Misaligned Priorities & Gender Inequalities Formed “Cracks” That Contributed To COVID-19 Pandemic
Men are more likely to suffer ill-health than women. (Photo Credit: Micha Serra for Global Health 50/50 ‘This is Gender’ Competition)

As the governments around the world struggle to control surging COVID-19 outbreaks, health experts highlighted cracks in global health systems that created conditions ripe for the pandemic.

A report titled Power, Privilege & Priorities released Monday by Global Health 50/50 found that an inequality of health benefits and an inequality of opportunities inside organizations have created a system where the priorities of the biggest global health organizations failed to prioritize gender equality and the most common causes of death and ill-health, leading to weak health systems around the world.

“The world’s attention now is on looking after people at immediate risk, and controlling the spread. This is an extreme pressure on an already-ill-equipped global health system. An escalation of the epidemic is inevitable,” Kent Buse, co-founder of Global Health 50/50 and chief of Strategic Policy Direction at UNAIDS told Health Policy Watch.

“If we continue to apply a gender-blind approach to healthcare I am afraid we will see additional global healthcare crises in the future.”

In the context of COVID-19, the stark gender disparity in mortality rates is an example of how a history of “gender-blind” approaches in global health have contributed to the current crisis, according to Sarah Hawkes, co-founder of Global Health 50/50 and director of University College London’s Centre for Gender and Global Health. In the WHO-China Joint Mission on COVID-19 Report, the case fatality rate in men is reported as nearly double that in women – 4.7% compared to 2.8%.

“We have to ask why more men in China are dying from the COVID-19 virus than women. Why are men more at risk?” questioned Hawkes. “Put simply, men are less healthy than women and we know that people with existing ill health are more at risk of dying.”

“While we don’t have the full picture, we know that within the affected regions more men smoke and hence there may be more men with cardiovascular disease and other non-communicable diseases than women.”

According to the WHO report, the case-fatality rate was much higher for people with pre-existing non-communicable diseases (NCDs) – hovering around 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.

Men have higher rates of harmful use of alcohol, tobacco use, and substance abuse, which are all contributing causes of NCDs, said Hawkes.

Yet, the Global Health 50/50 report found that two-thirds of global health funders and philanthropies do not address NCDs, and the vast majority of organizations do not make distinctions between the health-related risks of women and men – particularly for alcohol, tobacco, and substance abuse.

This “gender-blind” approach to health means that “decision making is often focused on politics rather than on people’s need,” said Hawkes.

“We see the consequence of these as contributory factors to the current crisis.”

Inequality in Global Governance as Other “Cracks in the System”

Along with highlighting the systematic neglect of certain health conditions, the Global Health 50/50 report found that a high number of organizations still do not balance gender in senior leadership roles, and people from low- or middle-income countries are barred from the highest echelons of major global health organizations, despite the majority of global health work happening in those countries.

In a review released on the tail of International Women’s Day that covered 200 organizations across 10 different health-related sectors, the report found that more than 70% of the chief executives and chairs of boards are men, while only 5% are women from low- and middle-income countries. Women continued to be barred from higher leadership positions – with the proportion of women board chairs growing only from 20% to 26% in the past two years.

Over 80% of leaders in these global health organizations are nationals of high-income countries, and over 90% among those in leadership roles completed their education in economically rich countries, despite low- and middle-income countries being home to 83% of the global population. Some 90% of all the organizations surveyed were headquartered in the United States, Switzerland, and the United Kingdom.

Other key findings of the report include:

  • Some 75% of global organizations declare a commitment to gender equality, up from 55% in 2018. Some 60% of organizations have gender equality policies in the public domain.
  • However, only 35% define the meaning of “gender” in their policies, only 44% have policies to advance diversity and inclusion beyond gender, and only 14% have policies available on gender equality, diversity and inclusion in their governing bodies
  • Along with the predominance of men in global health CEO roles, 64% of organizations have more men than women on governing boards. Some 54% have more men than women in senior management roles.

“Power asymmetries continue to define the global health architecture. These are rooted in economic power imbalances, global governance structures and also the fact that the global health system has not shaken the vestiges of its colonial past,” said Hawkes.

Image Credits: Micha Serra/Global Health 50/50.