Opinion: Gender equality in salaries is another frontier for global health

Global health has a largely female workforce and a largely male cadre of leaders. Despite recent progress in achieving gender parity among board chairs of nonprofit organizations, a troubling trend persists: Female CEOs in global health continue to earn substantially less than their male counterparts, with the pay gap widening over time. This growing inequity in compensation, coupled with the concentration of men in leadership roles at larger organizations, underscores the urgent need for systemic change in how the sector approaches gender equality at its highest levels. This is not a new topic to Devex, and calls for improving gender balance are not new: A 1997 World Health Assembly resolution sought gender parity by 2002. The World Health Organization had major gaps in women in leadership until Director-General Tedros Adhanom Ghebreyesus introduced a balanced leadership team in 2017. While male-dominated leadership is not unique to global health, for a sector that has been disproportionately staffed by women and one that has touted equity and opportunity, the gap in women’s leadership needs our urgent attention and action. Progress on gender parity on global health leadership Attention seems to be paying off, albeit slowly. For the first time in its reporting history, a new Global Health 50/50 report released this month has found gender parity in board chairs among almost two-thirds of 134 reviewed nonprofit organizations. Of 87 nonprofit organizations consistently in the analysis since 2018, women board chairs have increased from 30% in 2018 to 51% in 2024. However, as a signal of the need for continued focus on this issue, only 43% of 70 new nonprofit leaders appointed in 2023/24 (CEOs and board chairs, combined) are women, well below the numbers needed to achieve and maintain parity in CEO and board chair balance. While we work to achieve gender balance among CEOs, we need to pay attention to the experience of those leading, including perhaps the most quantifiable variable: pay. In this regard, the new report demonstrates significant inequity. A widening pay gap A review of tax returns filed by a subset of 29 U.S.-based nonprofit organizations for the 2015 and 2021 tax years revealed persistent inequity regarding pay. In 2021, 55% of CEOs of these 29 organizations were women, up from 38% of those same organizations in 2015. However, a closer look reveals that male CEOs continue to earn significantly more than female CEOs, with a gap of 18% in 2015 ($386,000 average among men; $315,000 average among women) which increased to 28% ($141,000) in 2021 ($507,000 compared to $366,000). Thus the average pay for women CEOs in 2021 was less than the average was for men six years prior, in 2015. What might drive these differences in pay? We know that, in this case, size matters. It’s typical for larger organizations to pay leaders more than midsized or smaller ones. Indeed, the average total revenue of organizations led by men was more than twice the average of those led by women in the 2021 financial data ($389 million compared to $187 million). Higher numbers of male leadership of larger organizations and female leadership of smaller ones was also reported by Fair Share of Women Leaders, among a sample of 95 international social sector organizations, despite gender parity in leadership being reported for the first time. In addition to budget size, we expect that other factors that may affect pay equality include past salaries being considered in making a job offer to a new leader, leadership position postings not including salary information — even organizations that have committed to salary transparency do not always follow that same practice for CEO recruitment — and different salary negotiation strategies and outcomes for male and female candidates. These are all factors that we can solve through policies and behaviors. This is absolutely within our influence. We need to have honest and challenging conversations about several key issues, conversations that will, hopefully, lead to awareness and action. For example: • When male leaders leave their positions are they “falling up” into bigger roles more often than female leaders? • Are female leaders experiencing increased burnout due to having less social support or more out-of-work roles (e.g. caretaking) than male leaders? • Is this burnout exacerbated by lower take-home pay available to fund logistical or caregiving support? • Are men more likely to chair the boards of larger organizations, and be less likely to “take a chance” on a woman CEO? We can all take action to address pay disparity and promote this next frontier of gender equality. Boards of directors can increase transparency about salary during recruitment of a new CEO and consider gender fairness (rather than try to be “blind” to it) when making offers. Firms that conduct CEO searches for global health organizations can review salary benchmarks that include data about the gender of CEOs and recognize that only with increased awareness of salary disparities will the sector be able to correct them. CEOs can participate in compensation surveys, actively advocate for gender analysis of data related to compensation and employment opportunities, share trends and strategies with their boards and each other, and provide mentorship and sponsorship to women leaders and leaders from low- and middle-income countries as we pass our batons to the next generation of CEOs. Researchers and initiatives that track global data can continue to underscore disparities, highlight areas of improvement, identify strategies and policies that promote more equitable remuneration, and shine light on areas where our sector can increasingly walk our talk about gender equality. Donors can scrutinize and query organizations’ policies related to recruitment, compensation, and retention of leaders and support the diversification of boards and leadership teams. With each glass ceiling we dismantle, we should celebrate our progress and remember that there is likely another layer that requires advocacy, determination, and willingness to rally for change. This reflects the wider effort for gender and other forms of social justice — an ongoing struggle in which we are stronger together. Competing interests: Kent Buse is co-founder and co-CEO of Global Health 50/50, whose reports are mentioned in this piece. Traci Baird is president and CEO of EngenderHealth, which is featured in the Global Health 50/50 reporting.