Today is International Women’s Day. We have come a long way since the days of Elizabeth Garrett Anderson or Emmeline Pankhurst, striving for the rights of women to be educated or to vote. In society and in medicine, women have reached the most senior positions—chief executives, chairpersons, prime ministers. Despite these successes, there is more to do—for example, organisational struggles with staff retention commonly affect women disproportionately, and there is evidence of differential attainment in many professions, including medical leadership and academia.
As a result, many Western societies continue to strive for equality of opportunity. Inequality of opportunity has two broad drivers: true bias and systemic bias. The former is usually easy to spot and has its origins in prejudice: this is not only wrong, but in many societies, illegal. The latter—in which a process inherently favours a particular group—takes more effort to identify. For example, negatively marked multiple-choice questions (now abandoned in UK medical degrees) disadvantage those who are risk-averse, and at population level, such individuals are more likely to be women.
We have recently contributed to two equal opportunities initiatives in our field—a “Women in Anaesthesia” special edition of the British Journal of Anaesthesia, and The National Institute for Academic Anaesthesia’s (NIAA) Equality, Diversity and Inclusivity report, aimed at improving equality of opportunity for anyone interested or active in research. Both these endeavours describe continued gender-associated challenges (ranging from preconceptions around carer or parental responsibilities to malign behaviours of the #metoo variety), areas of progress (e.g. gender distributions in academic authorship), and areas of continued inequity of outcome (e.g. in senior academic positions, editorial boards and leadership roles). Importantly, both endeavours also offer strategies to support further progress—ranging from amplification, mentorship and sponsorship to the implementation of codes of conduct for academic meetings and conferences.
It is clear that there are an increasing number of initiatives which aim to support those with legally protected characteristics to achieve their full potential, including women and racial and ethnic minorities. But there remain other disadvantaged groups which receive less attention—for example, the socially immobile. In the UK, poor white men are the societal group least likely to go to university. The challenges they face likely relate, in part, to true prejudice (someone’s appearance, accent, or name may confer advantage or disadvantage), but much is systemic, and systemic biases against these groups must also be addressed in medicine and academia.
So, on International Women’s Day, perhaps our challenge is addressing inequality of opportunity for anyone and everyone. We therefore offer five steps for consideration.
Step 1 is to acknowledge that we all have prejudices. These are unlikely to manifest as frank sexism, racism, homophobia and so on, but are more likely to be subtle unconscious biases derived from our own experiences, and which require continual self-reflection and challenge.
This leads us to Step 2—stop, think, be kind. When something happens which irks you, before reacting, take a breath. Could a behaviour or comment, which appears prejudicial or ill-conceived, have been misunderstood or misconstrued? Could our own prejudices be influencing our reaction? Can we consider a gentle word or a private discussion rather than a public beating?
Step 3 is to recognise our duty to call out malign behaviour when we see it. This is perhaps the biggest challenge, as it might require us to confront our seniors. If it was easy, we would all be doing it already. Perhaps we have all been guilty, on occasion, of not confronting those who have bullied, undermined, or objectified us or others.
Step 4: consider unforeseen consequences. A key aspiration of the NIAA work was to avoid recommendations which might swing us from being prejudiced against one group to being prejudiced against another. Awards specifically for women might disenfranchise some men, particularly those who share or take the brunt of parental or carer responsibilities in their relationships; perhaps worse still, such efforts might inadvertently reign in societal progress toward gender equity. Awards which aim to reduce systemic bias against individuals, based on their life choices, might be a better idea, although harder to articulate.
Related to this, and perhaps most importantly is Step 5—treat everyone as individuals. Martin Luther King said, “I have a dream that my four little children will one day live in a nation where they will not be judged by the colour of their skin, but by the content of their character…”
As an individual, take the time to understand me. Do not pigeon hole me. Look at me not as a white/black/brown/man/woman/non-binary/straight/gay individual but as an individual—with all my complexity, strengths and weaknesses. Judge me by the content of my character.
Happy International Individuals Day.
Ramani Moonesinghe is professor of perioperative medicine at UCL and consultant anaesthetist at UCL Hospitals. She leads the Health Services Research Centre at the Royal College of Anaesthetists
Cynthia A. Wong is an obstetric anesthesiologist and Professor and Chair of the Department of Anesthesia at the University of Iowa, Iowa City, IA, USA. @CynthiaAWongMD
Jennifer M Hunter MBE is an emeritus professor and senior research fellow at the University of Liverpool, England. She was Editor in Chief at the British Journal of Anaesthesia from 1997-2005 and Chair of the BJA Board from 2006-12.
Hugh Hemmings Jr is a Joseph F. Artusio Jr professor and chair of Anesthesiology, professor of Pharmacology, and senior associate dean for research at Weill Cornell Medicine and Anesthesiologist-in-Chief at NewYork-Presbyterian Hospital/Weill Cornell in New York City, USA. He serves as editor-in-chief of the British Journal of Anaesthesia.
Christa Boer is a professor of anesthesiology, research perioperative care and program director of the Cardiovascular Research master program at VU University Medical Center. She is trained as a biomedical scientist with a PhD in cardiovascular physiology.
Mike Grocott is vice president of the Royal College of Anaesthetists, professor of anaesthesia and critical care medicine at the University of Southampton, and a consultant in critical care medicine at University Hospital Southampton NHS Foundation Trust. He is an NIHR Senior Investigator and serves as chair of the board of the National Institute of Academic Anaesthesia.
- Ramani Moonesinghe, Christa Boer, Mike Grocott, Hugh Hemmings Jr, Jennifer Hunter, Cynthia Wong