A rights-based perspective: Addressing gender equality in global health security - Dr Shubha Nagesh, Women in Global Health

This week’s guest is Dr Shubha Nagesh, a medical doctor and a public health physician in India. She is currently the chapter development manager for Asia Pacific and the Middle East at Women in Global Health, where her work focuses on gender transformative leadership.

In this episode, we talk about the importance of gender equality to health security, including the disproportionate impact of infectious diseases on women and gender equality, and how health security can take a more gender responsive approach. 

We also discuss: 

• The impact of COVID-19 on gender equality
• How gender inequalities can influence those who are impacted most by infectious disease outbreaks and public health emergencies
• How power and privilege imbalances can undermine health outcomes and why gender transformative leadership and a rights-based perspective is needed
• Why women need to be at the decision-making table and in leadership positions to help advance gender equality and improve equity in global health
• How gender equality and women’s empowerment can be best integrated into the health security sector.

We encourage you to join the conversation at @CentreHealthSec.

You can also follow Dr Shuba Nagesh on Twitter at @snagesh2.

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.

 Larissa Burke 00:31

Hello, and welcome to Contain This. I’m Larissa Burke, Gender Equality, Disability, and Social Inclusion Adviser at the Indo Pacific Centre for Health Security. Firstly, I'd like to acknowledge the Traditional Owners and Custodians of Country throughout Australia and the Indo Pacific region. We recognise the continuing connection to land waters and community and pay our respects to Elders past and present. Today, I'm joined by Dr Shubha Nagesh, a medical doctor and a public health physician in India, based in the Himalayan state of Uttarakhand. Dr Nagesh is currently the Chapter Development Manager of the Asia Pacific and the Middle East at Women in Global Health, where her work focuses on gender transformative leadership. She has many years of experience working with children with disabilities in rural areas of India with a focus on improving access to services for young girls with disabilities. In this episode, we discussed the importance of gender equality to health security, including the disproportionate impact of infectious diseases on women and gender equality, and how health security can take a more gender responsive approach. Dr Nagesh also discusses her work with Women in Global Health, the importance of advocating for improved gender equality and women's empowerment in health security, and the steps being taken to advocate for the inclusion of women in global health security decision making. We hope you enjoy the conversation. 

Larissa Burke 01:58

So, welcome. Thanks so much, Shubha for joining us tonight for a conversation on gender equality, and health security. We must start with a question on why gender equality matters in conversations around health security, and in particular, interested to better understand the risk factors and barriers for women and girls, men and boys and people of diverse genders in relation to infectious diseases.

Dr Shubha Nagesh 02:33

Thank you, Larissa. I'm so glad to be here with you today talking about gender equality in the context of global health security. So just to give some insights into what you just asked public health emergencies of international concern, disease outbreaks and pandemics are not gender neutral. In fact, we know that they are disproportionately gendered in their impact. The dire impact of the pandemic on vulnerable communities and the disproportionate impact on women and girls has been documented. And experts now recognise that the pandemic could actually reverse gains in global health and primary health care, including childhood immunizations, maternal and child health, HIV AIDS, also the related surge in gender-based violence. The impact is varied on the prevalence, morbidity and mortality among men, women and people of diverse genders. We have seen that from doctors to community health workers from delivering services to delivering vaccinations or building vaccine confidence, this differential impact has been very evident. In India we have seen for instance, more men are taking the vaccine as compared to women and this is because of the lack of awareness or exposure to the wrong kind of information. Social norms and cultural variations we know lead to an excessive burden on women, girls, and children. And there is also an exacerbation of female insecurity and the threat of violence itself. The women on the frontlines of health and care have their health and lives at risk, and by extension the lives and health of their own families. The feminised healthcare workforce and the dominance of male representation in decision making for pandemic response and planning has been evident from world over, but particularly from low- and middle-income countries, like in the Asia Pacific, where the impacts of the pandemic has been particularly hard. So gender can therefore determine who gets sick and how, who makes decisions in a health emergency, who performs the frontline response and who suffers from the long term consequences of an outbreak. These issues have long been documented in research on HIV AIDS, Ebola, Zika, etc. And yet, until 2020 2021, the issues of women and gender and health emergencies were conspicuously invisible. 

 Larissa Burke 04:57

You touched on the impact of the pandemic on different groups, particularly women and girls, I wonder whether we could dive in a little bit deeper into the impact of COVID-19 on gender equality, and in particular interested in your views of how that has differed for different groups and particularly, for, for health workers. And considering we know women are not a homogenous group and gender is very diverse, any insights you have to how that how that inequality has impacted different different groups.

Dr Shubha Nagesh 05:34

They know for a fact that women deliver health, but men lead it. We know that women hold only 25% of senior roles in health, and the marginalisation of women and leadership has continued in this pandemic too. 85% of the 150 National COVID-19 task forces have majority male membership. And this lack of diversity in leadership has contributed to less robust decision making and poor outcomes. Women and gender are often conspicuously invisible from government strategy, policy practice and public discourse around the crisis response. In fact, one study in February 2020 found that only one woman was being quoted as an expert on the pandemic in the media for every three male experts. Even before the pandemic we had serious shortages of health and care workers, with an additional 18 million requiring though in middle income countries to achieve universal health coverage, and women health and care workers have borne the brunt of the shortage during the pandemic, working long hours, often without even water or toilet breaks. Women have been the majority of health and care workers infected by COVID 19. Almost 11,500 health workers have died, and millions have long term physical and mental health impacts. Emerging evidence suggests some groups of women health and care workers have been disproportionately affected by COVID 19, including older women on those marginalised by ethnicity or class. Women who work in under resourced health systems and humanitarian emergencies have been heavily impacted, as have older workers, women with underlying health conditions, those with marginalised ethnicities of different abilities or workers of lower status, health, and care professions. 

Larissa Burke 07:24

I'm interested in the importance of having women in leadership, you talked at the start, that often women drive the health workforce but aren't necessarily leading the conversations and not necessarily engaged in the decision-making forums. How important is it having women in leadership,

Dr Shubha Nagesh 07:44

I think including equal numbers of women, people of diverse abilities people from diverse social groups, people from diverse geographies, in leadership encourages more informed decisions on all policy measures, including lockdowns, maintenance of essential services, and other services which impact particularly on women. Women and men from marginalised groups bring different interests, priorities, and perspectives into leadership decisions. And it's not just about representation. It's also about making better and more informed decisions which come with more diverse teams. Yet, an analysis by UNDP and UN women found that only one in eight countries have measures in place to protect women against the social and economic impacts of the pandemic. While women are evident at every level of global health work and successful interventions rely on their paid and unpaid labour and compliance, issues of gender where either tokenistic or completely absent from policy and strategy around pandemic preparedness and response. So it is important to have women in leadership for when demanding in good health follows. As for examples, we we know the well-known examples of phenomenal women in leadership, Angela Merkel of Germany, Jacinda Ardern of New Zealand, Soumya Swaminathan of the WHO, or Gagandeep Kang in India, but examining data on the government response to COVID 19 pandemic and its relationship to the gender of government leaders, is also considered now by experts to be an important first step in understanding the relationship between gender leadership and the pandemic response. So it's very, very important to have women in decision making and in leadership around global health security. And as Dr. Tedros said, in June 2021, at the World Health Organization, now more than ever, it is clear that gender transformative policies and women in leadership are needed to support and advance women leaders in the health sector.

Larissa Burke 09:51

Thank Shubha. But that really resonates with me that line for women when women lead good health follows what in what other ways? Can gender equality and women's empowerment be best integrated into health security programmes? What is it that we can do to get better outcomes on health security,

Dr Shubha Nagesh 10:12

Addressing gender equality in the health and social care sector is not solely the responsibility of women leaders themselves. beyond gender parity, leaders of all genders must promote gender transformative policies to realise better global health and better global health, security. And gender transformative leadership, we believe is grounded in some principles, which are, we need a framework for gender equality, women's rights and human rights, we need to challenge privilege and power imbalances based on gender which can undermine health. Intersectionality addressing social and personal characteristics that intersect with gender, such as race, ethnicity, geography, etc, which tend to create multiple disadvantages, and be applicable to leaders of any gender, not just exclusively women leaders. So gender transformative leadership is something that we believe is very important to integrate in health security programmes to improve outcomes in the future. Apart from this, governments have to commit to gender equality, not just on paper, but in practice, there is also an urgent need for policymakers to pay attention to gender and framing policies around global health security. And as the global health security architecture is being rebuilt and strengthened globally, we need to ensure that gender is front and centre. Lived experiences of women during the pandemic matter they should be considered. We also need to take into account and measure how countries cared for their women and girls during the pandemic. We must ensure the inclusion of gender perspectives in the overarching principles at the World Health Organisation and the pandemic treaty instruments to demonstrate that we are responsive and transformative in the true sense of it. Gender equality must have specific inclusions in the pandemic treaty instrument.

Larissa Burke 12:07

Reversal of development gains and gains that we have seen in gender equality over more recent years, I think is being really challenged by the pandemic. Interested to you and I met recently at the Global Health Security Conference in Singapore at the end of June, where gender equality and women's role in health security was really up in lights, where there was a panel, a plenary session at the start of that conference to really talk about women in health security. I'm interested in your thoughts of the significance of that the significance of talking around gender equality in a forum, the Global Forum on Health Security.

 Dr Shubha Nagesh 12:52

Yes. So I thought that requiring a gender lens for global health security is consistent with global interests in advancing women and girls access to health care, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness response and recovery activities. The fact that a global health security conference had a plenary and a prominent panel on gender is a sure step forward. And I thought the panel was diverse was equitable and had great representation in terms of the speakers where they from all over the world. So for me personally, I thought that session was the best session In the whole conference, I also felt like this session was really strong in that it called for engagement and elevation of women at the community national and global levels as decision makers on health security, which includes female health care work. It will also allow us to prioritise women and girls in the global response to Covid-19, particularly addressing issues like gender-based violence, economic hardship, and loss of educational opportunities. And I think this prioritisation is something that shouldn't stop with Covid-19, it is something that should be taken forward in future epidemic planning as well. I also thought that it could strengthen access to sexual and reproductive health and maternal health for primary health care globally and for building stronger health systems. And finally, I thought that it could also elevate women and girls’ health and protection in future humanitarian crisis, and ensure that the response is not just inclusive, but also gender fair. 

Larissa Burke 14:36

Yeah, that's great. And I agree, Shubha I think it was one of the best sessions at the conference, and it really set the scene for the following days. We talked about gender transformative leadership, and gave some great examples of what it looks like. How would you simply describe gender transformative leadership, for those who are less familiar with it?

Dr Shubha Nagesh 14:58

Simply put, what we're trying to say is that gender equality should be based around a framework, which is looking at gender from a rights-based perspective, whether we're looking at women rights or human rights. It's not something about sympathy or pity, or, you know, it's about social justice. It's about human rights. And it's also trying to make people aware of power imbalances of privilege imbalances that exist, particularly based on gender. And unless people are actually aware of what this looks like, what this feels like, or what this seems like they feel like they may not even be able to identify these imbalances. And we believe that gender transformative leadership or gender transformative principles, help to provide this awareness to people to organisations, because a lot of these kinds of imbalances actually undermine health. The other aspect of gender Transformative Leadership is also about addressing intersectionality like I told you, so yes, there is gender and it does provide some disadvantages but along with gender, there are so many other things at play. So that intersection with race, ethnicity, geography, all of this is leading to so many disadvantages. So we can look at a woman we can look at a woman who's a widow, we can look at a woman widow who has AIDS, so you know, it just multiplies. So how can policies or how can leadership, which is gender transformative, be grounded so that these things can be avoided in the first place? 

 Larissa Burke 16:42

We're interested to hear more about the work of Women in Global Health. Could you talk more about Women in Global Health and the work you do and how you're advocating for gender equality within the health sector?

Dr Shubha Nagesh 16:52

So as a movement, Women in Global Health is committed to advocating for the protection of health and care workers and to achieving global health, security, and stronger health systems by all health and care workers everywhere can work in dignity, equality, and safety. So in this regard, our key asks are, include women in global health security decision making structures and public discourse, provide health workers, most of whom are women with safe and decent working conditions. Recognise and value women's work in health and social care by bringing women's unpaid work into the former labour market and redistributing unpaid family care equally between men and women. Adopt a gender sensitive approach to health security, data collection and analysis and Response Management. And finally, we also asked for funding women's movements, particularly women's organisations in low- and middle-income countries, so that they can unleash capacity to address the critical gender issues in their own context. Usually, the initiation comes from the chapter or the country. They have heard of women in global health, they have met one of the leadership team or they have attended a session that was being organised by them in global health. And they reach out to us it's usually one or two people who say that they are interested in starting the chapter. Say for example, you introduced me to Ani in PNG, we've had two meetings with Ani so far. And so Ani can come forward with another colleague and say, We are both interested in starting up women in global health chapter. So we have a meeting with them, and then we usually encourage them to have a core team of about three or four people at the minimum, because we believe that is how much it takes to actually set off this whole process. We also request chapters to find the host organisation who they become associated with. It could again be an academic institution, it could be a university, it could be a civil society, organisation, etc. Because when they apply for grants to women in global health, or even outside women and global health through a third donor or funder, these grants get channelled through the host organisation. It's also an affiliation, which helps to strengthen the chapter. Once all this is done, we score them on this, then we send them the application form, they fill it and the chapter officially becomes a WGH chapter. And they enter into what we call an incubation phase, which usually lasts from about six months to one year. So we're just creating the space where all these women from different contexts, regions, and countries are coming together with a common passion towards gender equality. And we also provide a lot of spotlight to women around their work, so if we are hosting a panel at UNGA, or at the World Health Summit, or the World Health Assembly, then we try and invite women from lesser contexts, because often Asia is India or Pakistan, or Australia. But can we get them in from Thailand? Can we get women from Indonesia? Or can we get women from Fiji Islands to come and talk about their work? How did they do during COVID, etc. So bringing visibility to women like Ani perhaps to her work, and bringing them to a global space setting examples for other cities, some of the things we do, I hope this helps.

Larissa Burke 20:14

Dr Shubha, Women in Global Health seem to have quite a strong social media presence. Do you think that's a powerful tool? Is it a way in which people contact you? Are they attracted you to the organisation through those social media channels?

Dr Shubha Nagesh 20:29

Absolutely. I think it's the social media presence and the social media messaging, which is making us making it possible for us to reach out to women in Egypt or in Zimbabwe or in Francophone West Africa. You know, language may be a barrier, but we are going all the way out to ensure that we have French translations, Spanish translations, Portuguese translations of all our messages. And I'm just happy to share with you that I think the number of chapters have increased the most in the last year. This is because of social media. And we are encouraging all country chapters to invest in a communications person or communications team because we have seen the magic it does to try and reach to people or populations who we could have never imagined reaching out to before we started using social media. So whether it's Twitter, whether it's LinkedIn, whether it's WhatsApp you know we have been trying to have a presence in all different forms of social media because people use different platforms. So we want good coverage, and it's really helped us.

Larissa Burke 21:37

So, thanks. Thanks so much for joining us tonight, Shubha and just interested whether you have any final kind of key messages that you want to share.

Dr Shubha Nagesh 21:48

Thanks, Larissa. It was my pleasure to be here with you on this podcast. The key message that I would like to leave with is each one of us men and women need to champion for gender equity, and equality in global health security, particularly equal leadership for women, and a new social contract for women health workers based on equal safe and decent work. Optimal implementation of a gender strategy in health security is in the best interests of everyone. And global health security is not a women's issue. It's everybody's health security. Thank you.

Larissa Burke 22:24

You've been listening to Dr Shubha Nagesh, from Women in Global Health speak about why gender equality matters to health security, and why it's important to integrate gender equality considerations into policy and programming. We hope you have enjoyed the conversation. I'm Larissa Burke from the Indo Pacific Centre for Health Security. Contain This aims to bring you fresh insights analysis and updates on what is shaping the future of global health in our region. We look forward to having your company on the next episode. 

Contain This is produced by the Indo Pacific Centre for Health Security. You can follow us on Twitter at centrehealthsec.