“Through the power of collaboration with health professionals we can make a life or death difference”—Executive Director

Speech by Phumzile Mlambo-Ngcuka, UN Under-Secretary-General, and Executive Director of UN Women, delivered by Khetsiwe Dlamini, Chief of Staff of UN Women at the Royal College of Nursing International Centenary Conference

Date: Wednesday, November 23, 2016

Cecilia Anim, President of the Royal College of Nursing
Janet Davies Chief Executive and General Secretary of the Royal College of Nursing
Donna Kinnair, Director of Nursing, Policy and Practice
Nurses of the Royal College of Nursing
Distinguished guests,
Ladies and gentlemen,

First of all, please let me convey the deep regret and disappointment of the Executive Director that she was unable to be with you here in person today.

As I read her speech, please know that she is here in spirit.

Thank you very much indeed for the honour of addressing you as you celebrate 100 years of the Royal College of Nursing.

Let me first express the enormous appreciation I have for the work that you do here.

Nursing globally occupies a place of greatest respect in providing expert professional skill combined with the human care that takes this work beyond the call of duty.

I have often thought that the uniform nurses wear is a particular badge of honour: it symbolizes the trust and the predictability of service, uniting what is now a richly multicultural body.

It is in a sense the symbol of the contract you have with the patients under your care and of the trust they have in you, as you spread your ability to heal across the country, and across the world.

As you now mark a century of this service, this is a moment to celebrate how far nursing has come as a profession.

It is also a moment to note important areas of convergence of our work and to consider the broader goals for humanity to which we strive.

At UN Women, we are the world’s champion for women’s rights, equality and empowerment.

This is now our seventh year—we are the youngest child of the United Nations—but we were born very feisty.

There is a universality in what we each do, both in your carrying out the duties of a nurse in different parts of the world, and in our case as staff of UN Women supporting women and communities all over the world.

We both believe that everyone deserves the same quality of care no matter who they are or where they are from.

One of the most important areas in which we work is that of ending violence against women—truly still a universal problem, and I will speak more on this later.

You see and help women and men with both physical and mental health problems, who are caught up in family strife, people in war zones or who have fled from them and those who are at risk in times of humanitarian disasters. You are an important lifeline: you rescue and heal people in so many different ways.

In our case, wherever there are injustices, exclusion and barriers to women thriving, we have a voice and a duty.

We are linked with decision makers and influencers both within the United Nations system where we support national governments, and with the worldwide women’s movement.

Through these rich networks we can amplify and connect the voices of others such as yours to those in power. Our aim is to mobilize those who can act on some of the most pressing concerns women have.

Ultimately, our work on the rights of women and on gender equality must contribute to the reduction of the number of women and girls who end up in your care with preventable injuries and illnesses.

Our first priority is to prevent the violation of rights of women and girls in the first place. 

Of course we are also there to support them to stand up again where their rights have been violated.

Our common interests with health professionals and nurses in particular were vividly highlighted to us during the Ebola virus crisis in West Africa.

Initially the contribution of women was not fully appreciated, nor their vulnerabilities. We encouraged and mobilized for greater women’s contribution, consultation and involvement.

This became a significant catalyst for a change in the approach to the response that recognized women’s position on the front line of defense.

Nurses were amongst those in the forefront, and were among those who suffered in the initial waves of the epidemics. They demanded that women were better engaged, and trained. They helped with the essential education and fact-sharing that put women into positions of informed authority.

Together with the health services of the affected countries, our country office staff worked with the families and communities, especially in the most rural parts of the countries. In Sierra Leone we were amongst the organizations that received a presidential medal for our service. That silver medal underlines the outstanding role of women, and how through the power of collaboration with health professionals and government officials, we can make a life or death difference.

The Ebola pandemic highlighted how challenging it is to respond when health systems are fragile. In those situations, the gaps can be filled through collaboration—between communities, women health professionals especially, and nurses. These partnerships are essential in every country, whether developed or developing.

Ladies and gentlemen,

The agenda for rights of women, health for all and ending of gender-based violence is at the core of a universal agenda. All countries have these needs, and that puts nurses right at the centre of the universal agenda for development that was adopted by all member states of the United Nations in 2015.

A universal agenda is one that is relevant for all nations, north or south, rich or poor. Our “2030 Agenda for Sustainable Development” focuses on the three dimensions of sustainable development—economic, environmental and social.

In all 17 of the Agenda’s development goals, the needs of women and girls are given attention. A key recognition of the new Agenda is that the goals are inter-dependent, and underlying the success of all of them, is the role of women and girls in making headway with poverty, education, health, inequality, economic development or infrastructure with the end point of 2030.

For us, the key health targets include:

  • the reduction of the global maternal mortality ratio;
  • universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes;
  • universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all;
  • the end to the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and progress against hepatitis, water-borne diseases and other communicable diseases; and
  • reduction by one third of premature mortality from non-communicable diseases through prevention and treatment and the promotion of mental health and well-being.

Of course almost every target of the whole Agenda relates to women, because the Agenda relates to every country and every population.

There is one specific goal—Goal 5—that is focused specifically on achieving gender equality and the empowerment of women and girls. It aims to ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life.

It focuses our attention on key structural barriers to advancing women’s human rights.

It is your Goal too. I would like to take a few minutes to highlight the areas in which there is particular convergence. To make progress, we need your skills and support.

Goal 5 covers:

  • legal and other forms of discrimination, which must be eliminated,
  • unpaid care which must be recognized, redistributed and compensated where possible,
  • norms and cultural practices that discriminate against women and girls,
  • participation in decision-making,
  • sexual and reproductive health and rights,
  • rights to economic resources, and
  • ending violence against women and girls and harmful practices.

I know that this institution has been a strong and courageous advocate in many ways that resonate strongly with these targets.

Your history shows your activism from very early days in calling for better wages for nurses, with effective campaigns across the decades since the 60s. You became a trade union in the 70’s, and after many years of building status and recognition, achieved the recognition of nursing as a graduate qualification in the 90s. You have been a beacon for the advancement of women in this field.

We recognize that the UK has certainly been a very strong player in the work to end discrimination and is a powerful voice in the United Nations in support of progress globally on this.

Most of these issues are present to a varying extent in every country in which we work, but they do not always have strong advocates to support them.

There is much to be done to break important barriers to change: for example, there are still more than 100 countries that have discriminatory laws that need to be repealed or replaced.

Globally women endure wage discrimination, being paid an average of 24 per cent less than their male counterparts for the same work. This disadvantage is compounded by having to do 2.5 times the amount of unpaid care work as men. 

Addressing matters of reproductive health and sexual health is a challenge in all countries, and in some is becoming even harder.

Goal 5 also singles out ending of female genital mutilation and child marriages as amongst the cultural practices that hurt and constrain women and girls and which must end. Again your role here is critical, as both practices contribute to maternal deaths and child mortality. I see nurses as playing a role beyond the hospital or clinic, that extends from public education to helping authorities to enforce laws that aim to end these practices.

Although the participation of women in decision-making bodies is improving, with the UK making good progress in this respect, it remains a challenge in most countries.

There are many organizations, including health bodies, which have women as a high proportion of their employees, yet few in leadership positions. This flies in the face of evidence of the known 30 per cent plus gender-equality dividend that can be reaped in the economy, and in both society and political life.

In the United Nations we are confronting the same problem of an inverse relationship between seniority and representation of women. UN Women is leading a multi-pronged approach to challenge the 32 entities who make up the UN family to change this.

We have also shared our methodology for this with the National Health Service, which is the fifth largest employer in the world, in which more than three-quarters of staff are women. The NHS is experiencing classic pipeline issues of horizontal differentiation into lower level and female-friendly roles, and bottlenecks in certain groups, for example, finance and medicine. Currently women are employed in only 26 per cent of finance director positions and as 24 per cent of medical directors. Women are also under-represented at higher pay grades in nursing and as senior managers.

These gaps have significant implications for the quality of service and financial bottom line and can only be addressed by system change.

In December last year the NHS launched its report on “NHS Women in leadership” with a plan for action that sets out an ambition to reach parity in employment by 2020.

For the NHS to commit to this is courageous, and will be an essential building block to 2030.

In taking on the challenge of gender equality, it is acting in line with other institutions of its size and importance.

Where there are high numbers of very well qualified, experienced and capable women currently employed, organizations such as the UN and the NHS have a rich pipeline of talent to draw on.

They are therefore not only ready to meet the target but may even exceed it. We were pleased to be asked to support the NHS in its endeavours and stand ready to support further.

Ladies and gentlemen,

Many of the kinds of system barriers that I have described are directly addressed by the goals and targets of our new development agenda and can be resolved at least in part through changes in legislation and policy.

Yet it is never as simple as just passing a law.

Gender inequality is an age-old problem that is deeply rooted in society, and so all-pervasive that in many instances it has become regarded as simply normal, with change threatening.

Addressing gender inequality is complex and needs a comprehensive response.

We have reached out to men and boys through our HeforShe movement, which provides a platform for activism for men and boys. We have already seen more than one million men and boys around the world sign up and take action. We encourage men to engage men in embracing positive masculinity as fathers, partners and leaders. 

We are looking for millions more men to join the movement, and to become role models to other men and boys.

One of the most difficult of the targets of Goal 5 to confront successfully is the call for ending violence against women and girls. It is an area where the role of men in making change is critical.

In some countries, as many as 70 per cent of women report having experienced physical or sexual violence from an intimate partner. And in some countries, intimate partner violence accounts for between 40 and 70 per cent of female murder victims.

The stubbornly high numbers of women who live with violence has prompted the World Health Organization to call it a global public health crisis of epidemic proportions. 

It is WHO that is our primary data source for monitoring the levels of violence against women. As you know, when injured women go to health service providers, they can feel more able to open up than with law enforcers or even family. 

As nurses, you are on the front line of seeing women and girls of all ages coming into A&E. Treating them with empathy and providing care and treatment is not only essential care. It also allows public health data collection so that globally some light can be shed on the vast scale of this problem.

The fact that we are now able to speak with more definition on the size and nature of this problem, and therefore to call for action on it by governments and societies, is largely due to the emergence of this authoritative information.

When I think of the nursing profession, I think of you not only as healers, but as those who represent the silent women who do not know how to explain what has happened to them, and who need your insight, your ability to hear the unspoken word and to reach unseen wounds.

I think of heroes.

Through your work and support these goals and especially goal 5 which is on gender equality can achieve so much more by 2030.

The 25 November is the annual International Day for the Elimination of Violence against Women.

This date relates to the day in 1960 when three sisters from the Mirabal family were assassinated in the Dominican Republic for being political activists.

From the 25 November to the 10 December we have annual 16 days of activism to end violence against women. The colour of the campaign is orange and you will see many iconic landmarks in the world turning orange from this week onwards.

We are happy to start this week with you and to celebrate your iconic achievements. we congratulate you for Royal college of Nursing International Centenary. We salute you for service to generations in every corner of the world.

Ladies and gentlemen,

For every generation there is a mission of their time. Ours is to fight and win on gender equality and to build on the progress we have made.

We still have a long way to go as no country has yet achieved gender equality. Building on the progress made we must now make gender equality achievable.

The need to work together for a fair world within countries, between countries, and between peoples has never been so urgent and so obvious.

This situation demands that we build a strong alliance of those who work for the counter-narrative of peace, gender equality, sustainability and shared prosperity, including for the most marginalized and excluded.

We are the first generation to have a possibility to change gender relations, and achieve substantive equality. We are the first to see that we really can ensure future generations will have a more inclusive and more equal society. This is what our nations adopted when they signed up to the Sustainable Development Goals with its deadline of 2030. By that date, we hope to have achieved a much better world - one that I believe is in line with your ethos and its noble tradition of nursing.

As you celebrate this 100th year, I extend again my warmest thanks for all that you have contributed to the women and girls of the UK, and everywhere that the enterprising, courageous and skilled nurses of this Royal College have travelled and worked.

I can think of no finer institution in which to celebrate the values of human dignity, integrity, autonomy, altruism, and social justice. These are values that resonate perfectly with the ambitions and aspirations of UN Women and our hopes for a healthy, equal, peaceful and prosperous world.

Thank you.