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My one and only brush with accidental homelessness unforgettably sensitized me to this issue. Newcomer to the US, focus on my science made me choose a basement apartment off the NIH campus in Bethesda, Maryland. Landlord an elderly widower retired from the NIH, a safe dwelling I surmised, little knowing that just a few months later, he'd trigger a short circuit in his house and it would go up in flames. Happening the day after Thanksgiving, both at home, we were both lucky to get out alive. Once the hubbub of firetrucks, police cars and ambulance chasing clean-up specialists cleared, he drove us to a downtown Bethesda hotel, promising I'd be back in my apartment within two weeks. The weeks passed with no progress. Meantime, thanks to those clean-up specialists, I'd been left standing in the clothes I wore. Sheer accident that I rushed out wallet in hand. Everything else packed and sped off for 'smoke damage clean-up'. Sheer luck a colleague looking to sub-let got me into another place within a month. All this to say that even though my experience was positively luxurious compared to the truly homeless, I can well appreciate the hell that is to be homeless.Where to sleep, to bathe, to go to toilet, get a meal. We take these essential basics of daily living for granted when we have a home to call our own. And that's not all. Situation's incalculably worse for those homeless even more unlucky to not be in the tropics. For such, staying warm through bitterly cold days and nights for weeks and months on end is yet another imperative on a long list of others we 'homed' take for granted and we still aren't done with the imperatives. A homeless woman has an additional imperative, how to stay safe and unmolested at all times of day and night. Sounds like a surefire recipe for insanity, no? Shocking then that it took an outsider to divine that rather than carrots and sticks, having a roof over one's head is the most essential first step for a homeless person to get on the track back to relative normalcy, maybe even permanently. The radical visionary who divined this is Sam Tsemberis, founder of Pathways to Housing.The radical aspect of Tsemberis' solution stems from giving homes without preconditions to people with all kinds of serious and chronic problems ranging from addiction to other serious mental health problems. This is in direct contrast to how social policy traditionally addressed homelessness in the US, i.e., a reward system. It went somewhat like this. Let's say homeless person issues are x, y, z while the bureaucrat's carrots are 1, 2, 3. Social policy dictated to the homeless you solve issue x, say addiction, we'll give you reward 1, say counseling. A trained psychologist, his stint doing outreach with the mentally ill in New York City in the early 1990s revealed to Tsemberis his epiphany about the homeless. It also reveals the blinkers even the most well-intentioned can harbor. Paternalism is deeply ingrained in the conventional understanding of the homeless. The homeless are perceived to lack ability to function. However, submerging himself in the world of the homeless taught Tsemberis that on the contrary, the homeless are enormously resourceful.I too got the same insight from watching someone at close quarters. During my time at the NIH, I met a brilliant researcher working in the building next to mine. Diagnosed with a mental disorder and forcibly institutionalized, having then managed to partially extricate herself, some years later she re-surfaced as a homeless person in the neighborhood. At unpredictable moments, she'd show up in the lab late at night as I harvested a thick stack of cell culture plates. She'd lean on a nearby counter and recount her experiences living on the street. Which intersections were best for panhandling. What time was best to panhandle at the intersection between Old Georgetown Road and Democracy Boulevard. How she negotiated with other panhandlers to gain a corner at this busy intersection. Which supermarket dumpsters were best for bread and other baked goods. Where years earlier, we'd discussed the latest paper on Toll-like receptor structure, now she'd regale with her varied and rich insights about life on the street. Not to mention I never found out how she even managed to get onto campus, let alone into the lab. I thought exactly the same as Tsemberis. What amazing resourcefulness!Equipped with the insight that the homeless are nothing if not resourceful, Tsemberis created a team peopled by outsiders that included a recovering heroin addict, a former homeless, a psychologist and a poet survivor of incest (1). Team in hand and with a $500000 in federal funding, Tsemberis started a pilot project with 139 chronically homeless his team immediately housed and offered counseling. The results? A retention rate of ~85%, far better than the 60% that was the then best metric. All this way back in 1997. When Tsemberis published his findings in 2000 in Psychiatric Services (2), a fairly respectable peer-reviewed journal, predictably, old hands in the homeless services community looked askance at this rude short shrift to conventional wisdom and by an outsider to boot (3, 4, 5, 6).However, as the years passed, empirical data by others who implemented/pilot tested Housing First (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17) bolstered support for it. Even the US federal government found it dramatically shrank addiction and health care costs (18). Success has been inconsistent when the local administration's commitment has been likewise, as in Washington D.C. Pilot projects in other countries such as Germany (19) showed promise. Homeless services researchers in the UK propose Housing First deserves serious consideration there as well (20, 21, 22) even as there's considerable resistance to the idea (23, 24, 25). Several studies in Canada find in favor of Housing First (26, 27, 28, 29, 30, 31, 32, 33). It also finds favor in Australia (34).Analysts attribute the success of Pathways to Housing and its ascent to orthodoxy as Housing First to the juxtaposition of key individuals with unique gifts and qualifications. Dennis Culhane, a researcher who works closely with policy makers and is 'unusually adept' at translating research findings to policy positions (35), the charismatic Sam Tsemberis, founder of Pathways to Housing, and policy maker Phil Mangano (36). Sold by Mangano to local mayors as a consumer choice model rather than a coercive measure (37), Housing First appealed to politicians keen to erase visible signs of capitalism's failure and what could be a more compelling sign than the chronically homeless visibly sleeping in city parks.Pathways to Housing and Housing First aren't interchangeable. However, both assert right to housing as a fundamental right. This is the reverse of beliefs that have historically shaped US welfare, namely, people have to first prove themselves worthy of government benefits or have earned it. However, there are unique aspects to what Pathways to Housing did in New York City. That blueprint isn't fully fleshed out even by its architects and already the model is being exported all over the US and even elsewhere. Several dangers are inherent to such an approach. Other policy makers may not have the same goals and commitments. Elsewhere, Housing First could easily become a tool for enforced gentrification of minority-dominated inner city blocks. It could be used as a cosmetic cover to relocate the chronically homeless to city outskirts without investing the corollary efforts necessary to get them on the path to autonomy and self-sufficiency (38). In other words, out of sight, out of mind could be a critical weakness of Housing First that could be easily exploited by less scrupulous policy makers keen to wall-paper a serious social problem that's also very embarrassing to leaders and policy makers in what's undoubtedly the wealthiest country in the world.Bibliography1. Terrence McCoy, The Washington Post, May 6, 2015. Meet the outsider who accidentally solved chronic homelessness2. Tsemberis, Sam, and Ronda F. Eisenberg. "Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities." Psychiatric services (2000). http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.51.4.4873. Shinn, Marybeth, Jim Baumohl, and Kim Hopper. "The prevention of homelessness revisited." Analyses of Social Issues and Public Policy 1.1 (2001): 95-127. https://www.researchgate.net/profile/Kim_Hopper/publication/227600480_The_Prevention_of_Homelessness_Revisited/links/02e7e5342e75e5a900000000.pdf4. Bassuk, Ellen L., and Stephanie Geller. "The role of housing and services in ending family homelessness." Housing Policy Debate 17.4 (2006): 781-806. https://www.researchgate.net/profile/Ellen_Bassuk/publication/239923491_The_role_of_housing_and_services_in_ending_family_homelessness/links/53e0c5540cf2d79877a4fd4a.pdf5. Culhane, Dennis P., and Stephen Metraux. "Rearranging the deck chairs or reallocating the lifeboats? Homelessness assistance and its alternatives." Journal of the American Planning Association 74.1 (2008): 111-121. http://repository.upenn.edu/cgi/viewcontent.cgi?article=1119&context=spp_papers6. Kertesz, Stefan G., et al. "Housing first for homeless persons with active addiction: are we overreaching?." Milbank Quarterly 87.2 (2009): 495-534. http://www.coloradocoalition.org/!userfiles/Library/Housing%20ready-substance%20use.pdf7. Siegel, Carole E., et al. "Tenant outcomes in supported housing and community residences in New York City." Psychiatric Services (2006). http://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2006.57.7.9828. Walsh, Adam, Jennifer Vaughn, and D. F. Duncan. "The Cost Effectiveness of Supportive Housing Teams at Eighteen Months." (2009). http://www.unc.edu/~dfduncan/papers/fs/November%202009%20HST%20Final%20Report.pdf9. Meschede, Tatjana. "Accessing housing: Exploring the impact of medical and substance abuse services on housing attainment for chronically homeless street dwellers." Journal of Human Behavior in the Social Environment 20.2 (2010): 153-16910. Rogers, E. Sally, et al. "Systematic Review of Supported Housing Literature 1993–2008." (2010). http://dcommon.bu.edu:8080/bitstream/handle/2144/1493/Systematic-Review-of-Supported-Housing-Literature-1993%E2%80%932008.pdf?sequence=1&isAllowed=y11. Collins, Susan E., et al. "Exploring transitions within a project-based Housing First setting: Qualitative evaluation and practice implications." Journal of health care for the poor and underserved 23.4 (2012): 1678. https://depts.washington.edu/harrtlab/wordpress/wp-content/uploads/2014/05/collins-et-al-2012-housing-transitions.pdf12. Brown, Molly. "Effectiveness of Housing First for Non-chronically Homeless Individuals Who Are High Utilizers of Inpatient Psychiatric Treatment." (2012). http://via.library.depaul.edu/cgi/viewcontent.cgi?article=1022&context=csh_etd13. Collins, Susan E., Daniel K. Malone, and Seema L. Clifasefi. "Housing retention in single-site Housing First for chronically homeless individuals with severe alcohol problems." American journal of public health 103.S2 (2013): S269-S274. https://www.researchgate.net/profile/Susan_Collins/publication/258034422_Housing_Retention_in_Single-Site_Housing_First_for_Chronically_Homeless_Individuals_With_Severe_Alcohol_Problems/links/02e7e5330784342b77000000.pdf14. Montgomery, Ann Elizabeth, et al. "Housing chronically homeless veterans: Evaluating the efficacy of a Housing First approach to HUD‐VASH." Journal of Community Psychology 41.4 (2013): 505-514.15. Clifasefi, Seema L., Daniel K. Malone, and Susan E. Collins. "Exposure to project-based Housing First is associated with reduced jail time and bookings." International Journal of Drug Policy 24.4 (2013): 291-296. https://www.researchgate.net/profile/Susan_Collins/publication/232811296_Exposure_to_project-based_Housing_First_is_associated_with_reduced_jail_time_and_bookings/links/0deec51d5d9186ba08000000.pdf16. Hwang, Stephen W., and Tom Burns. "Health interventions for people who are homeless." The Lancet 384.9953 (2014): 1541-1547. http://bibliobase.sermais.pt:8008/BiblioNET/Upload/PDF8/005815.pdf17. Davidson, Clare, et al. "Association of Housing First implementation and key outcomes among homeless persons with problematic substance use." Psychiatric Services (2014). https://www.researchgate.net/profile/Bryan_Kutner/publication/263935900_Association_of_Housing_First_Implementation_and_Key_Outcomes_Among_Homeless_Persons_With_Problematic_Substance_Use/links/5591735a08ae1e1f9baff280.pdf18. Burt, Martha R., and Brooke E. Spellman. "Changing homeless and mainstream service systems: Essential approaches to ending homelessness." Toward Understanding Homelessness: The 2007 National Symposium. Vol. 4. 2007. https://aspe.hhs.gov/sites/default/files/pdf/174201/report.pdf19. Fichter, M. M., and N. Quadflieg. "Intervention effects of supplying homeless individuals with permanent housing: a 3‐year prospective study." Acta Psychiatrica Scandinavica 113.s429 (2006): 36-40.20. Atherton, Iain, and Carol McNaughton Nicholls. "'Housing First' as a means of addressing multiple needs and homelessness." (2008). http://dspace.stir.ac.uk/bitstream/1893/9035/1/atherton_ejh2008.pdf21. Price, Sian. "Housing related support interventions: a rapid review of the evidence." Pridobljeno dne 2 (2010): 2013.22. McNaughton Nicholls, Carol, and Iain Atherton. "Housing First: Considering components for successful resettlement of homeless people with multiple needs." Housing Studies 26.5 (2011): 767-777.23. Johnsen, Sarah, and Lígia Teixeira. "‘Doing it already?’: stakeholder perceptions of Housing First in the UK." International Journal of Housing Policy 12.2 (2012): 183-203.24. Tsai, Jack, Alvin S. Mares, and Robert A. Rosenheck. "A multisite comparison of supported housing for chronically homeless adults:“housing first” versus “residential treatment first”." Psychological Services 7.4 (2010): 219. http://www.homelesshub.ca/sites/default/files/Tsai.2010.pdf25. Tsai, Jack, and Robert A. Rosenheck. "Considering Alternatives to the Housing First Model." European Journal of Homelessness _ Volume 6.2 (2012). http://feantsaresearch.all2all.org/IMG/pdf/ejh6_2_resp_housingfirst5.pdf26. Falvo, Nick. Homelessness, program responses, and an assessment of toronto's streets to homes program. Canadian Policy Research Networks Incorporated and Social Housing Services Corporation, 2009. http://cprn3.library.carleton.ca/documents/50981_EN.pdf27. Fitzpatrick-Lewis, Donna, et al. "Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review." BMC Public Health 11.1 (2011): 1. BMC Public Health28. Stergiopoulos, Vicky, et al. "Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups." BMC health services research 12.1 (2012): 1. BMC Health Services Research29. Patterson, Michelle, et al. "Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia." Social psychiatry and psychiatric epidemiology 48.8 (2013): 1245-1259. https://www.researchgate.net/profile/Julian_Somers/publication/237084669_Housing_First_improves_subjective_quality_of_life_among_homeless_adults_with_mental_illness_12-month_findings_from_a_randomized_controlled_trial_in_Vancouver_British_Columbia/links/53ceeed40cf25dc05cfad734.pdf30. Somers, Julian M., et al. "Housing first reduces re-offending among formerly homeless adults with mental disorders: results of a randomized controlled trial." PloS one 8.9 (2013): e72946. http://journals.plos.org/plosone/article/asset?id=10.1371%2Fjournal.pone.0072946.PDF31. Patterson, Michelle L., et al. "Trajectories of recovery among homeless adults with mental illness who participated in a randomised controlled trial of Housing First: a longitudinal, narrative analysis." BMJ open 3.9 (2013): e003442. http://www.habitation.gouv.qc.ca/fileadmin/internet/centredoc/CC/NS23331.pdf32. Tan de Bibiana, Jason. "Housing first and emergency department utilization among homeless individuals with mental illness in Vancouver." Electronic Theses and Dissertations (ETDs) 2008+ (2013). https://circle.ubc.ca/bitstream/handle/2429/44041/ubc_2013_spring_tandebibiana_jason.pdf?sequence=133. Russolillo, Angela, et al. "Emergency department utilisation among formerly homeless adults with mental disorders after one year of Housing First interventions: a randomised controlled trial." International Journal of Housing Policy 14.1 (2014): 79-97. http://summit.sfu.ca/system/files/iritems1/12927/etd7777_ARussolillo.pdf34. Johnson, Guy, Sharon Parkinson, and Cameron Parsell. "Policy shift or program drift? Implementing Housing First in Australia." AHURI Final Report 184 (2012): 1-21. http://espace.library.uq.edu.au/view/UQ:295061/UQ295061_OA.pdf35. Stanhope, Victoria, and Kerry Dunn. "The curious case of Housing first: The limits of evidence based policy." International journal of law and psychiatry 34.4 (2011): 275-282. http://web.pdx.edu/~nwallace/AHP/CuriousCaseHousing.pdf36. Shinn, Marybeth. "Waltzing with a monster: Bringing research to bear on public policy." Journal of Social Issues 63.1 (2007): 215-231.37. Mangano, P. (2008). The impact of the federal initiative to end chronic homelessness in10 Years. Paper presented at the Center for Homelessness Prevention Studies Grand Rounds, Columbia University Mailman School of Public Health.38. Hennigan, Brian Richard. "House Broken: The Functions and Contradictions of" Housing First"." (2013). http://surface.syr.edu/cgi/viewcontent.cgi?article=1008&context=thesis

What should be done for the over 20% of the population who suffer from one or more mental illnesses?What does Mental Illness mean?The American Psychiatric Association defines mental illness as: Mental illnesses are health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.The strong connection between poor mental health and the risk of developing expensive chronic illnesses indicates that resources used to prevent and speed recovery from mental illnesses have benefits that extend into savings on physical healthcare.Imagine, for a moment, a world where the focus is on maximizing the potential of every human. Compare that to our society where we strive to keep people functioning and low levels of functioning are routinely accepted even when the potential for thriving is present.Mental illness is the cause in 4 out of 10 disability claims.[1]7 out of 10 youth in state and local juvenile justice systems have a mental illness.[2]90% of completed suicides have an underlying mental illness.[3] Suicide is the #2 cause of death from age 10 - 54.[4]Scope of the problem:About 1 in 5 people experience mental illness each year.Depression: about 6.9%[5][5][5][5]Anxiety, (including PTSD, OCD, and phobias): about 18.1%[6][6][6][6]Eating disorders: 3.5%[7][7][7][7]Personality disorders: 9%[8][8][8][8]Schizophrenia: 1.1%[9][9][9][9]Bi-polar: 2.6%[10][10][10][10]Many individuals suffer from more than one mental illness at the same time.We all Pay the PriceWhen lives end too soon or are not productive because of illness or disease, society suffers economic loss. While individuals with mental illnesses suffer more, recognize that we are all already paying a price for not making mental health a priority.Mental illnesses significantly reduce both the quality of life and the longevity of individuals who suffer from mental illnesses.[11][11][11][11] As noted in Mental, Neurological, and Substance Use Disorders: Disease Control Priorities, Third Edition (Volume 4), “The life expectancy gap between those with mental disorders and the general population is widening. The general population enjoys a longer life, while the lifespan for those with mental, neurological, and substance use disorders remains significantly lower and unchanged.”[12][12][12][12]DangerThe fear that mentally ill people are dangerous is unfounded. This fear is exacerbated by the media’s focus on the rare occurrences when someone who is mentally ill does cause harm while the millions who push on with their lives in quiet desperation, taking care of their families, going to work, and living as normal of a life as possible are ignored.Stigma and Barriers to CareStigma continues to cause many people not to receive the care they need to recover. Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9% received mental health services in the past year.[13][13][13][13] [14][14][14][14]“There are approximately 8,300 practicing child and adolescent psychiatrists in the US and over 15 million children and adolescents who are in need of the special expertise of a child and adolescent psychiatrist.”[15][15][15][15] 96% of the counties in the United States have inadequate resources to provide care for the current mental health needs.[16][16][16][16]The cost of care prevents many people from obtaining the care they need to recover and/or prevent their situation from worsening.In some occupations such as clinicians, care-seeking must be reported to the medical board and brings the individual under additional scrutiny. They often forgo needed care because of the chilling effect of reporting requirement. Some states, such as North Carolina, have begun to recognize that such policies are misguided. North Carolina changed its rules last year and now mandates care seeking and disclosure only if the individual’s condition is adversely affecting the duties that are being performed.[17][17][17][17] For example, a surgeon could stop doing surgery as a precaution while being treated without being required to report to the medical board. He could still perform other duties that didn’t put patients at risk.Mental health continues to take a back seat to physical health in terms of funding and attention despite the fact that poor mental health frequently leads to poor physical health including many of the diseases that constitute the greatest financial burden on our healthcare system including Type II diabetes, obesity, and heart disease. “There is evidence that mental disorders are independent risk factors for cardiovascular disease, type 2 diabetes and injuries.” [18][18][18][18]“It would appear that the increase in longevity enjoyed by the general U. S. population over the past half century has been lost on those with serious mental illness. In fact, this drop in life expectancy due to mental illness would surpass the health disparities reported for most racial or ethnic groups. Yet this population is rarely identified as an underserved or at-risk group in surveys of the social determinants of health.”[19][19][19][19][20][20][20][20] (PDF)The years of life lost due to premature death for mental, neurological, and substance use disorders is reflected on the following chart. The numbers underestimate the years of life lost because some known factors are not measured well enough to include accurate numbers. “Several other mental disorders, such as major depressive disorder and bipolar disorder, exhibit significant and documented excess mortality.[21][21][21][21] [22][22][22][22] These were not included in the estimated cause-specific deaths and years of life lost (YLLs), because the method for cause-of-death estimation, where death counts are used to calculate YLLs, can only be attributed to the primary cause of death.”[23][23][23][23]Substance Use Disorders and Mental Illness“Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.”[24][24][24][24][25][25][25][25]Solution: Prevention and a Scalable CureMost mental illnesses can be traced back to chronic stress. When individuals learn skills that help them regulate their emotions in healthy ways and reduce stress, their risk of developing a mental illness declines. When individuals who suffer from mental illnesses learn these same skills, most of them experience improvements in their conditions. The link between stress and mental illness holds for genetically linked mental illnesses. Epigenetics demonstrates that the switch for adverse outcomes in both physical and mental health are turned on by chronic stress and traumatic stress events.Unlike therapy, these skills can be taught in large groups because they do not require anyone to disclose where they are. It only requires the communication of the skills to the audience. The people who learn the skills can then apply them in their own lives. This can often be done in the privacy of their own mind.Individuals who are motivated to learn the skills from a book can do so successfully.Parents, teachers, clergy, clinicians, and others who want to help people prevent and recover from mental illnesses can learn the skills and teach them as a part of their normal daily interactions.Research published ten years ago shines a light on one of the causes of the high stress experienced by so many people today.[26][26][26][26] The definition of the purpose and use of emotions was misunderstood by science early in the last century. That misunderstanding is prevalent in society today. When individuals learn the new, evidence-based definition of the purpose and use of emotions, they come into possession of a personal guidance system that guides them toward lower stress and better mental health without requiring them to give up any activities they enjoy.When people misunderstand the purpose of their emotions and misinterpret their meaning, it can lead them toward mental illnesses and reinforce high stress perceptions about their life and the situations they encounter every day.Employers Vested Interest“Research has conclusively shown that depression and other mental illness and substance abuse disorders are a major cause of lost productivity and absenteeism.[27][27][27][27][28][28][28][28][29][29][29][29]Mental illness causes more days of work loss and work impairment than many other chronic conditions such as diabetes, asthma, and arthritis.[30][30][30][30]Approximately 217 million days of work are lost annually due to productivity decline related to mental illness and substance abuse disorders, costing Unites States employers $17 billion each year.[31][31][31][31]In total, estimates of the indirect costs associated with mental illness and substance abuse disorders range from a low of $79 billion per year to a high of $105 billion per year (both figures based on 1990 dollars).”[32][32][32][32][33][33][33][33][34][34][34][34]Better mental health and stress management are tied to many employment-related outcomes including:Improved Customer SatisfactionIncreased ProductivityReduced TurnoverReduced DisabilityReduced Co-worker incivilityReduced Workplace bullying (the person with a mental illness can be the victim or the bully)Burnout Prevention and RecoveryPhysical health (prevention and recovery)Less Smoking60% of individuals who smoke suffer from anxietyLess Substance abuseSubstance abuse is a dysfunctional stress management strategy. Individuals will use the best strategy they know and if they don’t know any good ones, they will use ones that makes matters worse fast.Higher Employee EngagementCore self-evaluations account for 30 - 42% of employee engagementIncreased Emotional Intelligence (EQ)Improved Psychological FlexibilityIncreased Emotion Regulation SkillsBetter Relationship (all types)Less distraction at work from personal relationshipsIncreased Change ReadinessGrowth MindsetIncreased ResilienceBetter Self-ControlIncreased Cognitive AbilityStress reduces cognitive abilityImproved Corporate CitizenshipIncreased HappinessHigher QualityImproved safety for workers and patientsDiversity AppreciationIncreased Goal-focused behaviorsEmployers current spend $70.6 billion on employee training with the vast majority of it focused on a specific area or symptom instead of the root cause.[35][35][35][35] Most training is designed to be dose-dependent rather than create a sustainable culture that supports good mental health, stress management and all the benefits they provide.Culture change initiatives that empower every employee with great stress management skills will be self-supporting and sustainable. They will afford early adopters with significant competitive advantages. This type of culture will make them a preferred employer and enhance their ability to attract and retain top talent.Stress management and emotion regulation strategies are taught as educational sessions to provide information from new research, so they are not seen as stigmatizing.AlternativesSome employers are hiring on-site psychologists. One employer I’ve worked with has five hundred employees and one on-site psychologist. Within two weeks of her being hired she was fully booked for months. One-on-one counseling has its place but it will not make a significant shift in the number of individuals who suffer from mental illness when there are inadequate providers and the process is time-consuming. This solution does not help those who will not seek counseling because of stigma.EAP programs are also a good benefit but they are generally used when a problem has already developed. Many people do not use them because of stigma and a perception that their employer will have knowledge of their private lives.Mental Health Care coverage is a must have health care benefit but it also suffers from stigma, high deductibles, time constraints, and provider constraints.Employers who understand the problems with mental health will become part of the solution.For Additional Information:Jeanine Joy's answer to How important is mental health in public health context?Jeanine Joy's answer to Should I put my mental health first?Footnote:Substance Abuse and Mental Health Services Administration, Results from the 2014 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-50, HHS Publication No. (SMA) 15-4927. Rockville, MD: Substance Abuse and Mental Health Services Administration. (2015). Retrieved October 27, 2015 from http://www.samhsa.gov/data/sites...Footnotes[1] National Institutes of Health (NIH)[2] NIMH " Home[3] Risk of Suicide | NAMI: National Alliance on Mental Illness[4] NIMH " Suicide[5] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[5] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[5] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[5] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[6] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[6] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[6] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[6] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[7] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[7] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[7] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[7] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[8] National Survey Tracks Prevalence of Personality Disorders in U.S. Population[8] National Survey Tracks Prevalence of Personality Disorders in U.S. Population[8] National Survey Tracks Prevalence of Personality Disorders in U.S. Population[8] National Survey Tracks Prevalence of Personality Disorders in U.S. Population[9] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[9] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[9] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[9] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[10] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[10] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[10] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[10] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[11] Excess Mortality from Mental, Neurological, and Substance Use Disorders in the Global Burden of Disease Study 2010[11] Excess Mortality from Mental, Neurological, and Substance Use Disorders in the Global Burden of Disease Study 2010[11] Excess Mortality from Mental, Neurological, and Substance Use Disorders in the Global Burden of Disease Study 2010[11] Excess Mortality from Mental, Neurological, and Substance Use Disorders in the Global Burden of Disease Study 2010[12] The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers[12] The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers[12] The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers[12] The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers[13] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[13] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[13] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[13] Mental Health By the Numbers | NAMI: National Alliance on Mental Illness[14] http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf[14] http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf[14] http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf[14] http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf[15] Workforce Issues[15] Workforce Issues[15] Workforce Issues[15] Workforce Issues[16] 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There are many studies out there that prove the wage gap exists even after accounting for control variables, like maternity leave.Before I answer your question, I’d like to straighten out your botched understanding of the topics in your question, especially since you aren’t operating in good faith and your narrative appears to be nefarious in its intent.These are some of the invalidating arguments people tend make about the gender wage gap:“Men are more ambitious/Men work harder”: [1] [2]The workforce participation rate between women and men is at ~14%75% of single mothers are sole breadwinnersWomen are working outside the home in the largest rates ever, but also are more likely to be in charge of:childrendomestic houseworktaking care of other family membersvolunteer more on average then men2. “Women take more time off work/maternal leave”:An ICEDR global study found that: [3]Company bosses/CEOs/managers believe that women will leave their jobs at 30Women are not seen as good longterm investments because people assume that all women want to have babies and/or want to be stay at home moms [4]Ironically, women are more likely to leave a job because they found one that pays betterWomen who do leave their jobs to have children pay a 4% wage penalty per child [5]PayScale recently collected data from over 1.4 million workers - the data showed: [5]the wage gap in median earnings for women with children is 31%Married men with children get the highest pay among male earners ($67,900) - men typically experience an increase in pay after becoming fathers3. “Women should develop better negotiating skills”:“Just ask for a raise” [6]Women worry that pushing for more money will damage their image. Research shows they're right to be concerned: Both male and female managers are less likely to want to work with women who negotiate during a job interview.Women are seen as bossy, ungrateful and pushy when they ask for a raise and are 4x more likely to experience enduring negative views by their boss then men are after asking [7] [8]4. “Men just have more experience/education”:Women are currently graduating from college at higher rates then men are [9]Women are also going to graduate school at higher rates than men.Regardless, Georgetown's Center on Education and the Workforce found that men who had completed a little college but lacked a degree earn the same as women with a B.A. [9]In order for women to make as much as men with a B.A., women need to have a Ph. D.Women that spend longer amounts of time in the workforce experience the biggest gaps in pay to peers that are men [10]Women in their late 20s: earn ~92% of what their male peers receiveWomen in their early 50s: earn ~71% of a man's wages in the same fieldThe more women progress in their careers, the larger the pay gapThe biggest pay gap is at the executive level5. “Men go after the higher paying jobs”:True, but this is because men tend to be favored and they already dominate careers that pay the mostCareers that tend to be dominated by women (nursing, social work and teaching) are less compensated than the careers men dominateThis doesn’t reflect skill - it reflects gendered preconceptions, or in other words, society’s understanding of what work is valuableWhat is seen as feminine is undervalued, what is seen as masculine is overvalued.Regardless, physicians that are woman and that work the same amount of time in the same field make ~24% less than than their peers that are men in that field [11] [12]Edit: after reading a comment regarding this section of my answer, I thought I should explore this topic more thoroughly:One of the biggest studies done on variables found in the gender wage gap regarding job type and gender, Occupational Feminization and Pay: Assessing Causal Dynamics Using 1950–2000 U.S. Census Data [13][13][13][13], further backs up the trend that when more women move into a specific job sector that men traditionally/currently dominate(d), the wage decreases.This study’s controlled variables included:Level of educationWork experienceWork skillsRaceLocationDemand of jobThe overwhelming evidence shows that the work women do is placed at a lower value across the board.In an interview with The New York Times, England, the co author of this study, said:It’s not that women are always picking lesser things in terms of skill and importance. It’s just that the employers are deciding to pay it less.The New York Times explores the findings from Occupational Feminization and Pay: Assessing Causal Dynamics Using 1950–2000 U.S. Census Data by looking into specific careers: [14][14][14][14]Examples of jobs that show a decrease in wage when women start to enter a field at higher rates then men:…In the field of recreation — working in parks or leading camps — which went from predominantly male to female from 1950 to 2000:Median hourly wages in this field declined 57%, accounting for the change in the value of the dollar, according to a complex formula used by Professor Levanon.The job of ticket agent also went from mainly male to female during this period:Wages dropped 43%The same thing happened when women in large numbers became designers:Wages fell 34%Housekeepers:Wages fell 21%Biologists:Wages fell 18%The reverse was true when a job attracted more men.The New York Times continues on, saying the following points may influence the gender wage gap:Today, differences in the type of work men and women do account for 51% of the pay gapLarger portion than in 1980, according to definitive new research by Francine D. Blau and Lawrence M. Kahn, economists at Cornell.Women have moved into historically male jobs much more in white-collar fields than in blue-collar ones.Yet the gender pay gap is largest in higher-paying white-collar jobs, Ms. Blau and Mr. Kahn found…Of the 30 highest-paying jobs, including:chief executivearchitectcomputer engineer,26 are male-dominated, according to Labor Department data analyzed by Emily Liner, the author of the Third Way report.Of the 30 lowest-paying ones, including food server, housekeeper and child-care worker, 23 are female dominated.Many differences that contributed to the pay gap have diminished or disappeared since the 1980s:Women over all now obtain more education than men and have almost as much work experience.Women moved from clerical to managerial jobs and became slightly more likely than men to be union members.Both of these changes helped improve wage parity, Ms. Blau’s and Mr. Kahn’s research said.Yes, women sometimes voluntarily choose lower-paying occupations because they are drawn to work that happens to pay less, like caregiving or nonprofit jobs, or because they want less demanding jobs because they have more family responsibilities outside of work.…many social scientists say there are other factors, like:gender biassocial pressure, that bring down wages for women’s work.Other research, has found that any occupation that involves caregiving, like nursing or preschool teaching, pays less, even after controlling for the disproportionate share of female workers.After sifting through the data, Ms. Blau and Mr. Kahn concluded that pure discrimination may account for 38% of the gender pay gap.Discrimination could also indirectly cause an even larger portion of the pay gapFor instance, by discouraging women from pursuing high-paying, male-dominated careers in the first place.“Some of it undoubtedly does represent the preferences of women, either for particular job types or some flexibility, but there could be barriers to entry for women and these could be very subtle,” Ms. Blau said. “It could be because the very culture and male dominance of the occupation acts as a deterrent.”For example, social factors may be inducing more women than men to choose lower-paying but geographically flexible jobs, she and Mr. Kahn found.Even though dual-career marriages are now the norm, couples are more likely to choose their location based on the man’s job, since men earn more.This factor is both a response to and a cause of the gender pay gap.The New York Times article concludes with the following:Men and women are paid differently not just when they do different jobs but also when they do the same work.Research by Claudia Goldin, a Harvard economist, has found that a pay gap persists within occupations.Female physicians:earn 71% of what male physicians earnlawyers earn 82%It happens across professions:This month, the union that represents Dow Jones journalists announced that its female members working full time at Dow Jones publications made 87 cents for every dollar earned by their full-time male colleagues.Ms. Liner of Third Way said…give priority to people’s talents and interests when choosing careers, even if it means going outside gender norms…for instance encouraging girls to be engineers and boys to be teachers.An example of men getting paid more when they have jobs that are traditionally linked to women would be chefs.Stacy J. Williams, who has a Ph. D. in sociology, explains why women are constantly put at a disadvantage in the job market: [15][15][15][15]Since women spend more than twice as much time in home kitchens than men do, it seems strange that there are so few women in professional kitchens. Many social forces, ranging from the organization of professional kitchens to cultural ideas about women and cooking, can help explain the phenomenon.Mary Blair-Loy has written that there is a cultural “family devotion schema,” or a widespread cultural belief that women’s primary commitments should be to home and family.These expectations do not apply to men; instead, men are expected to have women partners who complete this care work.These cultural beliefs, combined with the historical definition of feeding the family as women’s work, contribute to the continued tendency for women to cook more often in the home.Many professional kitchens also have a culture of masculinity that is not welcoming to women. In 2011, 37% of the sexual discrimination cases that were reported to the federal government involved restaurants…Further, these men are concerned that women can’t “pull their weight” in a fast-paced kitchen environment that is built on teamwork and camaraderie. To prove that they are a useful part of the team, women often have to go above and beyond the required work and take on extra shifts. These behaviors and attitudes among the mostly male cooks and chefs make many women feel uncomfortable and unwelcome, turning the professional kitchen into a workplace where women feel they do not fit.The cultural understandings of women and food, combined with a workplace structure that is inhospitable to women and employees with family responsibilities, present significant obstacles to women chefs. Even though women are considered the authorities of home kitchens, they have a more difficult time gaining equal footing with men in restaurant kitchens. Despite these obstacles, there are women who defy these cultural expectations and compete in the restaurant world. Yet when these women aren’t portrayed as mothers or sex objects, they receive media attention for being outliers in a male-dominated occupation.NPR further explores this phenomenon: [16][16][16][16]Women have historically been told their place is in the kitchen — but not as chefs: According to statistics from the U.S. Labor Department, to this day, only about 20 percent of chefs are women.It all harks back to the fact that being a chef was not as glamorous as it is today, says Deborah Harris, a sociology professor at Texas State University…It might come as a surprise to some that back in the day, in 18th and 19th century France, being a chef was the opposite of being a celebrity."It was a really low-status career," says Harris. In response, she says, male chefs made a big deal about "differentiating between the cultural, high-status, intellectual cooking of men, and the low-status, every day work of women."The Austin Chronicle pointed out the prevailing glass ceiling women experience in an industry they used to dominate: [17][17][17][17]A full 45% of people working in the culinary industry are women, yet women hold less than 10% of the top positions…Most successful chefs are fairly compulsive about their work, women no less than men. And it definitely takes that sort of compulsive dedication to advance through the ranks…But is it really harder for a woman than it is for man?Only in the past two decades has cooking become a glamorous profession…The image of the chef has changed radically in the past decade, though, and there is a certain romantic allure to the field. Today's chefs are educated -- many hold graduate degrees from Ivy League universities. They appear on television, travel all over the world, and lecture on topics relating to food, social science, history, and literature.More evidence of discrimination in the food industry: [18][18][18][18]A new study from pay transparency web site Glassdoor finds female chefs make 28.3 percent less in base pay than their male colleagues. That's the second-highest "adjusted" percentage among the careers included in the study.Glassdoor analyzed more than 505,000 salaries shared by full-time U.S. employees to come up with its findings. The research determined 33 percent of the gap in pay between men and women in the United States is linked to "possible workplace gender bias."Not only are women making less in the kitchen, they seem to be far less likely to earn prestigious accolades for their work. Out of the 211 semifinalists for the James Beard Foundation's regional Best Chef awards in 2016, 30 were women — that's a paltry 14 percent. In the Midwest, all 22 semifinalists were men. The recognition disparity is nothing new. In 2013, Time magazine published a "Gods of Food" issue that was so male dominated, it became known as "Dudes of Food."Dr. Andrew Chamberlain, who wrote the study for Glassdoor, says "occupation and industry sorting of men and women into jobs that pay differently" is the main cause for the gender pay gap across all professions in the United States. That doesn't necessarily explain the pay gap in kitchens because "chef" can be a vague term…The New York Times calls out the sexism seen in the restaurant industry: [19][19][19][19]For decades, chefs of both sexes believed that inequality was inevitable. The same stereotypes used to keep women out of armed combat, off the judicial bench and out of medical school were invoked to explain why women didn’t stick it out in the kitchen. The work, it was said, is too physically demanding and psychologically grueling; the hours were too incompatible with family life…One big question — why even women who make it to the top rank of chefs struggle for recognition — has often been posed, and never fully answered…“We are the quiet power behind the throne,” Ms. Chan said. “But sometimes everyone gets tired of being quiet.”6. “Who Cares?”:With controlled variables (career level, skills, etc.) the gender wage gap is ~8–5% [20]This means that college-educated women who work full time will earn ~$500,000 less than their male peers do over their lifetime [21]>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Now I’ll move on to answering your question about the “spending gap”.In general, it is more expensive to be a woman because of unfair androcentric marketing/retail/economic concepts.So, not only do women get paid less than men on average, even when they have the same job/education level/time working/experience/skill, etc., they also have to pay more for basic items then men pay.French philosopher Simone de Beauvoir eloquently said:If the man’s the norm and the woman "different," then men’s products too are considered the "normal version." Women’s products are therefore considered to be more special, luxurious versions, and are consequently more expensive.6 basic examples of women “spending more”: [22][22][22][22]Mortgages:A 2011 study published in the Journal of Real Estate Finance and Economics found that women, on average, pay more for mortgages than men, with the mean mortgage interest rates for women coming in 0.4% higher than for men.“The disparity cannot be fully explained by traditional variables such as mortgage features, borrower characteristics, and market conditions,” the authors write.In other words, women with credit scores and other qualifying factors similar to men pay more for their mortgages.For a 30-year mortgage, that could mean a man pays $26,000 less in interest over the life of the loan than a woman (assuming he gets a 5% mortgage rate while she gets a 5.4% rate).2. Dry Cleaning:Not all items are more expensive for women to get dry-cleaned — suits, blazers and slacks tend to have similar prices — but shirts are, according to the study published in the journal Gender Issues in 2011.The average price to clean a men’s shirt was $2.06, while it was $3.95 for a woman’s shirt — and that’s before considering the added cost of shirts made from special fabric like silk or rayon, or with embellishments like sequins or pleats.“The observed pricing disparity is for identical shirts except that one is labeled a ‘men’s’ shirt while the other is a ‘women’s’ shirt,” the authors write.This means that if a man and woman got one shirt dry cleaned per month for 10 years, on average, it would cost a man $247.20 in today’s dollars, while a woman would end up paying $474.3. Haircuts & hair care products:As almost every woman knows, getting a haircut costs far more for women than for men.A study by economist Liston-Heyes found that even for the same haircut, women paid more than men.“We started calling different hairdressers and explicitly said we had the same haircut [as a man],” she says.Still, she says, in almost every case, the price for the woman’s cut was more than a price for a man’s cut.A 1996 study done in New York City had similar findings: Nearly half of hair salons charged women more for a simple haircut. (New York City now prohibits gender-based pricing, though the practice persists.)Liston-Heyes says that this may be because, on average, it takes more time and effort for salons to cut women’s hair than men’s hair, so when they create their pricing structure, they make women’s cuts more expensive.What’s more, the 2015 study by the NYC Department of Consumer Affairs found that the largest price discrepancy between men’s and women’s products existed for shampoo and conditioner (women, on average, paid 48% more for a similar product)4. Deodorant and other personal care products:Stopping odor is a pricier proposition for women than for men, according to a 2011 study published in the journal Gender Issues.While on the surface, prices for a stick of deodorant for men and women seem the same (roughly $3.15 per stick), men’s deodorant sticks tend to be larger than women’s (2.86 ounces vs. 2.29 ounces).This means that, on average, women pay $1.44 per ounce of deodorant, compared with $1.15 for men — a difference of about 20%.Among the other pricier products for women:Razor cartridges and razors cost more for women than men by an average of 11%, according to the NYC study of similar women’s and men’s productsBody wash costs 6% more.“Of all the industries analyzed, personal care had the highest premium for women, with products costing, on average, 13% more than personal care products for men,” the study concluded.“Women’s and men’s deodorant are the same,” says New York City-based dermatologist Dennis Gross.“If you check the label there are the same active ingredients at the same percentage based on FDA regulations.”5. Cars:A 2001 study published in The American Economic Review found that car dealers made better initial offers to white men than to white women (more than $200 lower) and black women (more than $400 lower).What’s more, the final markup was about 50% higher for white women than for white menMore than 100% higher for black women.“Without any negotiating at all, two out of five white males obtained a better offer than their counterparts achieved after bargaining on average for more than forty minutes,” the authors write.6. Clothing:Adult women, on average, pay 8% more for their clothes than men do.The largest price discrepancies were in shirts (15%), dress shirts (13%) and jeans (10%).The Pink Tax: [23][23][23][23]Whether it's razors, dry cleaning or toys, women still pay more for those gender-specific items than men, studies show…"Price discrimination adds another layer to the wage inequality women face, making it harder sometimes for women to make ends meet," said Surina Khan, CEO of the Women’s Foundation of California, a group devoted to advancement of gender equality.The Bureau of Labor Statistics said that in the decade between 2004 and 2014, women earned 80% to 83% as much as men.The Pink Tax, so named because of the color of products directly marketed to girls & women, is the price difference for female centered products compared with gender neutral goods or those marketed to men. And even though the issue has been around for decades, it is still profound.In late 2015, the New York City Department of Consumer Affairs published a study comparing nearly 800 products from more than 90 brands, looking for price differences in items marketed to different genders.On average, products for women or girls cost 7% more than comparable products for men and boys.For example:Apparel:Girls' clothing cost 4% more than boys, and women's clothing cost 8% more than men’s.Toys:Girls' toys and accessories cost an average of 7% more than boys' toys.Separately, a side-by-side comparison of two Radio Flyer My 1st Scooters showed this: A red scooter cost $24.99 and a pink scooter cost $49, despite them being identical in all other ways.Personal care:Women's personal care products also cost 13% more than men’s, according to the department's study.Normally, consumers look to supply and demand to remedy inequities. If prices get to high on a product or service, someone finds out how to provide it cheaper.But “not all markets are perfect,” said Michael Cone, a customs attorney who filed a lawsuit in the U.S. Court of International Trade in 2007 that raised the broader question of whether different tariff rates for men’s and women’s apparel violate constitutional equal protection provisions.The case was dismissed, but discussion around the issue goes on.Here is a basic visual of the pink tax:Edit #2: another commenter suggested they’d be interested in how auto repairs costs differ for women, so I looked into that as well and found further evidence of gender discrimination in pricing.According to a 2013 paper from the Kellogg School of Management, this is definitely another area that the pink tax affects: [24][24][24][24]For male callers, there is no difference between having “no idea” about an expected price and being a savvy consumer: either way, you are quoted something right around market price. But for female callers, says Zettelmeyer, “you’re much worse off saying you know nothing as opposed to quoting the price of $365."Below is an exert from a Washington Post article [25][25][25][25] regarding a study done by RepairPal[26][26][26][26] :77 percent of respondents said mechanics are more likely to sell women unnecessary repairs, and 66 percent believed that mechanics charge women more than men for the same services.Health insurance has consistently been more expensive for women. The fact that some women give birth does not justify the discrepancies: [27][27][27][27]…if we ignore all costs directly associated with pregnancy and childbearing (the logic here being that it takes two parties to create a child and both parties should be willing to pay equally to support that endeavor), men aren't actually any cheaper to insure than women."When you get older, men cost more to insure than women," explained Jonathan Gruber, a health economist at Massachusetts Institute of Technology. Later in life, men are more likely to have a variety of conditions including heart attacks, lung cancer, and liver cancer. They're also more likely to smoke, drink, and get in accidents, according to experts.Larry Levitt, a senior vice president of the Kaiser Family Foundation, said that while Kaiser doesn't have any independent analysis of this, insurers have historically charged younger women more than men in the individual market, even though those plans rarely covered maternity services. "That tends to reverse at older ages, when men have generally been charged more than women," he said. "It's reasonable to assume that insurers set those premiums based on the patterns of health care use that they saw."In 2008 the average expenditure per person with an expense, including expenses covered by insurance and those paid out-of-pocket, was slightly higher for women ($5,635) than for men ($4,952), according to data from the Agency for Healthcare Research and Quality. But the difference in expenditures is largely attributable to childbirth.…men's average expenditures significantly exceeded women's for hospital inpatient services ($18,984 versus $12,997, respectively).The New York Times investigated some of the themes in charging women more for health insurance after the ACA had passed (which was an attempt to end gender discrimination in pricing): [28][28][28][28]Women still pay more than men for the same health insurance coverage, according to new research and data from online brokers.The new health care law will prohibit such “gender rating,” starting in 2014. But gaps persist in most states, with no evidence that insurers have taken steps to reduce them.For a popular Blue Cross Blue Shield plan in Chicago, a 30-year-old woman pays $375 a month, which is 31 percent more than what a man of the same age pays for the same coverage, according to eHealthInsurance.com, a leading online source of health insurance.In a report to be issued this week, the National Women’s Law Center, a research and advocacy group, says that in states that have not banned gender rating, more than 90 percent of the best-selling health plans charge women more than men…Differences in rates for men and women are not explained by the cost of maternity care. In the individual insurance market, such care is usually not part of the standard package of benefits. Maternity coverage may be offered as an optional benefit, or rider, for a hefty additional premium.In Louisville, Ky., according to eHealthInsurance.com, a 40-year-old nonsmoking woman pays $196 a month for a HumanaOne policy. That is 53 percent more than the $128 premium paid for the same coverage by a nonsmoking man of the same age.In addition, the nonsmoking woman pays 14 percent more than the $172 premium charged to a man of the same age who has used tobacco in the past year.In an article from Public Policy, there is more evidence that the amount women pay for health insurance is not justified by pregnancies: [29][29][29][29]...ratings say that the different rates for men and women are justified because women and men use different amounts of healthcare. They also often point to childbirth and maternal care as reasons why men and women’s healthcare may differ in cost.The first part of this argument, that men and women use different amounts of healthcare and women are thus more expensive to insure, is false. The fact is, if you remove maternity services, women are not more expensive to insure than men are—they simply use healthcare differently. Women cost the healthcare system more when they are younger, since they use preventative healthcare more than men do.Men cost the healthcare system more when they are older, since they are more likely to have heart attacks, lung cancer, and liver cancer. Also, men are more likely to smoke, drink, and get in accidents. It is unjust to penalize women when in fact both men and women cost the health system relatively equal amounts, just at different points in their life.Additionally, we should not punish women for their cautiousness while rewarding men for their recklessness. The argument that women are charged more because they use healthcare more is also incorrect because the parts of healthcare that women and men use at the same rate, such as specialty clinics and the emergency room, charge women more.The second tenet of this argument is also untrue; women cannot be “more costly to insure” due to coverage of the maternal and child health services, since very few of the plans that gender rate cover maternity services.According to a 2012 report from the National Women’s Law Center, before the implementation of the gender rating ban and inclusion of maternity services on insurance:92% of best-selling insurance plans engaged in gender rating.Of those plans, only 3% covered maternity services.Regardless of the verity of this argument, however, this should never be a reason that women have to pay more for healthcare. Men and women play equal roles in the conception of a child—they should both have to pay for childbirth.Aside from financial facts behind gender rating, it is clear that unequal rates are unethical. The $1 billion that gender rating costs women is especially impactful because women tend to have a lower income, often due to the wage gap. Before the passage of the ACA, 52% of women reported delaying medical care because of cost, and 32% of women reported giving up basic necessities in order to pay for healthcare expenses.The BBC pointed out that women are also more likely to be overcharged in ride share companies. POC experience more cancelations and longer wait times: [30][30][30][30]Ride-hailing companies such as Uber and Lyft may discriminate against black people and women, a study from three US universities suggests.Black riders faced longer wait times and more frequent cancellations than white riders, the research indicates.Women were more likely to be overcharged or taken on elongated routes, it says.Researchers took nearly 1,500 rides in Seattle and Boston, gathering data from three taxi-hailing companies.The sexist stereotype that you (the person who asked this question) are trying to push - that women love to shop and buy things more then men - doesn’t stand up to scrutiny.Spending trends/habits: [31][31][31][31]“We found that men and women impulse shop about the same amount, but the way they feel and how much they spend when they do it are different,” said Credit Cards - Compare Credit Card Offers at CreditCards.com senior analyst Matt Schulz.Men were significantly more likely than women to spend serious money on that unplanned purchase.While just 7% of the women said they had spent $500 or more, 21% of the men did.Men also made more impulse purchases of $1,000 or more.Women tend to keep their impulse purchases small, under $25.Men are more than twice as likely to make an impulse purchase when they’re intoxicated.Women are twice as likely to buy impulsively when they are sad.Women are more likely to regret making an impulse purchase:52% of the women vs. 46% of the men said they experienced buyer’s remorse at one time or another.Women tend to be “in charge” of purchasing what everyone else needs (traditional gender roles): [32][32][32][32]In virtually every society in the world, women have primary care-giving responsibilities for both children and the elderly…In this primary caregiving role, women find themselves buying on behalf of everyone else in their lives.The list is long: in addition to buying for themselves, women buy on behalf of husbands, partners, kids, colleagues, adult children, friends, relatives, elderly parents, in-laws, their businesses and even their kids’ friends, to name just a few. If somebody, somewhere needs a gift, chances are there's a woman thinking about it; tracking it down; wrapping it; making sure it’s accompanied by a personal message and then arriving to the person on the appointed day.I sometimes think entire industries would collapse overnight if women stopped being so thoughtful. Consider the impact to the greeting card industry alone.There are a lot more variables that need to be considered; neither the gender wage gap or the “spending gap” (which is a red herring and is being used by you to obscure a real issue) is something that one basic pie chart can explain or that your uninformed opinion disproves or proves - I would encourage you to educate yourself instead of using Quora as a way to trivialize real issues by regurgitating talking points that originate in hostility.What is your goal here in denying real problems besides reinforcing the status quo, which further disadvantages women?Footnotes[1] Why Parental Leave Policies Are Changing[2] What Women Breadwinners Want[3] https://www.icedr.org/research/documents/15_millennial_women.pdf[4] A Dollar Short: What’s Holding Women Back from Equal Pay?[5] http://content.thirdway.org/publications/853/NEXT_-_Fatherhood_Motherhood.pdf[6] Why Women Don't Ask For More Money[7] Negotiation and the Gender Divide[8] Why Women Don’t Negotiate Their Job Offers[9] https://www.usnews.com/news/blogs/data-mine/2014/10/31/women-more-likely-to-graduate-college-but-still-earn-less-than-men[10] Gender Pay Gap Ratios, Stats and Infographics | PayScale[11] https://www.aauw.org/files/2013/02/graduating-to-a-pay-gap-the-earnings-of-women-and-men-one-year-after-college-graduation.pdf[12] Here's How Much Doctors Actually Make in 2016[13] Occupational Feminization and Pay: Assessing Causal Dynamics Using 1950–2000 U.S. Census Data | Social Forces | Oxford Academic[13] Occupational Feminization and Pay: Assessing Causal Dynamics Using 1950–2000 U.S. Census Data | Social Forces | Oxford Academic[13] Occupational Feminization and Pay: Assessing Causal Dynamics Using 1950–2000 U.S. Census Data | Social Forces | Oxford Academic[13] Occupational Feminization and Pay: Assessing Causal Dynamics Using 1950–2000 U.S. Census Data | Social Forces | Oxford Academic[14] As Women Take Over a Male-Dominated Field, the Pay Drops[14] As Women Take Over a Male-Dominated Field, the Pay Drops[14] As Women Take Over a Male-Dominated Field, the Pay Drops[14] As Women Take Over a Male-Dominated Field, the Pay Drops[15] Gender in Home Kitchens and Restaurants[15] Gender in Home Kitchens and Restaurants[15] Gender in Home Kitchens and Restaurants[15] Gender in Home Kitchens and Restaurants[16] Taking The Heat: Is Foodie Culture Making Room For Female Chefs?[16] Taking The Heat: Is Foodie Culture Making Room For Female Chefs?[16] Taking The Heat: Is Foodie Culture Making Room For Female Chefs?[16] Taking The Heat: Is Foodie Culture Making Room For Female Chefs?[17] The Whole Woman[17] The Whole Woman[17] The Whole Woman[17] The Whole Woman[18] Why Are Female Chefs Paid so Much Less Than Their Male Colleagues?[18] Why Are Female Chefs Paid so Much Less Than Their Male Colleagues?[18] Why Are Female Chefs Paid so Much Less Than Their Male Colleagues?[18] Why Are Female Chefs Paid so Much Less Than Their Male Colleagues?[19] A Change in the Kitchen[19] A Change in the Kitchen[19] A Change in the Kitchen[19] A Change in the Kitchen[20] Gender Pay Gap Ratios, Stats and Infographics | PayScale[21] collegepayoff-complete.pdf - Box[22] 6 times it’s more expensive to be a woman[22] 6 times it’s more expensive to be a woman[22] 6 times it’s more expensive to be a woman[22] 6 times it’s more expensive to be a woman[23] 'Pink Tax' forces women to pay more than men[23] 'Pink Tax' forces women to pay more than men[23] 'Pink Tax' forces women to pay more than men[23] 'Pink Tax' forces women to pay more than men[24] The Importance of Appearing Savvy[24] The Importance of Appearing Savvy[24] The Importance of Appearing Savvy[24] The Importance of Appearing Savvy[25] The auto-repair industry discriminates against women. So I quit my engineering job to become a mechanic.[25] The auto-repair industry discriminates against women. So I quit my engineering job to become a mechanic.[25] The auto-repair industry discriminates against women. So I quit my engineering job to become a mechanic.[25] The auto-repair industry discriminates against women. So I quit my engineering job to become a mechanic.[26] https://repairpal.com/consumer-survey-march-2013[26] https://repairpal.com/consumer-survey-march-2013[26] https://repairpal.com/consumer-survey-march-2013[26] https://repairpal.com/consumer-survey-march-2013[27] Why Making Women Pay More Than Men for Health Insurance Doesn't Make Sense[27] Why Making Women Pay More Than Men for Health Insurance Doesn't Make Sense[27] Why Making Women Pay More Than Men for Health Insurance Doesn't Make Sense[27] Why Making Women Pay More Than Men for Health Insurance Doesn't Make Sense[28] https://mobile.nytimes.com/redirect?to-mobile=https%3A%2F%2Fwww.nytimes.com%2F2012%2F03%2F19%2Fhealth%2Fpolicy%2Fwomen-still-pay-more-for-health-insurance-data-shows.html%3Freferer%3D[28] https://mobile.nytimes.com/redirect?to-mobile=https%3A%2F%2Fwww.nytimes.com%2F2012%2F03%2F19%2Fhealth%2Fpolicy%2Fwomen-still-pay-more-for-health-insurance-data-shows.html%3Freferer%3D[28] https://mobile.nytimes.com/redirect?to-mobile=https%3A%2F%2Fwww.nytimes.com%2F2012%2F03%2F19%2Fhealth%2Fpolicy%2Fwomen-still-pay-more-for-health-insurance-data-shows.html%3Freferer%3D[28] https://mobile.nytimes.com/redirect?to-mobile=https%3A%2F%2Fwww.nytimes.com%2F2012%2F03%2F19%2Fhealth%2Fpolicy%2Fwomen-still-pay-more-for-health-insurance-data-shows.html%3Freferer%3D[29] The End of Gender Rating: Women’s Insurance Under the ACA[29] The End of Gender Rating: Women’s Insurance Under the ACA[29] The End of Gender Rating: Women’s Insurance Under the ACA[29] The End of Gender Rating: Women’s Insurance Under the ACA[30] Uber 'race and sex discrimination'[30] Uber 'race and sex discrimination'[30] Uber 'race and sex discrimination'[30] Uber 'race and sex discrimination'[31] Guess which gender spends more on impulse[31] Guess which gender spends more on impulse[31] Guess which gender spends more on impulse[31] Guess which gender spends more on impulse[32] The Real Reason Women Shop More Than Men[32] The Real Reason Women Shop More Than Men[32] The Real Reason Women Shop More Than Men[32] The Real Reason Women Shop More Than Men