View chapter 1
Executive Summary
View chapter 2
Findings: Stated commitment to gender equality
View chapter 3
Findings: Definition of gender
View chapter 4
Findings: Workplace gender equality policies
View chapter 5
Findings: Diversity and inclusion policies - Workplace and Board
View chapter 6
Findings: Anti-sexual harassment policies
View chapter 7
Findings: Family-friendly workplace policies
View chapter 8
Findings: Gender and geography of global health leadership
View chapter 9
Findings: Gender pay gap
View chapter 10
Findings: Gender-responsiveness of global health programmes
View chapter 11
Findings: Sex-disaggregated monitoring and evaluation data
View chapter 12
Analysis: Are organisations’ COVID-19 programmatic activities gender-responsive?
View chapter 13
What next: How to use this report to push for change within your organisation
View chapter 14
View chapter 15

Chapter 1


Lee-Ann Olwage
A Word from Kumsal Bayazit, CEO of Elsevier

For all leaders, 2020 has indeed been a year of ‘Flying Blind’ with unprecedented health, safety, and productivity challenges to navigate within our organisations. It has also been a year of personal growth. I have been humbled and inspired by the resilience of our colleagues and how they have maintained their commitment to advancing inclusion and gender equity both within our own organisation and the research and health communities that we serve.

Elsevier is one of the largest publishers of scientific research, including leading health journals such as The Lancet and Cell amongst a portfolio of 2,600 journals. As the first woman CEO in Elsevier’s 140-year history, I am acutely aware of our responsibility to drive inclusion and diversity.

The Global Health 50/50 report is a unique and essential accountability mechanism in this challenging time. The Collective behind the report calls on organisations across the global health space to examine our gender-related policies and practices, including to ‘measure what we treasure’. At Elsevier, we believe that data-led insights are key to transparency and progress. Without which, we will continue to ‘fly blind’, whether we are examining employee pay equity, editorial board diversity or understanding how Covid-19 is affecting research output among women scientists.

“The Global Health 50/50 report is a unique and essential accountability mechanism in this challenging time.”

This year’s report reveals that although organisations are improving the way they talk about gender equality, very little has changed practically since the first report in 2018, including who holds power in senior leadership positions. Real progress is only possible if we actively drive change. This includes the basics such as establishing new flexible working policies and building on pandemic-learning to greatly reduce travel requirements. At Elsevier, we have expanded parental and family leave and now have stringent policies to deal with sexual harassment and discrimination. We are regularly assessing and rapidly addressing any pay gaps based on gender or race.

We have also made building an inclusive culture a key strategic priority for Elsevier. Together with my leadership team, we implemented unconscious bias and psychological safety training. We now use an inclusion index and a psychological safety score to measure progress and have revamped our recruitment processes to attract more diverse candidates.

But what about the communities we serve? Our 2020 report, “The researcher journey through a gender lens examined sex-disaggregated data across 15 countries and the EU to reveal systemic issues holding women back: low support for women’s research careers and leadership bids, lower research output, grants, citations, patents and a leaky pipeline. In response, my colleague, Dr. Richard Horton, the Editor-in-Chief of The Lancet, and I launched Elsevier‘s Inclusion & Diversity Advisory Board bringing together leaders from across the international research and healthcare community. Our focus goes beyond gender to include race, ethnicity and geography. We have created targeted interventions to balance editorial boards across our journals, ensure equitable participation in research for authors and reviewers, support career progression in research and healthcare and develop editorial guidelines to embed sex and gender analyses in research.

I am a big admirer of the late Ruth Bader Ginsburg, who said “real change, enduring change, happens one step at a time”. We all know that lasting change is often a result of many small, incremental steps in the same direction. Over time, these intentional steps build a groundswell of progress. The 2021 GH5050 Report shows that, over the past four years, these incremental changes are taking place. But it also underscores how far we have to go, and how much more we have to do to overcome systems of inequality.

Therefore, I encourage leaders of all global organisations active in health to use the GH5050 report and take bold, appropriate and long overdue steps with evidence-based decisions. I believe strongly that for organisations to move the needle on gender equality, and indeed all dimensions of diversity, requires advocacy at the most senior levels, supported by policies, measurement and accountability. I commend GH5050 for their pathfinding efforts to establish an independent accountability mechanism to support our efforts. My fervent hope is that we can catalyse our collective efforts to create a fair system of opportunities and progression for all people working in health and research around the world.

A word from the Global Health 50/50 Collective

Gender equality is fundamental to everyone’s health, dignity and livelihoods – especially in a time of crisis. It is a matter of social justice and human rights; principles that lie at the heart of global health. That we should have to call out health organisations for failing to take gender equality seriously during a pandemic is deeply frustrating. Urgency cannot serve as an excuse.

When we established Global Health 50/50 (GH5050) with a vision of better health and equal opportunities for all people of all genders, everywhere, we were not naive. We know that gender inequality is deeply entrenched and that social change takes time. Yet, we have been shocked and angered at the scale of the failure to provide effective, equitable and gendered responses to COVID-19.

In some areas reviewed by ‘Flying blind in a time of crisis’, we can celebrate progress. We are encouraged by the marked increase in the number of organisations and individuals using the findings of the GH5050 Gender and Health Index to drive change in organisational priorities and policies. Commitment to gender equality has grown quickly since GH5050 began publishing on it in 2018. And more and more organisations are embedding gender-transformative action in their strategies to advance the health of all people.

Yet we are concerned that lofty rhetoric is too often being used as a substitute for action. Determined and concrete measures to dismantle gender inequality inside organisations and to  apply a gender lens in health programmes remain too scarce.

In 2020, global health missed an opportunity of historic proportions to take a gendered approach to a gendered crisis. As data from this report reveals, organisations active in global health have been battling the pandemic with their eyes closed to the role gender plays—embedded in individuals and institutions—in influencing both policy-making and people’s exposure, behaviours and health outcomes. COVID-19 exposes that lives are lost and inequities deepened as a result of flying gender-blind across the health sector.

But with our frustration comes a renewed urgency to push harder for change, and we in GH5050 are galvanised to harness this power and drive forward.

Right now, social movements on all continents are profoundly challenging structural and systemic inequalities. People are rising up to demand an end to inequality and to claim their rights. We, in our push for gender equality, feel united with these broader struggles for social, economic and climate justice.

Last year, we reviewed power, privilege and priorities in organisations and highlighted the historic roots of inequity and inequality inherent across global health. We are disappointed to find that the latest cohort of nearly 100 CEOs and Board Chairs appointed in the past year is no more diverse than existing leaders. Compared to their predecessors, women made slight gains in representation, but so too did nationals of high-income countries. Systems of inequality are being sustained within the global health workforce. There is far too little support for equitable career opportunities and a slow pace of change in fair working practices. This is from a sector that claims to embrace gender equality. We believe that organisations active in global health should be leaders in acknowledging power and privilege imbalances, confronting intersectional inequities, and shaping diverse, inclusive workplaces – and we know they can.

We find hope in the numerous initiatives, organisations and people working to bring about change. Data and evidence from GH5050 and our partners is being used strategically to embed gender equality and diversity into work structures and programme delivery. We welcome this collaboration from organisations across the world.

We are also grateful to our Advisory Council and partners in organisations that contributed to data collection and validation for this report. Without your support, none of this would be possible.

To date, our focus has been on the global operations of organisations active in health. This was a strategic decision. We urge global organisations to get their own houses in order if they are to be credible gender and equality champions in countries. Essential impact, though, lies in ensuring that country-level health policies and programmes are gender-responsive. As such, GH5050 is excited to embark on a new phase of country-level work starting in Nepal, in partnership with the Nepal-based Center for Research on Environment, Health and Population Activities.

Gender inequality is not inevitable; it is made by people and reinforced in systems and organisations, including global health. And it can be unmade within those same systems. Gender equality is a precondition to achieving our shared ambitions of the Sustainable Development Goals by 2030 and delivering Health for All. Let us all take ownership of the demand for gender equality. Let us replace rhetoric with concrete action. Let us demand that leaders at all levels use this report to drive accountability and positive change for everyone’s dignity, health and livelihoods. After a calamitous year, we know positive change is possible; but it is up to all of us, individually and collectively, to take action and create opportunities for all.

“It is in collectivities that we find reservoirs of hope and optimism.”
Angela Y. Davis, Freedom Is a Constant Struggle
An empty word

From its inception, GH5050 has invited distinguished women exercising feminist leadership to write the Forewords to our annual flagship reports. We are indebted to Amina Mohammed, Prime Minister Jacinda Ardern, President Michelle Bachelet and Kumsal Bayazit who have situated our findings in a wider context and inspired us in new directions.

In 2021 we wanted to invite both a woman and a man to pen the forewords, to reaffirm the shared responsibility for gender equality. And so, Global Health 50/50 invited a number of men leaders to write this foreword.

We were unsuccessful.

As a collective, we are disappointed. We know that gender equality is everyone’s responsibility and that the benefits are realised across all of society. Nonetheless, the work to push for gender equality, and specifically to keep Global Heath 50/50 running, is largely undertaken by women. We hope that by sharing this anecdote, men in the global health sector will share their vision and actions with us. We want to hear from men about how they are informing, inspiring and inciting action on gender equality. Please send your contributions at and we will publish a selection on our website.