Forbes’ 18th annual list of power women includes 40 CEOs, 19 world leaders, an immunologist and, for the first time in more than a decade, a new number one.



LIKE SO MUCH in 2021, the state of female power around the world looks a bit different than it did just one or two years ago. Women have gained ground in the c-suite—among the women on Forbes’ 18th annual list of the World’s 100 Most Powerful Women are 40 CEOs, the most since 2015, who oversee a record $3.3 trillion in revenue. But what they gained in the boardroom, they lost elsewhere. For instance, there are two fewer female heads of states than a year ago.



Nothing illustrates the dynamics of this list better than the change at the very top. For only the third time in the 18 years we’ve compiled this ranking, German chancellor Angela Merkel is not No. 1. With her imminent retirement from public office comes a chance to find a new number one; this year, that honor goes to billionaire philanthropist MacKenzie Scott. She’s the third richest woman in the world, but it’s her unfettered access to that money—and her determination to donate it in a way that is meaningful and revolutionary—that puts her above the competition. 



“We are all attempting to give away a fortune that was enabled by systems in need of change,” Scott said this summer.



Just behind her at No. 2 is U.S. vice president Kamala Harris, who moves up one spot now that she’s been sworn into office, swapping places with Christine Lagarde, the president of the European Central Bank who is now No. 3. All of these women represent the driving thesis behind the compilation of the list: it’s not just enough to have money, or a position of power. 



A person must be doing something with their fortune, voice or public platform. Consider Rosalind Brewer, the former chief operating officer of Starbucks who took the helm of Walgreens in March and is currently the only Black woman running an S&amp;P 500 company. 



A longtime champion of diversity in the workplace, Brewer rose 15 spots to No. 17. Or BioNTech cofounder and immunologist Özlem Türeci, who is one of 20 newcomers this year. She makes her debut on the list at No. 48 not simply because she co-founded a biotech company, but also because of her role in leading the company’s development of the mRNA Covid vaccine, in partnership with global pharmaceuticals giant Pfizer.



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othing illustrates the dynamics of this list better than the change at the very top. For only the third time in the 18 years we’ve compiled this ranking, German chancellor Angela Merkel is not No. 1. With her imminent retirement from public office comes a chance to find a new number one; this year, that honor goes to billionaire philanthropist MacKenzie Scott. She’s the third richest woman in the world, but it’s her unfettered access to that money—and her determination to donate it in a way that is meaningful and revolutionary—that puts her above the competition. “We are all attempting to give away a fortune that was enabled by systems in need of change,” Scott said this summer. Just behind her at No. 2 is U.S. vice president Kamala Harris, who moves up one spot now that she’s been sworn into office, swapping places with Christine Lagarde, the president of the European Central Bank who is now No. 3. All of these women represent the driving thesis behind the compilation of the list: it’s not just enough to have money, or a position of power. A person must be doing something with their fortune, voice or public platform. Consider Rosalind Brewer, the former chief operating officer of Starbucks who took the helm of Walgreens in March and is currently the only Black woman running an S&amp;P 500 company. A longtime champion of diversity in the workplace, Brewer rose 15 spots to No. 17. Or BioNTech cofounder and immunologist Özlem Türeci, who is one of 20 newcomers this year. She makes her debut on the list at No. 48 not simply because she cofounded a biotech company, but also because of her role in leading the company’s development of the mRNA Covid vaccine, in partnership with global pharmaceuticals giant Pfizer.



Also making her debut on the list, at no. 94, is the new president of Tanzania, Samia Suluhu Hassan; she has been instrumental in implementing Covid protocols in her country. Then there’s Taiwan President Tsai Ing-wen, whose outspoken adherence to freedom and democracy in the face of increased pressure from China vaulted her 28 spots to No. 9. 



“We must safeguard our shared values to ensure our free and democratic way of life,” she said in late November. 



Some women on this list saw their power eroded in the past year. That’s particularly true for some of the women in China, where President Xi Jinping’s crackdown of the tech sector and business activities has meant less autonomy—and, in turn, lower ranks for the likes of Gree Electric’s Dong Mingzhu (down 11 spots to No. 58) and Yum China CEO Joey Wat (down 39 slots to No. 73). 



Even Queen Elizabeth isn’t immune from a reevaluation: now ranked No. 70, the monarch dropped 24 spots as a result of her diminished public appearances and the myriad of reputation crises that hit the Crown this year (including, but not limited to, Duchess Meghan Markle’s allegations of racist treatment). 



While the people on the 18th annual list of the World’s 100 Most Powerful Women come from 30 countries and territories and work across finance, technology, politics, philanthropy, entertainment and more, they are united by a sense of duty. Frances Haugen, the former Facebook employee-turned-whistleblower, and No. 100 on this year’s list, didn’t set out to release reams of data on her former employer, but has said she couldn’t stand by and watch as the company put profits over people. 



Taylor Swift (No. 78) didn’t make her first albums intending to re-record them a decade later, but it’s what she’s had to do to retain her ownership rights—and to prove to other artists the value of their work. 



“Our experience can’t be dictated by what we’re allowed to do or given permission to do,” says film director Ava Duvernay (No. 80). If there’s a thesis statement for this list, that’s as close as it comes: These are the women who are rewriting the rules of business, finance and politics. Their work is needed now more than ever.



Edited by Moira Forbes and Maggie McGrath with reporting by Nicolette Jones and Erika Burho



<a href="https://www.forbes.com/power-women/#3af596ce5e25">See full list here</a>

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THE WORLD’S MOST POWERFUL WOMEN 2021

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The Greatest Stories of Female Entrepreneurs of The 21st Century

One morning, when I was 14 years old, I woke up with&nbsp;excruciating&nbsp;stomach pain—the worst I’d ever had. My mom took me to urgent care, and the doctors there concluded that I had gastritis, or essentially a “bad stomach ache.”



But I&nbsp;knew&nbsp;they were wrong. I knew it was more than just a bad stomach ache. I kept pushing my parents until they finally took me to the hospital. After doing a variety of exams, the doctors said something along the lines of, “We really can’t find what’s wrong, but you seem to be in a lot of pain.” They gave me two options: wait four hours until the next available CAT scan, or let them do exploratory surgery and see what they find.



I decided to do the exploratory surgery. It ended up being a major, major surgery—over six hours long—and they found a tear in my intestine. They had to remove about 10 feet of my intestine, and it turns out that if I had waited for the CAT scan, I actually would have died. So, I like to say that that was the first time I learned how to trust my gut (in this case, my&nbsp;literal&nbsp;gut).



I think about this experience all the time, but I found myself reflecting on it even more as I was reading my friend Dr. Alyson McGregor’s new book, <a rel="noreferrer noopener" href="https://www.amazon.com/Sex-Matters-Male-Centric-Medicine-Endangers/dp/073824676X" target="_blank">Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It</a>. I don’t know how much of my near-death experience was linked to my being female, but I do know that when it comes to our medical system, women have consistently experienced poorer outcomes in every area of health than men.



McGregor writes: “One of the biggest and most flawed assumptions in medicine is this: if it makes sense in a male body, it must make sense in a female one.”



Our methods for evaluating, diagnosing, and treating disease for both men and women are based on previous research performed on male bodies. But women are physiologically different from men on every level—and these differences can have major impacts on everything in medicine, from how drugs are prescribed, to how routine tests are performed, to how pain is assessed and treated, to how systemic disease is diagnosed.



Here’s an example. Coronary artery disease is the leading cause of death in both men and women, but women have statistically poorer outcomes and higher mortality. Why? Because women’s symptoms are simply different from men’s. While men might experience left arm pain and chest heaviness (“typical” heart disease symptoms), women often present with only mild pain and discomfort, possibly combined with fatigue, shortness of breath, and a strong feeling that “something isn’t right.” Since women’s symptoms are not the symptoms that doctors typically associate with heart disease, their heart disease is&nbsp;<a href="https://www.world-heart-federation.org/news/new-study-women-likely-die-heart-attack-due-unequal-treatment/" target="_blank" rel="noreferrer noopener">50 percent</a>&nbsp;more likely to be initially misdiagnosed.



There are hundreds more examples like this one. It’s clear that there is work to do when it comes to unconscious biases in medicine—but, as women, how can we best advocate for our health and ensure that our concerns are heard and taken seriously?



1. Be prepared.



Your doctor may have gone through years of medical school, but that doesn’t mean they’re all-knowing. Research your conditions, your prescriptions, and how your prescriptions interact with each other. This way, you can have an informed conversation with your physician if something is wrong. Also, keep an up-to-date list of your prescriptions and allergies with you at all times so that any provider who cares for you will have all of the information they need.



2. Ask questions.



Even after you do your research, you may still have questions. Don’t be afraid to ask them—especially gender-specific ones. For example, “Has this medication been tested in women? If, so are there different dosing guidelines?” Or, “Will this prescription/test/procedure affect my birth control/pregnancy/breastfeeding?” It’s important to make sure you’re not only being treated for the correct conditions, but also that you’re being treated properly as a&nbsp;woman&nbsp;with those conditions.



3. Trust yourself.



Just like 14-year-old me trusted her (literal) gut! No one’s voice should take precedence over yours when it comes to your body and your health care. As women, we tend to be more attuned to our own bodies than men. We are more likely to notice symptoms when they first appear, and we usually seek treatment more frequently and earlier than men. If you feel like you’re being misdiagnosed or undertreated, keep pushing until you get answers—your life may depend on it.



4. Make your voice heard.



It’s important to advocate for yourself on an individual level, but you may be inspired to do even more. Financially, you can donate to research and advocacy foundations, or even specific research projects within your local universities and hospitals. Other effective advocacy ideas that don’t cost anything are to join a medical research trial, join a support group, or harness the power of social media to share your story. Any of this could be what makes it possible for others to get the treatment they need.



&#8211; <a href="https://www.forbes.com/sites/carriekerpen/people/carriekerpen/">Carrie Kerpen</a><a href="https://www.forbes.com/forbeswomen">, ForbesWomen</a>

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THE WORLD’S MOST POWERFUL WOMEN 2021

The Greatest Stories of Female Entrepreneurs of The 21st Century

4 Ways Women Can Better Advocate For Their Own Health