Today is World Health Day, celebrated this year under the theme of Universal Health Coverage for everyone, everywhere. Gender equality—from eliminating the gender pay gap in health workforces to ensuring all people have equal opportunity in accessing health services that meet their needs—serves as an essential pillar in achieving universal health coverage. So on this World Health Day, we review where global health organizations themselves lead and lag in advancing equality and call for gender-transformative action.
Globally, women earn less than men. As a result, human capital worldwide is about 20% lower than it ought to be. Much of this deficit is a result of policies and practices that range from the gender-blind to the overtly discriminatory. At the national level, the World Bank reports that 2.7 billion women are still legally barred from having the same choice of jobs as men, and just six countries currently provide women and men equal rights related to work.
A new report, Equality Works, reviews gender equality in the workplace, specifically of those organizations active in global health. We might expect that key actors in the health sector would be committed to gender equality, pursue gender-equitable workplaces, have gender-responsive strategies in place and at a minimum, report sex-disaggregated data in the monitoring and evaluation of their programs. Yet, far too often, this is not the case.
Global Health 50/50 produces the world’s most extensive interactive database on the state of gender equality in global organizations active in health. The initiative’s second annual report reviews the gender-related policies and practices of 198 such organizations, headquartered across 28 countries and employing 4.5 million people. The report provides an in-depth look at the extent to which organizations take action to promote gender equality within the workplace and through their programs across four dimensions and ten domains (see Figure 1).
Fig 1. Global Health 50/50 2019 Report Framework
Progress has been made in the year since our first report, as issues of gender equality and women’s empowerment reached new political heights, driven by the #MeToo, #TimesUp and She Decides movements, and furthered by independent initiatives such as Global Health 50/50. Organizational commitment to gender equality increased by 30%, reaching 71% in 2019. Progress in other domains has been less encouraging.
Terminology matters. Gender is often a flashpoint for language wars waged in international fora. At the 63rd Commission on the Status of Women last month, some Member States sought to replace what they dismiss as “gender jargon”, with a focus on women and girls. Political intentions vary; the results however include a limited scope to identify and redress the historical gender power imbalances if focus remains on only half the population, erasing men’s role—and benefit—in achieving gender equality, and defining transgender people out of existence.
Thus, it is troubling that despite a growing commitment to gender equality, the meaning of gender remains ill-defined by key actors, with significant variation across sectors. We found that just 32% of organizations define gender consistent with global norms i.e. as a social construct different from biological sex.
Fig 2. Organizational definition of gender: variation in sector performance
If history is any indication, power imbalances are not redressed passively -- progress is made through affirmative, deliberate demands and accountable action. Yet Equality Works reports that specific measures that would facilitate equal opportunity for career progression of women are lacking among half of organizations. Further, less than one-third of sexual harassment policies reviewed contain all four best practice components (as established by Global Health 50/50; Fig. 3).
Fig. 3 Sexual harassment policies with best practice elements
Inadequate leave for new parents and the lack of flexible working arrangements for people with families undermines efforts to achieve workplace gender equality. Mandating paternity leave to encourage a more equitable distribution of child-rearing activities between men and women raises, on average, the proportion of women employed in formal organizations by nearly 7%. Yet Equality Works finds that 42% of organizations offer 2 weeks or less of paid leave for new fathers.
Unsurprisingly then, vast power and pay asymmetries remain between men and women in global health. In four out of ten organizations, fewer than one-third of senior managers are women. Just one-quarter of organizations have gender parity on their governing bodies.
In global health, more than 70% of executive leaders and board chairs are men (Fig. 4). And women leaders are likely to be paid less: among the 27 US-based NGOs reviewed, male CEOs are paid on average $41,000 more than female CEOs, even after controlling for revenue size.
Fig 4. Seven out of ten executive leaders and board chairs are men
The data deficit remains a significant barrier to comprehensive monitoring of organizational performance on gender. Just 14% of the organizations had placed all three of the gender-related workplace policies reviewed by GH5050—workplace gender equality, sexual harassment and parental leave the public domain. For the majority of organizations, including publicly financed organizations, policies to facilitate the advancement of women’s careers are not publicly available. This inhibits both organizational comparisons and prospective staff from making informed choices.
Take the gender pay gap. We found that just eight organizations, out of 198, voluntarily report their gap. Another 42 reported their data as obligated under UK law—among those organizations, men’s median salary is 13.5% higher and men’s bonus pay is 22.8% higher than women’s.
We commend the World Bank for its commitment to and action on gender equality—the Bank was identified as a ‘high performer’ and among the few organizations that make the three gender-related workplace policies under review publicly available. Global Health 50/50 encourages all organizations to explore how to achieve more feminist, diverse and inclusive leadership and policies imperative to achieving universal health coverage and equality of career opportunities for everyone.