Achieving health equity in global health through workforce diversity

This International Women’s Day we honor the achievements of women leaders working to advance the health and well-being of people all over the world. Their path to success was certainly not easy. It was fraught with numerous challenges; challenges that are not only experienced by those of us working in global health but by women across all industries.

We are considered either too soft and feminine or too bossy and pushy to be seen as competent leaders. Our work culture lacks family-oriented, work-life balance policies which enable us to contribute to our field in significant ways. We lack female mentors to encourage us to grow and push us to overcome any obstacles we encounter in our career. We work for organizations where the people who make the big decisions on what policies and programmatic areas to focus on are men. The struggles we face trying to advance in our careers are reflected in the lack of gender equality in the global health workforce. While women make up 70% of the global health workforce, only 25% of leadership positions in global health are held by women.

We have known for a long time that when women are given equal opportunities for leadership at all levels of decision-making in economic, political, and public life, everyone in society does better. Female leaders in health “promote access to contraceptives, empowerment programs for girls, women’s rights to family planning and maternity care, safe abortions, and protecting environmental assaults on children’s health.” In addition, women leaders at all levels of governance have shown to be the primary driver toward financing public goods such as health, education, hospitals, clean water, and sanitation. Women’s participation and leadership in economic, political, and public life is so critical to advancing societies that it is even written into one of the sustainable development goals. When women have a voice at all levels of decision-making, we are closer to eliminating the inequities that lead to disparities in health.

More global health organizations are recognizing the need for women leaders and organizations such as Women in Global Health are working toward achieving gender equality in global health leadership. Last year the World Health Organization’s newest Director-General, Dr Tedros Adhanom, appointed eight women to senior leadership, effectively outnumbering the men. In doing so, he took one big leap toward achieving gender equity at the WHO – a goal that was first set in 1997 and that took two decades to realize.

Gender equality is not the only type of diversity we need to strive toward in our global health leadership however. Diversity in global health leadership must also focus on inclusion of people from different ages, race and ethnicity, sexual orientation, social class, geography, religion, and other characteristics of personal identity.  As a woman and a first-generation Filipino-American working in global health in the United States, I often find myself at global health and public health conferences and meetings wondering why there are very few leaders that encompass the diversity that I represent on stage (and occasionally even in the audience). The people who make the decisions with the biggest impact in global health must reflect the diversity of the people we serve.  

Learning from, understanding, and seeing the world through another person’s point of view is at the heart of working in global health and a driving reason for why I chose to work in this field. In order to truly reflect the diversity of this field though, the definition of diversity itself needs to go far and beyond the characteristics of one’s personal identity. To fully be inclusive, we must also be open to learning from, understanding, and seeing the world through the perspectives of individuals in the global health workforce with diverse backgrounds, life experiences, and competencies. Our field could benefit from the ideas of diverse individuals in solving some of the world’s most pressing global health problems. These ideas cannot always come out of our own echo chambers. 

Achieving diversity in the global health workforce is everyone’s job. It requires each one of us to recognize and overcome the personal biases (whether they are subconscious or not) which prevent us from hiring and working with more diverse talent. For those of us responsible for making decisions, we must work to create policies at all levels which not only promote but require inclusion. It’s only then that we can achieve true diversity in our workforce and our leadership. It’s only then that we can progress further in achieving health equity.

Stay tuned for part two of my series on Achieving health equity in global health through workforce diversity in which I will discuss different ideas for how we can achieve diversity in the global health workforce.

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Australia, you’ve done us proud…

Between September 12th and November 7th this year, Australia distributed the Australian Marriage Law Postal Survey, a national survey that gauged support for legalizing same-sex marriage. Unlike electoral voting, which is compulsory in Australia, responding to the survey was voluntary. The survey was returned with 61.6% “Yes” responses and 38.4% “No” responses. Even though the measure was expected to be approved, the size of the win and the unusually large participation of 12.7 million Australians out of the 16 million eligible voters added political legitimacy to it. It’s funny to think three letter strung together in the right order can mean so much to millions of proud Aussies. Several hours after the results of the survey were released, theMarriage Amendment Bill 2017 was introduced into the Australian Senate. The amendment  is a Bill for an Act to legalize same-sex marriage in Australia, by amending the definition to allow marriage between two people. This is not only a time to celebrate a historic moment for the country, but to understand the vast positive impact for the LGBT community especially when it comes to health. Continue reading “Australia, you’ve done us proud…”

The Year of the Girl

The United Nations declared October 11th the International Day of the Girl Child.  Everywhere I looked for this post’s inspiration, I saw story after story of the daily violence perpetrated against girls worldwide. I had to ask myself, why just a day?  Aren’t girls – roughly half of the world’s population – deserving of much more consideration? I say that we declare 2017 the YEAR of the Girl and devote our efforts to address the following issues.

Female Genital Mutilation

Female genital mutilation, or FGM, is a global concern. Some 200 million girls and women in 30 countries have undergone FGM, usually between infancy and 15 years of age. In many countries, FGM is a deeply entrenched cultural practice that has seen little decrease in the decades since foreign aid workers have been campaigning for is abolition. The risks might be high – infection, infertility, and complications of childbirth – but the perceived social benefits outweigh the physical costs. Bettina Shell-Duncan, an anthropology professor working as part of a five-year research project by the Population Council, has witnessed this conflict firsthand among the Rendille people of Northern Kenya:

One of the things that is important to understand about it is that people see the costs and benefits. It is certainly a cost, but the benefits are immediate. For a Rendille woman, are you going to be able to give legitimate birth? Or elsewhere, are you going to be a proper Muslim? Are you going to have your sexual desire attenuated and be a virgin until marriage? These are huge considerations, and so when you tip the balance and think about that, the benefits outweigh the costs.

Despite cultural ties, FGM is decreasing in some African countries as evidenced by rates from the prior generation.  However, with prevalence as high as 81% (Egypt), 79% (Sierra Leone), and 62% (Ethiopia), there is still much work to be done.

prevalence

For example, with prevalence at 60-70%, FGM in Iraqi Kurdistan is a “hidden” epidemic.  Prevalence of this practice elsewhere in Iraq is 8%.  Outlawed in 2011 by the Kurdistan Regional Government under the Family Violence Law, FGM has continued largely unabated due to poor implementation and push-back from religious leaders.  You can read the Human Rights Watch harrowing report about FGM in Iraqi Kurdistan here.

Rape and Child Marriage

Last Friday, the BBC reported on a bill under consideration by the Turkish Parliament that would clear a man of statutory rape if he married his victim.  This bill is evidence of increasing violence against Turkish women.  Between 2003 and 2010, the murder rate of women increased by 1,400%.  Of course, the bill isn’t couched in terms of legalizing rape, but as a loophole for those offenders who know not the errors of their ways:

The aim, says the government, is not to excuse rape but to rehabilitate those who may not have realised their sexual relations were unlawful – or to prevent girls who have sex under the age of 18 from feeling ostracised by their community.

If passed, the bill would release 3,000 men from prison as well as legitimize child rape and marriage. Per Girls Not Brides, Turkey has one of the highest child marriage rates in Europe with 15% of girls married before the age of 18. Globally 34% of women are married before the age of 18 and every day 39,000 girls join their ranks. According to a study recently published in the International Journal of Epidemiology, child marriage comes with health and social consequences. Along with unintended pregnancies, infant and maternal mortality, and HIV, girls who are married suffer from social isolation, power imbalance, and experience higher lifetime rates of physical and sexual intimate partner violence.

Coming-of-age “Cleansing” Rituals

Practiced in parts of Africa, girls as young as 12 are forced to have sex as part of a sexual cleansing ritual.  The men, known as “hyenas,” are paid by parents to usher girls through the transition between girlhood and womanhood.  Girls are coerced into this practice through familial and societal pressure.  It is believed that great tragedy will befall the family and community should she not comply.  The use of a condom is prohibited.

A BBC radio broadcast found that communities believe the spread of HIV to be a minimal risk since they can pick men they know are not infected. One Malawian hyena, Eric Aniva, has been charged with exposing hundreds of girls and women to HIV. Aniva knew of his HIV status but did not disclose to his customers.

Forty percent of the global burden of HIV infections are in Southern Africa. Thirty percent of new infections in this area are in girls and women aged 15-24. Young women contract HIV at rates four times greater than male peers and 5-7 years earlier, linked to sexual debut or sexual cleansing rituals.

Let’s face it: Girls around the globe are being short-changed. Though progress has been made, there is still much work to be done. The Sustainable Development Goals have promised to “end all forms of discrimination against all women and girls everywhere” by 2030. Others attest that it will take at least another century for women to reach wage equity in the United States.  However it happens, rest assured it will take more than a day.

Conference Calls and Radio Shows of Interest

Our very own Mini Murthy and Elvira Beracochea are co-hosting a radio show on the MDGs! The inaugural episode aired last week, but you can listen to it in the archives and tune in for future episodes. They will be on every Thursday at 12 p.m. EST. More information can be found below.

Millennium Development Goals: Progress and Challenges

A NEW AND EXCITING PROGRAM DEBUTS THIS WEEK ON AV RADIO
PROGRAM: Millennium Development Goals
TOPIC OF DISCUSSION: Millennium Development Goals: Progress and Challenges
PLEASE JOIN THIS WEEK’S DISCUSSION LIVE BY PHONE OR SKYPE
WHEN: THURSDAY, MARCH 15TH, 2012
TIME: 12: 00 P.M. to 1: 00 P.M. EASTERN STANDARD TIME
TO PARTICIPATE BY PHONE: CALL THIS NUMBER DURING SHOWTIME: (760) 283-0850
TO JOIN BY SKYPE ADD: AFRICANVIEWS (CALL IN DURING SHOWTIME)

TOPIC’S BACKGROUND:

In 2000, 189 nations made a promise to free people from extreme poverty and multiple deprivations. This pledge became the eight Millennium Development Goals to be achieved by 2015. The MDGs provide a framework for the entire UN system to work coherently together toward a common end. UNDP, global development network on the ground in 177 countries and territories, is in a unique position to advocate for change, connect countries to knowledge and resources, and coordinate broader efforts at the country level. In September 2010, the world recommitted itself to accelerate progress towards these goals.

The declaration established eight Millennium Development Goals (MDGs) and time-bound targets by which progress can be measured. With the 2015 deadline looming, how much progress has been made? And is the pace of progress sufficient to achieve the goals? The MDGs break down into 21 quantifiable targets that are measured by 60 indicators.

In our inaugural episode we hope to give a brief over view of the progress and challenges made from the year 2000- 2005 and focus on Sub Saharan Africa to review the progress made with reference to MDGs 1 and 4.

Join us as we explore this very important topic on MDGs.

HOST: DR. PADMINI MURTHY
Padmini (Mini) Murthy is a physician and an activist who did her residency in Obstetrics and Gynecology. She has practiced medicine in various countries. She has a Master’s in Public Health and a Masters in Management from New York University (NYU). Murthy has been on the Dean’s list at NYU stein hart School of Education and named Public service scholar at the Robert F Wagner Graduate School at New York University. She is also a Certified Health Education Specialist.

CO-HOST: DR. ELVIRA BERACOCHEA
Elvira Beracochea, MD, MPH, has more than 25 years of experience that encompass her work as physician, public health and international development expert, human rights advocate, epidemiologist, health policy advisor, researcher, health systems and hospital manager, consultant, professor and coach. She has worked in over 30 countries in Latin America, Africa, Asia, Eastern Europe and the South Pacific. Dr Elvira is committed to helping realize the right to health and the right to development and to improving the effectiveness of development assistance. For this reason, in 2005, she founded MIDEGO, an organization with an urgent rights-based mission: accelerate the achievement of the Millennium Development Goals (MDGs) approved by the United Nations in the year 2000.

ABOUT THE PROGRAM:
The Millennium Development Goal is a weekly discussion on AV Radio based on the Millennium Declaration, adopted by all 189 United Nations Member States in 2000, promised a better world with less poverty, hunger and disease; a world in which mothers and children have a greater chance of surviving and of receiving an education, and where women and girls have the same opportunities as men and boys. It promised a healthier environment and greater cooperation-a world in which developed and developing countries work in partnership for the betterment of all.

LISTEN TO THIS RADIO PROGRAM ARCHIVES AT: http://www.africanviews.org/index.php/av-radio/av-radio/AV-Radio/womens-education_c1021_m157/


Next month, APHA’s Trade and Health Forum will be holding an open Educational Session on Tobacco and International Trade Agreements. It will take place on April 12 at 2:30 PM Pacific/5:30PM Eastern.

The first 30 minutes of the call will be an educational session about recent activity pertaining to alcohol and tobacco in trade agreements and the question of “carve outs”. Donald Zeigler, PhD, Director of Prevention and Healthy Lifestyles at the American Medical Association (AMA) will lead the session. Dr. Zeigler has been active in the Trade and Health Forum, representing the Alcohol, Tobacco and Other Drug Section of the American Public Health Association and has been interested in trade and health issues for almost a decade. He was instrumental in getting the AMA to adopt policy on trade and has worked with other medical specialty societies to adopt policy, as well. The AMA recently called on the US Trade Representative to carve out tobacco and alcohol from the proposed Trans-Pacific Partnership agreement.
The second 30 minutes of the call will be dedicated to Trade and Health Forum business. You are welcome to join for the full call, and we welcome your input.

To dial in, please call (605) 475-4850 and use the following access code: 810329#. If you have questions, please direct them to Natalie Sampson (nsampson@umich).

Very best,

American Public Health Association’s
Trade & Health Forum Leaders

Giving Mom(s) a Piece of the Pie: Adding MNCH to the Global Fund

Last week, APHA, along with 58 other organizations, put its John Hancock on an open letter to the board of the Global Fund (pdf), calling on the Fund to “to fully fund the current mandate of the Global Fund; to strengthen the Global Fund’s engagement in maternal, newborn, child, and reproductive health (MNCH); and to mobilize additional resources to support such engagement.” Family Care International, which authored and coordinated the letter, reported an encouraging response from the Global Fund: the board committed to providing guidance to countries on how to integrate MNCH into their requests and to exploring the possibility of “broadening its engagement” as it develops its strategic plan for the next five years.

The prospect of adding MCNH to the Global Fund, while popular, is not without controversy. MCH advocates have been calling on donors to scale up these programs for many years, and proponents argue that organizations like the Global Fund have the drive and resources to implement and coordinate the programs that are so desperately needed to prevent the millions of needless maternal and newborn deaths each year. Others maintain that the Fund’s vertical approach is not appropriate for this issue: Alanna Shaikh argues that a narrow approach focusing on a few factors that affect maternal mortality would not be very effective, and that the funds would be better used by improving health systems in general. The Fund’s shortage of funds is an additional complication – it made headlines this past October when pledges from donors reached a meager $11.7 billion, short of the $13 billion it had set as the bare minimum to maintain its current programs and miles away from the $20 billion it had hoped to raise to expand operations.

IH members raised some very good points in the discussion leading up to the sign-on. MNCH is obviously a top priority and well deserving of attention, and the Global Fund’s current scope is limited in what it can currently do to address these issues. However, the call to expand the Fund’s activities must come with a commitment to help raise the funds needed to do so and to ensure that the energy put toward maternal health works with, and not against, the other programs. It will interesting to see the direction the Fund takes with this as it moves forward.