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.

Establishing an antiracism framework for dental education through critical assessment of accreditation standards.

PURPOSE: The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education. METHODS: The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts. RESULTS: Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service. CONCLUSIONS: The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.

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.

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.

Affirmative action: essential to achieving justice and good health care for all in America.

Affirmative action is an established principle that brings fairness and justice to admissions policies and practices by setting goals that encourage and pressure institutions and individuals to create educational and professional opportunities for minorities and women, if it were not for affirmative action, we would waste the talents of countless individuals who would be discounted because they are minorities or women. The result would be a nation that is weaker because it would be segregated once again in a system in which white people and men would have the preponderance of opportunity and authority and in which access would be very limited for minorities and women. It may be time to reframe the argument for affirmative action in language that denotes its benefits to all Americans by increasing access for emerging majority citizens now and in the future. ADEA, academic dentistry, and the dental profession should continue to do everything it can to preserve the policies and practices of affirmative action, especially through the support of the University of Michigan admissions policies as challenged in the cases before the U.S. Supreme Court and in our own practices.

Work environment perceptions of full-time dental educators: does gender matter?

This study investigates whether female and male full-time dental faculty members in U.S. dental schools differ in their workplace experiences and perceptions. A questionnaire was mailed to the 2,203 U.S. members of the American Dental Education Association (ADEA) in May 2001, and 870 faculty members responded (response rate: 40 percent). The data of the 738 full-time employed faculty members (female: 257, 34.8 percent; male: 481, 65.1 percent) were analyzed. The results showed that male and female faculty did not differ significantly in the average hours per week worked (men: 46.1 vs. women: 47.1), in the amount of time spent on research (11.67 percent vs. 12.76 percent), and in available grant support (20.1 percent vs. 19.7 percent). Men were more likely than women to have office space (99.2 percent vs. 96.5 percent; p = .0 12), secretarial support (87 percent vs. 75.8 percent; p = .000), protected time for research (37.8 percent vs. 31.6 percent; p = .056), and lab space (23.2 percent vs. 10.6 percent; p = .000). Compared to men, women spent more time on teaching (men: 16.84 percent vs. women: 19 percent; p = .078), and perceived the work environment as less supportive (30 percent vs. 9.3 percent; p = .000). While 73.8 percent of men felt welcome as members of the dental school community, only 50.2 percent of the women felt welcome (p = .000). Male and female respondents differed significantly in the degree of experienced and perceived harassment. We thus concluded that female and male faculty members differ in their experiences and perceptions of the academic climate at U.S. dental schools. These results may be useful when school leaders explore effective recruitment and retention strategies for dental faculty members.

Improving the oral health status of all Americans: roles and responsibilities of academic dental institutions: the report of the ADEA President's Commission.

Academic dental institutions are the fundamental underpinning of the nation's oral health. Education, research, and patient care are the cornerstones of academic dentistry that form the foundation upon which the dental profession rises to provide care to the public. The oral health status of Americans has improved dramatically over the past twenty-five to thirty years. In his 2000 report on oral health, the Surgeon General acknowledges the success of the dental profession in improving the oral health status of Americans over the past twenty-five years, but he also juxtaposes this success to profound and consequential disparities in the oral health of Americans. In 2002, the American Dental Education Association brought together an ADEA President's Commission of national experts to explore the roles and responsibilities of academic dental institutions in improving the oral health status of all Americans. They have issued this report and made a variety of policy recommendations, including a Statement of Position, to the 2003 ADEA House of Delegates. The commission's work will help guide ADEA in such areas as: identifying barriers to oral health care, providing guiding principles for academic dental institutions, anticipating workforce needs, and improving access through a diverse workforce and the types of oral health providers, including full utilization of allied dental professionals and collaborations with colleagues from medicine.

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.

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.

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.

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.