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Men — especially from rich countries — still fill the boards of global health groups

Men take up most of the seats on global health boards.
Malaka Gharib/NPR

The world of global health leadership is still very much a man's world – that's the conclusion of a new report published by Global Health 50/50. The title: "Boards for All?"

The report looked at the gender and geography of more than 2,000 board members across 146 global health organizations. Among the findings:

--Only a quarter of those seats were held by people from low- and middle-income countries, despite those countries being home to 83% of the world's population.

--Only 1% of board members were women from low-income countries.

--Nearly half the organizations evaluated had boards composed entirely of people from high-income countries.

"I knew there was inequality, but the magnitude of it was shocking," says Dr. Catherine Kyobutungi, executive director of the African Population and Health Research Center (APHRC). "For example, the statistic that more than 880 board seats out of 2,000 are occupied by Americans. That's 44% from one single country. How is that possible? This illustrates how bad the system is. This is not really global health."

Kyobutungi herself sits on five boards and advisory committees. She did not personally work on the report, but her organization is a partner of the Global Health 50/50 initiative and a team from her organization helped with some of the research.

Global Health 50/50 is an independent research project of the University College London's Centre for Gender and Global Health.

We spoke with Kyobutungi about the report's findings. This interview has been edited for length and clarity.

So why is it important to focus on boards? Board members are sometimes paid, sometimes not, but they're not out in the field doing the work.

Boards are responsible for how successful an organization is by making sure there are the right policies and systems in place. When the people shaping strategy in global health organizations are predominantly from certain parts of the world, then, of course, their worldview is expressed in the strategic decisions they make. That can be problematic.

Can you share an example?

I live in Kenya, and I come from Uganda. I see every day how global health priorities for African countries are distorted because they're determined by [Western-run] international global health organizations.

For example, for many years, HIV, TB and malaria have been the big three issues that most global health funding goes to in Africa, [because they disproportionately affect low- and middle-income countries.] Over the last 15 years, though, it's become clear that noncommunicable diseases (NCDs), [like heart disease, diabetes and cancer], are a bigger problem. But it's been impossible to convince these organizations that NCDs should be the priority, because the people who sit on the boards, their worldviews are not shaped by input from African countries.

Westerners still often think of HIV, TB and malaria are diseases of poverty and neglect, while diabetes, obesity and hypertension as diseases of affluence and privilege. To them, global health is not about helping "privileged" people. But if they listened to Africans they would realize that NCDs are also driven by environmental factors like poverty. Because these diseases are not receiving attention, we are walking into a health disaster.

According to the report, gender representation on boards has improved – in 138 organizations surveyed in 2018 and then in 2021, the percentage of women on boards went up from 20% to 32%. Have you noticed more women around the table?

Over the last few years. I've seen quite a bit of diversity in the forums I'm on. But many of those are committees that only last 3 or 4 years. For standing [permanent] committees, I've noticed less diversity. I'd like to see a few more years of data, before I can concretely say gender representation on boards is improving.

What's it like to be a woman board member in global health?

I only got approached to sit on boards after I became a CEO, even though I was qualified to be a board member before that. Then, once I was invited, I often felt like I didn't belong in that space. When you're the only Black woman on a board, you feel like an imposter. You feel intimidated. So then you're dealing with that pressure on top of everything else you're responsible for.

The women I know on boards are often overstretched, serving on four or five boards at a time, because there are so few of them in the pipeline of leadership. I myself am on five committees at the moment, and I'm invited to be on another one almost every month.

How can that pool of women candidates be expanded?

The more that women become leaders in different capacities – whether as politicians, senior lecturers at universities or CEOs of companies and NGOs [non-governmental organizations] – the larger the pool from which board members can be selected.

As a board member from a lower-income country, what kinds things are you able to contribute that people from wealthier countries can't?

Well, I'll tell you about a time I was invited to a board, and during the first strategy meeting, everyone was patting themselves on the back for their success in "global" advocacy. I put "global" in quotes, because how can it be global when the issues where I come from haven't been addressed in any significant way? To them, success was calls to action and statements on Twitter, but to me, success is when lives are actually improved. So, I kept pushing, "What is success?" In the end, I was able to shift their priorities, and the new strategy actually has a whole section on grassroots, country and community engagement.

It also helps when there are at least two or three people from lower-income countries, and together you can reinforce the same ideals.

So how do we fix it? How can organizations bring things into better balance?

It starts with self-reflection. People in positions of power need to ask themselves if the best way to achieve equity is the status quo. And I don't think it is. There has to be intentionality in shifting the power and seeking out diverse people, whether through quotas or only hiring high-income men of a certain age if there are no other qualified candidates.

The more that women become leaders in different capacities – whether as politicians, senior lecturers at universities or CEOs of companies and NGOs [non-governmental organizations] – the larger the pool from which board members can be selected.

We also don't need to wait for women to get to the top before we see them as potential board members. Maybe we can start inviting women [to boards] earlier in their leadership journeys.

Joanne Lu is a freelance journalist who covers global poverty and inequity. Her work has appeared in Humanosphere, The Guardian, Global Washington and War is Boring. Follow her on Twitter: @joannelu

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