VALUING THE INVALUABLE

CONTRIBUTIONS OF WOMEN
TO HEALTH AND THE HEALTH SECTOR
Women and Health
The key to sustainable development
University of Miami
Miller School of Medicine
October 1, 2015

Dr. Felicia Marie Knaul

Miami Institute for the Americas and Miller School of Medicine,

Key Findings & recommendations

Women produce the majority of pain and unpaid health care.
Women's contributions to health are valued at $3.1 trillion, almost
5% of GDP and approximately 50% is unpaid
Unpaid contributions have gone unrecognized and unaccounted for.
They are a hidden subsidy to health care.
The total value of the health sector exceeds what is reported in
official statistics or through national health accounts.
Countries are investing more in health than they report because of
the enormous contributions of women & men through unpaid work.
Health labor markets need to be reformulated to include unpaid
work & made adaptable to women over the life cycle.
Effective, fair health systems offer equal opportunities & incentives
for men to participate in caregiving & health promotion.

Outline

Women in transition
The framework: measuring myriad
contributions of women to health and the
health sector
The economic value of women's
contributions to health & the health sector
Global & Mexico

Average Years of Schooling for Women

0
Estonia

Ireland

UK

Germany

Hungary

Norway

Poland

Bulgaria

Netherlands

France

Romania

Spain

Greece

1950

Canada
Czech Republic

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

Cuba

South Africa

Argentina

Panama

Italy

Mexico

14

Peru

Uruguay

Portugal

China

Nicaragua

Turkey

India

Pakistan

Benin

Increased years of schooling for women

Ave years of education, Women 15 years+
2010

12

10

Panama

Jamaica

Ecuador

Paraguay

Trinidad & T.
El Salvador

Nicaragua

Colombia

United States

Argentina

Men

Uruguay

200

Guyana

Canada

Dominican Rep.

Fuente: Las mujeres latinoamericanas en cifras, FLACSO.

Peru

Costa Rica

Guatemala

Honduras

Venezuela

Brasil

Mexico

Growth rate of economically active

population in the period

Labor participation of women has Increased

& much more than among men

(Latin
America, 1960 2010)
300
Women

Average

100

Medicine; a global phenomenon

Women as % of all physicians 1980-2012, select countries
50
Australia

40

Canada
Czech
Republi
c
Denmark

30

Israel

20

Portugal

United
Kingdom
United States

2012

2010

2005

2000

1995

Source: OECD Statistics.

1990

1985

10

1980

Women physicians as % of total physicians

60

Yet, recognition and opportunities

for progress continue to be limited
Nobel Prizes Awarded to Women 1901 - 2014
Women (4.9%)

Men

No.

No.

1901 - 1920

101

4%

1921 - 1940

99

5%

1941 - 1960

113

4%

1961 - 1980

176

3%

1981 - 2000

11

286

4%

2001 - 2014

17

147

10%

Period

47

922

women/t
otal

Women

Chronic & NCD dominate the disease burden

DALYs (%), women 15+, by cause-group and region

6%

6%

9%

6%

4%

6%

32%

% DALYs

65%

64%

71%
80%

90%

62%

29%

27%

23%
14%

Injuries

Non-communicable

Source: Estimates based on Global Burden od Disease Study, 2013. IHME, 2015.

6%
Communicable, maternal
and nutritional

Demographic and epidemiologic

transitions have been rapid and profound
Women's epidemiologic transition, LAC

In just over 40
years, LAC will
71%
achieve the aging
rates that most
58%
European countries
Communicable
took over two
centuries to reach.
NonLife expectancy has 35%
Communicable
increased from 30+
Injuries
in 1920, to 75+
23%
today
In a very short time
7%
6%
period, the causes
of death have
1990
2013
reversed
Source: Cepal, 2012. The epidemiologic profile of Latin America and teh Caribbean: challenges, limits, and actions.; and IHME GBD Study 2013.

Outline

Women in transition

The framework: measuring

myriad contributions of women
to health and the health sector
The economic value of women's
contributions to health & the health sector
Global & Mexico

The many contributions of women

to health and the health sector
Paid work in the health sector
Paid and unpaid contributions to caregiving
& the health sector
Unpaid contributions through volunteerism

Discriminati
on

Womens contributions, even if paid,

are often undervalued and underpaid & congregate in low-pay,
feminized fields.

Data: 32 countries
Employment and time use survey data for
Canada, Spain, Turkey, Mexico and Peru
Published reports of results of Time Use
Surveys for 27 countries
Represents 52% of the global population
Low income, 4%
Lower middle income, 91%
Upper middle income, 17%
High income, 33%

Counting strategies and estimations (14)

standard
valuation

Salaried/
Paid

Public

Heckman

Voluntar
y/unpaid

Work in
Health
and the
Health
Sector

Net (1)

DF

Gross
(2)
Net (3)

Witho
ut DF

Gross
(4)

Minimum
wage
By
occupation

DF

Heckman

Private /
Unpaid

DF=Gender discrimination factor

Net/Gross: Social Security and taxes

Witho
ut DF

Gross
(6)
Net(7)
Gross
(8)
Net (9)

Minimum
wage

By
occupat
ion

Net (5)

DF
Witho
ut DF

Gross
(10)
Net
(11)

Gross (12)
Net
(13)
Gross
(14)

What could not be measured

Unpaid contributions to disease
prevention and health promotion in in
home-based activities that are only
partially health-related
Innovation and ideas
Investment of womens earning in health
directly or through taxation
Increased economic growth due to
increased health dynamic contributions

Outline
Women in transition
The framework: measuring myriad
contributions of women to health and the
health sector

The economic value of women's

contributions to health & the
health sector
Global & Mexico

Total value of women's

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

PAID:
51.2%
UNPAID:4
8.8%

Exceeds total US+UK health budget

2.9 times Mexican economy
20% of the US economy

Each and every woman contributes

$1,200 to health annually

Global Contributions of Women

to the Health Sector

% GDP & trillions of $US,

by method of wage valuation
Wages adjusted by social
benefits package and sex

3.5%

Wages reported in
the survey

2.35%
T$1.5

1.8%
2.47%
T$1.6

$T3.3

T$3.1
Unpaid

Based on Country
Minimum Wage

1.1%
0

2.5%
2

$T2.8

Paid
6

Proportion of global GDP (%)

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 0.4 0.4
Mexico
1.6
Peru

0.3

Paid
Unpaid

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

0.5 0.5

Proportion of GDP (%)

10

Mexico: Value of work in the health sector

Women & men 2010, by wage valuation method
Unpaid

Paid

20

0.045

10

What
are the
men
doing?

0.032

5.8

7.8

0.026

10.9

1.0% GDP

15

Men: B$8.7

8.1

1.6% GDP

USD $ BILLIONS

Women: B$13.6

Voluntary

4.9

3.8

0
Wages
reported in
survey

Women

Wages
reported in
survey

Men

Unpaid work dedicated to health activities in

the home, including health promotion
Women, 15 years and older
What
about
girls
<15?
Joint health and
other activities
assuming 25% of time
is health

Health care

7.2
2.3

2.3
Average hours per week

3.4%
GDP

B$14
1.1%
GDP

4.5% GDP

Mexico: The workday

Men and women, based on a 168 hour week
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

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

Vicious Cycle
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

VALUING THE INVALUABLE

CONTRIBUTIONS OF WOMEN
TO HEALTH AND THE HEALTH SECTOR
Women and Health
The key to sustainable development
University of Miami
Miller School of Medicine
October 1, 2015

Dr. Felicia Marie Knaul

Miami Institute for the Americas and Miller School of Medicine,

Global Contributions of Women to the

Health Sector: Upper & Lower Bound Estimates

% GDP & trillions of $US

Upper bound

2.43%

2.85%

Unpaid
Paid

Wages reported
in the survey

Lower bound

2.35%

2.47%

$1.49

$1.56

2.27%
0

2.17%
2

Proportion of global GDP (%)

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