The World Health Organization’s definition of health as a state of complete physical, mental, and social well-being has driven decades of frameworks built around the social determinants of health. Income, education, housing, and employment all feature prominently in these models. Time, however, remains largely absent, treated instead as a technical parameter within epidemiology. It appears in calculations of disability-adjusted life years, in critical periods of vulnerability, or as an implicit resource that people need to exercise, eat well, attend appointments, and maintain relationships. But this framing assumes everyone has roughly comparable access to time, an assumption the new paper argues is demonstrably false.

Sociology offers a richer picture. Time is not only measured by clocks and calendars but lived as duration, pace, and anticipation, all shaped by economic relations and the finite span of human life. Critically, perceptions of time are tied to identity and a person’s sense of control over their own existence. When people report lacking time, they are not simply reporting an insufficient number of hours; they are describing how their time is structured, valued, and constrained by forces beyond their individual choosing. Reframing time this way transforms it from a methodological convenience into a structural exposure—one that can be measured, modeled, and, in principle, changed through policy.

The paper identifies two interrelated dimensions through which time operates on health: availability and intensity. Availability refers to the absolute quantity of discretionary time a person commands. Intensity captures the lived experience of rushing, acceleration, and constant pressure. In many market-driven societies, emphases on productivity have accelerated daily rhythms at work and at home, intensified by technological change, urbanization, and flexible labor markets that blur the boundary between employment and the rest of life. The result is what researchers describe as boundaryless work—employment that seeps into evenings, weekends, and mental space—alongside the persistent devaluation of unpaid care.

Within labor markets, temporal pressure is organized through two dimensions of working time: control and variability. Working time control describes how much autonomy employees have over when, where, and how they work, which shapes their capacity to protect time for rest, care, and other non-market activities. Working time variability captures how much hours fluctuate, reflecting the predictability of daily rhythms. Evidence from across Europe shows that higher variability, especially when combined with low control, is associated with worse self-rated health, more psychosomatic complaints, and more frequent sleep problems. Meanwhile, indicators such as discretionary time, subjective time scarcity, time poverty, and time excess appear to mediate the well-documented association between socioeconomic status and health—and the health consequences of time poverty differ sharply between high- and low-income groups.

The burdens are not distributed equally. People working multiple jobs, and those combining paid employment with caregiving, face severe constraints on both the amount and the intensity of their time. Women are overrepresented in these situations and globally spend on average 2.8 more hours per day than men on unpaid care and domestic work. Because women, particularly those with lower incomes, perform the largest share of unpaid domestic and care labor, inequalities in time constitute a key mechanism through which social and gender disparities in health are reproduced. Migration, armed conflict, and economic instability deepen these patterns further, as uncertainty and chronic temporal strain become defining features of everyday life.

The relationship between time and health is also bidirectional, creating cycles that entrench disadvantage. Time constraints limit engagement in health-promoting behaviors such as physical activity or preparing nutritious meals, while fostering fatigue, negative mood, and stress-related physiological responses. Conversely, living with illness or disability reshapes how people can use and control their time, restricting participation in paid work, caregiving, and social life. Research on treatment burden shows that managing chronic illness entails substantial unpaid labor—information seeking, medication management, appointments, self-monitoring, lifestyle changes, financial tasks, and navigating health systems. These burdens are socially patterned too: most treatment burden measures were developed in high-income settings and may fail to reflect the experiences of people with lower health literacy or greater socioeconomic constraints. The result is a self-reinforcing loop in which poor health consumes time, and scarce time worsens health.

Healthcare systems themselves are built on temporal assumptions that often fail patients. Care is organized around clock time, standardized schedules, and linear treatment trajectories that rarely match the lived temporalities of chronic illness, disability, or long-term care. Patients juggling paid work and caregiving, or living with limited material resources, must navigate overlapping temporal scales and trade present time for uncertain future benefits. The misalignment disproportionately harms the socially disadvantaged. One promising response is coordinated care that aligns multiple appointments or services within a single visit, reducing the time costs of fragmented care—a model with demonstrated potential for patients with multimorbidity.

Making time visible in epidemiology has direct methodological consequences. Conventional models that treat time as neutral or exogenous obscure how temporal scarcity, acceleration, and uncertainty function as socially patterned exposures, and may systematically misattribute responsibility to individual behavior in ways that reproduce inequity. Existing infrastructures already make measurement feasible: the Harmonised European Time Use Surveys and the Multinational Time Use Study provide harmonised 24-hour diary data on paid work, unpaid care, personal care including sleep, travel, and leisure, alongside sociodemographic information. Incorporating these temporal dimensions into study design would allow research to better reflect lived experience across social groups and countries.

At the level of primordial prevention, the paper calls for engagement through public health diplomacy—advocating health in all policies beyond the health sector. That includes social protection systems that buffer economic uncertainty, labor policies regulating working hours and job security, housing policies shaping residential stability and commuting time, and transport infrastructure that reduces time poverty. Family-related policies such as paid parental leave, accessible childcare, and elder care support can ease the temporal pressures on working-age adults caring across generations. The ultimate claim is ambitious but straightforward: ensuring that people have the temporal conditions necessary to exercise choice, participate in society, and live healthy lives is not a luxury but a prerequisite for health equity, and reclaiming time as a determinant of health is fundamental to advancing population well-being.

Subject of Research: Time as a socially structured determinant of health and health equity

Article Title: Reclaiming time as a fundamental determinant of health equity

Article References: Reclaiming time as a fundamental determinant of health equity. (n.d.). https://doi.org/10.1016/j.ssmph.2026.101939

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101939

Keywords: health equity, social determinants of health, time poverty, working time, unpaid care work, gender inequality, treatment burden, chronic illness, public health policy, epidemiology, time use surveys, social acceleration

The research, published in SSM – Mental Health, draws on ten focus group discussions with 80 adult women in five rural communities in Isiolo and Samburu Counties, arid and semi-arid regions that were in the grip of severe drought when data were collected between June and July 2023. The interviews were conducted in the Samburu language by local research assistants and analyzed by a team from Emory University working with St. Paul’s University and World Vision Kenya as part of a multi-country initiative called Strong Women, Strong World: Beyond Access. The analysts used a modified grounded theory approach, applying established frameworks on cognitive labor and mental load to accounts that emerged spontaneously during broader conversations about water, time use, and economic life.

What the team found is striking in its consistency. Across every focus group, women described water collection not as a discrete physical chore but as a continuous cognitive project composed of four interlocking components: anticipation, identification, decision-making, and monitoring. Anticipation began in sleep. As one participant put it, even while sleeping women would start planning for the next day, calculating whether they would have water and how to fit collection into an already packed schedule. Upon waking, the mental sequencing resumed immediately—deciding what could be postponed, what demanded attention, and how the day’s chores could be arranged so that the long trip for water did not derail everything else.

Identification, the second component, involved continuously evaluating which water sources were viable, safe, and accessible under shifting conditions. During the rainy season, temporary sources such as water pans, gullies, and shallow dug wells appeared nearby, offering brief relief that might last only a week or two before drying up. In the dry season, women weighed distant sources that offered cleaner water against closer points contaminated by livestock and wildlife. They layered other tasks onto water trips—washing clothes, watering animals, shopping on market days—to conserve time and energy, and they adjusted plans when husbands requested extra water or when children’s needs intervened.

Decision-making, in turn, was not a single choice but a constantly revised calculation. Women chose whether to leave at dawn, before water points grew crowded and before livestock arrived, even though leaving early meant sacrificing time for school preparation and breakfast. They decided how much to carry, when to make a second trip, how to ration what they had collected across drinking, cooking, bathing, and cleaning, and when it was safe to walk routes where elephants had been spotted. Fatigue shaped these decisions in tangible ways: some women reported carrying smaller volumes of water or returning home earlier than planned because the cognitive and physical demands of the morning had already depleted them—a detail the researchers note adds empirical nuance to behavioral science, which increasingly recognizes that mental burden directly affects the performance of physically demanding tasks.

Monitoring, the fourth component, extended the labor well beyond the journey itself. Once home, women tracked water levels throughout the day, restricted household consumption, ensured children and livestock were supplied, and observed whether sources were drying, lowering, or becoming contaminated—observations that triggered fresh rounds of anticipation and planning. This vigilance was largely invisible within the household, unobservable to those who benefited from it, and therefore unrecognized and unshared. Women emphasized that the mental work of tracking what remained continued long after the physical labor of collection had ended, keeping water permanently on their minds.

Woven through all of this was emotional labor: regulating fear, suppressing frustration, buffering family members from scarcity, and absorbing responsibility for everyone’s wellbeing at the expense of their own. Women described the anguish of rationing, of giving the last water to others while going without bathing themselves, and the shame of borrowing food from neighbors after a long water journey. They described painful trade-offs between fetching water and preparing food, protecting children and earning income. They also described the emotional weight of watching daughters begin to shoulder the same burdens, and their determination to send girls to school to break the cycle. Women persistently subordinated their own needs—eating last, skipping meals, continuing to cook and care for others after reaching physical and emotional depletion.

The cumulative consequence, the researchers argue, is what they call the mental load of water collection: neither the sum of cognitive and emotional labor nor a synonym for stress, but the distinct product of their sustained co-occurrence. It manifested as sleepless nights, constant perseveration, headaches and lightheadedness, exhaustion, and neglected self-care. One woman summed it up: us women get sleepless nights knowing that in the morning you have to go and fetch water. The load was continuous, present day and night; boundaryless, following women across cooking, farming, childcare, and rest; and invisible, sustained by gender norms that frame water collection as women’s natural, unquestioned duty. Men’s participation was widely viewed as culturally inappropriate, with men risking social shame even for carrying a container a short distance, so women performed the work without household support—even as pregnant women faced risks including miscarriage from the weight of jerricans or sudden flight from wildlife.

The findings place rural Kenyan women’s experiences within a growing global literature linking water insecurity to anxiety, depression, and psychosocial distress, from Bolivia and Ethiopia to Uganda and India. But they extend that literature by demonstrating that the four components of cognitive labor documented in higher-income household research intensify under conditions of scarcity, seasonal variability, physical danger, and infrastructure failure, demanding constant recalibration that comparatively stable domestic settings do not. The burden, the authors stress, is not incidental but structurally produced by the gendered assignment of water responsibility, and it accumulates across the life course, beginning in childhood and intensifying during pregnancy and postpartum periods.

Yet the study also found buffers. Social networks softened the load: women walked to the river in groups, chatting, sharing information about water availability, coordinating decisions, and releasing stress through companionship that sometimes offered the only social connection in isolated homesteads. Membership in women’s groups provided practical help and belonging. These supports did not eliminate the hardship, the researchers note, but they made daily water work more bearable and emotionally sustainable.

The implications reach beyond Kenya. Globally, 1.8 billion people rely on off-premises water sources, and in seven out of ten households that must collect water, women and girls bear primary responsibility. Prior research using smartwatches and scales found that women in four countries walked an average of 3.5 kilometers and expended 231 kilocalories per collection trip; separate survey data show women have 1.5 times higher odds than men of reporting a water-fetching injury, with falls on dangerous terrain the predominant mechanism. The new study insists that the true burden cannot be measured in distance walked or weight carried alone. Improving water access through infrastructure that delivers safe water to the household could substantially reduce physical, cognitive, and emotional labor, and the authors argue for greater representation of women in water governance and leadership, alongside the application of frameworks such as the International Labour Organization’s 5Rs—recognizing, reducing, redistributing, rewarding, and representing unpaid care work. Until such change arrives, the researchers conclude, water collection must be recognized as a complex, gendered system of labor that shapes women’s time, energy, identities, and mental health—a burden they carry because, as they said repeatedly, everything depends on them.

Subject of Research: The cognitive and emotional labor of water collection and management among women in rural Kenya

Article Title: ‘Everything depends on us’: The cognitive and emotional labor of water collection and management in rural kenya

Article References: Dessalegn, B., Ogutu, E., Mink, T., Patrick, M., Sinharoy, S. S., Atandi, E., Mwangi, P., Koome, P., Onyango, R. O., Otuya, P., Ruto, P., & Caruso, B. A. (2026). ‘Everything depends on us’: The cognitive and emotional labor of water collection and management in rural kenya. SSM – Mental Health, 10, Article 100702. https://doi.org/10.1016/j.ssmmh.2026.100702

Image Credits: AI Generated

DOI: 10.1016/j.ssmmh.2026.100702

Keywords: water insecurity, cognitive labor, emotional labor, mental load, gender norms, rural Kenya, water collection, unpaid care work, mental health, WASH, Samburu, drought