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Session 3Session 3Differentiated environmental impacts on Differentiated environmental impacts on women’s and men’s health and well-beingwomen’s and men’s health and well-being

2020 Global Forum on Environment2020 Global Forum on Environment

M A I N S T R E A M I N G G E N D E R M A I N S T R E A M I N G G E N D E R A N D E M P OW E R I N G WO M E N A N D E M P OW E R I N G WO M E N F O R F O R E N V I RO N M E N TA LE N V I RO N M E N TA L S U S TA I N A B I L I T Y S U S TA I N A B I L I T Y

Paris, 5-6 MarchParis, 5-6 March

Session 3: Differentiated environmental impacts on women’s and men’s health and well-being

Environmental and climate-related effects on human health – both physical and mental - exist all around the world. Their impact may differ depending on geographic location, social and demographic structures of societies as well as biological and physiological characteristics. The different activities carried out by men and women- both at work and in the household - result in different exposures to chemicals and pollutants, as well as in different use of environmental goods. Both physical and economic geographical determinants may further exacerbate environmental impacts on health, and widen inequalities between men and women within different layers of society, especially low-income groups, migrants or single parents. These inequalities and inequities1 by gender exist both in developing and developed countries, even though they are of a different intensity or nature. Overcoming them is a global challenge that often requires tailored local solutions.

Air pollution

An increasing amount of pollutants is being released into the environment on a daily basis. With 91% of the world’s population living in places where air pollution exceeds WHO guideline limits, poor air quality poses the single biggest threat to human health, accounting for 3-4 million of premature deaths per year (OECD, 2017), and shortening life expectancy by 1.8 years globally (WHO, 2016). Furthermore, increasing global temperatures often exacerbate the effects of pollution on human health with urban areas being most affected (OECD, 2016). Only 2% of the global urban population lives today under what is identified as acceptable PM10 concertation levels (per WHO Air Quality Guidelines) (OECD, 2012a). Different studies show particularly negative correlations between high concentrations of air pollutants and health of women, elderly and children (Balestra and Sultan, 2013; Inyinbor Adejumoke et al. 2018).

In-door pollution can also be a serious threat to human health, mainly affecting women and children in developing countries. According to the Global Burden of Disease, every year over four million people die from respiratory diseases directly related to indoor air pollution possibly from highly-polluting fuels used for cooking and heating (GBD, 2017; WECF, 2018).

Increased air pollution exposure causes a variety of health problems, including decreased lung function, aggravated asthma, chronic bronchitis, diabetes, irregular heartbeat, nonfatal heart attacks, and premature death in people with heart and lung disease (Silva et al., 2012; OECD, 2014). Research links increased levels of particulate matter in air with respiratory and cardiovascular diseases, noting that the effects are more negative for children and the elderly compared to other adults (Aragón et al., 2017).

Ambient air pollution influences levels of infant mortality and morbidity, especially in the first weeks of a child’s life, while there are also indications linking pregnant women’s exposure to air pollutants with negative effects on the foetus (Currie and Neidell, 2005). Increased levels of NO2, produced usually by fuel combustion in diesel

1 Even though there is a distinction between equalities and equities, for ease of reference and due to – sometimes – the intertwined nature of the two, we used the term “inequalities” for both in the rest of the text.

vehicles, by 10-ppb per week, has been associated with a 16% rise in the probability of pregnancy loss (Leiser et al., 2019). This can be as harmful as tobacco smoking during the first trimester of a pregnancy (Corrington, 2019).

Low-income households located close to freeway traffic are among the most affected, with children’s health suffering most (Gauderman et al., 2007; Brunekeef et al, 1997). The 2019 OECD study “The Geography on Well-Being Database” shows that exposure to air pollution correlates with education and income levels in OECD countries (OECD, 2019d). As a result, air pollution can exacerbate socio-economic gaps and further contribute to the intergenerational transmission of poverty. Urban dwellers in OECD countries are less satisfied with their local environmental quality, when compared to rural dwellers (Balestra and Sultan, 2013). As women spend more time walking than men (who spend more time driving individual cars) (Ng and Acker, 2018), they are on average more exposed than men to urban air pollution. In developing countries, charcoal production by the main roads is also a major source of pollutants, affecting health of pedestrians who spend long periods walking along them, who are often women (FAO, 2002).

Recent OECD work on the economic cost of air pollution in Europe finds also a correlation between increased air pollution with productivity levels and economic activity (OECD, Forthcoming a). The results show that increasing average annual concentration of PM2.5 by 1μg/m³ reduces total GDP by 0.83% and decreases output by 0.80% per worker. These reductions result from changes in work productivity (reduced work attendance and absenteeism) as well as the direct effect of pollution on some sectors.

Moreover, increased air pollution affects health through food availability and quality, as it has severe effects on the agricultural sector. A report by the OECD on the economic cost of air pollution finds evidence in Europe that a 1μg/m³ increase in PM2.5 concentration in air can reduce agricultural gross value added by 4.6%, both due to the environmental effects and shifts in workers’ productivity (OECD, 2019c). This economic analysis supports existing literature on the detrimental effect of air pollution to human health and agricultural yields (Agrawal et al., 2003; Chay and Greenstone, 2003). A gender dimension is particularly relevant in countries where women represent more than half of rural population, e.g. Central and Eastern Europe (non-EU) (European Parliament, 2019), or in areas where women are in charge of sustenance agriculture.

Numerous other studies confirm the negative social and economic impact of air pollution. A survey in Lima, Peru, shows that households with dependent members (children, elderly) are more severely affected during days with higher levels of air pollution, than those without. A 10 μg/m³ increase in PM2.5 levels leads to a reduction of two working hours per week per household, as care responsibilities increase (Aragón et al., 2017). This could imply that women, as mainly responsible for caring obligations in the household, will be the ones most affected by high pollution days. In Santiago, Chile, where extremely high pollution days – of over 100 μg/m³ of PM10 – are very common, women are more likely to stay at home with their children or elderly family members. This doubles the gender gap in working hours between men and women, as women tend to reduce their hours worked in weeks of high pollution and men to compensate by increasing theirs (Montt, 2018).

Analysis also highlights that there is an increasing link on the economic consequences of air pollution and climate change, with the negative effects visible in many Asian and African economies (Roy, 2016). In particular, outdoor air pollution is an emerging problem in Africa, driven by increased traffic, power generation and industries. Roy (2016) estimates that dirty air could be killing 712,000 people a year prematurely, compared with approximately 542,000 from unsafe water and 391,000 from unsafe sanitation.

Other research provides a link between air pollution and mental and physical health, cognitive performance, and even violent behaviour. Kioumourtzoglou et al. show that long-term exposure to elevated levels of PM2.5 and ozone in the United States increases the risk of depression in middle-aged and older women (Kioumourtzoglou et al., 2017). On the other hand, contemporaneous and cumulative exposure to air pollution appears to affect more negatively men’s than women’s cognitive performance (Xi et al, 2017).

Experimental behavioural analysis of people living in the United States and Indian cities showed that air pollution elevates anxiety, triggering unethical behaviour among adults (Lu et al., 2019). Further recent findings in the United States by Burkhardt et al (2019) suggest a link between air pollution and violent behaviour. More specifically, they calculate that – for the period between 2006 and 2013 – a 10% increase in PM2.5 and a 10%

increase in ozone were associated with 0.14% and 0.3% increases in violent crimes and assault, respectively. These correlations are valid both for assaults in and out of the house, linking especially changes in outdoor PM2.5 with domestic violence. Women were statistically the main victims of domestic violence between 2003 and 2012 in the United States (76% female victims vs. 24% male) (Truman and Morgan, 2014). Burkhardt et al. (2019) also calculate the financial benefits from decreased violence as a result of a reduction in air pollution. According to their calculations, a 10% reduction of PM2.5 concentrations could reduce crime costs by more than USD 400 million, and a 10% reduction of ozone concentrations by USD 1 billion per year. Similar findings in London link increased crime activity to ambient air pollution (Malvina et al, 2018).

Water and soil contamination

Water contamination is a growing problem, affecting women in particular. Up to 80% of illnesses in the developing world are linked to inadequate water quality and poor sanitation (Women for Water, 2017). Every year, unsafe water sickens about 1 billion people. Water pollution caused 1.8 million deaths in 2015, according to The Lancet (2018). Over 800,000 people are estimated to die each year from diarrhoea as a result of unsafe drinking-water and poor sanitation and hand hygiene (WHO, 2016). In low income countries, women are often in charge of disposing of dirty water human waste and rarely have access to safe or private sanitation facilities, exposing them more to the transmission of diseases. But also in developed countries polluted water is a major concern influencing women’s health foremost (The Lancet, 2018).

Indeed, water and soil contamination remains a concern in many OECD countries. A recent OECD study indicates that there are increasing environmental concerns from active pharmaceutical residues in freshwater (OECD, 2019a). As the consumption of such products increases, there is a need for better monitoring and assessments of the effect of such ingredients to the environment in addition to improvements in the treatment of water resources. The study also points out the need to examine more thoroughly the effect of such pharmaceutical ingredients, and their mixtures, to human health, especially to the most sensitive groups of the population, such as pregnant women, foetuses and children (OECD, 2019a).

Water and soil contamination has a greater impact on women from minority groups and lower income levels due to the difficulty they face in order to avoid pollution, for instance due to their limited capacity to move to cleaner locations. In a study on the state of New Jersey, Currie et al. 2013 find a correlation between women’s level of education and the probability of a household moving as a result of contaminated water, indicating an effort by women to protect themselves and their families.

There are many examples of excessive use of toxic chemicals (e.g. pesticides) in agriculture, where women represent about 70% of the labour force in many developing countries, engaged in planting and harvesting, as well as in mining, where men are tasked with the more ‘’mainstream’’ dangerous jobs (Mrema et al, 2017; Roser, 2020). The UNDP has been working extensively on identifying guidelines for the sound management of chemicals in developing countries, and as part of this work, has been strengthening the gender dimensions (UNDP, 2011).

The extensive use of hazardous chemicals can potentially affect women more than men, especially in rural areas of developing countries where women are highly dependent on natural resources. The impacts of plastic litter, air pollution, mercury and other pollutants on animal and plant biodiversity have been widely documented (IPBES, 2019) and tend to have a greater impact on traditional and indigenous populations, with a specific incidence on women (See Inyinbor Adejumoke et al. 2018, for the effects of heavy metal pollution on pregnant women).

A recent study from a number of European countries has also provided evidence of the continuing problem of toxic chemicals and metals in fish consumed by pregnant women and children, as well as the lower concentrations of hazardous compounds contained in organic as opposed to conventionally grown fruits, because of the use of pesticides (Papadopoulou et al. 2019).

Other exposure to hazardous chemicals

The burden of disease related to exposure to hazardous chemicals is significant worldwide and falls more heavily in non-OECD countries where good chemical safety measures are not always in place. Men and women are exposed to chemicals on a daily basis, both at home and at work. The level of exposure, however, may differ depending on the length of the exposure and may be exacerbated due to additional stressors, such as heatwaves (WHO, 2014). In addition, there are differentiated gender effects based on women and men’s physiological, hormonal, and enzyme differences, potentially posing differentiated risks related to absorption, distribution, metabolism, storage and excretion.

Chemical substances such as Persistent Organic Pollutants (POPs), heavy metals and Endocrine Disrupting Chemicals (EDCs), have been widely identified as having differentiated impacts in men and women (WHO, 2008). In a recent study on pregnant women, EDC mixtures were found to have adverse health effects on new-born babies’ and children’s neurodevelopment, metabolism and growth, among others (Bergman et al., 2019), and hence affecting mental and physical health of their mothers.

As non-OECD countries’ share of the world’s chemicals production increases, the burden of diseases attributed to hazardous chemicals exposures is expected to grow. According to OECD calculations, a six-fold increase is expected in chemical production in non-OECD countries, mainly in the major emerging economies, such as Brazil, the Russian Federation, India, Indonesia, China and South Africa (BRIICS), by 2050 (OECD, 2012a). This would also increase the risk of exposure, especially for the most vulnerable populations.

Social factors determine differences in men and women’s exposure to hazardous chemicals based on traditional labour segregation and different consumption patterns. Even though women are participating increasingly in the labour market, occupational exposure to certain carcinogenic agents is still monitored mainly on males (Hohenadel et al., 2015). However, studies on occupational exposure are identifying differences at the level of exposure from various chemicals between male and female workers. A study in Italy has identified higher levels of exposure to certain chemicals for men or women related to task segregation in the wood industry and in furniture manufacturing (Scarselli et al., 2018). It is therefore necessary to take into account women’s and men’s different occupational roles and exposure to conduct meaningful research and monitoring of the effects of chemicals on human health.

Research also shows differences in chemical exposure even when men and women are in the same occupation (based on job titles). The aforementioned Italian study identified higher levels of exposure to nickel and chromium VI compounds for women working as machine operators, when compared to the predominately-male workforce in the sector (Scarselli et al., 2018). Other research, trying to identify the non-biological reasons behind these differences, has linked them to differences in cognitive skills or in how men and women perform certain tasks (Arbuckle, 2006). Moreover, the working environment in some traditionally male-dominated sectors is usually adapted to men’s needs, therefore protective uniforms or gloves may not be adequately sized for women (Arbuckle, 2006). There is room for further examination on the ergonomic nature of jobs (i.e. handling heavy machinery, or repetitive aerobic movement), as this could require women to put extra effort, leading – further to other health impacts – to increased breathing rate, and therefore to different intake levels of chemicals.

Another example of segregated labour is the textile and footwear industries. Since the mid-2000s, the production has concentrated in Asian countries, which now account for 62% of global exports, and which are expected to turn into major consumers of clothing by 2025 (ILO, 2019). The majority of workers in the textile and footwear industries and supply chain are women (80% of workers in industry), facing unsafe working conditions because of – among other factors – exposure to certain chemical substances (colouring, dyes, adhesives and primers, lack of protective materials and lack of sanitation and hygiene facilities). The OECD’s Due Diligence Guidance for Responsible Supply chain in the Garment and Footwear Sector provides a list of recommendations and a toolkit that helps companies to assess their environmental and social performance, and to integrate gender, health and environmental issues into their due diligence.

Due to social norms, socio-economic status and demographic trends, women are often in charge of household

management, and tend to be more in contact with household cleaning products and waste (such as faeces), thus increasing their exposure to certain hazardous chemicals and toxic substances (Hertz-Picciotto et al, 2010). Women are also more exposed to chemicals in personal care products, such as cosmetics, even jewellery (UNDP, 2011). Recent US data shows that women, being the major consumers of personal care products in the country, are more exposed than men to mercury, parabens and phthalates (all ingredients in beauty products) (Zota and Shamasunder, 2017).

OECD work has supported governments with their efforts in assessing the risks from human exposure to individual chemicals2. More specifically, the OECD Guidelines for the Testing of Chemicals (OECD, 2013) provide internationally accepted standard methods to assess the potential effects of chemicals (industrial, pesticides, personal care products, etc.) on humans and the environment. Many of these tests evaluate sex-specific effects; this is particularly relevant for the evaluation of chemicals that disrupt the endocrine system. More research on the combined exposure to mixtures of chemicals and potential male- / female-specific effects is also necessary, as very often chemicals are not found in isolation.

While the OECD has also been working on identifying the environmental impacts of plastics and plastic waste, more work could be carried out their human health impacts. In a recent research paper, Brink et al. refer to the potential hazardous effect on human health of various chemicals added to plastics (Brink et al. 2016). They refer especially to the potential problematic applications of plastic packaging, which is in contact with food, children’s toys or sewage and water pipes; as well as the limits chemical additives may bring to recycling plastic (OECD, 2019b). Such analysis should have a gender aspect, considering that women are often the main purchasers and users of these products (plastic packaging for food, etc) as well as decision-makers in waste management in the household (Lynn et al., 2016).

The OECD is currently carrying out a project on the willingness-to-pay (WTP) to avoid chemicals-related negative health impacts. In a first phase, surveys will be implemented in selected countries to estimate the WTP to avoid asthma, IQ loss in children, low birthweight, kidney failure and fertility loss. Gender is one of the socio-economic variables that respondents have had to answer about, as in most stated preferences surveys, and should serve as an example to future studies.

Climate change

Women’s health is also affected differently from men’s by climate change and increased temperatures, both in OECD and non-OECD countries. For example, the 2003 heatwave in France resulted in the premature death of 15 000 people, and the excess mortality rate for women was 75% higher than that for men (Fouillet et al. 2006). A 2019 study focusing on Spain showed that women – across all age ranges -- are more susceptible to death from cardiovascular disease than men, which can result from exposure to high temperatures (Achebak et al., 2019).

Climate change brings about a higher incidence and intensity of natural hazards such as droughts, landslides, floods and hurricanes. These hazards have a greater impact on more vulnerable populations because of their greater dependence on natural resources for their livelihoods, their lower capacity to adapt, lower quality dwellings and more exposed locations. Women often face higher risks and greater burdens from the impacts of climate change, as they account for the majority of the world’s poor. In addition climate change forces female headed households to migrate, worsening both the gender gap and mitigation efforts (Women for Water, 2017; UNESCO, 2018).

2 See REACH – Eliminating Toxic chemicals in the EU (https://www.wecf.eu/english/campaigns/2004/reach.php)

Questions for consideration

• What evidence is available on the impact of air and water pollution, as well as climate change, on women’s health, and their relation to productivity and employment patterns?

• What policy initiatives should governments introduce to ensure a better risk assessment of the impact of chemicals on women and men?

• What is the role of the industry in responding to the specific impact of chemicals on women and men, especially in the textiles, cosmetics, household products and plastics industries?

• How could the OECD further develop gender-based evidence gathering (including indicators) and analysis of environmental impact (air pollution, water and soil pollution, climate change and chemical exposure)?

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