The traditional focus on women’s health tends to emphasise only their healthcare needs. But women are important providers – as much as they are recipients – of healthcare in their homes and wider communities. This involvement is undervalued economically, politically and culturally.
Data analysed from 32 countries, constituting about 52% of the world’s population, and reported in the Lancet Commission on Women and Health, shows that women contribute around US $3 trillion in healthcare annually. The report is the culmination of three years work and represents an important milestone in the consideration of some of the key issues affecting women and their role in society.
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Women play a vital role in the global healthcare workforce as nurses, midwives, community health workers and doctors. In some countries 90% of nurses are women. Although they are still less likely than men to reach senior positions in healthcare professions, in some countries (such as the UK), women now predominate in terms of medical school intake. This does not, however, translate to equality in terms of those who go on to practice medicine once trained, nor equality in pay.
The report also documents the vital role that women play in healthcare that goes unpaid. This includes contributions made by women and children to giving care in the home. An ageing population, living longer but experiencing chronic diseases, means a larger demand for care, much of which is traditionally provided by women and children.
Such informal care responsibilities, while enhancing the care provided to individuals and making significant savings in the formal care sector, can impact caregivers in a number of ways. As well as affecting their own health, it can also hinder their ability to take up educational, employment and social opportunities.
Valuing the input of unpaid labour is certainly not straightforward but the commission undertook detailed research to “value the invaluable”. They estimate that women’s unpaid contributions equate to 2.35% of global GDP, with a large variation around this depending on assumptions made about wage rates and other factors.
This worldwide picture is reflected in the UK, where the informal care sector is dominated by women, with similar effects on their health and employment options. Just in terms of the ageing population, the demand for unpaid care is substantial.
In England, about 1.4m older people with disabilities living in their own homes currently receive unpaid care. Plus there are predictions that the demand for this care will rise sharply and a growing “care gap” will emerge in terms of the availability of unpaid carers.
As welfare cuts in both health and social care sectors in many European countries are implemented over the next few years, it is likely that these demands will only intensify.
The report also analyses the health status of women worldwide over the course of their life times. It focuses on the shifting burden of disease and illustrates that while there have been important advances in priority areas such as maternal and reproductive health, there is still some way to go.
Deaths from communicable diseases and maternal, perinatal and nutritional disorders decreased by about 20% between 2000 and 2013. But there are still big variations across the world and in the ten most fragile countries (mainly in sub-Saharan Africa) deaths from these largely preventable conditions account for two-thirds of the 3m neonatal deaths and 60% of all maternal deaths.
The commission also broadens the focus beyond traditional concerns that relate to reproductive health, to consider the entire life-course of women. It concludes that more attention to chronic disease and non-communicable disease is required as conditions such as cardiovascular diseases, stroke, cancer, diabetes and mental health disorders are now the leading causes of death and disability for women in almost all countries.
The position of women in society has a major impact on their access to healthcare and chances of avoiding or managing these health conditions.
It is worth noting that choosing to focus specifically on gender to categorise health status is not universally accepted as the best analytical approach. Particularly by those who see the complex interplay between a range of determining factors (such as socioeconomic status, race, geography) as being far more important for an in-depth understanding of health and health inequalities.
The authors recognise this issue in part by referring to policies that have improved overall healthcare. But they contend that the shifting demographic, social, political and environmental arena presents specific and complex challenges to women which require targeted rather than general measures. For instance, by ensuring that the political and cultural barriers to accessing healthcare by women are recognised.
The commission also makes suggestions for acting on their findings. Their solutions look at the role of women more broadly in society. They also suggest specific policies to address education, access to healthcare, workforce and remuneration policies, as well as changes to the way in which statistics and research studies account for women.
It seems very appropriate that rather than focusing only on things that can be done for women, there is a need to empower them. In recognition of the huge amount women contribute towards care giving, it makes sense that women who themselves are healthy contribute to a “virtuous circle” of health.
The authors make the case that those who experience gender equality and are valued in their societies, are best placed to make a substantial contribution to their own health and well-being, as well as that of their communities. As Kofi Annan once said:
When women thrive, all of society benefits, and succeeding generations are given a better start in life.