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For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions" /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Relation" content="10.1136/bmj.q2768" /> <meta name="DC.Relation" content="10.1136/bmj.o2469" /> <meta name="DC.Description" content="A new global evidence review on leadership outcomes bolsters advocacy for gender equality in the current context of backlash against rights and equity, diversity, and inclusion efforts, writes Jocalyn Clark There remains a vital need for more health leadership by women around the world. That healthcare globally is “delivered by women but led by men”1 encapsulates the stark inequalities. Women comprise 70% of health workers but hold just 20% of decision making roles.1 Leadership roles are associated with the power to shape agendas and drive outcomes, with higher status and remuneration. Senior leaders provide a model for their followers and should reflect the communities they serve, so diverse representation in leadership matters. Despite institutional commitments to gender equality, progress on improving representation is poor. In 2024 only 36% of global health non-profit organisations and 25% of for-profits had gender parity in their senior management teams; a mere 2% of board chairs were women from low income countries.2 Just 15 of the world’s 54 multilateral organisations have ever been led by women.3 At the World Health Assembly, currently less than 25% …" /> <meta name="DC.Contributor" content="Jocalyn Clark" /> <meta name="article:published_time" content="2025-02-04" /> <meta name="article:section" content="Opinion" /> <meta name="citation_title" content="The case for women’s leadership in global health" /> <meta name="citation_abstract" lang="en" scheme="teaser" content="<p>A new global evidence review on leadership outcomes bolsters advocacy for gender equality in the current context of backlash against rights and equity, diversity, and inclusion efforts, writes <b>Jocalyn Clark</b></p>" /> <meta name="citation_journal_title" content="BMJ" /> <meta name="citation_publisher" content="British Medical Journal Publishing Group" /> <meta name="citation_publication_date" content="2025/02/04" /> <meta name="citation_mjid" content="bmj;388/feb04_8/r190" /> <meta name="citation_id" content="388/feb04_8/r190" /> <meta name="citation_public_url" content="https://www.bmj.com/content/388/bmj.r190" /> <meta name="citation_abstract_html_url" content="https://www.bmj.com/content/388/bmj.r190.abstract" /> <meta name="citation_full_html_url" content="https://www.bmj.com/content/388/bmj.r190.full" /> <meta name="citation_pdf_url" content="https://www.bmj.com/content/bmj/388/bmj.r190.full.pdf" /> <meta name="citation_issn" content="1756-1833" /> <meta name="citation_journal_abbrev" content="BMJ" /> <meta name="citation_doi" content="10.1136/bmj.r190" /> <meta name="citation_pmid" content="39904529" /> <meta name="citation_volume" content="388" /> <meta name="citation_article_type" content="Editorial" /> <meta name="citation_section" content="Opinion" /> <meta name="citation_author" content="Jocalyn Clark" /> <meta name="citation_author_institution" content="The BMJ, London, UK" /> <meta name="citation_reference" content="World Health Organization. Delivered by women, led by men: a gender and equity analysis of the global health and social workforce. Human Resources for Health Observer Series No 24. 2019. https://apps.who.int/iris/handle/10665/311322" /> <meta name="citation_reference" content="Global Health 5050. 2024 report: gaining ground. https://globalhealth5050.org/2024-report/" /> <meta name="citation_reference" content="GWL Voices. Women in multilateralism. https://gwlvoices.com/download/women-in-multilateralism-2024-in-english/" /> <meta name="citation_reference" content="citation_journal_title=BMJ Glob Health;citation_author=KR. van Daalen;citation_author=M. Chowdhury;citation_author=S. Dada;citation_title=Does global health governance walk the talk? Gender representation in World Health Assemblies, 1948-2021;citation_volume=7;citation_year=2022;citation_pmid=35998979;citation_doi=10.1136/bmjgh-2022-009312" /> <meta name="citation_reference" content="citation_journal_title=BMJ;citation_author=J. Clark;citation_author=R. Dhatt;citation_title=Backsliding in gender equality: a reminder that progress is a constant struggle;citation_volume=379;citation_year=2022;citation_pmid=36241209;citation_doi=10.1136/bmj.o2469" /> <meta name="citation_reference" content="citation_journal_title=Lancet;citation_author=J. Clark;citation_author=E. Zuccala;citation_author=R. Horton;citation_title=Women in science, medicine, and global health: call for papers;citation_pages=2423-4;citation_volume=390;citation_year=2017;citation_pmid=29208297;citation_doi=10.1016/S0140-6736(17)32903-3" /> <meta name="citation_reference" content="citation_journal_title=World Med Health Policy;citation_author=V. Dimitrova-Grajzl;citation_author=J. Gornick;citation_author=I. 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Clark;citation_title=Equity for women in science: the role of gatekeepers;citation_pages=1070-1;citation_volume=401;citation_year=2023;citation_doi=10.1016/S0140-6736(23)00625-6" /> <meta name="citation_reference" content="citation_journal_title=BMJ;citation_author=J. Clark;citation_author=S. Hawkes;citation_title=Overcoming gender gaps in health leadership;citation_volume=387;citation_year=2024;citation_pmid=39667778;citation_doi=10.1136/bmj.q2768" /> <meta name="citation_reference" content="citation_journal_title=BMJ Glob Health;citation_title=A scoping review on the impact of women’s global leadership: evidence to inform health leadership;citation_author=A. Kalbarczyk;citation_volume=10;citation_year=2025" /> <meta name="citation_reference" content="citation_journal_title=Lancet;citation_author=SK. Kang;citation_author=S. Kaplan;citation_title=Working toward gender diversity and inclusion in medicine: myths and solutions;citation_pages=579-86;citation_volume=393;citation_year=2019;citation_pmid=30739693;citation_doi=10.1016/S0140-6736(18)33138-6" /> <meta name="twitter:title" content="The case for women’s leadership in global health" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:description" content="A new global evidence review on leadership outcomes bolsters advocacy for gender equality in the current context of backlash against rights and equity, diversity, and inclusion efforts, writes Jocalyn Clark There remains a vital need for more health leadership by women around the world. That healthcare globally is “delivered by women but led by men”1 encapsulates the stark inequalities. Women comprise 70% of health workers but hold just 20% of decision making roles.1 Leadership roles are associated with the power to shape agendas and drive outcomes, with higher status and remuneration. Senior leaders provide a model for their followers and should reflect the communities they serve, so diverse representation in leadership matters. Despite institutional commitments to gender equality, progress on improving representation is poor. In 2024 only 36% of global health non-profit organisations and 25% of for-profits had gender parity in their senior management teams; a mere 2% of board chairs were women from low income countries.2 Just 15 of the world’s 54 multilateral organisations have ever been led by women.3 At the World Health Assembly, currently less than 25% …" /> <meta name="og-title" property="og:title" content="The case for women’s leadership in global health" /> <meta name="og-url" property="og:url" content="https://www.bmj.com/content/388/bmj.r190" /> <meta name="og-site-name" property="og:site_name" content="The BMJ" /> <meta name="og-description" property="og:description" content="A new global evidence review on leadership outcomes bolsters advocacy for gender equality in the current context of backlash against rights and equity, diversity, and inclusion efforts, writes Jocalyn Clark There remains a vital need for more health leadership by women around the world. That healthcare globally is “delivered by women but led by men”1 encapsulates the stark inequalities. Women comprise 70% of health workers but hold just 20% of decision making roles.1 Leadership roles are associated with the power to shape agendas and drive outcomes, with higher status and remuneration. Senior leaders provide a model for their followers and should reflect the communities they serve, so diverse representation in leadership matters. Despite institutional commitments to gender equality, progress on improving representation is poor. In 2024 only 36% of global health non-profit organisations and 25% of for-profits had gender parity in their senior management teams; a mere 2% of board chairs were women from low income countries.2 Just 15 of the world’s 54 multilateral organisations have ever been led by women.3 At the World Health Assembly, currently less than 25% …" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og:image" property="og:image" content="https://www.bmj.com/sites/default/files/highwire/bmj/388/8457.cover-source.jpg"/> <meta name="twitter:card" content="summary_large_image"><meta name="twitter:image" property="twitter:image" content="https://www.bmj.com/sites/default/files/sites/defautl/files/attachments/bmj-article/2025/02/doctor_writes_prescriptions_pakistan_a4dh38.jpg"><meta name="twitter:title" content="The case for women’s leadership in global health" /><link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/388/bmj.r190.full.txt" /> 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class="block block-system clearfix"> <div class="panel-display" > <div class="hero"> <div class="hero-wrapper"> <div class="hero-content" style="position: relative; left: 0px; top: 35.5px;"> </div>  </div>  </div>  <div class="row"> <div class="left-content col-xs-12 col-sm-8 col-md-8 col-lg-8"> <article> <div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node1106261" data-node-nid="1106261" id="node-1106261--21689592150" data-pisa="bmj;388/feb04_8/r190" data-pisa-master="bmj;bmj.r190" data-apath="/bmj/388/bmj.r190.atom"><cite class='highwire-cite highwire-citation-bmj-article-top'> <span class='highwire-cite-article-type'>Opinion</span> <h1 class="highwire-cite-title" id="page-title">The case for women’s leadership in global health</h1> <span class='highwire-cite-journal'>BMJ</span> <span class='highwire-cite-published-year'>2025</span>; <span class='highwire-cite-volume-issue'>388</span> <span class='highwire-cite-doi'> doi: <a href="https://doi.org/10.1136/bmj.r190">https://doi.org/10.1136/bmj.r190</a></span> <span class='highwire-cite-date'>(Published 04 February 2025)</span> <span class='highwire-cite-article-as'> Cite this as: <span class="italic">BMJ</span> 2025;388:r190 </span> <span class='sound-cloud'><a href="https://gh.bmj.com/content/10/2/e015982" style="color:#FFFFFF;" target="new"> <div style="background-color: #1bb1a6; width 200px; padding: 10px; border-radius: 5px; margin: 15px 0px"> <h2 style="color: #FFFFFF;">Linked Research</h2> <p style="margin-bottom: 0px;">A scoping review on the impact of women’s global leadership: evidence to inform health leadership</p> </div> </a> </span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <ul class="tabs inline panels-ajax-tab"><li class="first"><a 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class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_bmj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://www.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_bmj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="last" id="contrib-1"><span class="name">Jocalyn Clark</span><span class="contrib-role">, international editor</span></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address>The BMJ, London, UK</address></li></ol></div><div class="teaser"><p id="p-1">A new global evidence review on leadership outcomes bolsters advocacy for gender equality in the current context of backlash against rights and equity, diversity, and inclusion efforts, writes <strong>Jocalyn Clark</strong></p></div><p id="p-2">There remains a vital need for more health leadership by women around the world. That healthcare globally is “delivered by women but led by men”<a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a> encapsulates the stark inequalities. Women comprise 70% of health workers but hold just 20% of decision making roles.<a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a> Leadership roles are associated with the power to shape agendas and drive outcomes, with higher status and remuneration. Senior leaders provide a model for their followers and should reflect the communities they serve, so diverse representation in leadership matters.</p><p id="p-3">Despite institutional commitments to gender equality, progress on improving representation is poor. In 2024 only 36% of global health non-profit organisations and 25% of for-profits had gender parity in their senior management teams; a mere 2% of board chairs were women from low income countries.<a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a> Just 15 of the world’s 54 multilateral organisations have ever been led by women.<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a> At the World Health Assembly, currently less than 25% of chief delegates are women.<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></p><p id="p-4">Advocacy for more female leaders in global health tends to fall into three categories: an ethical case (it’s the right and fair thing to do), a case of social justice (women’s right to participate fully in decision making systems is protected by international law and treaties), and a business case (women’s leadership is good for an organisation’s bottom line, work culture, and customer and patient satisfaction). These are all legitimate and have been used, usually in combination, in global health advocacy.</p><p id="p-5">Inclusion of women, especially those of intersectional identities, provides the gender parity and diversity promised by international health organisations<a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a> and realises women’s rights, creativity, and productivity. The counterargument that there are not enough qualified women to fill health leadership roles and the prejudicial stereotype that men deliver better leadership especially in times of crisis, have both been debunked. These outdated views persist in part because they maintain the status quo of men’s dominance in science, medicine, and global health.<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6</a></p><p id="p-6">Evidence for women’s health leadership is accumulating. Countries led by women had better covid-19 outcomes,<a id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7</a><a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8</a><a id="xref-ref-9-1" class="xref-bibr" href="#ref-9">9</a> and female principal investigators are associated with greater diversity and robustness of science.<a id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10</a><a id="xref-ref-11-1" class="xref-bibr" href="#ref-11">11</a><a id="xref-ref-12-1" class="xref-bibr" href="#ref-12">12</a> This includes research that benefits women’s health and wellbeing, countering a long legacy of male led science that excluded or adversely impacted the diversity of women’s perspectives and health. While female and male leaders are needed to tackle inequalities and advance health, women are more likely to expand public health agendas, strengthen health systems, and prioritise issues such as domestic violence.<a id="xref-ref-13-1" class="xref-bibr" href="#ref-13">13</a></p><p id="p-7">Recent political changes—including the new US administration’s withdrawal of support for global health, foreign aid, and abortion access—make the movement for gender and health equality harder than ever. And as human rights and women’s reproductive autonomy are being profoundly threatened, the ethical and justice cases for women’s inclusion also risk being disregarded. This heightens the importance in our strategic advocacy of deploying a business case for women’s leadership.</p><div class="section other1" id="sec-1"><h2 class="">Evidence based advocacy</h2><p id="p-8">A new comprehensive scientific review in <em>BMJ Global Health</em> lays out all the evidence across multiple sectors of women’s leadership in multinational settings—showing their effectiveness as leaders and disputing women’s exclusion from leadership roles.<a id="xref-ref-14-1" class="xref-bibr" href="#ref-14">14</a></p><p id="p-9">The review of 137 studies globally will be useful in strategic advocacy across sectors. Crucially, it could help target investment and attention to areas where women’s leadership needs to be better nurtured and applied.</p><p id="p-10">The review reports that female leaders have positive effects on financial performance, innovation, ethical practice, health, organisational culture, and other women’s career outcomes. For example, 87% of all studies examining the impact of female board directors found companies to have higher profitability and market value than those without. The review also clearly affirms previous evidence on critical mass—female leaders are more effective when there are more of them.</p><p id="p-11">Some of the most powerful evidence comes from studies that showed female leaders improving organisational cultures and other women’s aspirations. In the current political climate of denigrating diversity and changing work patterns, this affirms how female leaders can support and nurture inclusive, productive workplaces, and how they do so. Rich detail across the six domains is reported in the review, which can inform implementation of strategies.</p></div><div class="section other2" id="sec-2"><h2 class="">Representation is not enough</h2><p id="p-12">Support and systems must improve. Women in global health areas continue to face penalties for motherhood, lack of recognition and support for leadership bids, fewer promotions and resources, and exclusion from the “old boys’ club” cultures, which is exacerbated for women from minoritised groups.<a id="xref-ref-6-2" class="xref-bibr" href="#ref-6">6</a><a id="xref-ref-15-1" class="xref-bibr" href="#ref-15">15</a> Change is the responsibility of everyone—not just women. But clearly more women appointed to leadership positions could drive transformative change in these biased systems.<a id="xref-ref-13-2" class="xref-bibr" href="#ref-13">13</a><a id="xref-ref-14-2" class="xref-bibr" href="#ref-14">14</a></p><p id="p-13">Evidence is a powerful tool to help disrupt systems—men’s monopoly on global health leadership is at odds with the scientific evidence. Defying the evidence and maintaining the status quo would favour many interests. But it will also compromise the ability of companies, organisations, and institutions to excel. Funders, including investors, should take note of this new evidence review to validate and build their confidence in women’s ability and effectiveness to lead. Donors, including member states, can no longer justify the continued exclusion of women in the multilateral system and must commit to change. As advocates we must welcome and deploy the findings of this new comprehensive review to bolster our demands for diverse women’s leadership in global health.</p></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-conflict" id="fn-1"><p id="p-14">Competing interests: None declared.</p></li><li class="fn-other" id="fn-2"><p id="p-15">Provenance and peer review: Commissioned, not externally peer reviewed.</p></li></ul></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-web" id="cit-388.feb04_8.r190.1"><div class="cit-metadata unstructured">World Health Organization. Delivered by women, led by men: a gender and equity analysis of the global health and social workforce. 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