This article, first published on 7 March 2022, is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD. To keep updated on all of the OECD's work supporting the fight against COVID-19, visit our Digital Content Hub.
When the story of the pandemic is written, will history record that women, as 70% of health and care workers and 90% of nurses, carried us through this global health emergency? In the early stages of the pandemic, women health workers were applauded as “angels” but this did not fix the long-standing gender inequities in the health workforce that, after two years, appear to have deepened. To date, global health has been built on women being in a subordinate position in the health workforce: earning less than their male counterparts, with millions of women working unpaid and grossly underpaid; clustered into lower status roles and sectors; frequently subject to violence and sexual harassment; undervalued and without an equal say in decision making. The pandemic has demonstrated that global health security is fragile because it is built on this unequal foundation.
Women are the experts in the health systems they largely deliver, but their professional expertise and diverse perspectives are not valued sufficiently to guarantee them an equal place in leadership. Women held only 25% of leadership roles in health before the pandemic and have lost ground in global health governance since the pandemic began. Women from the Global South are especially marginalised in global health decision-making. Analysis by Women in Global Health shows that the proportion of chief delegates to the World Health Assembly who are women peaked at 31% in 2017 and fell back down to 26% in 2021.
At the Executive Board of the World Health Organization, the percentage of seats held by women had risen to 32% in early 2020 but after two years of the pandemic, had fallen to 6% in January 2022. Women should always have had an equal place in health decision-making, but now more than ever we need all talent at the table.
At country level in 2020, the picture was no better with 85% of national COVID-19 task forces in 87 countries having a majority of men as members, 11% having a majority of women and only 3.5% having gender parity. Social norms and stereotypes reinforce the myth that men are “natural leaders” and women are destined to be followers. It seems that in a global emergency, men know best.
Women health workers have made an extraordinary contribution to health systems in the pandemic, coping with surging patient numbers and risking their own health and safety.
The over representation of men in health leadership has costs for everyone. When the pandemic started the world had a serious health worker shortage, with an additional 18 million health workers needed in low-and middle-income countries by 2030 to achieve the global Sustainable Development Goal of Universal Health Coverage. Women health workers have made an extraordinary contribution to health systems in the pandemic, coping with surging patient numbers and risking their own health and safety. Across the world personal protective equipment (PPE) has been in short supply, and in addition medical PPE modelled on men’s bodies has left women health workers at greater risk of infection and death. After two years of the pandemic, there are reports from many countries of health workers, particularly women, being burnt out, mentally exhausted and planning to leave the profession. In 2020 the Royal College of Nursing found that around a third of nurses in the United Kingdom were considering leaving their jobs.
Addressing the gender inequities in the health workforce, including women’s underrepresentation in leadership, is critical to retaining women in the health workforce and attracting new applicants to fill vacant jobs in an expanding sector. A “great resignation” of women health workers in high-income countries threatens health systems in those countries, but also in the Global South as low-income country health workers may be incentivised to migrate.
Women health workers cannot wait for a gender-equal recovery from the pandemic, they need a new social contract now with safe and decent work, equal pay, equal career progression and an equal say in leadership. A gender-equal health workforce is an essential building block of a gender-equal pandemic recovery—and a gender-equal pandemic recovery will be the foundation for future global health and economic resilience.
The OECD Gender Initiative examines existing barriers to gender equality in education, employment, and entrepreneurship. Find out more!
And learn more about how we may ensure that the global community is ready for the next crisis with the OECD report: Ready for the Next Crisis? Investing in Health System Resilience (February 2023)