The health and caregiving workforce:

An array of inequities
Gender Equal Health and Care Workforce:
Economic Justice and Equality for Women in Health and Social Care

Generation Equality Forum Mexico Side Event

March 29, 2021

Felicia Marie Knaul, Beverley Essue and Héctor Arreola-Ornelas

on behalf of the Research Hub on
Gender Equity in Health Systems and Caring Economies
 Women produce
the majority of
health care
- paid & unpaid –
in a context of
adversity Langer, Meleis, Knaul, Atun
et al. The Lancet, 2015.

and discrimination.
Women and Health Initiative
Harvard THChan
School of Public Health
 Data: Lancet commission 2015,
and 2021 Update
2015 2021
Micro data - 5 countries: - 14 countries: Pakistan, Ghana,
•
•
wages by occupation
hours of paid work Turkey, Mexico, Mongolia, Brazil, Mexico,
• hours of unpaid work Colombia, Peru, USA, Chile,
• hours of health promoting
work
Canada, Spain, Germany, Canada, Iceland,
Peru Spain, Japan

Aggregate data
• hours of unpaid health
- 30 countries - 49 countries
work

Knaul, Arreola-Ornelas,
Essue, Atun, Langer, on
behalf of the Research
Hub on Gender Equity
in Health Systems and
Langer, Meleis,
Caring Economies
Knaul, Atun et al.
The Lancet, 2015.
Value of women's contributions to
the health sector globally:
(Lancet, Women and Health, 2015)
PAID:
TOTAL: 51%
US$ 3.1 TRILLION
4.8% Global GDP UNPAID:
49%
• Exceeds total US+UK health budget
• 2.9
Ourtimes Mexican
research economy
update
includes• an
20% of the US
estimate ofeconomy
discrimination:
• Each and every
2-3% higher & a woman
larger %contributes
is unpaid
$1,200 to health annually
 Globally: Women contribute the majority of
Unpaid and Paid Hours, Lancet Commission 2015

Distribution UNPAID hours Distribution PAID hours

26Men
Men
45
62% Women
Women 55

74
Globally: Women´s contributions outweigh those of
men: paid and unpaid, Lancet Commission 2015
% GDP

UNPAID PAID

2.35 % 2.47%

1.24

0.71

WOMEN MEN
1 2

Women Men Women Men

 Women contribute the majority of
UNPAID health-specific caregiving and
health promoting domestic work
(min, median, max over 14 country sample)
• Hours:
– health-specific caregiving: 68% (63 – 83%)
– health-promoting domestic work: 64% (57% - 82%)
• Total hours: 63% (59% - 77%).
• Value:
– health-specific caregiving: 62% (57% - 74%)
– health-promoting domestic work: 58% (53% - 73%)
• Total Value: 58% (54% - 73%).
 Unpaid work: health specific caregiving &
health promoting domestic work, México, 2019
Average hours / week Value
15 years + (% GDP)
health-promoting
domestic work

27 hours
18 hours 10.9
7.9

7 hours 4 hours 2.9 2.0

1 2

Women Men Women Men

Women contribute the majority of PAID
PAID health care and caring
(min, median, max over 14 country sample)

• Paid personnel:
75% (25% - 83%)
• Hours of paid work:
72% (23% - 82%)
• Estimated value of contribution in health
(without discrimination adjustment):
63% (18% - 83%)
 “Discrimination” Gap
in Value of Paid Health Contributions
(average over all health occupations)

14 countries 15% - 40%

analyzed

Mexico 22%
 Women in Medicine
% of all physicians 1980-2018,
60
select countries (OECD) Canada:
->40% of doctors
50
-63% of medical
40
students.
-2/17 deans of
30
medicine
20
-6/26 Canadian
2000 2005 2010 2015 2018
Medical Association
Austria

Germany
Belgium

Greece
Canada

Hungary
Denmark

Ireland
Israel

Slovak Rep.
board
Netherlands New Zealand Poland Portugal USA

Sweden Switzerland Turkey U.K https://cmajnews.com/2018/03/26/rise-of-

France women-in-medicine-not-matched-by-
Source: OECD Statistics. Italy Spain leadership-roles-cmaj-109-5567/
 Membership of Women in LatAm
National Academies of Medicina, 2020
Country Total
members Women, %
Mexico:
Founded in 1864, Argentina   245  4.%

the first women was Bolivia 15  20%

Brazil
admitted in 1957. 107 5%
Colombia 228 6%
Today 15% of the Chile 125 6%
650+ members are Mexico 650 15%
 
women and the first Panama 30 10%
female President Peru 151 12%
was elected in 2018. Venezuela 108 14%
Uruguay 48 13%
 “Full” medical employment
Mexico, 1990 -2019
100
Women Men

79 79
80
68
64 62
60 57
51

40
32

20

0
1990 2000 2014 2019
 Womenomics or just
common sense?
• Women account for approximately 40% of the
world’s workforce, with a labor force
participation of 53%; well below the 80% men

• If female labor market participation = men

– Women would contribute an additional $28
trillion, or 26% of global GDP in 2025
– (the US and Chinese economies combined) *
*McKinsey Global Institute. (2015). The Power of Parity.
 Women are
the motors of economic growth &
produce the majority of health care
- paid & unpaid—,
subsidizing economies.
Yet,
health systems are disabling
instead of enabling to women.
First steps: count, value & invest.
 Research Hub on
Gender Equity in Health Systems and Caring Economies

Felicia M. Knaul, Universidad de Miami & Tómatelo a Pecho. (Mexico)

Beverley Essue, Universidad de Toronto (Canada)
Héctor Arreola Ornelas, Fundación Mexicana para la Salud, (México)
Xiaoxiao Jiang, Universidad Harvard, (China)
Óscar Méndez Carniado, Fundación Mexicana para la Salud, (México)
Renzo Calderón, Universidad Cayetano Heredia (Perú)
Renu Sara, Universidad de Miami (USA)
Layla Claure, Universidad de Miami (USA)
Benjamin Tortonali, Universidad de Miami (USA)
Maya Symes, Universidad de Miami (USA)
Alyssa Liu, Universidad Harvard, (China)
Sonia X. Ortega, Fundación Mexicana para la Salud, (México)
Salvador Acevedo, Fundación Mexicana para la Salud, (México)