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Issue 131 Spring 2019

Endocrinologist > Spring 2019 > Features

What you don’t know can’t hurt you … can it?

Maralyn Druce | Features

It is just over 100 years since the suffragettes campaigned for gender parity for voting in the UK, and we really have come a long way since that time. Now we know that over half of our medical students are women, and more and more women are studying science-based subjects and developing careers in science. So all is well, right? Or is it?

Large datasets, such as those collected by the OECD (Organisation for Economic Development), help us to understand how things are in our own country with respect to gender equality, and to compare ourselves with other member countries. The expression ‘think globally, act locally’ has become embedded as the way to get things done. How can we ‘act locally’ without knowing what action needs to be taken? For higher education establishments, the Equality Challenge Unit (ECU) provides a mechanism.


The Athena Project was a national science, technology, engineering, maths and medicine (STEMM) diversity project, which ran from 1999 to 2007. Its aim was to ‘advance and promote the careers of women in science, engineering and technology in higher education and research, and to achieve a significant increase in the number of women recruited to top posts in the UK’. The project was set up by and for women in the academic science community, and has been further developed in the Athena SWAN Charter.

This charter initially aimed to increase the representation of women in STEMM, but its scope was expanded in 2015 to include non-STEMM subjects and to consider the issues of gender balance and gender representation more broadly among academic and also professional and technical staff . It has been overseen by the ECU but was latterly taken over by Higher Education England.


Institutions – which can be individual departments, schools or whole universities – make a formal commitment to follow the ten principles of the charter and apply for an Athena SWAN Award, at bronze, silver or gold level. Each award is valid for 4 years under the post-2015 rules.

The principles focus on promoting and supporting gender equality. In particular, the charter aims to address what is known as the ‘leaky pipeline’ of women progressing to senior roles in science by:

  • removing obstacles to their advancement
  • ensuring equal pay and
  • mainstreaming support.

This is achieved through action at all levels across the department or organisation.


The process of applying for an award is one of extensive data collection and intensive data analysis, applying the findings to devise institution-specific interventions to improve imbalance. To achieve a silver award, such interventions and initiatives must have demonstrable impact. Institutions at gold level should be beacons of achievement in gender equality, should champion and promote good practice and should have measurable impact in the wider community, nationally or internationally.


Minds have been focused by money. The NIHR BRC/BRU (National Institute for Health Research Biomedical Research Centres and Units) funding guidance states that a minimum silver Athena Swan Award is required. In addition, the NIHR have announced that academic clinical fellows and clinical lecturers may now only be funded if attached to units holding an Athena SWAN silver award. The linkage to money is not a bad thing, as guidelines where there is no penalty for failing to achieve rarely succeed. For this reason, most universities and departments now have their own self-assessment teams, preparing or planning applications.


There is some evidence that charters such as Athena SWAN can have measurable and positive impacts on the areas of imbalance that they seek to redress.1 However, the programme itself recapitulates the gender imbalance, as the proportion of women engaged in this unremunerated and academically unrewarded work exceeds roles taken by men,2 and institutional attitudes to the programme and its implementation remain cynical.

It is difficult to link specific impacts to particular interventions, as the wider context is so relevant. For example, it is difficult to say honestly that a mentoring scheme is directly responsible for an increase in women receiving academic promotion. Appropriate goals, targets and benchmarks are a perennial problem – is a 50/50 split of men and women at all levels the only reasonable ideal in all circumstances?

Finally, even institutions that adhere closely to action plans may report dispiriting results. The national data on the proportion of women in professorial roles remain disappointingly flat over several years. However, with the gender pay gap topical, it is worth noting that modelling implementation gender equality programmes can be shown to have an important impact.3


While we might debate the nuances of the programme, such as whether the focus is too broad, or the workload inequitably distributed, a key feature of the Athena SWAN Awards is the close evaluation of organisation-specific data and the ability to benchmark your own institution against other comparable departments, via published data or by other institutions’ own, freely available, Athena SWAN self-assessment documents.

Understanding one’s own context is the first building block in seeing where change is needed and creating the possibility for change to occur. Presenting institutional data to the senior leadership is also an important exercise in winning hearts and minds over to supporting an action plan for change.

It is undoubtedly a cumbersome, often painful, time- and life-consuming experience to chair an Athena SWAN self-assessment team. However, at least a process exists, and it is one which is clear, transparent and shared across the higher education sector.

Gender inequality is as real and problematic in clinical medicine as it is in academia, yet the NHS has no comparable national framework to review information or create change. Perhaps it is time to consider such a thing?

Maralyn Druce, Professor of Endocrine Medicine, Department of Endocrinology, Barts and the London School of Medicine


  1. Ovseiko PV et al. 2017 Health Research Policy and Systems 15 12.
  2. Caffrey L et al. 2016 BMJ Open 6 e012090.
  3. Rao AD et al. 2018 JAMA Network Open 1 e186054.

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