VALUING THE INVALUABLE

CONTRIBUTIONS OF WOMEN
TO HEALTH AND THE HEALTH SECTOR
THE LANCET HSPH COMMISSION ON WOMEN AND
HEALTH LAUNCH
Women and Health Initiative,
Harvard TH Chan School of Public Health

June 5, 2015

Felicia Marie Knaul

With Hector Arreola Ornelas and Oscar Mendez

Outline
Social, labor market, and
economic transitions
The framework: myriad contributions of
women to health and the health sector
Methods and data
The economic value of womens
contributions to health and the health sector

Increased years of schooling for women

Average years of schooling for women

(Women 15 years or more in LAC)

12

1950

2010

10
8
6
4
2
0

Source: Barro & Lee, 2014 (http://www.barrolee.com/data/yrsch.htm).

Source: ILO, 2013. ( http://www.ilo.org/ilostat/faces/home/statisticaldata/data_by_subject )

United States

Argentina

Uruguay

Guyana

Canada

Dominican Rep.

Panama

Men

Jamaica

Ecuador

Paraguay

Trinidad & T.
El Salvador

Nicaragua

Colombia

300

Peru

Costa Rica

Guatemala

Honduras

Venezuela

Brazil

Mexico

Growth rate of economically active

population in the period

Labor participation of women has also

increased substantially

(1970 2010 in LAC)

Women
AVERAGE LAC

200

100

The proportion of professionals who are

women has increased substantially, Mexico

1990

60

2000

2011

40

20

Engineers

Architects

Lawyers

Physicians

Women as % of total physicians

1980-2012, select countries
50
Australia

40
30

Canada
Czech
Republi
c
Denmark

20

Israel
Portugal

United
Kingdom
United States

2012

2010

2005

2000

1995

Source: OECD Statistics.

1990

1985

10

1980

Women physicians as % of total physicians

60

Nobel Prize Awarded to Women

1901 - 2014
Women (5.5%)
Women

47

801

1901 - 1921

1921 - 1940

1941 - 1960

1961 - 1980

1981 - 2000

11

2001 - 2014

17

Men

The workday of women, Mexico

Hours a week (168)
Care giving

MEN

Domestic work

20
Rest and
relaxation

Work outside
of the home

9
56

Source: Own estimates based on INEGI 2012 and CEPAL..

WOMEN

d
n
a n?
t
s tio
e
R xa
la
e
r

41

41

42

Outline
Social, labor market, and economic
transitions

The framework: myriad

contributions of women to
health and the health sector
Methods and data
The economic value of womens
contributions to health and the health sector

Project components
1. Literature review valuing unpaid work of women
2. Framework, strategy and methodology to account for the
many contributions of women to health and the health
sector, including catalytic contributions through cases
3. Detailed study of Mexico, Turkey, Peru, Canada and Spain
of paid and unpaid work
4. Collection of time use survey data for 32 countries: 52% of
the global population including China and India
5. Global projections of value of:
a.
b.

Unpaid work in health: for 32 countries, by income block

based on (3)
Paid work in health: Global projection based on (3) and
average country wages

The many contributions of women

to health and the health sector
Paid work in the health sector
Paid and unpaid contributions to caregiving
Paid and unpaid contributions through civil
society and community action
Women are a motor of economic growth. e.g.
earnings of women are invested in health directly
or through taxation
Discrimina
tion

These contributions, even if paid, are often

undervalued and under-remunerated.

Framework for categorizing

time use and work in health
Public

Private

Health sector
PAID BUT
Health- in another
OFTEN
sectors
UNDERVALUED In the homes of others

UNPAID
Volunteer work and
AND / OR
community service
UNDERVALUED

Childcare, elderly and sick

Within the same
household
Other household
(family or friends)

What could not be measured

Work preventing illness and disease
and promoting health in joint
activities in the home activities that
are only partially health related
Innovations and ideas
Increased economic growth due to
increased health dynamic
contributions

Outline
Social, labor market, and economic
transitions
The framework: myriad contributions of
women to health and the health sector

Methods and data

The economic value of womens
contributions to health and the health sector

Data
Canada, Spain, Turkey, Mexico and Peru
Time Use Surveys
Employment Surveys
27 countries: Published reports of results of
Time Use Surveys
World Development Indicators, World Bank
Minimum wages as reported by the ILO

Countries 32 - by income region

and % population covered
Low income, 3.8%:
Madagascar & Benin

Lower middle income, 90.6%:

Pakistan, India, Nicaragua & China

Upper middle income, 17.2%:

Cuba, Peru, Bulgaria, Panama, South Africa, Romania, Mexico,
Argentina, Turkey, Uruguay, Poland & Hungary

High income, 32.5%:

Estonia, Czech Republic, Portugal, Greece, Spain, Italy, UK, France,
Germany, Ireland, Canada, Netherlands, Sweden & Norway

Total: 52% of the global population

Counting strategies and estimations (14)

standard
valuation

DF=Gender discrimination factor

Net/Gross: Social Security and taxes

Outline
Social, labor market and economic transition of
women

The framework: contributions of women to health

and the health sector
Methods and data

The economic value of womens

contributions

Total value of women's

contributions to the health sector:
TOTAL:
4.8% Global GDP
$US 3.1 TRILLION

PAID:
51.2%
UNPAID:4
8.8%

2.9 times the Mexican economy

20% of the US economy
> 40% measured global spending on health
> total US+UK spending on health
Each and every woman contributes approx
US $ 1000 to health annually

Women: Global Contributions to the Health Sector

Upper & Lower Bound
% GDP & trillions of $US
Upper bound

2.43%

2.85%

$1.54

$1.81
Unpaid

Wages reported
in the survey
Lower bound
0

2.35%

2.47%

$1.49

$1.56

2.27%

2.17%

$1.44

$1.38
20

40

Paid

60

Proportion of global GDP (%)

USD$ 2010, millions. Estimates are shown for each proportion of global GDP. The lower bound is the lower average estimate based on Wages
Reported in the survey and the lower bound mean variation of values of remunerated and non-remunerated work in Canada, Spain, Mexico, Peru and
Turkey; the upper bound is the upper average estimate based on Wages Reported in the survey and the upper bound mean variation of values of
remunerated and non-remunerated work in Canada, Spain, Mexico, Peru and Turkey.

Women: Global Contributions to the Health Sector

by method of wage valuation
% GDP

Wages adjusted by social

benefits package and sex

3.5

1.8
Unpaid

Wages reported in the survey

Minimum Wage

2.35

1.1

2.47

2.47

Paid

Estimated Value of Women's Paid and Unpaid

Contributions to the Health Sector
Canada, Spain, Turkey, Mexico, Peru
6

Paid

Unpai
d

Unpaid

Canad
a

4
% GDP

4.2

Spain
Turkey
1.8

2
1.6

1.3
0

0.4
0.4

Canada

Spain

Turkey

0.7

Mexic
o

0.9

Peru
0.3

Mexico

0.2
Peru

Paid

Unpaid/
paid

0.7 4.2 17 47%

2.9%
6.2%
0.4 1.8 22 68%
2.1%
3.1%
0.2 0.4 50 92%
0.9%
0.9%
0.8 0.7 114
1.2%
1.0% using120%
Detailed calculations
household surveys and several
0.2
0.3 scenarios
67 91%
0.5%
0.5%

Estimated Value of Women's Paid and Unpaid

Contributions to the Health Sector
Canada, Spain, Turkey, Mexico, Peru

Adjusted by social
Benefits package
and sex differences

Wages reported
in the survey

Detailed calculations using household surveys and several wage scenarios

4.2

Canada
1.6
Spain
1.3
Turkey 0.40.4
Mexico
1.6
Peru

0.3

0.7

0.2

6.2

2.9

Canada
Spain
Turkey
Mexico
Peru

1.8

2.1
0.9 0.9

3.1

2.2

0.50.5

Proportion of GDP (%)

10

Hours a week per capita devoted

to health care at home

Hours per woman per week dedicated to

caring for health at home,
by income region
3

3.13

3.12

Global average = 2.51

2.01

1.83

1
0

Lower
income

Lower middle Upper middle

income
income

Source: Own estimates based on data from 32 countries

High
income

Non-exclusive health promotion activities:

MUCH larger figures for unpaid work

Total contributions, Mexico, with nonexclusive, joint health promotion/illness

preventing activities:
6.5-14-7% GDP
a) collection, preparation or storage of
firewood
b) sourcing of fruits and vegetables
c) carrying or collecting water
d) preparing, cooking and grinding corn or
flour for making tortillas
e) lighting or tending a stove for cooking
with firewood or charcoal
f) cooking or preparing food or drink for
breakfast, lunch, dinner, or between meals

g) warming food or drink for breakfast, lunch, dinner

or between meals
h) washing, drying or putting away dishes
i) cleaning the inside of the house
j) cleaning the exterior of the house
k) separating, discarding, or burning trash
l) washing and drying clothes
m) home repairs or installation of household items
n) shopping for household goods
o) waiting for gas, water, trash collection or other
utility service

Women's Contributions
to Health and the Economy - the choice:
Do we aspire to a Virtuous or a Vicious Cycle
Vicious Cycle

Virtuous Cycle
Healthy women invest
time effectively in
producing health and
preventing disease

Healthy and more

education
women women
produce more
health care
More economic
growth means
more money to
invest in health
and human
development

More health is
produced for men,
women and children

Unhealthy women
invest time ineffectively
in an attempt to prevent
disease and loss of life

Unhealthy, poor,
More equal
disenfranchised
opportunitie
women produce
s
Children learn
less health care
better and adults
are more
productive

More health and

education mean
more economic
growth

Less
health for
men,
women
and
children

Unhealthy children
learn less and
adults are less
productive
Suboptimal
development
of human
capital
Inequality of
opportunities

More
poverty

Less money to
invest in health
and human
development

Poor health and

less education
means reduced
economic growth

Not a Virtuous Cycle, but rather

Less health for men,
women and children
Unhealthy women invest
time ineffectively in an
attempt to prevent disease
and loss of life

Reduced
economic
growth

Unhealthy children
learn less and adults
are less productive
Less
education
Inequality of
opportunities

Unhealthy, poor,
disenfranchised women
produce less health care
More
poverty
Less money to
invest in health and
human development

Poor health and less

education means reduced
economic growth

We aspire to a Virtuous Cycle

women, health and the economy
through gender-transformative policies
Healthy women invest time
effectively in producing
health and preventing
disease
Economic
growth
Healthy and more
educated women
produce more health
and health care

More equitable
opportunities
Poverty
reduction

More economic
growth means more
money to invest in
health and human
development

More health is
produced for men,
women and children

Children learn
better and adults
are more
productive

More health and

education mean more
economic growth

VALUING THE INVALUABLE

CONTRIBUTIONS OF WOMEN
TO HEALTH AND THE HEALTH SECTOR
THE LANCET HSPH COMMISSION ON WOMEN AND
HEALTH LAUNCH
Women and Health Initiative,
Harvard TH Chan School of Public Health

June 5, 2015

Felicia Marie Knaul

With Hector Arreola Ornelas and Oscar Mendez