Despite making up half of the world’s population, women are still underrepresented
in many fields of science, business and politics. At conferences, the all-male panel
(‘manel’) is a well-known and increasingly criticised phenomenon. Furthermore, there
is growing awareness of the need to ensure diversity among speakers at international
conferences. Especially in panel sessions at scientific conferences that aim to debate
issues from a variety of perspectives, it is crucial that these perspectives extend
beyond those of white men.
In our own personal experience, the health economics and outcomes research (HEOR)
field is not particularly male-dominated. In our own organisations and in scholarly
work, we encounter many women who make important contributions to the field. Yet,
in recent years we have observed that speaker diversity at many conferences, workshops
and symposia in the HEOR field remains disappointing. In order to assess whether our
own observations held any truth, we assessed the gender distribution of speakers at
the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Europe
conferences issue panels and plenary sessions. We selected ISPOR conferences as ISPOR
is “the leading professional society for health economics and outcomes research globally”
[1] and the annual European meeting is its largest meeting, with almost 5000 attendees
in 2017 [2] making it, to the best of our knowledge, the largest annual scientific
conference in HEOR worldwide.
We included ISPOR Europe conferences of the last 3 years (2018 Barcelona; 2017 Glasgow;
2016 Vienna) in our sample. We did not include more years in our dataset as the programmes
of conferences that took place earlier than 2016 were no longer accessible through
the ISPOR website. For each conference, we used the programme to identify the list
of speakers for each issue panel (between 20 and 30 in total per conference) and for
all plenary sessions (three per conference). We included issue panels as these are
meant to debate views on controversial topics. The submission instructions for issue
panels are that they are “designed to stimulate real debate on new or controversial
topics in health economics and outcomes research” and that “each panelist is expected
to provide a different perspective on the issue” [3]. In addition, in order to be
able to submit an abstract for an issue panel, the moderator of the issue panel must
have invited the experts to participate in the panel. The ability to participate in
issue panels, therefore, requires a panellist to be recognised by their peers as an
expert on the issue panel’s topic and to be invited to contribute to an abstract for
submission to the conference.
We assumed people listed in the conference programme with names commonly used by males
to identify as male and people listed with names commonly used by females to identify
as female. When we encountered a name where gender was not obvious (e.g. Kim, Robin)
we used Google to assess the gender the person most likely identified as, for example
through their LinkedIn profile page. Although some people will identify as neither
male nor female, for the purposes of this study we were unable to be more specific.
Both authors extracted all data independently. Inter-rater reliability was assessed
and all divergences were solved through consensus. We used Microsoft Excel® to calculate
the gender distributions for each year.
We found that, in total, 70% of speakers listed on issue panels and plenary sessions
at ISPOR Europe conferences during 2016–2018 were males. In total, 346 people participated
in 85 issue panels and plenary sessions at ISPOR Europe conferences in 2016, 2017
and 2018 (Table 1). In 2016, 73% speakers were male, with 66% male speakers in 2017
and 70% male speakers in 2018.
Table 1
Male and female speakers and distribution of speakers on issue panels and plenary
sessions at International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
Europe conferences in 2016, 2017 and 2018
Conference
Males [n (%)]
Females [n (%)]
Distribution of speakers on panels and plenary sessions [n (%)]
Manels
> 50% males
> 50% females
All-female panels
Barcelona, 2018
87 (70)
37 (30)
9 (30)
19 (63)
3 (10)
1 (3)
Glasgow, 2017
82 (66)
42 (34)
8 (26)
18 (58)
4 (13)
1 (3)
Vienna, 2016
72 (73)
26 (27)
8 (33)
17 (71)
2 (8)
0 (0)
Total
241 (70)
105 (30)
25 (29)
54 (64)
9 (11)
2 (2)
Almost 30% of all panels at ISPOR Europe conferences were manels (29.4% in 2016–2018)
(Fig. 1, Table 1). Furthermore, issue panels and plenary sessions were male-dominated
even if they were not a manel: 64% of all panels at the three conferences had a majority
of male speakers (> 50%). Only 11% of the panels and plenary sessions had mostly female
speakers (> 50%), and 26% of panels and plenary sessions had an equal amount of male
and female speakers.
Fig. 1
Distribution of speakers for all issue panels and plenary sessions at International
Society for Pharmacoeconomics and Outcomes Research (ISPOR) Europe conferences in
2016, 2017 and 2018. Each bar represents an issue panel. The plenary sessions are
indicated using black borders (three per conference)
Only 2% of all panels (two panels of 85 in total) were all-female. Although we did
not have access to the gender distribution of ISPOR members, in our experience HEOR
is not a particularly male-dominated field, illustrated by the fact that eight of
the 12 current members of the ISPOR Board of Directors are women. We highly doubt
that our results can be explained solely by a lack of availability of sufficient female
HEOR experts to participate in issue panels and plenary sessions.
The ‘gender role hypothesis’ assumes that the lower the number of women in a group,
the less women participate in and influence its discussions and decision-making [4].
Reasons for this effect include that simply being a numerical minority in the group
will lower the status and, subsequently, the authority and participation of women
in the group’s discussions [4]. The literature also suggests that women tend to participate
in discussions less than men in male-dominated groups due to gendered norms of interaction
that vary with gender composition, and that women’s participation, and influence,
increases as their proportion increases [4]. Currently, 64% of panels at ISPOR Europe
are male-dominated. This means that, apart from the existence of a barrier for women
to even participate in issue panels (as 29% of them do not include women at all),
the current gender composition of ISPOR Europe’s issue panels and plenary sessions
might continue to contribute to undermining women’s authority and participation in
HEOR, simply due to them often being a minority on a panel.
ISPOR could make a meaningful contribution to advancing women in HEOR—the aim of ISPOR’s
own Women in HEOR Initiative [5]—by no longer accepting abstract submissions for issue
panels where there is not at least one female panellist, preferably in a non-moderator
role, and by banning all-male plenary sessions. Given ISPOR’s interest in advancing
women in HEOR, banning manels would both improve the gender balance of speakers at
ISPOR conferences and also send a clear signal that ISPOR is serious about its commitment
to advance women’s leadership in the field. Speaking opportunities at plenary sessions
and as a panellist for an issue panel can be important to advance the career of a
HEOR professional, and, thus, are important for men and women to establish themselves
as experts on key HEOR issues.
We did not take moderator versus non-moderator roles on issue panels and during plenary
sessions into account. However, there is evidence to suggest that women are more often
assigned the role of moderator, rather than as a panellist, when being invited to
participate in a panel [6]. We were also not able to study other types of diversity
at ISPOR, such as representation of speakers from different countries or from ethnic
minorities, as there is not a straightforward method to do so. Notwithstanding, we
strongly believe steps to improve diversity should not be limited to improving gender
balance. Making other diversity requirements for the representativeness of speakers
would be easy to implement and should be considered in the process of abstract submission
and review.
Not everyone will share our view that the high proportion of manels at ISPOR Europe
conferences—or any conference—is a problem. We believe that any person in the HEOR
field, regardless of their gender or ethnicity, deserves equal access to career opportunities
such as participating as experts in panel discussions and plenary sessions. There
is evidence to suggest that women in different fields of science, including economics,
face considerable gender bias that could explain why men frequently submit abstracts
for issue panels that do not include women. Recent Dutch and French studies found
that in university courses, female instructors received lower scores than male instructors
on teaching evaluations despite producing similar grades, and this effect was mainly
driven by male students scoring female instructors lower than male instructors [7,
8]. Women were found to receive lower scores on grant applications in Canada, an effect
that disappeared when only the quality of the application was reviewed, and not the
principal investigator [9]. When staff at a US university were asked to review job
applications for a laboratory manager position where the applications were randomly
assigned male or female names, male applicants were rated as significantly more competent
and hireable than identical female applicants [10]. Therefore, there is evidence to
suggest that women, including women in HEOR, are less likely to be recognised as experts
by their peers, which could explain why so few women end up on issue panels at ISPOR
Europe.
The persistence of gender bias also means that policies that encourage but do not
enforce female participation are unlikely to be effective in creating more balanced
panels. Gender bias is largely unconscious; we suspect that the men who submit manel
abstracts for ISPOR Europe might not just exclude women from their panels purely because
they are women; they might hold beliefs that there are no female experts available,
or that the female experts they do know do not have the same level of authority or
eminence as male experts do. Furthermore, seniority could be seen as a proxy for expertise,
and it is possible there are fewer senior female HEOR experts. We believe it is unlikely
people will make different choices, as they are largely driven by unconscious bias,
unless they are forced to make a different choice. Therefore, we believe a manel ban
for ISPOR Europe (and other conferences) is needed to improve the gender balance of
its panels and plenary sessions.
There are several limitations to this study. First, we only included data for the
last 3 years of ISPOR Europe conferences, as the programmes for earlier years were
not available. We cannot exclude the possibility that gender distribution was much
more favourable before 2016, but, if this were the case, the decrease in diversity
among speakers in recent years would be slightly alarming and even more reason for
considering implementing policy changes. In addition, all data were collected manually
and it is possible that some names were misclassified or errors made. However, both
authors extracted all data independently, initial inter-rater agreement was 94%, and
all identified divergences were solved through consensus. We did not extend our analysis
to other, similar conferences in HEOR. Different conferences use different formats
for their online programmes, which limits the ability to collect the data in the same
way we did for this study. For example, if the conference programme does not list
first and last names, but only uses initials, it is much more challenging to assess
gender distribution.
Despite laudable efforts to support women’s leadership in the HEOR field, ISPOR’s
biggest conference has severe underrepresentation of women on issue panels and plenary
sessions. Implementing a manel ban, by making it a requirement that an abstract submission
for an issue panel has at least one woman, would be a highly effective way to improve
the gender balance of issue panels. ISPOR’s own Women in HEOR Initiative states that
“diversity in the field will result in better research and better healthcare decisions”
[4]. We could not agree more.
Electronic supplementary material
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Supplementary material 1 (XLSX 38 kb)