The Paradox of Public Health: Driven by Women, But Led by Men

Public health professionals are often called to do the work that they do. They are dedicated to protecting and improving the health of communities. They are often driven by passion and fueled by a desire to make a tangible difference in people's lives. But who are they?

​In the U.S., the public health workforce is aligned somewhat closely to the U.S. population in terms of diversity, but a major difference is the representation of women. Women make up the majority of the U.S. public health workforce (79%). From 2005 to 2016, 70-73% of all public health degrees in the U.S. were awarded to women.

Looking globally, women make up 69% of the global health and social care workforce. Women provide essential health services for an estimated 5 billion people worldwide, making our input into global health systems over US$3 trillion annually.
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However, a paradox emerges when we look at leadership positions within public health. While women make up the backbone of the public health workforce, men disproportionately hold leadership roles, from directors of public health agencies to CEOs of major health organizations. These disparities are more pronounced among women with intersectional identities (e.g., women of color).

Women health workers tend to be employed in roles given lower social value, status, and pay, like public health nursing and unpaid community health work. Men are the majority of surgeons, policymakers, and high-paying leadership roles. Approximately 75% of leadership roles in global health are held by men.

Not only are men overrepresented in leadership, but they’re also making more money than their female counterparts.  In 2014, women in the U.S. public health workforce earned $6,000 less per year than men, and were less likely to hold an executive leadership position. In 2017, women in leadership roles in women in the U.S. public health workforce earned about $3,000 less per year than their male counterparts, and that gap increased at the executive level. By 2018, the pay gap for female employees in the U.S. Department of Health and Human Services decreased from earning about 13% less than men in 2010 to 9.2% less. Globally, in 2022, women in the health and care workforce earned 15-24% less than their male counterparts.

This creates a crucial question that we should be asking ourselves, especially during Women’s History Month: Why is there such a stark discrepancy between the composition of the workforce and its leadership?​

Several systemic factors contribute to this gender gap:

• Segregation by gender: Women have been historically excluded from medical education and practice, and have experienced persistent discrimination and bias within these fields. Women in community health particularly, are often unable to advance in the workforce because of the lack of clear paths from unpaid work to formal, paid positions. 
• Inequitable gender norms: Societal gender roles place a disproportionate amount of unpaid caregiving and household management on women. People can’t seem to reconcile how women are supposed to complete these roles while also meeting the demands of leadership roles at work. And then, in some unhinged turn of events, HR departments, particularly those in the US, create policies that completely disregard women’s reproductive health and place major obstacles in the way of women who choose to have a family and a career.
• Gender bias: Unconscious and conscious biases in recruitment, hiring, and promotions keep qualified women from advancing in the public health and healthcare workforces. These biases also limit women’s access to professional networks and mentorship.
• Gender-based violence: Women have limited protections in their workspace against verbal abuse, bullying, and sexual harassment.

​Addressing this disparity requires a multifaceted approach that needs to start now.

1. Close the gap: Commit to creating pathways for women into formal public health and healthcare roles and hiring women for open leadership positions for which they are qualified, particularly those never held by women.
2. Promote and maintain equity: Implement gender-neutral hiring, compensation, and promotion practices based solely on qualifications and not the possession of male reproductive anatomy. 
3. Zero tolerance for violence: Create policies that clearly prohibit violence against public health and healthcare workers, have clear responses and consequences for prohibited behaviors, and recognize and address gender-based differences in the mechanisms (e.g. power dynamics) that facilitate prohibited behaviors and contribute to women being affected by violence.
4. Mobilize male allyship: Encourage men to advocate for more equal workplaces by normalizing paternity leave and other family-friendly policies that defy current gender norms and promote equitable distribution of unpaid work at home.

We cannot wait the 140 years it is estimated to take for women to achieve equal leadership positions. Women in the public health and healthcare workforce are burnt out and planning to leave, and the world can’t afford to lose them. The U.S. public health workforce is already facing a shortage of 80,000 workers, and the global health workforce is facing a shortage of 10 million workers.

By: Monique Thornton, MPH