Diapositiva 1

Women and HealthThe key to sustainable development

University of Miami Shalala Students CenterOctober 2, 2015

Dr. Felicia Marie KnaulMiami Institute for the Americas and Miller School of Medicine, University of MiamiFundacin Mexicana para la Salud & Tmatelo a Pecho

VALUING THE INVALUABLECONTRIBUTIONS OF WOMEN TO HEALTH AND THE HEALTH SECTOR

Key Findings & recommendationsWomen produce the majority of paid and unpaid health care. Women's contributions to health are valued at $3.1 trillion, almost 5% of GDP and approximately 50% is unpaidUnpaid contributions are unrecognized, unaccounted for, unregulated & deprofessionalized - 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.OutlineWomen in transitionThe framework: measuring myriad contributions of women to health and the health sectorThe economic value of women's contributions to health & the health sector Global & Mexico

I would recommend making this first section shorter so that you can get more quickly to whats new in this study the estimates of the value of womens unpaid and paid contributions to health. People are generally aware that womens participation in education, the labor force, various professions, etc. have increased and that women still do a great deal more work and caregiving at home as well (as the last slide in the section highlights). I dont think we need more slides to make that point than we have in either the second or third sections of the presentation. 3Source: Barro & Lee, 2014 (http://www.barrolee.com/data/yrsch.htm).1950201002468101214BeninPakistanIndiaTurkeyNicaraguaChinaPortugalUruguayPeruMexicoItalyPanamaArgentinaSouth AfricaCubaGreeceSpainRomaniaFranceNetherlandsBulgariaPolandNorwayHungaryGermanyUKIrelandEstoniaCanadaCzech RepublicAverage Years of Schooling for WomenIncreased years of schooling for women Ave years of education, Women 15 years+It might be easier to convey the point of this slide by using fewer countries a representative sample of 2 or 3 each of low-income, lower-middle, upper-middle, and high-income countries. If the bars could be wider and the type a little bigger, it would be easier to pick up the point the slide is making without getting lost in trying to decipher the details. 4

0100200300MexicoBrasilVenezuelaHondurasGuatemalaCosta RicaPeruColombiaNicaraguaTrinidad & T.El SalvadorParaguayEcuadorJamaicaPanamaDominican Rep.CanadaGuyanaUruguayArgentinaUnited StatesAverageLabor participation of women has Increased & much more than among men

(Latin America, 1960 2010)Men WomenFuente: Las mujeres latinoamericanas en cifras, FLACSO.Growth rate of economically activepopulation in the periodMedicine; a global phenomenon

Women as % of all physicians 1980-2012, select countriesSource: OECD Statistics.Women physicians as % of total physicians010203040506019801985199019952000200520102012AustraliaCanadaCzech RepublicDenmarkIsraelPortugalUnited KingdomUnited States6Yet, recognition and opportunities for progress continue to be limitedPeriodWomenMenwomen/totalNo.No.%1901 - 192041014%1921 - 19405995%1941 - 196051134%1961 - 198051763%1981 - 2000112864%2001 - 20141714710%Women (4.9%)47922Nobel Prizes Awarded to Women 1901 - 2014This might be a slide to lose -- partly because its a little hard to see what the main point is and how it fits into the narrative. The other slides in this section have shown womens increased participation. But it would seem that the intent here and in the next slide is to show that women remain extremely unrepresented at the highest levels while remaining overburdened with caregiving and domestic work on top of their work outside the home. Is that it? Or do we want to show that there has been a recent increase in Nobels for women just since 2000, after a century of no gain? If the goal is to show change, then a single pie chart covering the entire period doesnt do it. No ha creciso el nmero de premio, lo que ha pasado es que ha ido en aumento el nmero de personas que reciben el galardn en un mismo ao, es decir comparten dicho premio.But when showing how well (or badly) women are represented among people awarded the Nobel Prize, isnt the more significant number their share among the people who were named laureates? If so, the %age of women in the totals will be lower for every 20 year period -- 3.8%, 4.8%, 4.2%, 2.8%, 3.7%, 10.3%. Since two or more people often share a single prize, women may often have shared a prize with a man or two. Do we want to suggest that those are prizes won by women and not men. The number of prizes awarded did increase from 5 to 6 per year (or 100 to 120 per 20 year period) in 1968, when they added the prize in economics.

7Chronic & NCD dominate the disease burden

DALYs (%), women 15+, by cause-group and regionSource: Estimates based on Global Burden od Disease Study, 2013. IHME, 2015.InjuriesNon-communicableCommunicable, maternal and nutritional% DALYs

Source: Cepal, 2012. The epidemiologic profile of Latin America and teh Caribbean: challenges, limits, and actions.; and IHME GBD Study 2013. CommunicableNon-CommunicableInjuriesIn just over 40 years, LAC will achieve the aging rates that most European countries took over two centuries to reach.Life expectancy has increased from 30+ in 1920, to 75+ todayIn a very short time period, the causes of death have reversedDemographic and epidemiologic transitions have been rapid and profoundWomen's epidemiologic transition, LAC1990201335%58%7%23%71%6%OutlineWomen in transitionThe framework: measuring myriad contributions of women to health and the health sectorThe economic value of women's contributions to health & the health sector Global & Mexico

I would recommend making this first section shorter so that you can get more quickly to whats new in this study the estimates of the value of womens unpaid and paid contributions to health. People are generally aware that womens participation in education, the labor force, various professions, etc. have increased and that women still do a great deal more work and caregiving at home as well (as the last slide in the section highlights). I dont think we need more slides to make that point than we have in either the second or third sections of the presentation. 10The many contributions of women to health and the health sectorPaid work in the health sectorPaid and unpaid contributions to caregiving & the health sectorUnpaid contributions through volunteerism

Womens contributions, even if paid, are often undervalued and under-paid & congregate in low-pay, feminized fields. DiscriminationThis slide might go better BEFORE the previous one, which refers to paid and unpaid etc.Data: 32 countriesEmployment and time use survey data for Canada, Spain, Turkey, Mexico and PeruPublished reports of results of Time Use Surveys for 27 countriesRepresents 52% of the global populationLow income, 4%Lower middle income, 91% Upper middle income, 17%High income, 33%

Counting strategies and estimations (14)DF=Gender discrimination factorNet/Gross: Social Security and taxes standard valuationI find this slide quite confusing both visually and conceptually. It might be less so if the primary division were between paid and unpaid, rather than between public and private. The voluntary/unpaid branch in the public tree confuses things somewhat for me especially since it includes the same sub-branches as the other unpaid work (Heckman, minimum wage, by occupation) but inexplicably ends there, without the DF-Without DF branches and Net-Gross twigs.Or perhaps it would make sense to replace this slide with the slide that has been moved out of the active deck that presents this methodology in text. This may be a case where a summary of the words you will be saying on the screen would be more helpful to reinforcing the information you are conveying than trying to talk to a complicated and potentially confusing visual representation. 13What could not be measuredUnpaid contributions to disease prevention and health promotion in in home-based activities that are only partially health-relatedInnovation and ideasInvestment of womens earning in health directly or through taxationIncreased economic growth due to increased health dynamic contributionsOutlineWomen in transitionThe framework: measuring myriad contributions of women to health and the health sectorThe economic value of women's contributions to health & the health sector Global & Mexico

I would recommend making this first section shorter so that you can get more quickly to whats new in this study the estimates of the value of womens unpaid and paid contributions to health. People are generally aware that womens participation in education, the labor force, various professions, etc. have increased and that women still do a great deal more work and caregiving at home as well (as the last slide in the section highlights). I dont think we need more slides to make that point than we have in either the second or third sections of the presentation. 15PAID: 51.2%UNPAID: 48.8%TOTAL:US$ 3.1 TRILLION4.8% Global GDP Exceeds total US+UK health budget2.9 times Mexican economy 20% of the US economyEach and every woman contributes $1,200 to health annuallyTotal value of women's contributions to the health sector: PaidUnpaidLower boundWages reported in the surveyUpper bound2.43%2.85%6420Proportion of global GDP (%)Global Contributions of Women to the Health Sector: Upper & Lower Bound Estimates

% GDP & trillions of $US$1.56$1.49 2.35%2.47%2.27%2.17%The labeling of the x-axis on this graph appears to be off by a factor of 10. It shows womens contribution ranging from 40+% to over 50%. It should be more like 4.4% to 5.3%.

171.1%2.35%T$1.53.5%2.5%2.47%T$1.61.8%PaidUnpaidBased on Country Minimum WageWages reported in the surveyWages adjusted by social benefits package and sexGlobal Contributions of Women to the Health Sector

% GDP & trillions of $US, by method of wage valuation6420Proportion of global GDP (%)8T$3.1$T3.3$T2.8This graph could use an x-axis, like the one before but with the right numbers on it.18Hours per woman per week dedicated to caring for health at home, by income regionHours a week per capita devoted to health care at homeSource: Own estimates based on data from 32 countriesGlobal average = 2.513.133.122.011.83Lower incomeLower middle incomeUpper middle incomeHigh income3120These numbers look low especially in comparison to the numbers of hours per week shown for care giving in the pie charts on slide 8 41 hours for women and 20 hours for men. Slide 8 didnt limit it to care at home so I guess that could account for much of the difference. Do the numbers on this slide also reflect a narrower definition of caring for health vs. the care giving on slide 8?19Estimated Value of Women's Paid and Unpaid Contributions to the Health SectorCanada, Spain, Turkey, Mexico, PeruDetailed calculations using household surveys and several wage scenarios6.2Wages reported in the surveyAdjusted by social Benefits package and sex differencesProportion of GDP (%)0.41.31.60.41.84.20.71.60.20.3PeruMexicoTurkeySpainCanada0.92.12.90.93.16.212.20.50.5PeruMexicoTurkeySpainCanada0246810PaidUnpaidMexico: Value of work in the health sector Women & men 2010, by wage valuation method VoluntaryPaid

Unpaid1.6% GDP1.0% GDPWomen: B$13.6Men: B$8.7Wages reported in surveyWomenMen0.0320.0450.0268.110.905101520USD $ BILLIONSWages reported in surveyWhat are the men doing? 5.87.84.93.8Unpaid work dedicated to health activities in the home, including health promotion

Women, 15 years and older, average hours / week2.3Unpaid full time health care Joint health and other activities assuming 25% of time is health3.4% GDP1.1% GDP2.3 hours7.2 hours (of 29)What about girls