IN Indonesia, heartbreaking stories about health care workers who died as a result of the coronavirus disease 2019 (Covid-19) started appearing in newspapers within weeks of the first diagnosed cases in the country. Doctors, nurses and other frontline health workers without appropriate personal protectic equipment (PPE) were falling gravely ill and in far too many cases, dying. Similar stories appeared across many Association of Southeast Asian Nations (Asean) member-states.
We are now about six months into the Covid-19 crisis and a few things have become clear:
– Older people are more vulnerable to the disease and more likely to need substantial care.
– Increased exposure results in higher likelihood of infection. Care providers are on the frontline of exposure — often without proper PPE.
– A strong immune system is key to minimizing susceptibility.
– Women who are caring for others are often expected to maintain their usual roles and responsibilities which leads to long hours of work, sleep deprivation, exhaustion and ultimately less capacity to fight off viruses.
– Women comprise a disproportionately large share of healthcare workers — the World Health Organization (WHO) estimates that 70 percent of health workers globally, with an even larger representation in care homes. In the informal sector, the discrepancy is even greater. Women are three times more likely than men to care for ill people. Daughters are expected to care for ageing parents — their own and their husband’s. Women are much more likely than men to care for aged friends and neighbors who fall ill.
Taken together, these facts expose several issues related to the gender gap in healthcare, especially in Asean. In the immediate term, women make up by far the larger percentage of coronavirus infections among health care workers. In a recent study based on data from Spain, United Nations Women found that 76 percent of infected health care workers were women. Similar percentages were found in the United States (73 percent) and Italy (69 percent). This is dramatically higher than the percentages representing the general population where women make up about 46 percent of those infected. And these percentages did not include informal caregivers, where women make up an even higher percentage of carers. Furthermore, UN Women reported that women in the Asia-Pacific region are much less likely to receive health and safety information to help them prepare for Covid-19.
In a nutshell, the immediate problem is how to assist the Covid-19 heroes — the women who make up the majority of caregivers for the sick and elderly. But this quickly merges into the larger issue of addressing the gender gap in ageing care in Asean in general. In fact, this is an issue that is growing in importance regardless of the pandemic as many Asean countries are entering a phase of ageing population.
Asean has one of the fastest growing ageing populations in the world. Singapore and Thailand are already, with Vietnam and Brunei trailing by just a few years. Within about 20 years, Asean as a whole will have reached this stage. Asean is aware of this issue and has already recognized the need for bilateral and region cooperation to address the issue (Chairman’s Statement of the 20th commemorative summit of Asean Plus 3).
The impact of ageing populations on women, as the main providers of elderly care, is huge. These jobs are generally low-paid and often provide unsafe working conditions.
A recent study of elderly care in the Philippines funded by the Economic Research Institute for Asean and East Asia (ERIA 2019) showed that informal care for older people was provided by women to a far greater extent than by men. (Cruz, G.T., C.J.P. Cruz and Y. Saito [eds.], 2019, Ageing and Health in the Philipines. Jakarta: ERIA)
About 6 in 10 men reported that their major caregiver is their spouse. Women most commonly reported a daughter as their major caregiver (38 percent) with only 18 percent cared for by their spouse.
This gender gap is even wider when it comes to long-term care (LTC) because “the idea of LTC being handed over to non-family members, much less to institutional facilities such as nursing homes, is not yet in the consciousness of the current cohort of older Filipinos.”
(ERIA, 2019) In fact, 73 percent of the respondents to the survey over the age of 60 believed it was preferable to live with a daughter rather than with a son. (ERIA, 2019)
These kinds of numbers are not unique to the Philippines. At a recent ERIA event on post-Covid-19 care for older people, co-hosted with the Indonesian Ministry of Planning and Development, Dr. Kirana Pritasari, the director general of Public Health at Indonesia’s Ministry of Health, said about 80 percent of Indonesia’s older people live with family, where women are the main caregivers.
The impact on women, and in turn on families, is huge. In the informal sector, women who do not receive appropriate training are far more likely to fall ill. They are then more likely to spread illnesses to their families, especially if they are not aware of appropriate protocols. Women who are providing care for elderly family are often unable to continue earning an income outside the home.
Policies to adopt
As Asean governments prepare recovery packages, they can consider addressing the gender gap in informal care as a long-term issue, not just one that has arisen due to the pandemic. As developing countries, many Asean members do not have the same capacity as more advanced economies to care for older people. Yet they are among the most rapidly ageing populations in the world. This reality calls for early planning in order to support policies that can address the issues:
– Training is needed for informal caregivers in order that they know basic best treatment and safety practices and can cope with the physical and emotional burden of care.
– Incentivize the private sector to provide more care facilities and higher wages for care workers through tax deductions or other policy mechanisms. The low wages issue needs to be addressed to attract more people to work in this field.
– Consider providing financial benefits in the form of allowances for qualified long-term care workers in the informal sector.
– Develop professional long-term care services so that the responsibilities for care can shift from the informal sector.
Covid-19 presents an opportunity. By exposing the ‘essential’ nature of informal care, especially for older people, the pandemic has significantly raised awareness of this critical role that women play. As Asean is home to one of the most rapidly aging populations in the world, there is no better time than now to start addressing the issue in the pandemic recovery plans with policies and programs that tackle the current gender gap in long-term informal care.
The author is director of communications at the Economic Research Institute for Asean and East Asia, Jakarta, Indonesia.