London School of Hygiene & Tropical Medicine

We spoke to Layla McCay (MSc Health Policy, Planning & Financing, 2011) this Pride Month about her new book exploring the challenges and triumphs of LGBTQ+ professionals in the modern workplace. As Director of Policy at the NHS Confederation and an adjunct professor at Georgetown University, Layla uncovers the persistent barriers LGBTQ+ individuals face in climbing the career ladder.

What inspired you to write your book?

A few years after I applied for a fellowship, I ran into someone who had been on the selection panel. He recalled, quite casually, that during that selection process, a panel member had discouraged the others from choosing me because I was a lesbian. And I was shocked. While I had known that homophobia could theoretically affect my career, I had not really believed it. But now I knew that it had happened, and worse, I kept thinking about other opportunities I might have lost over the years because I am gay. And I would never know whether this factor had played a role.

Then, in my current job as Director of Policy at the NHS Confederation, I was analysing the staff survey. The NHS employs about 1.4 million people and its staff survey is one of the biggest in the world. They had recently enabled analysis by sexual orientation and gender. And it showed that LGBTQ+ staff in the NHS were having a less good experience than their peers. I started thinking about the various ways that this might affect people’s careers, and wondered what the data tells us, and how it varies by sector and location? I wanted to read a book on the topic but when I looked, I couldn’t find one. So, I decided to write it.

What does your book explore?

Breaking the Rainbow Ceiling looks at why LGBTQ+ people are disproportionately less likely to be promoted to the most senior jobs – and what to do about it. For example, just 0.6% of Fortune 500 CEOs are known to be LGBTQ+. Many people will be familiar with the ‘glass ceiling’, a metaphor for the system of bias and discrimination that holds women back at work. My book explores the concept of a ‘rainbow ceiling’ that holds LGBTQ+ people back as we climb the career ladder. It explores the composition of the ceiling, why it still exists, and what we can all do about it.

I combine existing research with interviews with LGBTQ+ trailblazers who bring the data to life with personal anecdotes that range from funny to tragic. But this is ultimately a hopeful and inspiring book. When I was growing up, I had no queer role models, and it affected my aspirations. I have tried to write the book that would give the younger me a wide range of visible, brilliant role models thriving in different professions. And also one that would help me understand what it means to be LGBTQ+ in my career right now and in future, and provide valuable insight for my managers and colleagues about how to increase fairness and belonging in an organization.

How can alumni find your book?

Breaking the Rainbow Ceiling comes out on 23 May 2024. It’s available to order direct from my publisher, Bloomsbury, or you can buy it anywhere that sells books.

How did a degree from LSHTM help you with your career?

I did a Master’s degree in Health Policy, Planning and Financing at LSHTM part time while working as a psychiatrist at the Maudsley Hospital. My degree gave me a much deeper understanding of health policy and led to my roles at the World Bank and in several international health NGOs. It also gave me an academic grounding that I found incredibly helpful as an adjunct professor at Georgetown University. The degree gave me the flexibility and confidence to found a health policy think tank, the Centre for Urban Design and Mental Health, that helped to define a new discipline. Today as Director of Policy at the NHS Confederation, my academic background enables me to underpin my practice with theory – and of course, I always have an academic side project or two going on! (It’s hard to tell if I’m more excited this year by my book or by my first publication in Nature!) It’s lovely to be able to find synergies in the different facets of my study, my work, and my passion projects.

Breaking the Rainbow Ceiling: How LGBTQ+ people can thrive and succeed at work by Layla McCay is published by Bloomsbury Business on May 23 2024.