Gender equality in the 21st century: Overcoming barriers to women's leadership in global health.

PURPOSE: The purpose of this manuscript is to provide an overview of the significant role that women play in providing global health care, barriers encountered to achieving gender equality in global health leadership, and to propose key recommendations for advancing gender equality in global health decision-making through the integration of gender mainstreaming, gender-based analysis, and gender transformative leadership (GTL) approaches. METHOD: Data were evaluated to determine the participation rate of women in global health care and social sector roles in comparison to men. Gender equality data from the United Nations, World Health Organization, Organization for Economic Co-operation and Development, International Labour Organization, and other resources were analyzed to assess the impact of the coronavirus disease 2019 pandemic on gender equality with an emphasis on women in global health leadership positions, the health care and social sector, and gender equality measures for girls and women throughout the world. The literature was examined to identify persistent barriers to gender equality in global health leadership positions. Additionally, a review of the literature was conducted to identify key strategies and recommendations for achieving gender equality in global health decision-making; integrating gender mainstreaming; conducting gender-based analysis; and adopting GTL programs, incentives, and policies to advance gender equality in global health organizations. FINDINGS: Women represent 70% of the health and social care sector global workforce but only 25% of senior global health leadership roles. Since 2018, there has been a lack of meaningful change in the gender equality policy arenas at global health organizations that has led to significant increases in women serving in global leadership decision-making senior positions. During the pandemic in 2020, there were nearly 100 open vacancies-one-quarter of CEO and board chair positions-at global health organizations, but none were filled by women. Women disproportionately provide caregiving and unpaid care work, and the pandemic has increased this burden with women spending 15 hours a week more on domestic labor than men. A lack of uniform, state-sponsored paid parental leave and support for childcare, eldercare, and caregiving, which is overwhelmingly assumed by women, serve as major barriers to gender parity in global health leadership and the career advancement of women. CONCLUSION: The pandemic has adversely impacted women in global health care and social sector roles. During the pandemic, there has been a widening of the gender pay gap, a lack of gains for women in global health leadership positions, an increase in caregiving responsibilities for women, and more women and girls have been pushed back into extreme poverty than men and boys. Globally, there is still resistance to women serving in senior leadership roles, and social and cultural norms, gender stereotypes, and restrictions on women's rights are deeply intertwined with barriers that reinforce gender inequality in global health leadership. To ensure comprehensive human rights and that equitable workforce opportunities are available, the concept of gender equality must be expanded within the global health community to consistently include not only women and girls and men and boys, but also persons who identify as nonbinary and gender nonconforming. Efforts to eliminate remnants of systemic and structural gender discrimination must also incorporate gender mainstreaming, gender-based analysis, and gender transformative approaches to achieve gender equality throughout global health systems and organizations.

Workforce diversity in dentistry - current status and future challenges.

The racial and ethnic diversity of the US oral health care workforce remains insufficient to meet the needs of an increasingly diverse population and to address persistent health disparities. The findings from a recent national survey of underrepresented minority dentists are reviewed and recommendations are made for enhancing diversity in the dental profession.

Women's oral health: growing evidence for enhancing perspectives.

Women's health, including oral health, is an evolving science with foundation knowledge from many disciplines. Key milestones, particularly in the last decade, provide a roadmap towards the necessary inclusion of gender into dental practice. Such focus is especially important for the evolving role of oral health care providers as primary health care providers. Continued progress of the vibrant incorporation of evidence-based women's oral health into the standard practice of oral health care is encouraged. This expanded preface provides an introduction to this DCNA issue, a brief history and timeline of major women's oral health events, and resources for further consideration.

Working with dental school admissions committees to enroll a more diverse student body.

The American Dental Education Association's Admissions Committee Workshop (ADEA ACW) was designed to challenge dental school administrators and admissions committee members to review their current admissions practices and to explore ways to attract a more diverse student body. Presented at the invitation of dental schools, this half-day interactive workshop provides opportunities for a dental school's administrators, staff, and admissions committee members to learn about the value of diversity in the educational environment and how to implement holistic admissions practices that take into consideration the experiences, attributes, and metrics of candidates for admission. This report explores the rationale for the development of the ADEA ACW, discusses lessons learned from presentation of the workshop at more than twenty-seven U.S. dental schools, and tracks enrollment trends of underrepresented minority students in dental schools where the workshop has been presented.

Evaluating the impact of the ADEA Admissions Committee Workshops.

Drawing on the interconnection of workforce diversity and oral health access, the American Dental Education Association (ADEA) is leading a novel approach to improve student body diversity in U.S. dental schools through an admissions committee development program. With funding provided by the Pipeline, Profession, and Practice: Community-Based Dental Education program and the Robert Wood Johnson Foundation, ten dental directors/deans of admissions from a cross-section of U.S. dental schools were selected through a competitive application process to participate in a Train-the-Trainers Admissions Committee Workshop. After completing intensive training that was built on legally sound admissions practices, these new trainers copresented ADEA Admissions Committee Workshops in two-member teams at six U.S. dental schools. This report summarizes the evaluation of both the train-the-trainers workshop and six workshops held in summer 2009. Also summarized are post-workshop outcomes relative to structural diversity at the participating schools.

Advancement of women in dental education: expanding opportunities, enriching the pool.

In the recent past, we have seen both the dental student applicant and enrollment pools of women in the United States increase. There has been an increase in both women applicants and first-year enrollees from the year 2000. The advancement of women in advanced educational programs and into dental faculty positions has likewise seen a trend of increase. The challenge to dental education is to ensure that the recruitment and advancement of women to careers in dental education and research in the future are consistent with their talent, expertise, and career expectations. Within this pool of women are our future leaders, deans, and researchers. As we consider future faculty needs for all dental faculty members, we must consider the unique needs of women who must balance their careers with other societal demands related to their gender.

Minority dental faculty development: responsibility and challenge.

Over at least the last twenty years, the American Dental Education Association (ADEA) has given attention and priority to increasing the number of underrepresented minority (URM) dental school applicants, enrollees, and faculty members and to meeting the challenges of achieving diversity in the oral health workforce of the future as racial and ethnic minorities continue to grow and are expected to comprise more than 50 percent of the U.S. population by the middle of the twenty-first century. Dental schools have the responsibility of preparing dentists to provide oral health care for the nation's population. This includes creating a workforce of adequate size and racial/ethnic composition. As part of ADEA's priorities to improve the recruitment, retention, and development of URMs in the dental profession, with funding from the W.K. Kellogg Foundation, ADEA launched the Minority Dental Faculty Development Program in 2004. The intent of the program is to foster academic partnerships, mentoring, and institutional commitment and leadership designed to increase the number of URM individuals interested in and prepared for careers in academic dentistry.

Components of effective outreach and recruitment programs for underrepresented minority and low-income dental students.

Dental schools in the Pipeline, Profession, and Practice: Community-Based Dental Education program that increased the number of underrepresented minority (URM) and low-income (LI) students in their predoctoral programs used focused approaches in their outreach, recruitment, and retention initiatives. Various combinations of approaches were used by the fifteen schools that received funding during Phase I of the program, which spanned 2003 to 2007. URM enrollment in the Pipeline schools increased from 184 students in 2003 to 246 in 2007. These enrollment numbers represent 16 and 20 percent of the first-year class in the Pipeline schools in 2003 and 2007, respectively. If the historically minority-serving institutions--Howard University College of Dentistry and Meharry Medical College School of Dentistry--are removed from these totals, the numbers changed from 100 in 2003 to 144 in 2007, representing 10 and 13 percent of the first-year classes. This chapter describes the approaches used by the fifteen Pipeline schools to increase the number of URM and LI students recruited to and enrolled in their predoctoral programs. It describes the internal infrastructural and organizational approaches these dental schools used to increase awareness about oral health careers among URM and LI students and to recruit applicants from these populations to their educational programs. The effective partnerships and collaborations these dental schools established with each other and external stakeholders to bolster their career outreach and recruitment efforts and some of the informal efforts that supported increased diversity are also examined.

Full-time dental faculty perceptions of satisfaction with the academic work environment.

A significant factor in a faculty member's accepting or maintaining an academic appointment is the work environment. Assessing the work environment to identify characteristics that could increase faculty retention and recruitment could be valuable to an educational institution. This study assessed the academic dental work environment to identify positive and negative areas affecting career satisfaction. An online survey about departmental structure and individual work patterns was sent to the deans of fifty-two U.S. dental schools who then forwarded the survey to their faculty. Thirty-eight institutions (73 percent) and 451 full-time faculty members from those thirty-eight schools responded. Most dental faculty members in this survey intend to remain in academia for the next five to eight years. Slightly fewer male faculty members intend to remain in dental education for five to eight years than do female faculty members. Positive satisfaction aspects of the work environment listed by respondents included supportive chair/administration, working relationships with colleagues, and interactions with students. Negative satisfaction aspects of the work environment included low salary, long hours, and heavy workloads. Both positive aspects of job satisfaction and negative factors that impede productivity need to be analyzed within the framework of each institution to enact change for career enrichment, leading to increased faculty recruitment and retention.

Women's oral health: the evolving science.

The evidence base for women's oral health is emerging from legislative action, clinical research, and survey documentation. The Women's Health in the Dental School Curriculum study (1999) followed a similar study (1996) of medical school curricula. Both of these major efforts resulted from statutory mandates in the National Institutes of Health Revitalization Act of 1993 (updated October 2000). A major study of the Institute of Medicine (IOM) National Academy of Sciences in 2001 concluded that "the study of sex differences is evolving into a mature science." This IOM study documented the scientific basis for gender-related policy and research and challenged the dental research enterprise to conduct collaborative, cross-disciplinary research on gender-related issues in oral health, disease, and disparities. This report chronicles some of the factors that have and continue to influence concepts of women's oral health in dental education, research, and practice. Gender issues related to women's health are no longer restricted to reproductive issues but are being considered across the life span and include psychosocial factors that impact women's health and treatment outcomes.