Whether it’s thanks to shouldering the majority of unpaid care work, or facing poor conditions in their roles as paid carers, women laboring in the care economy face serious threats to their health.

Felicia Knaul is an international health economist and professor in the University of Miami’s Department of Public Health Sciences. Her work on women’s health includes a leading co-author role on the final report of the Lancet Commission on Women and Health, and an advisory role to the Healthy Women, Healthy Economies initiative funded by Merck KGaA, Darmstadt, Germany, which operates its businesses as EMD Serono, MilliporeSigma and EMD Performance Materials in US and Canada.

As part of our spotlight on the care economy, we spoke to Knaul about the threats to women’s health thanks to care work, and how governments and societies can address them.

Apart from the obvious moral imperative, what is the economic imperative for improving health outcomes for women worldwide?

Policymakers have a choice between creating a vicious circle or creating a virtuous circle between women, health and the economy.

Investing in health, the health of anyone, has a huge economic return. And this has been proven. We have evidence — historical, about the determinants of economic growth, and microeconomic data.

For me, the most elegant research illustrating this is the Nobel prizewinning work of Robert Fogel, where he looked at a couple of hundred years’ worth of data from Great Britain that showed how height had changed and how this is related to improved health and nutrition. Investing in the health of women, in addition to its intrinsic importance, means more economic growth.

The women and health approach shows that in addition to our concern for the health of women, women produce the majority of healthcare in our world. They are both consumers and very important producers of health care. I participated as a co-author in a paper that actually measures the value of all of the contributions of women to health care, both paid and unpaid.

Women produce the majority of health care. This may not have been true historically, but it is today. The majority of medical students are women, as are nurses. And women also produce the majority of unpaid care-giving. So if you don’t invest in the health of women you’re also detracting from their ability to produce health directly as paid providers.

What is the scale of women’s contributions as “producers of healthcare”?

Our estimated economic value of women´s multiple paid and unpaid contributions to health care is over five percent of global GDP. A huge number – over $3trillion. About half of that is unpaid work.

And, even five percent is a very conservative and likely underestimated figure because we only quantified hours of unpaid caregiving that are directly associated with health.

It does not account for all of the myriad tasks that are undertaken to promote health and prevent disease, including the hours and hours that so many women around the world spend looking for wood to boil water. Another example is the work that women do to prepare nutritious meals.

In terms of unpaid care, what are the health implications of that burden falling on women?

Women’s employment has gone up tremendously, education has gone up tremendously; in many countries we’re approaching gender equity. We have in many places a situation where women want and should be able to participate in the labor market fully (though often with a gap in their pay) and combine this in a healthy way with other facets of life, like having a family.

But there is a downside to that incredible opportunity to work. Just take the 24 hour day, the 168 hour week, and ask the simple question: “if you have an eight hour job and then you do eight hours or more of caretaking and domestic work, how much is left for sleep?” The data suggest that many women don’t have even six hours in a day left for rest. These women do not have the opportunity to invest the necessary hours to maintain their health and wellbeing — mental or physical.

As I see it, there is one route and it is equitable, fulfilling and efficient. Both men and women should have the opportunity and joy of caring for one’s family and combining this with work.

Skipping to another, specific issue around unpaid caregiving that there is no formal training or professional support or legal protection. You are expected to learn on the job – how to lift, manage personal hygiene and care for yourself in the process of caring for another person.

Women working in paid care roles can still be difficult for government to reach: they may be migrants, or working in under regulated sectors. How do governments improve health outcomes for them?

First, I believe very strongly that what you don’t measure you can’t correct. That’s why we felt so strongly in the Healthy Women, Healthy Economies programs about measuring women’s contribution and bringing that to the attention of policymakers.

But I also believe very strongly in universal health coverage and health insurance. When you ask “how do you reach these women?” if they aren’t covered by health insurance, it’s just that much more difficult.

One example to draw from is the 2004 policy innovation in Mexico called the Seguro Popular, that seeks to make a package of benefits available to all those who do not have salaried employment and work in the so-called informal sector.

Guaranteeing universal access to prepaid, pooled public insurance for all is essential for health and for healthy economies.

Read More:

• The Costs of Caring: Balancing the Burden of Caregiving for Women and Men
• The Burden of Care: The Impact of Progressive Policies
• This Indian Women’s Union Invented a Flexible Childcare Model
• The Workplace Has Failed to Adapt to Mothers’ Needs — and It’s Taking a Toll
• “Norway’s “Daddy Quota” Means 90 Percent of Fathers Take Parental Leave”