Equal exposure, unequal burden of climate change: Gendered impacts on mental health and intra-household spillovers

Mental health disparities between male and female constitute a significant yet underexplored manifestation of gender inequality, a challenge increasingly exacerbated by climate change. This paper explores the impact of climate change on mental health and health expenditure, with a particular focus on gender inequality and its spillover effects. We develop a theoretical framework of intra-household resource allocation, and employ micro-level panel datasets matched with a climate physical risk dataset to estimate the impacts of climate change. Our findings reveal that climate change significantly increases depression and related health expenditures, with female disproportionately affected. In male-preferred households, the deterioration of male’s mental health generates negative spillovers that further undermine female’s mental well-being. Channel analysis shows that climate change impairs mental health through reduced exercise, declining physical health, and economic uncertainty. Structural disparities and intra-household dynamics give rise to selection effects that exacerbate unequal mental health outcomes and financial burdens. While improved access to local employment opportunities and healthcare resources provides partial mitigation, substantial gaps remain in effective climate adaptation. Using China’s healthy cities pilot policy as a case study, we present empirical evidence on the role of government support in strengthening residents’ mental health adaptation to climate change. These findings underscore the urgency of gender-responsive policies to enhance adaptive capacity and safeguard mental health under escalating climate risks.