professor Emerita of Africana Studies at Wellesley College, the key problems that perpetuate gender inequities in global health are: (1) gender norms; (2) gender discrimination; (3) colonialism; and (4) medical systems that mirror societal hierarchies.
• “Sexual harassment and bullying are global issues that cut across the health sector. It’s not just harassment of a sexual nature that women face at work. Gender-based bullying runs rampant.” – Janani Shanthosh, Research Fellow (Health, Economics, and Law) at The George Institute.
• The latest Global Health 50/50 Report states that organizations need: a commitment to zero tolerance; a definition of sexual harassment; confidentiality of reporting and non-retaliation; mandatory training; and transparency of reporting.

Barriers to Progress in Women’s Health

• According to Neo Tapela, Senior Research Fellow at University of Oxford’s Nuffield Department of Population Health, the main barriers to cancer diagnoses in women are: (1) work commitments; (2) caregiving obligations; and (3) transport issues. We must address these inequities for better, earlier cancer diagnoses and care.
• When asked about the needs of overlooked female tobacco users and marginalized bidi workers in India, Rajani Ved replied that international organizations must support grassroots collective bargaining for institutional change in global health funding.
• Temie Giwa-Tubosun, CEO and Founder of LifeBank Nigeria, spoke about how women have access to the least amount of financing in structural healthcare and the need for innovation. She noted that, in many places, women are dependent upon their husbands or other male family members for their livelihoods, leaving them particularly vulnerable to the impacts of epidemics, disasters, and armed conflict.
• “Researchers must design business models to support their innovations in order to achieve scale. We need an ecosystem of innovation that supports women.” – Fred St. Goar, Vice Chairman of the board of the Fogarty Institute for Innovation

The Need for Institutional Change

• According to Hannah Valantine, Chief Officer for Scientific Workforce Diversity at the National Institutes of Health, progress is not about fixing or adapting women to the current system, but rather transforming the structures that create unequal and inequitable regimes within organizations. In order to do so, she said, we need more and better data, especially from low- and middle-income countries (LMICs).
• “The interventions that will make the most impact for women are those that threaten the patriarchy and status quo the most. They require the most courage and strongest collective voice. We have to get comfortable with making people uncomfortable.” – Senait Fisseha, Director of International Programs at the Buffett Foundation.

Intersectionality

• “Be mindful of class, power, and intersectionality when discussing gender equality and equity in access to care and resources.” – Senait Fisseha
• “Sexism and racism unfairly disadvantage some, unfairly advantage others, and sap the strength of society through a waste of human resources.” – Camara Jones, Fellow at the Harvard Radcliffe Institute for Advanced Study
• “Including women with disabilities in comprehensive healthcare services is critical to attaining universal health coverage and the [sustainable development goals]. 15% of the global population and 19% of all women have a disability. In LMICs, 75% of disabled people are women.” – Charlotte Mcclain Nhlapo, Global Disability Advisor at the World Bank

Gender-Inclusive Research

• A key theme of the conference was fairness in research. Speakers explored questions such as: How do we design and do research? Are we including and focusing on women and minorities? Who does the research? Who owns the research? Peter Piot, Director of the London School of Health and Tropical Medicine, spoke specifically about how women receive fewer and smaller research grants, and the long-term disadvantages.
• Professor Pascale Allotey, Director of the United Nations University International Institute for Global Health, discussed the methodological gaps between frontline health workers and researchers focused on minorities and women; she also addressed the lack of gender-specific funding. “We need to think of research in service of the populations we serve. We need co-production of research questions if we are going to effectively integrate the voices of marginalized and underrepresented people in research. We need to be creative about how dissemination is done.”