9.5.3. Data
description and analysis
Health inequalities
Lifestyle, as well as familial predisposition, can
influence the risk of contracting diseases such as cancers. Restricted
lifestyles, with less advantageous work conditions, lower education and other
stresses that affect lifestyle choices and access to screening and treatment,
may adversely influence health risk behaviours.
Figure 9.5.1.
Percentage of deaths in the 15-44 age group compared to total deaths for men
and women for selected EUGLOREH countries
Economic
inequalities mean that in many countries women have difficulty in acquiring the
basic necessities for a healthy life. It is notable that women with children
have lower employment rates than those without (European Commission, 2006).
Figure 9.5.2.
Unemployed persons as a percentage of the labour force, 2003
In most countries,
the overwhelming majority (80% or over) of single parents are women (Council of
Europe: OECD). Women also appear more affected by the tension of combining
participation in the labour market with private responsibilities. This
manifests itself as back pain (30%), stress (28%), muscular pains in the arms
or legs (17%), skin diseases, infectious diseases, asthma and allergies
(European Commission, 2003). By contrast, males suffer more from accidents,
back pain and hearing loss (EU Agency for Health & Safety at Work, 2004).
Unshared domestic work can be exhausting and debilitating, especially when
combined with inadequate resources and/or pregnancy. Mental health can be
damaged when the work is given little recognition and is carried out in
isolation (Doyal, 1998).
Table
9.5.1. Sex differences
in the prevalence of mental disorders across the life-cycle
Source: WHO (2004)
Table 9.5.2. Prevalence of depression in European epidemiological
studies
Table 9.5.3. Suicide Rates
Gender differences
are apparent in the patterns of help sought for psychological disorder. Women
are more likely to seek help from their primary care physician and disclose
mental health problems to him/her. Men are more likely to seek specialist
mental healthcare, and are the main users of inpatient care. Gender bias can
also occur in the treatment of psychological disorders. Doctors are more likely
to diagnose depression in women compared to men, even when they have similar
scores on standardised measures of depression, or present identical symptoms.
There may also be differences in access to specific treatments such as
psychotherapy or anti-depressants, and in the response to treatments and their
outcomes. Female gender is a significant predictor of being prescribed mood altering
psychotropic drugs. The disability associated to mental illness falls most
heavily on those who experience three or more co-morbid disorders; this occurs
mainly with women (Austbury et al, 2002; Hällström
et al, 2001).
Biological factors
in the way women develop can put them at social disadvantage and thereby
influence health. Girls who reached menarche by the age of 11 are more likely
to say they are too fat than girls who mature later. Thus, these girls are more
likely to engage in dieting/weight control behaviour and can also be more prone
to risk behaviours, e.g. as they are perceived as older and more mature than
other girls of the same age, they may begin to socialise with older peers.
Consequently, they may come under more social pressure to indulge in risk
behaviours. Being younger, they may also be more malleable in conforming to the
ideas of peers (WHO/HBSC, 2004).
Education
Numerous studies
demonstrate that life expectancy and ‘positive health experiences’ increase for
those with higher levels of education.. The prevalence of ill-health is seen to
increase steadily with decreasing educational level (EP/EIWH, 2007).
Individuals of
either gender with low levels of education are more likely to suffer chronic
from health problems and resulting disability than the more educated. Studies
have shown that children of mothers educated only to primary school level have
a higher risk of health problems than children of more educated mothers
(European Commission, 2003). Education is also
significantly associated to health risk behaviours: the more advanced the
smoking epidemic curve in a country, the more smoking is concentrated among the
least educated of that country.
Poor education,
poverty, bad lifestyle choices and bad working conditions can negatively affect
functional capacity in later life. Some countries have noted that people with
poor functional ability are more likely to become institutionalised, which in
itself can lead to dependence. In most countries, older people have a lower
average standard of education than that of younger people. This lack of
education will influence the income, social role, expectations and the
aspirations a person has during his/her life (WHO, 1999).
In the EU25, more
women than men aged 20 to 24 had completed at least upper secondary education
in 2005: 80% of women compared to 75% of men. Only in the Czech
Republic and the United Kingdom the proportions are similar
(Eurostat, 2006).
Table 9.5.4. Percentage of 25-64 year old females with at least
upper secondary education (2003)
Poverty in old age
Although reduced,
poverty amongst the elderly in Europe has not been eliminated. The United
Kingdom continues to show relatively high poverty rates; Finland and Sweden now
register in the lower scale of overall elder poverty levels. Poverty rates rise
with both age and changes in living arrangements. The rate of poverty directly
affects a greater number of women 75 years old or older who are living alone
compared to men. Poverty is highest amongst the divorced, widowed and
never-married. (Smeeding and Sandström, 2005).
Pensions: The elderly invariably receive lower
average incomes than the non-elderly, though there are large variations across
countries. Pensions represent the main source of an older person’s income. An
adequate standard of living for an older person can be measured by the
inequality reduction potential of old age pensions rather than their generosity
(Heinrich, 2000). While the life quality of all older people may be affected by
lower income, women are particularly affected due to their biological potential
to live longer than men.
Carers: In the UK, nearly one in four women in
their 50s are likely to be providing care (Age Concern, 2007a), although
statistics show that over the age of 65, unpaid care is more likely to be
provided by men (UK National Statistics On-line, 2007). (See Figure 9.5.3)
Carers can often be penalised financially by employers’ inflexibility and rigid
state pension rules if taking time out of work to care for sick, older and
disabled partners, relatives and friends (Age Concern, 2007b).
Violence
Violence episodes
take place every day, although precise national and international statistics
are lacking. Violence can take the form of physical, sexual or psychological
abuse. Violence against women is perpetrated for reasons connected with
discriminatory cultural policies, practices which deny gender equality, or
which tolerate this form of violence (Council of Europe, 2004). Domestic
violence does not distinguish between geographical boundaries, age or race, and
occurs in every kind of family relationship and in every social milieu.
Estimates on violence against women, published by various sources, are reported
in Table 9.5.5.
Table 9.5.5. Violence against women
Most reported intimate partner violence is perpetrated by
men towards women. However, violence is also committed by women towards men,
and within same sex relationships. One in 4 women and 1 in 6 men will experience domestic violence over their lifetimes (Council of Europe, 2002). In
England and Wales in the year preceding interview, there were an estimated 12.9
million incidents of domestic violence acts against women, and 2.5 million
against men (Women’s Aid, 2004).
The cost of domestic violence to the health services
appears to be high. Victims are found to have more operative surgery, more
doctor visits, hospital stays, visits to pharmacies and mental health
consultations over their lifetime than the non-victimised. Wider costs include
those to judicial systems, refuge provision, lost earnings and emotional costs
to the victim. In England & Wales in 2004, the cost of intimate partner
violence was estimated at £5.7 billion (Euro 8.4 billion), with an extra £17
billion (Euro 25 billion) for emotional costs to the victim (WHO, 2007). In
Finland, it has been established that one act of violence in a family may cost
society 185 000 Finnish marks (about Euro 30 000). In comparison, treatment for
the perpetrator costs as little as Euro 1 000 (FIDH, 2006).
There is wide variation in the legislative means used to
address intimate partner violence. Several Member States, normally regarded as
advanced (e.g. Holland), have no specific legislation on domestic violence,
while others have legislation which is underused. In Greece, marital rape does
not expressly constitute an offence; in Italy it is considered a crime (though
the law is rarely applied). In France, marital rape is recognised as an offence
and therefore punished. In some countries (e.g. Portugal), laws were adopted
under international pressure rather than through increased awareness of the
issues, and there are no means for implementing the law (FIDH, 2006).
Alcohol misuse
Alcohol related problems represent about 9% of the disease
burden in Europe, perhaps as high as 10.7% in Eastern Europe. Men are generally
heavier drinkers than women; women may be at a higher risk due to lower body
weight and their different metabolisms as related to alcohol
dehydrogenase activity. A recent study has shown that in the UK young females are most likely to drink at or above ‘high risk levels (WHO/GENACIS,
2005). Levels of consumption or genetic difference alone do not explain
cross-cultural variation in behaviour when people drink. Drinking behaviour is
related to cultural beliefs about alcohol, expectancies regarding the effects
of alcohol and social norms regarding drunken comportment. This is not to
detract from the fact that alcohol exacerbates financial difficulties,
childcare problems, infidelity or other family stressors, and creates tension
and conflict between partners (WHO, 2007). Socio-economic grouping is a
significant factor in the causes of mortality associated with alcohol (European
Commission, 2002).
Fourteen per cent of men and 4 per cent of women report
lifetime experience of alcohol misuse or dependence. Some 42 million Europeans
experience alcohol problems at some time in their lives and it is estimated
that there are 84 million people in Europe either suffering from alcohol
problems or afflicted by another one's drinking. One third of problem drinkers
receiving treatment cite marital conflict as one of the main problems caused by
drinking. There is much evidence to show that there is a correlation between
domestic violence and alcohol. High proportions of perpetrators of domestic
violence are either problem drinkers or under the influence of alcohol at the
time of the assault. Equally, high proportions of victims of violence are also
under the influence of alcohol at the time of the assault (EUROCARE, 1998).
Socio-economic grouping is a significant factor in the causes of mortality
associated with alcohol (European Commission, 2002). More complete and reliable
information is needed on the contribution of alcohol to divorce, family
break-up, child neglect and abuse.
Risk factors for
breast cancer in women may include regular use of alcohol (especially if
combined with hormone replacement therapy (Beral, 2003), and higher body mass
index (BMI) in early adulthood (Michels, 2006)
In adolescence,
the number of girls who drink alcohol weekly rises sharply between 11 and 15
years of age. A survey among 15-16 year-olds found that 26% of boys and 22% of
girls in Sweden had been drunk at the age of 13 or earlier. In Greece the rate was 11% and 6% respectively (Jernigan, 2001).
Table 9.5.6 below
illustrates drinking patterns for men and women in selected EU countries. While
a high percentage of Italian and French women drink every day, the highest
percentage of female binge drinkers are in the UK and Ireland.
Table 9.5.6. Drinking patterns among men and women in selected
European countries
Figure 9.5.4. Girls who drink any alcoholic drink weekly (%)
Tobacco smoking
Women are more
likely than men to take up smoking as a means of weight control, and to
continue smoking, rather than risk putting on weight. Moreover, many women
smoke in order to relax and relieve stress. Australian research has suggested
that women smoke more in situations of difficulty and negative emotion and are
more likely to begin smoking again while feeling sad or depressed.
In 2002, the rates
of regular daily smokers were slightly higher in the ten Accession Countries
than EU-15 (32% vs 29%) with the highest prevalence in the Netherlands (33.5 per 100 000) and Latvia (33.2) (WHO, 2002a). Overall, rates appear to have been on
a slight decrease since accession, though data to support this statement are
patchy. A marginal increase was seen in Belgium, Estonia, Ireland and Italy. The highest prevalence in 2004 was in Poland (32.0) and the Netherlands (30.8 per 100.000). (WHO HFA-DB, 2006). Across the EU, more men are seen to
smoke than women, with the only exception being Sweden (EUROSTAT, 2007) with
correspondingly higher levels of smoking related health problems.
Table
9.5.7. Percentage of Female Adults Smoking in 1985 and 2002-2003
The issues around
quitting smoking are complex. Evaluations need to take account of variables
such as socio-economic status and educational level as well as gender roles and
expectations. There is evidence to suggest that pharmacologically-based aids to
cessation are not equally effective for both sexes (Borland, 1990), though this
may be influenced by social experience and available support.
There are some
important gender differences in smoking behaviour. About nine out of 10 tobacco
users start before they are 18 years old. Smoking is driven predominantly by
psychosocial reasons such as wanting to look older, needing to relax, feeling
rebellious, or even as a result of boredom. Girls especially are attracted by
the idea that it might control weight gain. It has been noticed that children
who smoke frequently have low self esteem, impaired psychological wellbeing, or are poor achievers at school, and tend not to be
succeeding according to their own or society's terms
(Jarvis, 2004). While boys are more likely to start smoking
earlier than girls, smoking rates for girls are overtaking those for boys in
many northern and western European countries.
Women who continue
to smoke, and those who fail at attempts to stop smoking, tend to have lower
education and employment levels than women who quit smoking. They smoke a
higher number of cigarettes per day and tend, therefore, to be more addicted to
cigarettes. They have less social support to stop smoking, are less confident
in resisting temptations to smoke, and are thus cognitively less ready to stop
smoking (CDC, 2001). There is some evidence that pharmacologically-based aids
to cessation are not equally effective for both sexes (Borland, 1990), but this
may be due to social experience and available support rather than the treatment
per se. Women are more likely to participate in cessation programmes but rarely
show better results than for men. Extraordinary circumstances of poverty,
violence, severe depression, chronic stress, oppressive racial or sexual
discrimination and other immobilising forces preclude cessation (Christen et al,
1998).
The WHO/HBSC
report Health Behaviour in School-aged Children recommends
gender-specific intervention programmes to control adolescent smoking, in
particular for adolescent girls, as their smoking behaviour may influence
future health. The interaction between smoking and oral contraceptives is
thought to increase the risk of cardiovascular disease and affect reproductive
health. Smoking in young women may therefore have a
significant impact on the developmental and growth environment of the next
generation (WHO/HBSC, 2004).
Nutrition
A Eurobarometer
survey has found that in 11 out of 15 Member States the weight of citizens has
increased, with the most striking increases in Luxembourg (2.7 kg), Denmark (1.7 kg) and Ireland (1.6 kg) (Eurobarometer, 2006). In April 2007 the European
Commission launched their Strategy for Europe on Nutrition, Overweight and
Obesity related health issues.
Current EU environments favour obesity. There is an abundance
of food in Europe that, while energy-rich, is often poor in nutrients. Food
portion sizes are growing, though people with sedentary lifestyles actually
need less energy. Social and economic pressures can mean that both work and
leisure hours offer decreasing opportunities for physical
activity. There are distinct differences in the northern and southern
(Mediterranean) food cultures. Nevertheless, it has been seen that across all
Member States it is the least educated who consume fewer fresh vegetables, and
are on average shorter and more obese than the most educated, though the
dimension of these differences can vary between men and women and in accordance
with the drinking and diet culture (European Commission, 2003).
It is more
commonly women who provide food, health and care to their families. They choose
which foods to purchase and decide which way they will feed the family. Men
attach less importance to health when selecting their diet compared to women,
but the pressures affecting their different lifestyle choices have not yet been
fully understood.
Figure 9.5.5. Adults (15+) selecting ‘trying to eat healthily’ as
an important influence on food choice, divided per sex and age, 1996 (%)
Women’s personal food choices, however, may have a shortage of
nutrients. Poor
nutrition in females can reduce learning and employment potential (Hammarström
and Janlert, 2005) and increase reproductive and health risks. In addition,
women’s reduced economic and empowerment opportunities may have an impact on
patterns of behaviour and access to resources, leading ultimately to poorer
health in older age. Poverty can increase with age, and leave some elderly
women and men at risk of vitamin or mineral deficiency (Volkert, 2005).
Physical activity
Levels of physical activity vary
across the member states of EU-15, but in general southern countries of the
EU-15 have lower levels of physical activity than northern
and western countries. Physical inactivity is defined as less than 2.5 hours
per week of moderate exercise or 1 hour per week of vigorous exercise. The
World Health Report 2002 estimates that over 3% of all disease burden, over 20%
of CHD, and 10% of stroke in developed countries is caused by physical
inactivity.
The data on the
levels of physical inactivity across Europe are poor. There have been only two
multinational surveys, both of which were carried out only in member states of
the EU-15. The most recent was the 2002 Eurobarometer survey on physical
activity, which asked a series of questions on the frequency and
duration of vigorous activity, moderate activity and walking. The results of
the survey are regarded as difficult to interpret. However, it is clear that
the proportion of adults who regularly undertake physical
activity is low. In 2002, over 40% of adults in EU-15 countries
reported no moderate level physical activity in the past
week, 17% no episodes of walking for 10 minutes or more, while 49% spent in
excess of 4.5 hours each day sitting. Only 15% reported daily moderate level physical
activity. Investigations into work-related physical
activity showed that 49% of the EU population get little or no physical
activity at work.
Table 9.5.8. Days of vigorous physical
activity in the last 7 days per gender
Table 9.5.9. Time spent on vigorous physical
activity in the last 7 days per gender
Current evidence
suggests that the immediate social environment of children and youth -
including parents, peers and teachers - has an influence on their physical
activity habits. The impact of social modelling appears to be more
significant for girls. The absence of active role models may negatively
influence girls’ long-term decision to participate in physical
activity and sport (New South Wales Department of Education and
Training, 2007).
Girls are less active than boys across all countries
and regions and all age groups and the gender gap increases with age. Reduced physical
activity may stem from cultural factors or learned behaviour. Clear
activity preferences are apparent from the time of puberty (Bedward and
Williams, 2000). It has been observed that while boys tend to use most of the
playground space for active games, girls tend to prefer natural areas over
manufactured equipment (Brodin and Lindstrand, 2006: Lindholm, 1995). Access to
school sports facilities may be unequal, and resourcing of extracurricular
activities can have a male-sport bias. Activities are often targeted at elite
performers and not at students wanting to participate in non-competitive or
non-traditional activities. To demonstrate their masculinity, many boys want to
be seen as assertive, if not aggressive. Some girls demonstrate
femininity by being passive and submissive. Young people need guidance in
discovering how dominant masculinities and femininities can limit the
way they see themselves as male and female (Paechter, 2003).
Feelings of
dissatisfaction with body shape, low self-esteem and lack of confidence cause
anxiety and lack of interest and are a major deterrent to girls’ and some boys’
participation in physical activity and sport. The display
of the body has the potential to embarrass the individual (Probyn, 2000).
Caring duties
Women continue to meet the majority of society’s caring
needs. Among those who were employed, women working in the public sector were
more likely than those in the private sector to be carers. Women who had worked
in a caring profession were more likely to become unpaid carers (Rowntree,
Foundation, 2006). In Germany it is calculated that 80% of carers are women
(Schneekloth and Müller, 2000). Due to the higher life
expectancy of women and their lower average age at marriage, older men in need
of care are more likely to be cared for by their spouses than vice versa (Stiehr,
2004). In addition, family members –
disproportionately daughters and daughters-in-law – are an important source of
support and care for older women all over Europe (EIWH, 2006).
Reviews of caring responsibilities conducted in North
America reveal diversity in the type of duties women and men carers engage in,
and in the differential effect these duties have on their lives (Women’s Health
Council 2005: Navaie-Waliser, Spriggs and Feldman, 2000; Morris, 2001;
Armstrong and Kits, 2004). More women than men provide demanding and intensive
forms of daily caring: bathing and dressing, care with incontinence and
walking, dressing changes, assistance with medical equipment and the
administration of multiple prescription medication. Women also more often have
responsibility for more than one care recipient than men. Men are more likely
to concentrate on care management or household maintenance, shopping or
transportation, and are more likely than women to get formal help. Women are
more likely to provide daily, inflexible care, while men provide care that can
be more easily planned and organised around paid work.
A study conducted
in 2001 by the Joseph Rowntree Foundation in Britain found that care giving was
associated with disadvantage. The proportion of the population providing unpaid
care was higher in deprived areas and areas with higher levels of poor health.
Carers were also relatively disadvantaged and more likely than others of the
same age to be in poor health themselves. Caregivers were less likely than
others of the same age to be employed (Rowntree Foundation, 2006).
Workforce and Family Responsibilities
The inactivity rate of women aged between 25
and 54 was 23.6% in 2006 in the EU27, compared to 8.1% for men. This period is
the main working age, and also the age when families are founded and children
are raised. The main single reason for prime-aged women to be outside the
labour force is therefore family responsibilities. Among prime-aged women, the
percentage inactive due to family responsibilities varied greatly between
Member States: the United Kingdom (1.9%) had the lowest percentage, followed by
Sweden (2.1%) and Denmark (2.3%). At the other end of the scale, Malta (45.9%),
followed by Ireland (23.1%) and Luxembourg (21.7%) had the highest
rates. Education and retirement explain the higher inactivity rates observed at
either end of the age scale.
(Eurostat, 2007)
In the Member States for which data is
available, the total number of hours spent in gainful work/study and domestic
work is generally higher for women than for men: over an hour more in Italy,
Slovenia, Estonia, Lithuania, Spain and Hungary. Women work the longest hours
in Lithuania and Slovenia (around 8 hours a day) and the least in Germany and
Belgium (around 6h:30 a day). In the United Kingdom and Sweden the number of
hours are almost equal, perhaps reflecting the statistics on the number of
prime aged women in the workforce. Women spend more time than men on domestic
work, while the reverse is true for gainful work and study.
In the Member
States for which data is available, women have less free time than men. The
difference ranged from 20 minutes in Sweden to 1h:05 in Slovenia. Women have
the most free time in Finland (5h:30) and Germany (5h:24), and the least in
Lithuania (3h:49). The main domestic tasks carried out by women are food
preparation and cleaning and other upkeep. In general, men tend to spend a
higher proportion of time on gardening, shopping and services, construction and
repairs. Women and men spend almost equal amounts of time on eating meals and
personal care, ranging from 2 to 3 hours a day depending on the Member State
(Eurostat, 2006).
Patients
With increasing
life expectancies, chronic disease prevalence and incidence, and a changing
demographic and economic profile, individuals with disabling health conditions
are likely to spend a longer period of time needing managed care. EURODEM
research found that people with dementia are over 30 times more likely to die
in an institution than people who do not have dementia. This has serious
implications for healthcare systems, as it is currently estimated that European
countries need to provide one year of dementia care per person over the age of
65. Characteristics associated to increased chances of moving into
institutional care included older age, being unmarried, poorer health, being a
tenant rather than an owner occupier and, among women, having no children
(Joseph Rowntree Foundation, 2006).
Gender differences
have been observed in care receiving, with women receiving fewer hours of care
than men (Morris, 2004). There is an implicit presumption that women are
better able to look after themselves, leading to the needs of women being
unmet. On average, 10% of EU women report having had one or more (non-birth)
hospitalisations in the past year, with a total of about 10 days of stay. Older
women are about twice as likely as younger women to have been hospitalised, and
tend to stay longer (See: http://ec.europa.eu/health/index_en.htm).
