The current political landscape punishes those who resist the capitalist and patriarchal order, enforcing an oppressive ideology that benefits only those at the top. This complex web of intersecting struggles calls for a fundamental reimagining of global health governance through the critical lenses of intersectional feminism and decolonial praxis.
At the heart of this challenge is the systematic invisibilization of gender within global health programs and policies. Scholars have pointed out that gender inequity in health is both a subset of, and influenced by, broader societal notions of equality, hierarchies, and privilege. This invisibility is not accidental; it is part of a deliberate strategy to sideline the contributions and struggles of women, particularly those from marginalized communities. At the same time, global health is critically dependent on women in unpaid care roles, a reality that remains largely unrecognized and uncompensated. This unpaid labor underpins many health systems, yet it is often invisible in policy discussions, rendering women’s contributions economically and socially devalued. Studies have shown that gender inequality is frequently informal, thriving in hidden spaces where structural power dynamics go unchallenged. From household caregiving to community-based health support, these contributions are systematically excluded from formal accounts of health sector work.
To expose, recognize, and address the informal and hidden ways in which inequality persists, we need more diverse leadership in global health that is accountable to diverse populations. People from low-income countries continue to be largely denied the opportunity to contribute to the governance and decision-making of global health, with women especially under-represented: research shows that in a sample of 200 global health organizations, most board seats of nonprofit organizations are occupied by nationals from high-income countries, with only 5% held by nationals from low-income countries. Women from low-income countries hold just 2% of nonprofit board seats, while men from the USA alone hold 17% of seats. Making a shift in global health leadership and decision-making to better represent the people who deliver health, directly influences how resources are allocated and how policies are designed to protect the most marginalized populations that inequitably bear the brunt of poor health outcomes.
Simultaneously, the current neocolonial governance of global health continues to reflect and reinforce existing power imbalances. The multiple and intersecting inequities we must address do not conform to the priority-setting and funding models that have shaped the past decades, often devoid of strong and meaningful national and regional ownership of the health agenda. Decolonial thought and praxis have gained popularity in academic circles, but they need to be operationalized in global health governance through local ownership and regionally-driven resource allocation. This priority setting needs to consider the complexity of the systems and structures of exclusion, marginalization, and oppression that lead to intersectional health inequities. Indeed, health inequities cannot be addressed without tackling gender, race, class, and socio-economic inequality; global health must be intersectional across research, program delivery, and implementation - only by integrating local perspectives and dismantling imposed neocolonial paradigms can global health systems begin to reflect the true diversity of experiences and challenges.
Advocating for intersectional gender equity means acknowledging that race, class, gender, and colonial histories are intertwined in creating domination, oppression, and disadvantages and shaping how neoliberalism affects communities worldwide. The path forward involves challenging neoliberal governance and reorienting health strategies to address systemic injustice. This includes recalibrating research agendas to move beyond treating symptoms and instead curing the root causes of inequity: the trinity of capitalism, colonialism, and patriarchy. Ultimately, these shifts demand a collective commitment, measurement, and accountability to gender equitable, anti-capitalist, and decolonial frameworks—approaches that broaden our understanding of health and open pathways for genuine, lasting change.
As we reflect on International Women’s Day 2025, the call to action is clear: dismantle oppressive systems, amplify marginalized voices, and reorient global health governance toward a future where intersectional justice and equity are the norm rather than the exception.
About the author
Zahra Zeinali, MD MPH, is a doctoral candidate at the Department of Global Health at the University of Washington. Her research focuses on evidence-based health policy-making, health equity, and gender equality. She is particularly interested in operationalizing intersectionality in health research and governance to serve disadvantaged populations better. She is a board member of the Emerging Voices for Global Health and a member of the Collective for the Political Determinants of Health.
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