The global health workforce nearly tripled during the period studied, rising from 40.9 million workers in 1990 to 122.1 million in 2023. Women accounted for 71.4% of that increase, adding tens of millions of workers to hospitals, clinics, pharmacies, community programs, and other health services. The growth included an increase of 18.9 million nurses and 8.7 million doctors, although the pace varied widely between countries and professional categories. Researchers describe the expansion as one of the most significant transformations in the structure of global health systems over the past three decades, while emphasizing that numerical growth alone has not eliminated geographic inequality, professional hierarchies, or persistent shortages.

In 2023, women represented 68.9% of all health workers worldwide. Their presence was particularly strong in professions traditionally associated with caregiving and community-based health delivery. Women made up 80.7% of nurses, 96.0% of midwives, and 89.5% of community health workers. By contrast, women accounted for less than half of doctors globally. Similar patterns appeared in dentistry and pharmacy, where women were more likely to work as dental or pharmaceutical assistants than as dentists or pharmacists themselves. These differences are important because professional roles are linked to income, autonomy, access to advanced training, and the likelihood of reaching senior management or policy-making positions.

“Women have transformed the global health workforce over the past three decades, but they continue to be concentrated in professions that generally offer lower pay and fewer opportunities for leadership,” said Megan Knight, the study’s lead author and a researcher at the Institute for Health Metrics and Evaluation. The pattern reflects a long-standing division of labor in health care, in which women perform a large share of direct patient care and essential support work while remaining underrepresented in the most highly paid and influential positions. The researchers argue that expanding opportunity will require more than recruiting additional workers. Health systems will also need leadership pathways, protection from harassment and discrimination, paid parental leave, flexible work arrangements, and safe working conditions that allow women to remain and advance in the profession.

The study estimates that an additional 34.4 million health workers would be needed to achieve a score of 80 out of 100 on the GBD universal health coverage effective coverage index. This benchmark represents a moderate level of universal health coverage, defined as access to essential health services without financial hardship. The projected gap includes 23.9 million nurses and midwives, 7.1 million doctors, 1.8 million dentists, and 1.6 million pharmacists. These figures do not simply represent vacancies in existing facilities. They estimate the workforce required for countries to deliver a defined level of effective coverage, taking into account population needs, service availability, and the relationship between worker density and health outcomes.

The shortages are concentrated in regions where populations are growing rapidly and health systems often operate with limited financial and educational resources. South Asia would require an additional 2.6 million doctors and 10 million nurses and midwives to reach the moderate universal health coverage threshold used in the analysis. Sub-Saharan Africa also faces severe deficits across major health professions. Nursing density in the region was estimated at 14.5 workers per 10,000 people, compared with 121.8 per 10,000 in high-income countries. At the country level, the contrast was even more pronounced: Chad had an estimated nursing density of 3.2 per 10,000 people and Madagascar 3.3, while Belgium reached 171.7 and the United States 161.4.

To translate workforce numbers into planning targets, the researchers identified minimum densities associated with moderate universal health coverage. The thresholds were 23.8 doctors and 64.5 nurses and midwives per 10,000 people, along with 5.2 dentists and 5.6 pharmacists per 10,000. Such benchmarks are not intended to function as universal staffing formulas for every hospital or community. Instead, they provide a population-level measure that governments can use to compare current capacity with projected needs. The authors say the estimates can help identify where investments in medical schools, nursing education, recruitment, retention, and distribution are most urgent, particularly in places where the workforce is clustered in major cities while rural and remote communities remain underserved.

The analysis also offers a new way to examine progress toward two United Nations Sustainable Development Goals: target 3.c.1, which calls for increased recruitment, development, training, and retention of health workers, and target 3.8, which aims to achieve universal health coverage. By separating estimates by sex and professional category, the study reveals that a country can appear to be expanding its workforce while still failing to address inequalities within it. A growing number of women may improve access to care, especially in nursing, midwifery, and community health, but unequal pay, limited promotion, and inadequate workplace support can weaken retention. At the same time, a high national worker density may conceal major shortages among rural populations or low-income communities.

“Health workers are the foundation of every health system,” said Dr. Annie Haakenstad, senior author of the study and assistant professor of health metrics sciences at the Institute for Health Metrics and Evaluation. She said the findings establish minimum thresholds that countries can use when planning how many doctors, nurses, midwives, dentists, and pharmacists will be needed to strengthen health systems and move toward universal coverage. Meeting those thresholds will require sustained investment rather than short-term emergency recruitment. Governments will need to expand training capacity, finance salaries and equipment, improve working conditions, and create policies that encourage trained professionals to stay in areas with the greatest need.

The study’s message is ultimately larger than a global head count. The world has added more than 81 million health workers since 1990, but workforce growth has not kept pace with the distribution of disease, population change, and demand for care. Women have supplied most of the expansion, yet their concentration in lower-paid roles exposes a structural weakness in the way health systems value labor. Closing the projected gap of 34.4 million workers will depend on educating and retaining far more professionals, while also ensuring that women can enter every health occupation, reach leadership positions, and work in environments where they are protected and supported. Without those changes, the global health workforce may continue to grow on paper while millions of people remain unable to obtain essential care.

Subject of Research: People

Article Title: Measuring the composition and availability of human resources for health by sex in 204 countries and territories, 1990–2023, and workforce gaps for universal health coverage: a systematic analysis for the Global Burden of Disease Study 2023

News Publication Date: 18-Aug-2026

Web References: The Lancet Public Health: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(26)00145-3/fulltext; Institute for Health Metrics and Evaluation: https://healthdata.org/

References: DOI: 10.1016/S2468-2667(26)00145-3

Keywords: Global health workforce, women in science, nursing, midwifery, doctors, pharmacists, dentists, community health workers, universal health coverage, health equity, health disparities, public health, health care delivery, scientific workforce, health systems

The investigation examined datasets from nearly 200 countries worldwide, parsing out sex-disaggregated data across multiple stages of what the researchers call the “health pathway.” This pathway traces the trajectory from exposure to risk factors, through disease development to diagnosis, treatment initiation, and eventual health outcomes, including mortality. The comprehensive approach illuminated profound differences not only in disease prevalence but also in patterns of healthcare access and treatment adherence between males and females, shaping an often-overlooked dimension of global health inequity.

One of the most disturbing revelations of the study is that males generally show higher prevalence and mortality rates for all three conditions, yet paradoxically are less likely to seek medical care or adhere to prescribed treatments. This trend was particularly pronounced in many low- and middle-income countries, where cultural norms often discourage men from engaging with healthcare systems. For example, in more than 200 countries studied for hypertension, men not only were more vulnerable to developing high blood pressure but also consistently lagged in diagnosis and management, translating to poorer health outcomes compared to women.

In the case of diabetes, disparities manifest with slightly different nuances. Although the disease is prevalent in both sexes, women disproportionately face risks linked to obesity—a well-known contributor to type 2 diabetes—while men again show higher rates of undiagnosed disease and lower treatment persistence. This phenomenon highlights how biological factors intersect with gendered behaviors and societal expectations, reinforcing vulnerabilities from multiple angles. The researchers emphasize that these patterns cannot be adequately addressed without sex-sensitive data informing clinical guidelines and public health initiatives.

HIV/AIDS presented a complex and multifaceted landscape in the investigation. The study found striking differences in exposure risk factors, particularly in unsafe sexual practices, where women were more likely to encounter certain risks, yet men had higher mortality rates. Additionally, males were less engaged in treatment programs, with significantly lower rates of antiretroviral therapy initiation and viral suppression. Such findings underscore the need for gender-responsive health programs that not only facilitate access but also dismantle barriers rooted in stigma and gender norms.

Crucially, the study directs attention to behavioral risk factors that vary by sex and significantly influence disease trajectories. For instance, men were consistently more likely to smoke tobacco, an established risk factor exacerbating hypertension and diabetes outcomes. Conversely, women showed higher obesity prevalence, a condition intricately linked to metabolic disorders and cardiovascular health. These contrasting risk profiles reflect how underlying societal gender structures shape daily behaviors that, in aggregate, result in dramatically different health burdens by sex.

This research challenges the prevailing “one size fits all” model of healthcare delivery. Despite mounting evidence for sex and gender influences on health, many clinical protocols and public health policies remain inadequately tailored. Males, in particular, fall through the cracks at numerous points in the health pathway, from delayed or absent diagnosis to insufficient treatment engagement. The researchers advocate for comprehensive data collection efforts that disaggregate results by sex and gender at every step, enabling targeted interventions designed with these disparities in mind.

Global health experts Kent Buse and Sarah Hawkes, co-founders of Global Health 50/50, emphasize that these disparities are rarely attributable to biology alone but are deeply rooted in social constructs of gender. They assert that achieving health equity requires integrating gender analysis into the design and delivery of healthcare systems. Such an approach would recognize the nuances of masculinity and femininity in health behaviors and experiences, seeking to dismantle harmful norms that deter males from seeking timely care.

Angela Chang underscores the problems caused by insufficient sex-specific data, describing the current state as "flying blind." Without disaggregated data on diagnosis, treatment uptake, and completeness of care cascades, public health professionals remain incapable of identifying which groups—particularly men—are most likely to be missed by preventive and therapeutic programs. This opacity hinders the design of interventions that could prevent avoidable deaths and improve health outcomes on a massive scale.

The implications of this study are far-reaching. Changing entrenched health inequities requires not only the availability of sex-disaggregated data but also an intentional commitment from global institutions, governments, clinicians, and researchers to incorporate these insights into policy. Tailoring health communication, outreach, diagnostic criteria, and treatment protocols can optimize efficacy and foster equity, especially in diseases like hypertension, diabetes, and HIV/AIDS that contribute heavily to the global burden of disease.

While the research draws principally on observational data, its scope and depth provide robust evidence of sex and gender differentials in health pathways worldwide. Undertaking this analysis across multiple diseases simultaneously is innovative and furnishes a template for future studies aiming to integrate sex and gender perspectives systematically. The study also signals a need for improved health information systems capable of capturing relevant demographic nuances, empowering decision-makers with clear metrics on vulnerable populations.

Finally, the study highlights that addressing health inequities is inseparable from broader social changes. Combating stigma, transforming gender norms, and creating supportive environments where men are encouraged and enabled to seek care must accompany biomedical and systemic reforms. These intertwined strategies offer the best hope for minimizing disparities in disease burden, improving quality of life, and closing gender gaps that have persisted for decades in global health.

In conclusion, Chang and colleagues provide an urgently needed lens through which to view the divergent but intertwined health trajectories of men and women globally. Their work not only draws attention to the disparities themselves but also charts a way forward via the routine collection and application of sex and gender-specific data. As health systems evolve to meet these challenges, adopting a gender justice approach will be paramount to delivering equitable care and achieving better health outcomes for all.

Subject of Research: People

Article Title: Sex-disaggregated data along the gendered health pathways: A review and analysis of global data on hypertension, diabetes, HIV, and AIDS

News Publication Date: May 1, 2025

Web References: http://dx.doi.org/10.1371/journal.pmed.1004592

References: Feraldi A, Zarulli V, Buse K, Hawkes S, Chang AY (2025) Sex-disaggregated data along the gendered health pathways: A review and analysis of global data on hypertension, diabetes, HIV, and AIDS. PLoS Med 22(5): e1004592.

Image Credits: Nnebuifé Kwubéi (CC-BY 4.0)

Keywords: Sex-disaggregated data, gendered health pathways, hypertension, diabetes, HIV/AIDS, health inequities, global health, sex differences, gender norms, treatment adherence, diagnosis disparities, public health policy