In a world dominated by commerce and capital, you would be forgiven for thinking that, even in the arena of health and wellness, it is business that generates the wealth. But you'd be wrong. According to a recent article in The Lancet, the contribution women make to healthcare worldwide makes up almost 5 percent of global economic output — even though half of it is unpaid.
A major commission on women and health has discovered that the contribution to global health care made by women totals around $3 trillion, but nearly half of this — according to authors, that's 2.35 percent of global GDP — is "unpaid and unrecognized." The commission examined the evidence surrounding the complex relationships between women and health, and shows that women's distinctive contribution to society remains economically, socially, politically and culturally undervalued.
The report outlines the way in which women's changing needs remain unmet, as both providers and recipients of healthcare. The commission was co-led by Professor Ana Langer, head of the Women and Health Initiative at Harvard T. H. Chan School of Public Health in Boston. According to Langer, "too often, women's health is essentially equated to maternal and reproductive health. However, the evidence outlined by this commission overturns this conventional interpretation, and we urge the global health community and policymakers worldwide to embrace a more holistic — and realistic — understanding of women and health."
The commission brought together experts, heads of programs and women's rights activists from around the world to study the complex biological, economic and social factors that affect women throughout their lives. These include the profound effects on health of globalization, urbanization, and climate change. Afaf Meleis of the University of Pennsylvania, who co-led the commission with Langer describes how, "often urban areas are developed without any input from women, and without addressing their needs for adequate lighting, safe transportation, access to healthy food, to infrastructures that promote community connectivity, and to integrated health care, child and elderly care. This puts women at increased risk of violence, non-communicable diseases and stressful life overload, which may in turn have adverse consequences for their families."
Meleis says, "Nurses form the largest global workforce in health care, and the majority of them are women. Many nurses work in unprotected environments and their scope of authority is incongruent with education and experience. All this can lead to burnout, attrition, severe shortage and [this] affects their health, and the health of others."
The commission analyzed data from 32 countries — covering around 52 percent of the world's population. They calculated that the financial value of women's paid contribution to the health system in 2010 amounted to 2.47 percent of the global gross domestic product (GDP) and 2.35 percent of GDP for unpaid work. This figure comes in most part from those providing domestic care for family members — something only officially acknowledged and compensated in a small number of countries, including Costa Rica, Turkey and the U.K.
According to Dr Felicia Knaul, co-author of the commission and Director of the Harvard Global Equity Initiative: "Our findings on women's paid and unpaid financial contributions to health worldwide only begin to explore and quantify the work of women as health professionals in the paid health care labor force, and their unpaid work to support health and prevent illness undertaken in their own homes, in the homes of others and through volunteering in the health sector. The contributions of women to health and health care are myriad, and the data to fully measure them are lacking."
The commission puts forward a number of recommendations. These include a call to recognize the importance of the needs and roles of girls and women, the strengthening of health systems and the improvement of health outcomes. They also recommend ensuring that the planning and financing of the development of health care is responsive to the concerns and needs of women. The authors call for the participation of women at all levels of decision-making in society, involving strong leadership in health, nationally and internationally.
"Worldwide, most providers of health care are women," says Langer. "But the health systems to which they contribute so much are often completely unresponsive to their needs — despite the fact that they rely heavily on their paid and unpaid contributions. Women are undervalued and unsupported by the systems in which they work, and this problem is exacerbated by inequitable access to healthcare experienced by too many women worldwide — particularly those in the most vulnerable groups."
Women's contribution to health care is a serious investment in the world economy. The authors argue that, as a consequence, gender equality must be central to the policies used to improve future healthcare and to those affecting human, social and economic development. Langer says, "It's time to acknowledge women's comprehensive health needs throughout their lives, and their productive contributions to health care and society as a whole, as well as their similarly important roles as mothers and homemakers."