Six weeks ago, World Bank president Jim Yong Kim, MD, tweeted a photo of top leaders of the World Health Organization. It showed a group of men in business suits seated around a large table.

Michele Barry, MD, director of Stanford's Center for Innovation in Global Health, displayed the photo on a large screen. "Where are the women?" she said to a crowd of nearly 400 people - mostly women - Oct. 12 at Stanford's Li Ka Shing Center for Learning and Knowledge.

"We are here," a chorus of female voices in the crowd responded.

So began the inaugural Women Leaders in Global Health conference, designed to highlight the accomplishments of women in the field and empower the next generation of leaders to fill the gap of women at the top.

Barry noted that some 90 percent of health care around the globe occurs at home, mostly by female caregivers. "On the frontline, at least 75 percent of the health workforce are women, and looking around this room, there is no shortage of women in the pipeline," she said.

Few women at highest echelons

Yet there are few women at the highest echelons. Most health administrators, health-sector CEOs, deans, ministers of health and members of the World Health Assembly are men. And they are making critical decisions that impact the health of women around the world.

"When we have diversity, careers prosper, companies flourish and health outcomes improve," Barry said. "We all win."

Stanford's Michele Barry tells conference attendees that diversity means "we all win."
Rod Searcey

Stanford Provost Persis Drell, PhD, told the group, "Quite simply, we won't get the right answers without women in leadership roles."

The conference was held with the aim of beginning a movement for change. It featured some 400 female leaders from 68 countries, representing 250 universities, companies and nonprofits.

Harriet Mayanja-Kizza, MD, dean of medicine at Uganda's Makerere University, noted that in her sub-Saharan country, nearly all the bedside care is provided by women, whether they're nurses in hospitals or family members at home.

"I have had people tell me it's better for the wife to outlive the husband because the wife can look after him," she told the audience. "If the wife is sick, she has to find a sister or an aunt to take care of her."

Yet women in Uganda are not encouraged to join the medical profession or the sciences. She said that when she went to medical school, only 8 percent of the students were women; now it's 30 percent. Yet, she said, "Women have many things pulling against them," including the fact that many girls drop out of school by the age of 12 and are urged into early marriage and childbirth. Those who do make it into higher education have to balance family demands; one graduate student told her she was due to give birth the day her classes began. She had employed a caregiver who could sit by a tree outside to look after her baby so that she could occasionally leave class to feed the child.

Earlier this year, Sania Nishtar, MD, a Pakistani cardiologist and activist, was short-listed as a nominee to be director-general of the World Health Organization. She was the only woman on the list. During the campaign for the position, she said she visited dozens of countries.

"Women's leadership was not on the agenda of most governments," Nishtar said. "There were very few that talked about appropriate gender representation. That is a mindset that clearly needs to change."

'A lot to gain'

Men have a role to play as well through programs that mentor women and promote them as role models, said Peter Piot, MD, director of the London School for Hygiene and Tropical Medicine.

"There's the reality that in order to achieve gender parity, men have to give up something," Piot said. "But it will be better for them ultimately."

Gary Darmstadt, MD, professor of pediatrics and associate dean for maternal and child health at Stanford, agreed. "Where you have greater gender equity, men's longevity improves, as does women's longevity," he said. "So I think we have a lot to gain."

Toward the end of the daylong conference, the participants talked about concrete actions for change and received advice from some distinguished panelists on how to become "change agents."

Peru's former minister of health Patricia Garcia, MD, PhD, MPH, said women seeking to advance in the global health field should be persistent and passionate and be willing to speak up and be open to unexpected opportunities. That is, in essence, the story of her own career.

Where you have greater gender equity, men's longevity improves, as does women's longevity.

Garcia was the dean of the School of Public Health at Peru's Cayetano Heredia University in 2016 when she received a surprising call from the country's president, she said. The president invited her to his home, and after they talked, he offered her the country's top health job.

"I thought it was an opportunity to make a difference in my country, although I knew the average time of a minister in my country was six months," she said, speaking rapid-fire and with hand flourishes. "I have to tell you it was really tough, really tough. There was a lot of politics and corruption," which she said she fought against.

Still, Garcia said she managed to make some headway, increasing access to human papilloma vaccination by 85 percent, introducing telemedicine and electronic medical records and raising the salaries of health workers, among other initiatives. She lasted a year and two months in the job before the president's entire cabinet resigned in September 2017 and she returned to the university. In the process, though, she said she learned a great deal, offering this advice to the audience:

"You have to work with passion, and you have to love what you do, and I do love public health. Do your best to create opportunities. That's why I jumped into the ministry of public health, though everybody thought I was crazy - though I call it passionate crazy. And fight against your own fears. Raise your voice when you need it. That's what I learned. And be honest. Be perseverant and also have patience because change takes time."

After her talk, Donna Shalala, PhD, former U.S. secretary for health and human services and the panel's moderator, offered a lighthearted suggestion: "You know, Patty, the United States has an opening for a minister of health," she said.

The conference was sponsored by 18 organizations.

The London School for Hygiene and Tropical Medicine has agreed to host the next conference in 2018. Patricia Garcia and Agnes Binagwaho, MD, PhD, former Minister of Health for Rwanda, also have offered to host future conferences, Barry said.