A growing body of evidence suggests that legislation and government programs to promote gender equality can be effective tools for improving public health. This column outlines some of the key research findings and what they might imply in the context of policy-making to combat the Covid-19 crisis.
Effective policies to reduce the burden of infectious diseases are critical to people across the globe. Economists are producing a growing body of evidence that a wide array of policies belongs in this discussion, including those that promote gender equality in legal frameworks, court rulings, social programs, customs, and the labor market.
Because gender inequality inside the household mirrors inequality across markets and social institutions, changes outside the home can increase women’s bargaining power within the family. When mothers and fathers have more equal say in how families allocate their scarce resources, the family tends to have better health outcomes. As such, a law focused on gender equality, which may seem to have no relationship with healthcare, can actually be an effective tool to promote public health through changes in household choices.
These findings come with more developed methods for measuring intra-household bargaining power – a necessary prerequisite for directly assessing the extent of intra-household inequality – and conducting program evaluations to learn what kinds of policies make a difference directly.
For example, Rosella Calvi measures the share of family resources that women have control over, and how changes in India’s inheritance laws affect that share. More equal inheritance rights provide women with more control over resources, increasing equality within the household. This change is partially responsible for increases in women’s life expectancy in India in the last 40 years. Increasing gender equality in inheritance laws – a policy seemingly unrelated to healthcare – has led to large improvement in the health of women and girls.
We find similar effects in our own work. We document how a monthly cash transfer targeted at mothers can increase their bargaining power in the family – and how that empowerment can lead to improved nutrition and health outcomes for all family members. For example, the women’s empowerment engendered by the famous Mexican cash transfer program, Progresa/Oportunidades/Prospera, increased nutritional attainment for the whole household. A similar cash transfer could reduce the malaria burden in Malawi substantially by supporting the role of women in pursuing healthy choices for their families.
Other policies that focus on gender equality have similar effects. For example, increasing the share of women working in a police force encourages women to report domestic abuse, and may thus decrease its likelihood. This, in turn, can improve women’s bargaining positions in the family, leading to improvements in household members’ health along a number of dimensions. Yet another policy example is equality in divorce legislation.
In the context of the Covid-19 pandemic, many decisions facing families across the globe could affect their risk of infection. Some critical examples include whether parents should work or children should attend school, and what kind of health prevention efforts to pursue. Social distancing has positive health externalities for all family members and so is a public good, at home and in the community. As such, we might expect more equal families to self-distance to a greater degree, and not contract Covid-19 as frequently.
Policy makers responding to Covid-19 should consider two critical questions.
First, should there be specific policies passed to promote gender equality during stay-at-home periods, and might they subsequently lead to lower infection rates? Pandemics can exacerbate domestic abuse through many channels, and policies to promote screening for violence in all health check-ups can be extremely valuable.
For example, the Australian government recently increased funding for programs to counter domestic abuse and promote mental health by hundreds of millions of dollars. These programs can increase women’s bargaining power in the family, and thus may result in a reduction in total infection rates.
Second, should policies be targeted more towards women so that they have empowerment effects as well as income effects? Gender targeting can increase a program’s effectiveness.
For example, cash transfers, such as the $1,200 stimulus payment being sent to Americans below a certain income level, could have been targeted to women. The Spanish government recently announced the rollout of a universal basic income (UBI) program, and that this is likely to be a permanent addition to their government services. Permanent cash transfers with an explicit focus on gender equality are more likely to be effective. Adding an empowerment effect on top of an income effect contributes to the primary goal of economic recovery, and can improve health, nutrition, education, and other critical outcomes for child and family welfare.
In sum, public health programs can be augmented through initiatives that promote gender equality. The Covid-19 crisis provides a huge opportunity. Large-scale changes to government services are temporarily palatable for the general public and governing elites in many countries, including the United States. Incorporating gender equality promotion provisions in Covid-19 responses can have large and enduring benefits for families and communities across the globe.