Have you perhaps been wondering to what degree the health and wellbeing of women & girls will be valued as the global patriarchal structure shudders under the ongoing environmental, geopolitical, economic, and social shocks flowing from climate change? You are not the only one.

The Lancet

Vol 404 August 24, 2024

Many crises, one call to action: advancing gender equality in health in response to polycrises

Rajat Khosla, Gita Sen,

Tedros Adhanom Ghebreyesus,

Winnie Byanyima, Sima Bahous,

Debora Diniz, et al.

Published: July 24, 2024

The state of polycrises linked to concurrent conflict, climate catastrophe, the COVID-19 pandemic, the ongoing HIV epidemic, and geopolitical, economic, and social shocks is a cause of deep concern for the global health community. Polycrises, including the ongoing atrocities in Gaza, Sudan, and Myanmar, political movements in different countries that threaten to over-turn human rights and climate laws, or the flash floods in Bangladesh, Brazil, and Tanzania, have led to a new era likely to worsen gender inequalities and health challenges in terms of scale, severity, and complexity. Not only have these crises laid bare injustices and entrenched gender-based intersectional inequalities that exist in health, but they have also deepened and widened health disparities within and across countries, with differences starkly marked along lines of income, sex, age, race, ethnicity, migratory status, disability, and geographical location, among other factors.1

Taking stock of the gendered impact of polycrises is the first step towards forging a collective response from governments and the global health community. Globally, women make up the majority of extreme poor among people aged 15 years and older, with the gender poverty gap forecast to widen by 2030.2 Disproportionate job losses and limited access to financial resources in a climate of economic insecurity have pushed women into precarious work environments, jeopardising their health, integrity, and safety.3 The responsibilities of caregiving also intensifies during polycrises, with women and girls taking on greater responsibilities, including childcare, care of ill or dependent persons, and older persons care, and frequently neglecting their own health needs.4, 5 Clinic closures, resource shortages, and displacement due to crises disproportionately affect women's access to health services, such as reproductive health care, prenatal care, and safe childbirth.6 Even some high-income nations are among the 19 countries that had a higher maternal mortality ratio in 2020 compared with 1990. 7 Furthermore, conflict, climate displacement, and the effects of the COVID-19 pandemic are contributing to concerning increases in gender-based violence and harmful practices such as child, early, and forced marriage, female genital mutilation, and son preference.7

The adverse impacts of polycrises on women's and girls' rights and health extend to their crucial roles as health workers. Women, who make up almost 70% of the global health workforce and 90% of nurses and midwives, are the front line of the health system; they deliver vital health services during crises and are often exposed to violence, especially in places affected by conflict.8, 9 Yet women in the health workforce are usually inadequately paid, insufficiently valued, and under-represented in leadership and decision-making positions.10

Alongside polycrises, there have been unprecedented attacks on the bodily autonomy, choices, and human rights of women and girls.7 Globally organised movements have mobilised against laws related to access to safe abortion and contraception, LGBTQI+ rights, and comprehensive sexuality education.7 This is visible in different forms, ranging from increasing levels of violence, hate speech, and misinformation campaigns to difficulties accessing funding for health and human rights organisations and the introduction of regressive laws or failure to eliminate discriminatory laws and policies.11

In this climate of competing priorities and recurrent crises, governments, UN agencies, donors, and civil society groups collectively hold immense power to ensure action is taken to advance and prioritise women's rights, gender equality, and human rights, including the right to health. This approach is paramount for mitigating and preventing the deepening of future crises.12 Evidence indicates that narrowing the gap in women's health would avoid 24 million life-years lost due to disability, add more than US$1 trillion to the global economy, and increase economic productivity by up to $400 billion.13 However, these investments need to be combined with enabling legislation and support for gender equality in health, including bodily autonomy and integrity more broadly. In this context, it is only through true collective action that we can bring about the changes that are direly needed. In particular, our joint efforts need to focus on three key areas.

First, funding and increased support are needed to strengthen investments, partnerships, and research led by grass-roots communities and feminist and women-led civil society organisations. Communities, notably, feminist and women-led civil society groups, hold a rich understanding of how crises play out and affect gender disparities, health, and rights of communities. They are well placed to document and deepen our understanding of this impact and identify contextually relevant solutions to advance gender equality and rights. During a crisis feminist and women-led organisations are also often directly involved in the provision of health services, including sexual and reproductive health services and information, in contexts where public goods and services are limited or no longer available.14, 15 Despite widespread evidence of the essential roles of feminist civil society and movements, investments in community-led research and partnerships are shrinking and being deprioritised in the context of polycrises.16, 17 Governments, UN agencies, and donors must act now and reverse this trend.

Second, policies are needed to support alignment across institutions and struggles for equality and rights. Fragmentation is happening at multiple levels and includes disjointed systems that promote siloes, competition, or polarisation between movements striving for gender equality and women's rights.18, 19 These challenges can manifest as the frequent exclusion of ministries of finance in discussions to ensure the right to health and wellbeing of women and girls, or as hostile attacks between gender equality and rights-based movements that unfold on social media platforms, quickly degenerating into the use of stigmatising labels and exclusionary language. Irrespective of how this fragmentation develops, it is fuelling mistrust and creating restrictive environments that hinder meaningful collaboration and collective action. It is imperative that collective efforts better integrate systems and processes and build links across struggles, particularly the multiple intersections of inequalities.

Third, financial responses at global, regional, and national levels need to be formulated so that they support gender equality and women's rights. Current financial responses during crises frequently impede the upholding of human rights and in turn deepen income inequalities.20 For instance, immense pressure on governments to focus on austerity policies and debt repayments during and after crises detracts from investments in essential public services and in communities that have been most impacted.20 The global financial architecture, right down to national budgets and ministries of health and finance, needs to have a more deliberate approach to investing in gender-related issues and women's rights to ensure support is provided to the communities and groups most affected by crises. Learning from and with feminist financing models offers a strong baseline to build from.21, 22 Not only will this approach support short-term stabilisation during crises, but it will also build long-term resilience and equity in resource mobilisation and allocation.

Global overlapping crises are worsening gender equality and health disparities. Addressing these issues requires us to unite political, health, and civil society leadership efforts towards reinforcing community-driven partnerships, reforming financial and health strategies to support equality, and integrating systems to create cohesive responses. Now is the crucial moment to act.

1 World Economic Forum. The global risks report 2023. 2023. https://www.weforum.org/publications/global-risks-report-2023/ (accessed July 8, 2024).

2 UN Women. From insights to action: gender equality in the wake of COVID-19. 2020. https://www.unwomen.org/en/digital-library/publications/2020/09/gender-equality-in-the-wake-of-covid-19 (accessed July 8, 2024).

3 International Labour Organization. Policy brief: a gender-responsive employment recovery: building back fairer. 2020. https://www.ilo.org/publications/gender-responsive-employment-recovery-building-back-fairer (accessed July 8, 2024).

4 UN Women. Gender alert: the gendered impact of the crisis in Gaza.2024. https://www.unwomen.org/sites/default/files/202401/Gender%20Alert%20The%20Gendered%20Impact%20of%20the%20Crisis%20in%20 Gaza.pdf (accessed July 8, 2024).

5 Power K. The COVID-19 pandemic has increased the care burden of women and families. Sustainability Sci Pract Policy 2020; 16: 67–73.

6 World Economic Forum. Why we need more female voices while addressing humanitarian crises. 2022. https://www.weforum.org/agenda/2022/05/listening-to-female-voices-can-stop-humanitarian-crises-harmingwomen-s-and-girls-health/ (accessed July 8, 2024).

7 UNFPA. Interwoven lives, threads of hope: ending inequalities in sexual and reproductive health and rights. 2024. https://www.unfpa.org/ swp2024 (accessed July 8, 2024).

8 Ignacio AR, Sales K, Tamayo RL. Seeking gender equality in the global health workforce. Think Global Health. March 8, 2024. https://www.thinkglobalhealth.org/article/seeking-gender-equality-global-healthworkforce (accessed July 8, 2024).

9 WHO, Global Health Workforce Network, Women in Global Health. Closing the leadership gap: gender equity and leadership in the global health and care workforce. 2021. https://www.who.int/publications/i/item/9789240025905 (accessed July 8, 2024).

10 Phillips G, Kendino M, Brolan CE, et al. Women on the frontline: exploring the gendered experience for Pacific healthcare workers during the COVID-19 pandemic. Lancet Reg Health West Pac 2023; 42: 100961.

11 Petersen MJ. Religion, gender, and sexuality: three points on freedom of religion or belief. BYU Law International Center for Law and Religion Studies. Nov 21, 2022. https://talkabout.iclrs.org/2022/11/21/religiongender-and-sexuality/ (accessed July 8, 2024).

12 Percival V, Thoms OT, Oppenheim B, et al. The Lancet Commission on peaceful societies through health equity and gender equality. Lancet 2023; 402: 1661–722.

13 World Economic Forum. Closing the women’s health gap: a $1 trillion opportunity to improve lives and economies. 2024. https://www.weforum.org/publications/closing-the-women-s-health-gap-a-1-trillionopportunity-to-improve-lives-and-economies/ (accessed July 8, 2024).

14 UN. Human Rights Council. A/HRC/47/38: women’s and girls’ sexual and reproductive health rights in crisis. Report of the Working Group on discrimination against women and girls. April 28, 2021. https://www.ohchr.org/en/documents/thematic-reports/ahrc4738-womens-and-girlssexual-and-reproductive-health-rights-crisis (accessed July 8, 2024).

15 UN Women. Gender alert: voices of strength: contributions of Palestinian women-led organizations to the humanitarian response in the Occupied Palestinian Territory. 2024. https://www.unwomen.org/en/digital-library/publications/2024/06/gender-alert-voices-of-strength-contributions-ofpalestinian-women-led-organizations-to-the-humanitarian-response-inthe-occupied-palestinian-territory (accessed July 8, 2024).

16 The Young Feminist Fund, The Association for Women’s Rights in Development’s Young Feminist Activism Program. The global state of young feminist organizing. 2016. https://youngfeministfund.org/wpcontent/uploads/2017/05/Global-State-of-Young-Feminist-Organizing.pdf (accessed July 8, 2024).

17 Aho E, Grinde J. Shrinking space for civil society—challenges in implementing the 2030 Agenda. Forum SYD. 2017. https://www.forumciv.org/sites/ default/files/2018-03/Shrinking-Space%20%20Challenges%20in%20implementing%20the%202030%20agenda.pdf (accessed July 8, 2024).

18 UN Women. Discussion paper. Democratic backsliding and the backlash against women’s rights: understanding the current challenges for feminist politics. 2020. https://www.unwomen.org/sites/default/files/Headquarters/Attachments/Sections/Library/Publications/2020/Discussion-paper-Democratic-backsliding-and-the-backlash-againstwomens-rights-en.pdf (accessed July 8, 2024).

19 Touimi-Benjelloun Z, Sandler J. Collective power for gender equality: an unfinished agenda for the UN. 2022. United Nations University International Institute for Global Health. August, 2022. http://collections.unu.edu/eserv/UNU:8897/Collective_Power_for_Gender_Equality.pdf (accessed July 8, 2024).

20 UN. United Nations Conference on Trade and Development. A world of debt report 2024: a growing burden to global prosperity. 2024. https://unctad.org/publication/world-of-debt (accessed July 8, 2024).

21 International Labour Organization, UN Women. Financing social protection: feminist alternatives to austerity. 2023. https://www.unwomen.org/sites/default/files/2024-01/financing_social_protection_en.pdf (accessed July 8, 2024).

22 Hessini L. Financing for gender equality and women’s rights: the role of feminist funds. Gender Development 2020; 28: 357–76.

 

RBA Governor Lowe set to meet with Suicide Prevention Australia after indications there is a surge in people reporting elevated distress over cost-of-living pressures

 

The 10th consecutive cash rate rise announced by the Reserve Bank of Australia has low income and middle income Australia reeling.

Post, a daily newsletter from The Saturday Paper, from the pen of the Emails Editor, 8 March 2023, excerpt:

RBA governor Philip Lowe has announced a record 10th consecutive interest rate rise, but signalled the run may be coming to an end amid concerns the hikes are hurting wellbeing.

What we know:

• The RBA increased rates by 25 basis points at the board's March meeting, to 3.6% — the highest interest rate since May 2012 (Nine);

• Mortgage holders with a balance of $750,000 will pay an extra $121 a month — and are now likely paying about $18,900 more in repayments annually since May (realestate.com.au);

• Lowe’s language softened on the prospect of future rate rises however, with economists suggesting there might only be one or two left (AFR $);

• He is set to meet representatives of Suicide Prevention Australia, the peak body that has raised the alarm about a surge in people reporting elevated distress over cost-of-living pressures (The Age);

• Research by Suicide Prevention Australia, given to Lowe late last week, shows 46% of people are reporting high levels of cost-of-living distress;

• There has also been a lift in the number of people reporting serious thoughts of suicide, which reached 16%, with sharp increases in NSW and Victoria;

• Lowe will give further clues as to the RBA’s plans in a speech about inflation and recent economic data to a business conference today (Canberra Times);

• The RBA governor has previously warned of a wage-price spiral driving inflation, though wage growth has been slowing, while corporate profits are surging (The Saturday Paper).

BACKGROUND

Reserve Bank of Australia

Media Release

Statement by Philip Lowe, Governor: Monetary Policy Decision

Number 2023-07

Date 7 March 2023

At its meeting today, the Board decided to increase the cash rate target by 25 basis points to 3.60 per cent. It also increased the interest rate on Exchange Settlement balances by 25 basis points to 3.50 per cent.

Global inflation remains very high. In headline terms it is moderating, although services price inflation remains elevated in many economies. It will be some time before inflation is back to target rates. The outlook for the global economy remains subdued, with below average growth expected this year and next.

The monthly CPI indicator suggests that inflation has peaked in Australia. Goods price inflation is expected to moderate over the months ahead due to both global developments and softer demand in Australia. Services price inflation remains high, with strong demand for some services over the summer. Rents are increasing at the fastest rate in some years, with vacancy rates low in many parts of the country. The central forecast is for inflation to decline this year and next, to be around 3 per cent in mid-2025. Medium-term inflation expectations remain well anchored, and it is important that this remains the case.

Growth in the Australian economy has slowed, with GDP increasing by 0.5 per cent in the December quarter and 2.7 per cent over the year. Growth over the next couple of years is expected to be below trend. Household consumption growth has slowed due to the tighter financial conditions and the outlook for housing construction has softened. In contrast, the outlook for business investment remains positive, with many businesses operating at a very high level of capacity utilisation.

The labour market remains very tight, although conditions have eased a little. The unemployment rate remains at close to a 50-year low. Employment fell in January, but this partly reflects changing seasonal patterns in labour hiring. Many firms continue to experience difficulty hiring workers, although some report a recent easing in labour shortages. As economic growth slows, unemployment is expected to increase.

Wages growth is continuing to pick up in response to the tight labour market and higher inflation. At the aggregate level, wages growth is still consistent with the inflation target and recent data suggest a lower risk of a cycle in which prices and wages chase one another. The Board, however, remains alert to the risk of a prices-wages spiral, given the limited spare capacity in the economy and the historically low rate of unemployment. Accordingly, it will continue to pay close attention to both the evolution of labour costs and the price-setting behaviour of firms.

The Board recognises that monetary policy operates with a lag and that the full effect of the cumulative increase in interest rates is yet to be felt in mortgage payments. There is uncertainty around the timing and extent of the slowdown in household spending. Some households have substantial savings buffers, but others are experiencing a painful squeeze on their budgets due to higher interest rates and the increase in the cost of living. Household balance sheets are also being affected by the decline in housing prices. Another source of uncertainty is how the global economy responds to the large and rapid increase in interest rates around the world. These uncertainties mean that there are a range of potential scenarios for the Australian economy.

The Board’s priority is to return inflation to target. High inflation makes life difficult for people and damages the functioning of the economy. And if high inflation were to become entrenched in people’s expectations, it would be very costly to reduce later, involving even higher interest rates and a larger rise in unemployment. The Board is seeking to return inflation to the 2–3 per cent target range while keeping the economy on an even keel, but the path to achieving a soft landing remains a narrow one.

The Board expects that further tightening of monetary policy will be needed to ensure that inflation returns to target and that this period of high inflation is only temporary. In assessing when and how much further interest rates need to increase, the Board will be paying close attention to developments in the global economy, trends in household spending and the outlook for inflation and the labour market. The Board remains resolute in its determination to return inflation to target and will do what is necessary to achieve that.

NSW State of Play 2023: governments being 'city-centric' has consequences that follow remote & outer regional populations to their graves

 

The Australia Institute, media release, 14 February 2023:

New analysis reveals residents born in Far West NSW are suffering substantially worse health outcomes than residents in Sydney.

People in Far West NSW are dying earlier than they should, from avoidable causes, and while suicide rates have steadied in Sydney, they are on the rise in the most remote parts of the state.

The report warns of serious and growing inequality in health outcomes between city and country residents and recommends immediate investment in the sector.

Key points:

• Life expectancy: People born in the Far West have a life expectancy 5.7 years less than those in Sydney, with the divide worsening

• Premature death: Residents in Far Western NSW are 2x more likely to die prematurely than those in Sydney

• Avoidable death: ‘Potentially avoidable deaths’ are 2.5x more likely in the Far West than in Sydney

• Suicide: Residents in the NSW Far West are 2x as likely to commit suicide than those in Sydney, with a clear upwards trend in suicide rates

“Far West NSW is in serious need of medical attention. Where you live shouldn’t dictate how long you’ll live, but unfortunately in NSW it does” said Kate McBride, Researcher at The Australia Institute.

“Those in the Far West have significantly poorer health outcomes, inferior access to health services and face substantial financial challenges to access services.

“Life expectancy, premature deaths, and ‘potentially avoidable’ deaths are key statistical indicators of whether our health system is working. It is clear from the analysis in this report, sirens should be sounding from the Far West of the state.

“There’s a compelling case for significant investment across the continuum of care, from disease prevention to rehabilitation and ongoing care, in regional NSW.

“The first release in a series, this report reflects a wider national trend: That the health system is failing those living in regional and remote Australia” said Kate McBride.

~~~~~~~~~~~~~~~~~~~~~~

RELATED RESEARCH

Kate McBride, The Unlucky Country: Life expectancy and health in regional and remote Australia. Part 1: NSW, February 2023.

FULL REPORT

~~~~~~~~~~~~~~~~~~~~~~

Excerpts from the McBride report:

“Australia has the world’s third highest life expectancy at 84.3 years. However, this national average masks the fact that the ‘lucky country’ has some rather less lucky residents. In every state and territory, those in regional and remote areas have life expectancies several years lower than in the city.

New South Wales (NSW) is a stark example of this divide. Life expectancy in Far West NSW is 79.1 years compared to 84.5 years in Sydney. This more than five-year gap has grown from relative parity at the turn of the millennium to the current gap. Today, a person in far west NSW is more than twice as likely to die prematurely (under 75) than someone in Sydney.

While there are many possible reasons for this discrepancy, overall, people die of the same causes in urban and remote parts of NSW; a comparison of the top causes of death in each area reveals that the top 10 are almost identical. However, regional and remote people are dying younger and from preventable causes at much higher rates than those in Sydney. Deaths considered ‘potentially avoidable’ are more than two and a half times as common in the far west than in the state’s capital.

It has been known for years that there is a suicide issue in regional Australia. Suicide rates in far west NSW—already more than twice as high than those in Sydney—are continuing to rise, while those in urban areas remain steady. But while suicide is a significant problem, it is only the tenth leading cause of death in the region. Suicide tends to take people at a younger age than other causes and as a result can disproportionally skew life expectancy, having said this there are other factors likely at play.

In 2022, a NSW Parliamentary Inquiry into health outcomes and access to services in rural, regional, and remote NSW found that people outside urban areas had significantly poorer health outcomes, inferior access to health services, and faced substantial financial challenges to access services.

This divide between life expectancy in the cities and in the country is a problem that extends beyond far western NSW. The city/country divide exists across Australia, and it is growing. Inequity between Australians living in capitals and remote areas is a significant problem that demands government intervention, particularly concerning overwhelmed and under resourced health systems.”

NOTE: I draw to the attention of "North Coast Voices" readers, living in what is the Australian Bureau of Statistics' Coffs Harbour-Grafton Level 4 Statistical Area, the fact that the combined populations of Clarence Valley and Coffs Harbour City have a projected life expectancy at birth which is 3.9 years lower than that of the population of the Greater Sydney metropolitan area. Only the projected life expectancy at birth for the Far West and Orana region has a worse comparative figure.

The only differences are dehydration and suicide (more below) in the Far West being replaced by heart failure and breast cancer in Greater Sydney. The similarity in causes of death suggests that the factors driving lower life expectancy in the far west are not due to different physical conditions or different lifestyles, but to how causes of death are prevented and managed. [my yellow highlighting]

Sadly, what the preceding paragraph is politely hinting at is that there is a culture within governments which tolerates and, perhaps even relies upon, inequality of access to health care along with an acceptance of delivery of poorer quality health care to those living in remote areas of New South Wales, as one of the tools which allows the provision of a much higher quality of health care to those living in metropolitan centres and inner regional areas on the fringes of major cities. 

That is where the bulk of the state's electorates and voter numbers are concentrated and, it will come as no surprise that ahead of the March 2023 state election little electoral growth was expected in the western half of New South Wales [Report of the Electoral Districts Redistribution Panel on the draft determination of the names and boundaries of electoral districts of New South Wales, 9 Nov 2020].

Australia's National Disability Insurance Scheme in 2020-21

"We have been bullied, berated, intimidated and lied to. We feel diminished and dehumanised." #NDIS participant Verity says "I would rather be dead than deal with more of this" #auspol @SBSNews pic.twitter.com/jPzx8Ec16Y

— Brett Mason (@BrettMasonNews) November 21, 2019

In December 2019 the Morrison Coalition Government was handed the Review of the NDIS Act report.

This report was published and reported on in January 2020 and the Morrison Government released its formal response in August 2020.

Concerns about details in the Morrison Government's response and other statements by the department and minister responsible led the parliamentary Joint Standing Committee on the National Disability Insurance Scheme to issue this media release on 16 December 2020:

COMMITTEE LAUNCHES INQUIRY INTO INDEPENDENT ASSESSMENTS

The Joint Standing Committee on the National Disability Insurance Scheme (NDIS) will conduct an inquiry into independent assessments under the NDIS. 

An independent assessment is an assessment of a person’s functional capacity, which will be used to inform decisions about eligibility for the NDIS and about funding in a participant’s plan. 

The National Disability Insurance Agency proposes to introduce independent assessments as part of the NDIS access and planning processes in 2021. 

“Through its other inquiries, the committee has heard that many stakeholders—particularly in the disability and allied health sectors—have strong concerns about the independent assessments process, and about how assessments will be used to inform access and planning decisions,” Committee Chair, the Hon Kevin Andrews said. 

The inquiry will have a particular focus on: 

• the rationale for introducing independent assessments into the NDIS, and the evidence to support this decision; 

• the assessment process and its impacts; 

• the implications of independent assessments for NDIS access and planning decisions; and 

• the appropriateness of independent assessments for particular cohorts of people with disability. 

The committee is particularly interested in hearing from people with disability, families and carers; allied health professionals; and representative organisations. 

Full terms of reference for the inquiry are published on the committee’s website. 

The closing date for submissions to the inquiry is 31 March 2021.

Terms of reference and guide to making a submission can be found at:

https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/National_Disability_Insurance_Scheme/IndependentAssessments