The coronavirus pandemic has revealed the limitations of the United States and Europe’s current approach to global health. Experts had long predicted the rapid spread of a contagious respiratory virus. But while global health spending increased at an average annual rate of 3.9 percent from 2000 to 2017, countries around the world were ill-prepared for the coronavirus pandemic, global shutdowns, and the economic shocks that followed.
Women experience unique challenges during global health crises, and COVID-19 has exacerbated preexisting gender inequalities, including domestic violence and access to critical health care. Women’s economic participation has also suffered. According to the International Labor Organization and U.N. Women, 41 percent of women work in the sectors hardest hit by the pandemic: hospitality, real estate, business, manufacturing, and retail. A recent McKinsey study found that the pandemic has adversely affected women, particularly women of color; one in four women are considering downshifting their career or leaving the workforce entirely.
While policymakers often see women as vulnerable, they rarely view them as agents of change critical to crisis preparedness and response. The few women accorded leadership roles during the pandemic have performed better on average than their male counterparts: Witness the resounding reelection of New Zealand Prime Minister Jacinda Ardern last October on the back of her successful COVID-19 response. Still, women remain dramatically underrepresented in positions of power in government and across the global health system.
Responding effectively to the current pandemic and preparing for the next one will require a new strategy to shore up health systems, including investing in women. It is imperative to ensure women’s representation in the global health system and political leadership. To win the fight against the coronavirus and any future infectious disease, the global health community and national governments must capitalize on all of the world’s talent and experience—not half.
Too often, government officials and health systems overlook the critical role of women as health-care workers and first responders in their own communities. Women make up a majority of frontline health-care workers globally: 70 percent of community health and social workers are female. Through both paid and unpaid work, women contribute over $3 trillion annually to the global health sector. These contributions are significant, not least because female health workers are remarkably successful in changing household practices, such as increasing family-planning uptake and vaccination, improving sanitation, and addressing the spread of disease.
Consider, for example, the effects of the Women’s Development Army (WDA) in Ethiopia and the Female Community Health Volunteers Program (FCHV) in Nepal. Both initiatives established a grassroots network of women volunteers to plug gaps between the formal health system and the community, disseminate vital information, and improve health-care referrals. Between 1991 and 2001, there was an 80 percent reduction in Nepal’s maternal mortality rate after the introduction of the FCHV program. The women leading the WDA in Ethiopia similarly achieved remarkable success, reducing Ethiopia’s under-five mortality rate by 69 percent by 2013, two years ahead of the deadline set by the Millennium Development Goals.
Despite their overrepresentation on the front lines of global health response teams, women remain undervalued by the national governments that rely on their contributions to ensure their health systems function. Of the $3 trillion that female health-care workers contribute to the global economy annually, an estimated 50 percent is in the form of unpaid labor. Government officials must do more than applaud the women on the front lines; they should also ensure fair working conditions, including fair compensation.
Women also play crucial roles in the health of their households, which are ground zero for disease identification and eradication. During a pandemic, the first sign of illness is typically reported to a female household leader—a mother, aunt, or grandmother—who serves as primary decision-maker regarding treatment, isolation, and reporting. Pandemic preparedness strategies should fund, develop, and distribute digital tools to capture this data. Systems that capitalize on household-level information, rather than wait for individuals to report their illness or present themselves for treatment, could help global health systems control transmission.
Training and digital tools, provided by national health systems and tailored to women’s roles as front-line workers and household leaders, could lead to more targeted use of medical facilities—preventing overburdening with conditions that could be treated virtually. It would also improve timely reporting to health-care authorities, which in turn would advance early disease detection, control, and prevention.
Artificial intelligence-enabled systems that are gender-sensitive could improve health systems, too. For example, these systems could build in medical advice in responses that explicitly reflect women’s role as health-care givers in their families. Such reforms would benefit women and their families. Women being able to provide care to extended family members based on better medical evidence would increase the quality of care and health outcomes, as well as lower costs—and provide women with new marketable skills.
Furthermore, women represent a massive, untapped group of leaders the world over. In addition to underrepresentation in political leadership, gender inequity is a persistent problem across global health organizations: in ministries of health; delegations to global bodies; and donor institutions. Research shows that gender diversity correlates with better governance, decreased corruption, and increased support for public health reforms. Women’s participation in governance is also linked to increased likelihood of finding common ground across political divides—an advantage in an era in which even wearing a facemask has become controversial.
Amid the peak of the first wave of the pandemic, in May 2020, countries with women in positions of leadership had death rates that were six times lower than countries led by men. Women-led countries locked down earlier and had higher rates of testing and lower absolute COVID-19 cases than peer countries led by men.
Finally, women leaders are more likely to address concerns related to gender equality—a perspective that is critical to recovery, given the pandemic’s disproportionate effect on women. But this is all too rare: A recent CARE study found that the majority of 30 countries examined did not have a gender-inclusive COVID-19 response. Government failure to implement gender-equitable reactions leaves issues such as gender-based violence and reduced access to sexual and reproductive health services largely unaddressed, despite their effects on community well-being.
COVID-19 will not be the last pandemic. As the world seeks to recover from the current health crisis and strives to prepare for the next one, the global health community should capitalize on the talents and strategies of women—from the household level to the national stage. Investing in women’s full participation in and leadership of global health response efforts promises a healthier, more prosperous, and more secure future for all.
