Beverley Essue : On the Economics of Investing in Women
Listen to the interview
Share
Jump to theme
Beverley Essue : On the Economics of Investing in Women
For Beverley Essue, economics is a way of tracing where power sits, where resources flow, and how systems can be re-engineered to better serve women.
In the halls of the old King George V Memorial Hospital for Mothers and Babies – long since repurposed into administrative and research spaces - Associate Professor Beverley Essue and I worked together more than a decade ago. Desks were stacked high with papers and books. The walls, lined with scrawled whiteboards and untidy notes, felt alive with ideas. Conversations on health systems, impact measurement, and innovative care approaches spilled out of offices and into the corridors, each cross-pollinating with the next, often in the tiny hallway kitchen.
Even then Beverley’s presence shifted the room. She thinks across layers, and with an eye for ripple effects. In conversation, she lingers on a word, weighs an idea, then accelerates into a rapid series of points that always return to the human stakes. It’s this focus – and perhaps just as much her infectious laugh - that galvanises action and draws others to her work. Since then, her career – as Associate Professor and Canada Research Chair in Economics of Global Health Systems Equity at the University of Toronto – has tackled some of the toughest questions in global health.
Beverley draws on a toolkit that often includes health economics, and while economics provides the lens, Beverley wields it with a distinctly feminist edge. At its core, she asks: how can health systems be fair, accessible, and responsive – especially to women and others in situations of vulnerability? Her answer lies in the mechanics of the system itself: how it is financed, how resources are allocated, and who is at the table when decisions are made. These choices determine who receives care, who bears the cost, and whose voices are too often absent from shaping the policies that affect their lives.
In this conversation, Beverley unpacks how she returned to gender-focussed work, the politics of centring gender in decision making, and the ideas and inspirations that anchor her, and ultimately how a gender-aware approach to health economics doesn't just illuminate inequities, it reshaped the structures that determine who is allowed to thrive.
A return to roots
A return to roots
Beverley’s central critique is that health systems are not neutral. Earlier in her career, she explored this through chronic disease prevention, financial risk protection and universal health coverage (UHC) – the goal of ensuring everyone can access essential health services without financial hardship. Gender was present in the background – her and her team knew women often spent more out of pocket on health care, or faced barriers to accessing care - but few opportunities existed to surface and focus those patterns. “My career started in sexual reproductive health – community programs, abortion care. Then I pivoted to chronic disease, which opened a lot of other opportunities, but also felt like a turn away from my roots in gender,” Beverley reflects.
“Health economics is about decision-making. It’s about using scarce resources in ways that are fair and just.”
She embraced the opportunity to serve as a Scientific Advisor on the Lancet Commission on Gender-Based Violence and Maltreatment of Young People. “It was a important opportunity – Lancet commissions bring together a cross-section of expertise, shake up conventional thinking, and spotlight issues. While new to gender-based violence research, I brought a foundation of economic methods and a health systems lens that nicely complimented the expertise of people who have been in this field for years. This Commission provided a platform to reframe violence not only as a social and public health crisis, but as an economic and systems failure, elevating the argument that investing in prevention and healing is both a moral and macroeconomic imperative, especially when viewed through a gender lens.”
Economics as a lens for gender equality
Economics as a lens for gender equality
Before diving deeper, I ask Beverley to take a step back for readers unfamiliar with the area. What role does economics play in advancing gender equality, and why has it often been absent from conversations even among seasoned advocates?
“Health economics is about decision-making,” she says. “I came to it through public health, which shapes my research practice. At its core, it’s about using scarce resources – money, time, human capital, health – in ways that are not only efficient, but importantly, fair and just. It’s about options and choices. How do we use information to support decisions that advance equity?”
The absence of gender in economics hasn't happened in a vaccuum. For decades, mainstream economic analysis largely ignored women – both as contributors and as recipients – a critique that feminist economists have long raised. Early health economics often assumed that households were unitary, overlooking the ways women’s labour, care work, and health needs shaped outcomes. Thinkers like Amartya Sen further challenged these assumptions, arguing that development and wellbeing should be assessed not just in terms of income, but in terms of what people are actually able to do – their capabilities. This shift reframed questions of equity: access, agency, and the real freedoms people have. Beverley situates her work firmly in this lineage, using economic tools not as an abstract exercise, but to make inequities visible and actionable.
“If we’re not really intentional in thinking about gender, then these outcomes are predictable.”
The consequences of ignoring gender are tangible. “Take pandemic response planning,” Beverley explains, reflecting on her review of pandemic response plans across eight African countries. “Gender considerations were largely invisible. Service closures led to spikes in unplanned pregnancies, disrupted adolescent health programs, and restricted access to essential nutrition and mental health supports.”
In some rural areas, clinics were suspended for months just when communities needed them most; elsewhere forced migration compounded risks, dismantling safe spaces for displaced girls and interrupting legal protections. “If we’re not really intentional in thinking about gender, even at the stage of planning, then these outcomes are predictable.”
Influencing policymaking
Translating these ideas into policymaking
I ask Beverley how health economics, when applied through a gender lens – think gender-responsive budgeting, priority-setting, and resource allocation – actually informs policy. She leans back and frames the challenge thoughtfully.
“It’s a fair question,” she begins. “It makes you ask: are our planning systems even set up to use this information? Will decision-makers pay attention? Once we generate gender-informed economic evidence, will it meaningfully shift choices? What is the value of this information? These are areas I want to explore more.”
She draws on pandemic lessons. “We saw that inclusive planning matters – New Zealand and Germany stood out, especially with female leadership – but the broader insight is this: integrating gender explicitly into health economics doesn’t just help women. It surfaces inequities and improves outcomes for everyone. Considering the needs of the most marginalised of women elevates the system as a whole. It raises the bar for everybody.”
Concrete examples are few and far between, but they are instructive. “In our recent review [in Nature Medicine] we highlight Iceland and Namibia. They haven’t measured outcomes longitudinally, but you can’t help but look at the collection of things that have happened, the collection of gender responsive, gender-attentive policies that are in place – addressing wage differences, representation, threshold quotas, gender-responsive planning, all of these things come together and when you look at population outcomes, they score very well.”
Yet Beverley cautions that the current backlash against gender poses a serious threat to tracking successful models. “Any attempt to measure outcomes is now impacted by this hard pushback. It complicates evidence gathering, it slows progress and mutes accountability.”
"Considering the needs of the most marginalised of women elevates the system as a whole. It raises the bar for everybody.”
I mention my surprise that Canada isn’t leading in gender-responsive policymaking, especially given its role in funding global gender initiatives. She nods, firm.
“Canada is not doing poorly - frameworks exist, and some elements of Iceland’s approaches are present. And yet, one in four women report experiencing violence in their lifetime – much higher for Indigenous and racialized women as well as gender-diverse individuals, around three in five individuals are impacted. Wage gaps persist across most sectors, most sharply in health, and women still carry a disproportionate share of unpaid care."
She goes onto explain that intersectional analyses - where outcomes are examined not just by gender, but by how gender intersects with factors like race, migration status, disability, and socioeconomic status - show core groups of women are consistently left out of planning. "So even with explicit commitments to gender-focused analysis within all policy planning, we’re not there yet. Some might call it a long-run game, but balancing patience with the urgency of gender inequity can be frustrating.”
On intersectionality
Making voices count
I press Beverley on the question of intersectionality: through an economic lens, what does it take for investments to truly reflect intersectionality, rather than just paying lip service?
She leans forward, measured but animated. “There are a couple of things. Representation matters. When you track the metrics around who sits around the table, even when women are present in ministries of health or major planning bodies, racialized women often occupy only a small share of those seats. I think this should be obvious – lived experience provides a lens through which we understand potential impacts and benefits of policy. Without it, decisions risk missing who gains and who loses.”
"Even when women are present in ministries of health or major planning bodies, racialized women often occupy only a small share of those seats.”
Her point extends into data. “Across Canada – and frankly, much of the world – we still lack disaggregated data. We get stuck at the binary of women, men, and sometimes we don’t even have that. But not all women are the same; not all men are the same; not all individuals are the same. If data are not broken down, we can’t know who gains from policy or investment, which undermines the core goal of health economics: supporting decisions under scarcity.”
Political will matters, but it’s not enough. Beverley gestures to Canada: “Our former prime minister declared himself a feminist and committed to gender equality. That’s necessary but it’s not sufficient. What drives change are levers across levels of government.”
She concludes candidly: “There’s no magic bullet. A combination of representation, disaggregated data, political commitment, and empowered community organisations and publics needs to happen together. Too often, these investments are haphazard. We know what works; the challenge is putting it into practice.”
Beverley points to promising signs at the local level: “Female mayors with lived experience are taking action where federal policy lags - declaring intimate partner violence a public health emergency, addressing unequal access to shelters and housing, and working closely with Native and other community organisations to ensure local voices shape decisions.”
Inspirations and anchors
Inspirations and anchors
As our conversation draws to a close, I ask Beverley to reflect on the frameworks, ideas, and mental models that continue to shape her work – and those she wishes policymakers would embed into decision-making. She leans back and considers.
“I really like this question because it makes me reflect on some of my anchoring values,” she tells me. “I’m grounded in lived experience and the skin that I live in,” she begins. “Those have afforded me opportunities to see the world in particular ways and to sit at particular tables…and not sit at those tables.” Then, almost catching herself in a moment, she adds, “This commitment to fairness and justice is deep-seated in my soul, I’m triggered and activated by injustice.”
“Not everyone has equal access to healthcare when they need it. Not everybody has the same opportunity to live the life that they deserve and develop capabilities and opportunities. That shapes how I see research opportunities – always through a justice lens.” It’s this grounding in lived experiences that drives her prioritisation of authentic, community-driven engagement and partnerships.
Beverley pairs that anchor with a systems perspective. “Problems don’t exist in isolation. Health systems are nested within broader social systems. I think about complexity, interconnections, and long-term leverage. Otherwise, we’re stuck with pilots that never scale. Even small wins can become levers for larger change. If you look at our community research partnership on dental care access for survivors of gender-based violence. We built this project with a dedicated community partner and very small amount of money, which has now led to discussions about embedding questions on GBV and barriers to access experienced by women marginalized by diverse disadvantages into formal disciplinary accreditations across Ontario – something that could scale nationally.”
“Zayna Khayat’s work on futurism has opened new ways of imagining systemic change in wicked problems.”
She also cites the thinkers who shape her work and inspire her thinking: “I return to Di McIntyre, whose scholarship on equity and health financing in low- and middle-income countries has influenced my understanding of justice in health systems. Esther Duflo’s empirically grounded work on poverty. Mariana Mazzucato’s bold political economy lens inspires me to reimagine how we define and create value in health systems”.
And lately, she’s been exploring the intersection of futurism and equity – borrowing tools from strategic foresight, like backcasting, to explore the steps needed to reach an equitable future. “Zayna Khayat’s work on futurism has opened new ways of imagining systemic change in wicked problems.” Futurism is usually the domain of technology or innovation, but Beverley sees untapped potential in applying it to equity and gender equality work: defining the systems we want, then working backward to redesign the policy, financing, and cultural levers that could make them a reality.
For Beverley, the economics of investing in women becomes a discipline of accountability – a method for tracing where power sits, where resources flow, and how systems can be re-engineered so that the women pushed furthest to the margins are finally centred in the decisions that shape their lives.
Image credit: University of Toronto and surrounds by White Rainforest