‘Shame on us’: Global Health Governance’s Shameful Lack of Diversity

The COVID-19 pandemic has exposed unprecedented levels of global inequality. With many countries in the Global South still struggling to access life-saving vaccines, it is more vital than ever that the organizations setting the priorities and budgets of global health policy–organizations responsible for the health outcomes of billions of people across the globe–represent those they claim to serve. It is why the findings of Global Health 50/50’s recent groundbreaking report, Boards For All?, are a damning indictment of global health governance more broadly. 

Global Health 50/50 assesses, for the first time, the gender and geographic diversity of the boards of 147 leading global health organizations, from Oxfam and Pfizer to the Bill & Melinda Gates Foundation. It reveals a stark picture of who holds power in global health and who does not. 

Of the 1,965 individuals holding 2,033 board seats in the world’s major global health organizations:

• Over half (51%) are British or American nationals
• Only 25% are drawn from low- and middle-income countries (LMICs), despite the fact that these countries are home to 83% of the world’s population. 

Even more shocking is the woeful underrepresentation of women from low-income countries (LICs).

When the researchers broke down their data to focus on the world’s poorest countries, they found that women from LICs hold only 1% of board seats across all the organizations they assessed–a mere 17 of the more than 2,000 seats. In other words, the report lays out what many of us working in the global health sector have known for years: that our sector’s leadership positions are still dominated by men from the Global North. Were the data to be disaggregated by age, gender identity, disability, income, and other marginalizations, the evidence of exclusion would be even more troubling.

Time and again, the global health sector has proven itself incompetent at engaging with the full breadth and depth of the human experience, and that it does not care enough about systemic bias to end it. It is a disgrace that our sector is still led in ways that deny the people of the Global South, in all their diversity, the opportunity to influence health policy on a global scale. 

Shame on us.

By bringing in diverse and thus far richer perspectives, boards can disrupt rigid thinking patterns and draw upon a range of outlooks, opinions, and competencies. It also makes good business sense. Studies by Board Ready and McKinsey & Company show that companies with diverse leadership teams consistently outperform their peers in terms of year-on-year revenue and emerge stronger from crises. Mounting evidence supports the idea that companies with diverse boards make more effective decisions, and overcome adversity more successfully than those without.

As members of the Board of Trustees of the International Planned Parenthood Foundation (IPPF), we have seen firsthand the incredible benefits that diversity brings to our leadership, priorities, operations, and approach. IPPF has been gifted with a highly diverse board, with 60% of seats held by women, 30% of seats held by members under the age of 30, and 60% by members from the Global South. Our trustees are cisgender, transgender, and nonbinary.

In our experience, there isn’t a single decision that hasn’t been made better; that hasn’t been transformed, deepened, and made more nuanced to local contexts because of that richer and broader thinking that diversity of board membership enables. We are better at listening to others whose experiences and standpoints are different to our own; better at thinking through what our decisions mean in different settings; and better at sharing our power more generously. 

Ultimately, global organizations have a responsibility to ensure that their boards reflect the diversity of the individuals, customers, and stakeholders they serve. This is especially true when those organizations’ purpose is to ensure equitable health outcomes for all. When, as is the case today, board membership is based not on merit, but on privileging the identities and experiences of a narrow cross-section of the human population, we all lose out.

We now face a pivotal turning point. Hitherto excluded and marginalized groups are insisting on policies that transform the way power is held. As the Global Health 50/50 report makes clear, the onus is now on our organizations to act with this tide of change, not against it. We must reform and publish our constitutional documents and board mandates, we must set and be held accountable for quotas and targets. Those of us who hold positions of power must make room for those previously locked out of power, or simply step aside.  Every board member must work so that all boards have no choice but to be fully diverse, representative, and effective.

Kate Gilmore and Ulukbek Batyrgaliev are board members of the International Planned Parenthood Federation.