A major new Commission on women and health has found that women contribute approximately $3 trillion to health care globally—nearly 5% of global gross domestic product (GDP)—but almost half of this (2.35%) is unpaid and unrecognized.

The Commission’s report, published in The Lancet (2015; doi:10.1016/S0140-6736(15)60497-4), is one of the most exhaustive analyses to date of the evidence surrounding the complex relationships between women and health, and demonstrates that women’s distinctive contribution to society is under-recognized and undervalued—economically, socially, politically, and culturally.

The report underlines that women are important providers as much as recipients of health care, and that globally, their changing needs in both of these respects are not being met.

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“Too often, women’s health is essentially equated to maternal and reproductive health.  However, the evidence outlined by this Commission overturns this conventional interpretation, and we urge the global health community and policymakers worldwide to embrace a more holistic—and realistic—understanding of women and health,” said Ana Langer, MD, head of the Women and Health Initiative at Harvard T.H. Chan School of Public Health in Boston, Massachusetts, who co-led the commission. “It’s time to acknowledge women’s comprehensive health needs throughout their lives, and their productive contributions to health care and society as a whole, as well as their similarly important roles as mothers and homemakers.”

The Commission, which brought together leading thinkers, heads of programs, and activists from around the world, examines the complex links between biological, economic, and social factors in improving women’s health throughout their lives. These include the substantial effects of rapid globalization, urbanization, and climate change, all of which have inequitable effects on women’s health.

“Often urban areas are developed without any input from women, and without addressing their needs for adequate lighting, safe transportation, access to healthy food, to infrastructures that promote community connectivity, and to integrated health care, child, and elder care. This puts women at increased risk of violence, noncommunicable diseases, and stressful life overload, which may in turn have adverse consequences for their families,” said Afaf Meleis, PhD, from the University of Pennsylvania School of Nursing in Philadelphia, who co-led the Commission with Langer.

The authors concluded that gender equality and empowerment must be central to the policies and interventions used to improve health care and to human, social, and economic development, especially in the post-2015 era.

In addition, the Commission analyzes data from 32 countries, accounting for 52% of the world’s population, to estimate that the financial value of women’s paid contribution to the health system in 2010 was 2.47% of the global GDP and 2.35% of GDP for unpaid work (largely domestic care for family members, which is only officially acknowledged and compensated in a small number of countries, including Costa Rica, Turkey, and the United Kingdom). Women’s contributions to health care amount to a total of US$3 trillion, more than the US and UK government’s combined total annual expenditure.

“Nurses form the largest global workforce in health care, and the majority of them are women. Many nurses work in unprotected environments and their scope of authority is incongruent with education and experience. All this can lead to burnout, attrition, severe shortage, and affects their health, and the health of others,” added Meleis.