Representation in Global Health: Is It a White Privileged World?

Written by Nohemie Mawaka, UHRA Newsletter & Graphic Design Coordinator

At the age of 25, I graduated from my Master’s degree in global health. As a Congolese-Canadian woman, I wanted to work at the systems-level to strategize programs implemented in Sub-Saharan Africa, as it is my area of expertise and interest because of my lived experiences within that part of the world. I had the passion and enthusiasm to conquer this world and channel all of my energy into addressing pressing global health issues that continue to impact low-to-middle income countries. To me, it was a given that people like myself would be represented in leadership roles at the bureaux-level in some of the top global health institutions. Little did I know that this was far from being the case.

Soon after graduating, I came to realize that we still live in a white-privileged world. If you don’t believe me, just follow the trajectory of the 2016 United States political outcome. Even the field of global health, with its slogans to “promote equity, and fight for the rights of those without a voice” in underserved settings like Sub-Saharan Africa, continues to be led mostly by people from privileged, and often white, backgrounds. Take for example the Gates Foundation: nearly all of its leading executive members are people from privileged, white backgrounds. And while they are certainly making important contributions in this field, this lack of representation worries me. The Global Fund’s organizational structure is a bit more diverse, yet out of 48 key board members, close to 50% are white and only 7 are from Sub-Saharan Africa. Only 2 out of 8 Global Vaccine Alliance (GAVI) are from Southern Africa. And none of the United Nations Development Programs (UNDP) executive board secretariats are of African descent.

Why is the lack of African representatives in executive positions in these global health organizations a problem? To better understand the structure of global health, and who holds the power, let’s follow the money. In 2016, the top five most funded global health institutions were: the Gates Foundation (USD $33 billion), Global Fund to Fight, Malaria, and Tuberculosis (USD $8.9 billion), GAVI (USD $8.8 billion), and the United Nations Development Programs (USD $5 billion). Yes, the most funded global health organizations (i.e. the ones setting the world global health agendas impacting populations in Sub-Saharan Africa), are mostly led by white, non-African people. The question then remains, should global health organizations bear the responsibility to ensure that their leading members are representative of the populations they serve? How else can you ensure that your executed projects ‘on-the-ground’ are going to be sustainable, if they are not lead by people with cultural and lived experiences?     

For these reasons, global health organizations must step up and recognize the gaps in representation in their elected executive board members. With more representation at the leadership level in global health, native Congolese women like myself could look up and identify with people in leadership roles. This way, I would know that I too can hold those positions and set agendas for those residing in Sub-Saharan Africa, because I was once the recipient of failed global health programs. This is why I enjoy being part of the UHRA, as we are an organization that tries to bring attention to health issues affecting sub-Saharan Africa, while showcasing the valuable work that African scholars are contributing to help combat these issues.