The 2021 Global Health 50/50 report, “Gender equality: Flying blind in a time of crisis,” reviews the gender-related policies and practices of 201 global organisations active in global health.
Against the backdrop of a calamitous 2020, the report finds notable areas of progress and hope. The new data and research show that organisational commitment to gender equality is surging, and that organisations are becoming more transparent about their policies on shaping diverse, inclusive and equitable working environments for people.
The latest data also suggest, however, that rhetoric is often used as a substitute for action. The report reveals that the vast majority of programmatic activity to prevent and address the health impacts of COVID-19 largely ignores the role of gender. Evidence gathered by the GH5050 collective of researchers, strategists and practitioners shows that gender influences everything from who gets tested for COVID-19 to risk of severe disease and death. Yet, in a male-default world, the report finds that gender as a driver of everyone’s health, including that of men and boys, remains under-appreciated, under-counted and under-addressed. The result is gender-blind pandemic responses that are less effective than they should be, with grave consequences for the health of people everywhere.
The year 2020 marked the 25th anniversary of the Beijing Declaration and Platform for Action, a global blueprint for gender equality and women’s rights. This year, however, sees the appointment of yet another cohort of mostly male global health leaders, predominantly from high-income countries, with the mandate to exert influence over the health and wellbeing of people worldwide. Despite substantial rhetoric, the data reveals little progress towards gender equality and diversity in leadership across the health sector and no progress on closing the gender pay gap among UK organisations mandated to report on it.
In the face of multiple global crises, a global health system dominated by individuals and institutions in high-income countries forgoes essential talent, knowledge and expertise, with serious implications for pandemic preparedness, progress on Universal Health Coverage and meeting the health-related targets of the Sustainable Development Goals.
Addresses the causes of gender-based health inequities by including ways to transform harmful gender norms, roles and relations. The objective of such programmes is often to promote gender equality and foster progressive changes in power relationships between women and men.
Ignores gender norms, roles and relations and very often reinforces gender-based discrimination. By ignoring differences in opportunities and resource allocation for women and men, such policies are often assumed to be “fair” as they claim to treat everyone the same.
The 2021 Report assesses organisations on 14 variables across four dimensions. 45 high-scoring organisations are recognised in the report. The Gender and Health Index presents detailed results for each organisation. High-level findings include:
1. Words matter: Most organisations active in global health state that gender equality matters to their work
- Stated commitment to gender equality has grown steadily since 2018. Today, 79% (159/201) of organisations in the sample commit to gender equality. Read more
- Organisations that state what they mean by ‘gender’ are on the rise, but still only 40% of organisations define gender in their public communications. While progress has been made since 2018, the majority of organisations are not seizing the narrative power of defining gender in their policies and strategies. Read more
2. Policies fall short: Despite strong rhetoric, only 60% of organisations have transparent gender equality policies and even fewer have diversity and inclusion policies
- Progress on transparency of workplace gender equality policies has stalled. Gender equality policies were accessible for six out of ten organisations - the same proportion as in 2020. Progress on public facing transparency, recorded over previous years, has stalled. Read more
- More organisations are making public reference to diversity and inclusion. Diversity and inclusion policies - beyond those on gender diversity - were accessible for half of the surveyed organisations. Reference to diversity and inclusion increased by 10% over the past year. Read more
- A small fraction of organisations have transparent board diversity and inclusion policies. Governing boards are among the most influential decision-makers in global health. Commitment and measures to promote diversity and representation in these bodies are on the rise, yet 80% appear to still lack specific policy measures to advance diversity. Read more
- Transparency of anti-sexual harassment policies and family-friendly policies is low but growing. The availability of both anti-sexual harassment and family-friendly workplace policies increased by 10% over the past two years. Still, policies were accessible for fewer than half of organisations surveyed. Read more - Sexual harassment / Family-friendly
3. Power imbalances pervade: Male privilege in global health still circulates
- The global health sector ought to lead on equity and justice, but instead male privilege pervades. One-quarter of CEO and Board Chair positions changed hands in 2020, offering an opportunity to appoint a more diverse cohort of leaders amidst a proliferation of commitments to diversity and inclusion. Data show, however, that men continued to hold 70% of leadership positions and nationals of high-income countries held 84% - marking no change over the previous year, despite the appointment of nearly 100 new leaders. Read more
- It’s a slow crawl towards parity in senior management and governing bodies. One-third of organisations had parity (45-54% women) in their governing bodies or senior management. The proportion of organisations with senior management composed of at least ⅓ women increased by 14% since 2018, reaching 70% in 2021. Read more
- Fewer women at the top - and paid less too. CEO salaries at the 34 US-based NGOs in the sample were found to be consistently higher for men. On average, women CEOs were paid $308,000, while men CEOs were paid $415,000 - a gender gap of $106,000 per year. Read more
4. COVID-19 programmes fly gender-blind: The majority of COVID-19 health programming activities do not recognise how gender affects people’s health
- More organisations are adopting gender-responsive language on their core programmes. 39% of organisations position the work they do in relation to transforming gender norms and gendered systems and structures that stand in the way of better health outcomes, an increase of 10% over the previous year. Read more
- Yet over 80% of COVID-19 health programming activities are gender-blind. While organisations increasingly adopt gender-responsive language in relation to their core programmes, such approaches were not applied to COVID-19 programmes. Support across a range of WHO-recommended areas for pandemic responses - including vaccine development, prevention, access to treatment and care, health workforce protection, and surveillance - was found to be largely gender-blind. Read more
GH5050 has seen a marked increase in organisations engaging with GH5050 findings to implement change in their organisations and the communities they serve. The data in “Flying blind in a time of crisis” can equip leaders at all levels – from communities to workforces to boards – to take concrete action, drive change and hold those in power accountable. To support this effort, the report offers a series of analyses, stories of progress, and resources.
The health and well-being of the people both employed and served by organisations active in global health cannot afford another year of missed opportunities. Drawing on the findings across four years of data presented in successive reports, evidence-informed, rights-based action on five interrelated fronts is urgently needed.
Turn the dial from gender-blind to gender-transformative. Gender-transformative approaches recognise that gender drives health inequities and aim to transform harmful gender norms, systems and structures and foster gender equality. They are not only the just and fair thing to do, but also increase the effectiveness and impact of interventions to improve everyone’s health. Organisations need to examine how they can take an increasingly strategic approach to shifting power dynamics and tackling oppressive gender norms to advance the health of everyone.
Measure what you treasure. Data disaggregation is fundamental to the full implementation of the Sustainable Development Goals and fulfilling the ambition of leaving no one behind and delivering Health for All. Organisations need to to report on and recalibrate programmes based on data that is disaggregated by sex but also by other intersecting social stratifiers, including race, class, geography, age and (dis)ability.
Set a timer for the fair distribution of power. Leadership that reflects the global community is more likely to bring relevant and diverse perspectives, expertise and lived experience to the challenges of global health. Organisations must challenge inequalities in power and privilege in leadership and management, including through the establishment of time-bound targets, specific policy measures and accountability mechanisms that will lead to equitable representation.
Publish what you promise. Organisations should put their gender and diversity policies, related targets and progress reports in the public domain to inform their staff, facilitate public scrutiny and ensure accountability for progress. Staff should seize their right to collective bargaining practices in order to mobilise and organise pressure for change.
Connect and take action. The world today faces multiple, interconnected crises. Global health actors should unite around a feminist vision where all people are valued and entitled to voice and agency in order to equitably share in the distribution of power, knowledge and resources. People working in organisations active in global health should join forces across movements for gender, social and climate justice, and hold each other accountable, including through mechanisms like GH5050, to accelerate progress for the health and well-being of people and planet.
“We hope that you can use these findings to turn the dial from gender-blind to gender-transformative, actively addressing harmful gender norms, systems and structures and fostering gender equality. Champion, challenge and act for gender equality in the communities you work with, the organisations you work for, the world you live in.”
Jagnoor Jagnoor, GH5050 Collective Member and Senior Research Fellow, The George Institute for Global Health