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.

Anti-racism structures in academic dentistry: Supporting underrepresented racially/ethnically diverse faculty.

OBJECTIVES: The purpose of this paper is to describe the racialized barriers to recruiting and retaining historically underrepresented racially/ethnically diverse (HURE) faculty at U.S. dental schools and the linkages of these barriers to structural racism to assist dental schools in eliminating these hurdles through an antiracism framework. METHODS: Data is used to describe the trends in the racial/ethnic composition of dental school faculty and the parity gaps by race/ethnicity between dentists and the U.S. POPULATION: Literature on the recruitment and retention of faculty of color at higher education institutions is reviewed to identify challenges and best practices. Barriers to the full participation of HURE faculty, outlined in the American Dental Education Association's Faculty Diversity Toolkit, are also identified. Research on antiracism frameworks is also investigated to denote their uses and key components. RESULTS: There is a critical shortage of HURE faculty at dental schools and active HURE dentists in the U.S. A history of racism and its legacy reinforce biases, stereotypes, and power structures that harm HURE faculty at U.S. dental schools. An anti-racism framework is needed to holistically eliminate inequities and racialized policies and practices that persists as barriers for HURE faculty. CONCLUSIONS: Increasing the representation of HURE dentists in the workforce and dental school faculty requires a major disruption to culture and institutional practices that mask centuries of structural racism embedded within complex academic systems. Dental schools must use antiracism models to create strategic initiatives that support a humanistic, equitable, and antiracism environment where HURE faculty can thrive.

ADEA Faculty Diversity Toolkit: A Comprehensive Approach to Improving Diversity and Inclusion in Dental Education.

Population demographic shifts in the United States and Canada have led to an increasingly diverse postsecondary student population. However, the largely homogenous dental faculty in the United States and Canada does not reflect the rapidly changing student body and the diverse patient population academic dentistry has been called to serve. Therefore, recruitment and retention of diverse dental faculty in dental education must be a priority. Substantial evidence also indicates improved outcomes for faculty, students, and institutions when faculty diversity on campus is increased. Beyond the positive impact faculty diversity can deliver to the learning and working environments of an academic institution, a variety of regulatory bodies mandate good faith efforts to maintain a diverse faculty, including the Commission on Dental Accreditation (CODA) standards for dental schools and dental therapy education programs. To assist its member institutions with answering the call for improved faculty diversity, the American Dental Education Association (ADEA) worked with its members to develop the ADEA Faculty Diversity Toolkit (ADEA FDT), a landmark evidence-based resource designed to assist dental education with the design and implementation of faculty recruitment and retention initiatives that can be tailored to their unique needs. This article provides an overview of the changing landscape of the United States and Canadian populations, shares the historic homogeneity of dental education faculty, provides an overview of some of the benefits associated with faculty diversity and highlights the challenges and barriers related to recruiting and retaining diverse faculty. Most importantly, it introduces the ADEA FDT and the need for dental schools and allied dental programs to use the Toolkit as a proactive resource in increasing and maintaining faculty diversity. Furthermore, it provides an overview of how to utilize and adapt the highlighted best practices and model programs to improve faculty diversity on their campuses.

Pipeline programs in the health professions, part 1: preserving diversity and reducing health disparities.

BACKGROUND: Racial and ethnic minorities are underrepresented in the health professions. Affirmative action and educational pipeline programs play a vital role in increasing the diversity of health professions, addressing educational opportunity gaps, and reducing health disparities. Part 1 of this 2-part series discusses the need for educational pipeline programs to assist underrepresented minorities (URMs) in entering the health professions and the importance of these programs in developing a cadre of diverse providers to reduce health care inequality. METHODS: Part 1 presents an overview of diversity in the medical and health care workforce, educational enrichment programs, key components of successful pipeline programs, and notable pipeline examples for underrepresented students at the University of Nebraska Medical Center. Recommendations for improving and developing pipeline programs are also included. Part 2 reviews affirmative action case law and legislation along with recommendations for maintaining and reviewing diversity pipeline programs in light of recent anti-affirmative action challenges. CONCLUSION: Pipeline programs are an important strategy for addressing the shortage of URMs in the health professions. Anti-affirmative action initiatives threaten the existence of these student preparation programs and the ability of our nation to produce physicians of color and other health care providers who are more likely to serve in underrepresented communities and work to reduce related health disparities. Programs at universities and academic medical centers must develop innovative partnerships with underserved communities, adopt strategies that demonstrate a strong commitment to increasing racial and ethnic minorities in the health professions, and develop viable funding mechanisms to support diversity enrichment programs.

Pipeline programs in the health professions, part 2: the impact of recent legal challenges to affirmative action.

BACKGROUND: Despite recent challenges to educational pipeline programs, these academic enrichment programs are still an integral component in diversifying the health professions and reducing health disparities. This is part 2 of a 2-part series on the role of pipeline programs in increasing the number of racial and ethnic minorities in the health professions and addressing related health disparities. Part 1 of this series looked at the role of pipeline programs in achieving a diverse health professional workforce and provided strategies to expand pipeline programs. METHODS: This paper presents an historical overview of affirmative action case law, anti-affirmative action legislation, and race-conscious and race-neutral admission programs in education. Additionally, part 2 reviews current legal theory and related law that impact the diversity and cultural competence pipeline programming at higher-education institutions. Finally, based on recommendations from a review of legal and other literature, the authors offer recommendations for reviewing and preserving diverse pipeline programs for health professional schools. CONCLUSION: Affirmative action is an essential legal means to ensure the diversity-related educational programs in the health profession educational programs. Anti-affirmative action legislation and state-sponsored antiaffirmative voter initiatives have the potential to limit the number of underrepresented minorities in the health professions and create even greater opportunity gaps and educational disparities. Therefore, we must shift the paradigm and reframe the dialogue involving affirmative action and move from debate to a collaborative discussion in order to address the historical and contemporary disparities that make affirmative action necessary today.