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The Importance of Gender Equality in Science and Medicine

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High-profile scandals and downfalls of the rich, famous, and powerful have been in the news on a daily basis in what has become a reckoning for decades of bad behavior. Still, issues like equal pay, equal opportunity for advancement, and equal recognition persist, and they plague just about every industry. Science and medicine are no exception. For the most part, academic medicine provides examples of the same gender gaps as any other profession, like a tougher path to promotion or fewer opportunities for those just starting out. Studies have found women who graduate medical school are less likely than their male counterparts to rise to the ranks of associate or full professor, despite the fact that more female med school graduates go on to pursue a career in academic medicine.

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In August 2018, the president of the World Bank noted that “‘Human capital’—the potential of individuals—is going to be the most important long-term investment any country can make for its people's future prosperity and quality of life”. Nevertheless, leaders and practitioners in academic science and medicine continue to be unaware of and poorly educated about the nature, extent, and impact of barriers to full participation of women and minorities in science and medicine around the world. This lack of awareness and education results in failures to fully mobilise the human capital of half the population and limits global technological and medical advancements. The chronic lack of recruitment, promotion, and retention of women in science and medicine is due to systemic, structural, organisational, institutional, cultural, and societal barriers to equity and inclusion. These barriers must be identified and removed through increased awareness of the challenges combined with evidence-based, data-driven approaches leading to measurable targets and outcomes. We describe tools that include formal legislation and mandated quotas at national or large-scale levels (eg, gender parity), techniques that increase fairness (eg, gender equity) through facilitated organisational cultural change at institutional levels, and professional development of core competencies at individual levels. This Review is not intended to be an extensive analysis of all the literature currently available on achieving gender equality in academic medicine and science, but rather, a reflection on finding multifactorial solutions. Climate and culture must be addressed together because efforts to build a good climate will be unsuccessful if the policies conflict with the beliefs, assumptions, and values of an organisation; conversely, a positive culture will not produce the desired result if policies and procedures are not organised around the collective goals and beliefs. Thus, addressing and improving organisational culture and climate in science and medicine are essential if women are to feel welcome, safe, supported, successful, and respected in these disciplines and if girls are to see their aspirations of careers in science and medicine as tangible options. Many advocates, including women in academic science and medicine, are tired of initiatives that focus on women as being the problem, and which assume a masculine heteronormative view of the world, requiring women to achieve a set of behaviours and measures that have been defined, determined, and continue to be measured by systems that are inherently sexist and racist by design. The various barriers that comprise the glass obstacle course9 for women in science, such as gender stereotyping and tokenism, have been well described.

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Gender differences in academia, captured by disparities in the number of female and male authors, their productivity, citations, recognition, and salary, are well documented across all disciplines and countries (Y

Xie, K. A. Shauman, 1998). The epitome of gender difference is the “productivity puzzle” —the persistent evidence that men publish more than women over the course of their career, which has inspired a plethora of possible explanations, from differences in family responsibilities, to career absences, resource allocation, the role of peer review, collaboration, role stereotypes, academic rank, specialization, and work climate. The persistence of these gender differences could perpetuate the naive interpretation that the research programs of female and male scientists are not equivalent. However, such simplistic reading of the data dismisses increasing evidence that systemic barriers impede the female academic. Indeed, the deep interrelatedness of these factors has limited our ability to differentiate the causes from the consequences of the productivity puzzle, complicating the scientific community’s ability to enact effective policies to address it. A key methodological obstacle has been the difficulty to reconstruct full publishing careers for scientists of both genders across the diverse academic population. Consequently, much of the available evidence on gender differences is based on case studies limited to subsets of active scientists in specific countries, disciplines, or institutions, making it difficult to compare and generalize the finding to all of science (M. F. Fox, K. Whittington, 2017).

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Obviously, beyond quantitative gender equality, we must strive for a cultural transformation that allows for the inclusion of values of transparency, honesty, fairness, and justice

With the evolving landscape, we are in the position to demand more from the evidence, to innovate beyond current discourses, and to realise true gender equality for everyone, everywhere. Achieving gender equality is not simply instrumental for health and development, its impact has wide-ranging benefits and is a matter of fairness and social justice for everyone.

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J. S. Long, Measures of sex differences in scientific productivity. Soc. Forces 71, 159–178 (1992).

Y. Xie, K. A. Shauman, Sex differences in research productivity: New evidence about an old puzzle. Am. Socio. Rev. 63, 847–870 (1998).

M. F. Fox, K. Whittington, M. Linkova, “Gender,(in) equity, and the scientific workforce” in Handbook of Science and Technology Studies (MIT Press, Cambridge, MA, 2017).

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