A small group of privileged men based in Europe and the US preside over a global health system that is 70 percent male, new research has found.
The Global Health 50/50 report, published yesterday by University College London’s (UCL) Institute of Global Health, said that it could take 54 years until the world’s major health organizations have equality in their leadership.
Researchers said that although women make up 70 percent of workers in the global health sector, only 5 percent of leadership positions are occupied by women from low and middle-income countries.
Power is concentrated in rich countries, where 85 percent of global health organizations have their headquarters, the report said, adding that most of the leaders are nationals of these countries or had studied in their universities.
“It’s a stagnant and stagnating system,” said professor Sarah Hawkes, a professor of global public health at UCL and cofounder of the initiative, which reviewed the performance of 200 organizations working in health.
“It’s not kept pace with the changing nature of disease and it’s also essentially failing to take gender into account,” she said.
The current global health system has its roots in colonial-era structures that were often focused on specific diseases and preventing their spread to Europe, the report said.
Anuj Kapilashrami, a senior lecturer in global health at Queen Mary University of London, said that these structures mean much of the health sector focuses on select diseases rather than the structural issues that lead to disease.
“We need radical change in the ways aid gets dispersed, and structural changes,” she said.
There needs to be a greater focus on poverty, migration and food security, rather than measuring aid responses for communicable diseases, Kapilashrami said.
“Instead of just looking for silver bullets, it would be looking at causes of causes, the issues that push people into disease,” she said.
Hakwes said the lack of evolution in leadership is reflected in global health policy agendas, which have often failed to keep pace with changes around the world.
Policy in the 20th century was often focused on population control, and while it developed a specific focus on women’s health, the general understanding of gender was limited, she said.
“A lot of the programs we’ve looked at, they’re not looking at women’s health in general, they’re looking at women’s reproduction,” Hawkes said.
Programs have failed to take account of other health issues women face, especially as more women worldwide have moved into urban environments and workplaces, experiencing major changes in their lifestyles as a result, she said.
There was an increase in organizations announcing plans to address their shortcomings, with two-thirds now having gender policies in place, but only 44 percent actually have measures to encourage diversity and inclusion, the report said.
“I’m quite frustrated by statements and by initiatives made for marketing purposes and political statements that don’t make a big difference,” said Devi Sridhar, director of the global health governance program based at the University of Edinburgh.
She said that, with young women from around the world increasingly receiving support from her own and other institutes, she is optimistic that the sector would change and that the next generation would secure leadership positions in the next decade.
“Don’t say to me there’s not good women, there are plenty, but what happens when I go to big meets with big organizations and big pharma heads is, I don’t see that reflected,” she said. “There is a lot of talk and not much evidence that at the highest levels things have shifted, but I see a lot of hope in young women.”
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