Boards for all?
Boards are some of the most influential decision-makers in global health. They often nominate an organisation’s leadership, set strategic direction and provide oversight for financial, management and programmatic decision-making.
Spheres of power in global health have long been dominated by men from high-income countries. Two years ago, we reported that power imbalances resulting from systemic patriarchal, colonial and imperial norms pervaded the global health system. This year, we find that in the corridors of power and the rules determining who is given a platform to govern, considerations of gender and diversity are all too often lacking.
In Part 1 of Boards for all?, we present our most in-depth examination to date of the demographics of the 2,014 board members of the most influential organisations active in global health. We also take a deep dive into the board policies of these organisations to assess the measures that are being taken to foster diverse and inclusive leadership. Our findings show that decision-making seats are dominated by a small number of nationalities, sectors and institutions while considerations of gender and diversity in the policies that guide them are all too often absent.
In Part 2, we present GH5050’s annual review of the equality- and gender-related policies and practices of 200 global organisations active in health and health policy. While some organisations in our sample have continuously performed well across the core variables, and others have made notable progress, there remains a large subset of organisations whose performance has not improved in the past three years.
The following key findings of Boards for all? make strikingly clear that systemic reform to bring about diverse and inclusive global health governance bodies is long-overdue. Only through achieving global representation at the highest levels of leadership will we realise a global health system that is fit-for-purpose and able to achieve health for all.
1. THE ‘GLOBAL’ IS MISSING FROM GLOBAL HEALTH GOVERNANCE
Global health governing boards are intended to advise, inform and guide decision-making on behalf of the global population they serve. Yet they are not globally representative. Roughly three-quarters of the board seats of 146 organisations active in global health are held by nationals of high-income countries. Nationals of the US and the UK dominate global health boardrooms, occupying 44% and 7% of board seats respectively. Just 25% of board seats are held by nationals of all low- and middle-income countries combined and 2.5% are held by nationals of low-income countries.
2. REPRESENTATION OF WOMEN FROM LOW- AND MIDDLE-INCOME COUNTRIES IS DISPROPORTIONATELY LOW
The starkest inequalities reported by Boards for All? is in the disproportionately low representation of women from low- and middle-income countries in the governance of global health. Women from low- and middle-income countries make up 42% of the global population yet are notably underrepresented in global health decision-making spaces, holding 9% of board seats. Women from low-income countries account for just 1% of board seats.
3. Board inequities are linked to the power of sectors in global health
Different types of organisations wield different types of power. An analysis of the board members of private for-profit companies, a sector which wields considerable financial power, reveals even deeper imbalances than the sample overall. Among 43 private companies, women hold 30% of board seats, and they are overwhelmingly women from high-income countries – just 11 seats (2%) are occupied by women from middle-income countries.
Among the 11 philanthropic funders, which together distribute more than US$16 billion annually, women hold 37% of board seats. Of 123 board seats of philanthropic funders, 82% are held by nationals of high-income countries. Four board seats (3%) are held by nationals of low-income countries, with just one occupied by a woman from a low-income country.
b. Click on any bar to explore how the data breaks down
c. Click the + icon to add another variable to explore
4. LITTLE EVIDENCE OF POLICY ACTION TO PROMOTE DIVERSITY IN GOVERNANCE
Changing the status quo and redistributing power doesn’t happen on its own. Affirmative measures to improve gender equality and diversity among board members, such as dedicated seats and board composition targets for underrepresented groups, are often necessary to institutionalise change. We find however that only a fraction of organisations have transparent policies to promote diversity on their boards. We found policy information guiding the board composition for 111 organisations. In that information, we found board targets on gender parity from just 23 organisations. We found even fewer measures to promote regional diversity, representation of civil society or affected communities, or diversity in other characteristics of board members, including age and ethnicity.
5. STRIDES AND STAGNATION ON THE ROAD TO GENDER EQUALITY IN GLOBAL HEALTH
Five years of robust evidence summarised in the Gender and Health Index provides an increasingly clear picture of where progress is being made and where it is not, and whether and how organisations are using the findings of the Index to drive change. While numerous organisations have continually performed well in the Gender and Health Index, and dozens more have made measurable progress, many organisations have made little to no progress in the five years that GH5050 has been monitoring them.
For the first time, the report publishes the overall performance of each organisation in the sample. The report also publishes which organisations have continued to score poorly on each core variable tracked over the past five years.
See the individual performance of each organisation over multiple years here: https://globalhealth5050.org/report-profile/
“When organisations don’t embrace diversity, I say it's their loss. If we are going to have people making decisions about issues in low- and middle-income countries, we must listen to the people who see the reality on the ground. Sometimes the things that matter are very basic. And we need to have that voice in board meetings.”
Director of Development Policy and Head of the Malawi office of the African Institute for Development Policy; Board member of Population Council and Trustee of Liverpool School of Tropical Medicine
“Take your constitutional documents, take your board mandates and reform, reform, reform until such time where you have no choice but to be fully diverse, fully representative and fully accountable. That’s in your hands. Don’t say boards have no power. Get on with what you can do.”
Chairperson of International Planned Parenthood Federation
Benchmarking organisational performance: the Gender and Health Index
Every year, Global Health 50/50 shines a light on whether and how organisations are playing their part to address two interlinked dimensions of inequality: inequality of opportunity in career pathways inside organisations and inequality in who benefits from the global health system.
Now in its 5th year, the Global Health 50/50 Report assesses 200 global organisations active in health and health policy. The report publishes findings of the Gender and Health Index across four dimensions:
(1) Commitments to equity
(2) Presence of workplace gender equality and diversity policies
(3) Gender and geography of global health leadership, and
(4) Whether gender is addressed in health policies and programmes.
The Gender and Health Index is the world’s most comprehensive interactive database on gender in global health organisations. It is designed to advance action and accountability for gender equality and social justice in global health workplaces and programmes.
To engage with us on advancing gender equality in global health, or to learn more about our methodology, collective, leadership and values, contact us at: email@example.com.