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Universidade Nova de Lisboa Escola Nacional de Saúde Pública. Gender inequality in health care. Ana Fernandes Julian Perelman Céu Mateus Meeting of the Aachen Group Sintra, 9-10th April 2006. Common Values. General focus. Health services achieving Universality Solidarity

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Gender inequality in health care

Universidade Nova de Lisboa

Escola Nacional de Saúde Pública

Gender inequality in health care

Ana Fernandes

Julian Perelman

Céu Mateus

Meeting of the Aachen Group Sintra, 9-10th April 2006


General focus

Common Values

General focus

  • Health services achieving

    • Universality

    • Solidarity

    • Equity in access/outcomes

  • Health policies

    • Promoting adequacy of health services

    • Sensitive to the changing health needs of citizens


Dimensions of inequality
Dimensions of inequality

Socio-economic:

- income

- education

- profession

V

e

c

t

o

r

s

o

f

a

n

a

l

i

s

y

s

Mortality

Health

Morbidity

Use

Health care provision

Geographic:

- regions

- counties

- municipalities

Access

Resources’ source

Funding

  • Age

  • Gender

Resources’ allocation


Research on gender inequalities in health care
Research on gender inequalities in health care

Inequalities in access / treatment for:

  • Cardiovascular diseases

  • Cerebro-vascular diseases (stroke)

  • Diabetes

  • Dialysis and kidney transplant

  • Screening for lung cancer

  • HIV/AIDS (access to antiretroviral therapy)

  • Higher use of pharmaceuticals among women


Cardiovascular diseases gender inequalities in treatment
Cardiovascular diseases: Gender inequalities in treatment

  • In early stage (before AMI) women have lower access to:

    • non-invasive procedures (stress test)

    • diagnostic high-technology procedures (angiography)

    • revascularization (PCI or bypass)

  • In admissions for acute myocardial infarction:

    • lower access to bypass, but equal or higher access to PCI

      • higher mortality and harder recovery for women after bypass

    • several studies do not ascertain any gender inequality in access to high-tech treatment


Cardiovascular disease causes for gender inequalities in treatment
Cardiovascular disease: causes for gender inequalities in treatment

  • Lower access related to women’s lower socio-economic status (lower access to private insurance, out-of-pocket payments, poorer information)

  • Physician’s discrimination

    • Subjective

    • Objective – due to higher difficulty in interpreting or targeting symptoms (male-oriented research and guidelines)

  • Higher reluctance by women to follow invasive treatments


Socio economic inequality related to gender
Socio-economic inequality related to gender treatment

  • In all OECD countries, women have, on average, a lower socio-economic status than men

    • In 2002, in Portugal, the average monthly income was € 601 for women and € 747 for men


Women s average pay as of men s 2004
Women's average pay as % of men's - 2004 treatment

Notes: figures are for 2004 except * 2002,

** 2000, *** 2003, **** 1998, ***** 2001 ;

Source: EIRO


Inequity in access to general practitioner

Pro rich treatment

Pro poor

Inequity in access to general practitioner


Inequity in access to general specialist

Pro rich treatment

Inequity in access to general specialist


Women s health
Women’s health treatment

Main priorities when studying women’s health

  • Main causes of death

  • Diseases with a higher prevalence

  • Reproductive health

  • Violence against women

  • Health determinants

Chesney and Ozer, 1995


Women s health1
Women’s health treatment

Main priorities when studying women’s health

  • Main causes of death

  • Diseases with a higher prevalence

  • Reproductive health

  • Violence against women

  • Health determinants

Chesney and Ozer, 1995


Main causes of death
Main causes of death treatment

  • Cardiovascular diseases

  • Stroke

  • Female cancers (breast, uterus & cervix, ovary)

  • Cancer of colon and rectum

  • Lung cancer

    Sources:

    http://www.euro.who.int/

    P. Boyle* & J. Ferlay Annals of Oncology 16: 481–488, 2005


Age standardized death rates from cardio vascular disease women aged 35 74 latest available year
Age-standardized death rates from cardio-vascular disease, women aged 35-74, latest available year

Source:World Health Organization (2004)

http://www3.who.int/whosis/menu.cfm

www.heartstats.org


Age standardized death rates from stroke women aged 35 74 latest available year
Age-standardized death rates from stroke, women aged 35-74, latest available year

Source:World Health Organization (2004)

http://www3.who.int/whosis/menu.cfm

www.heartstats.org


Gender inequality in health care 1347511

Source: Atlas of Health in Europe, 2003 latest available year

http://www.euro.who.int


Gender inequality in health care 1347511

Source: Atlas of Health in Europe, 2003 latest available year

http://www.euro.who.int


Gender inequality in health care 1347511

Source: The European Health Report, 2005 latest available year

http://www.euro.who.int/ehr2005


Women s health2
Women’s health latest available year

Main priorities when studying women’s health

  • Main causes of death

  • Diseases with a higher prevalence

  • Reproductive health

  • Violence against women

  • Health determinants

Chesney and Ozer, 1995


Diseases with higher prevalence
Diseases with higher prevalence latest available year

  • Chronic diseases and mental health diseases

Chronic diseases in Portugal

Source: National Health Survey, 1998/99, ONSA


Women s health3
Women’s health latest available year

Main priorities when studying women’s health

  • Main causes of death

  • Diseases with a higher prevalence

  • Reproductive health

  • Violence against women

  • Health determinants

Chesney and Ozer, 1995


Gender inequality in health care 1347511

Source: Atlas of Health in Europe, 2003 latest available year

http://www.euro.who.int

Source: Atlas of Health in Europe

http://www.euro.who.it


Gender inequality in health care 1347511

Source: Atlas of Health in Europe, 2003 latest available year

http://www.euro.who.int


Gender inequality in health care 1347511

Source: Atlas of Health in Europe, 2003 latest available year

http://www.euro.who.int


Women s health4
Women’s health latest available year

Main priorities when studying women’s health

  • Main causes of death

  • Diseases with a higher prevalence

  • Reproductive health

  • Violence against women

  • Health determinants (tobacco and alcohol consumption, physical activity, etc.)

Chesney and Ozer, 1995


Women s health5
Women’s health latest available year

Women’s health is an issue that goes well beyond gender inequalities in access and treatment


European health report 2005
European Health Report 2005 latest available year

“Differences across countries and population groups indicate how much impact policies to prevent and control major risk factors could have”


Research outline for portugal
Research Outline for Portugal latest available year

  • Inpatient administrative data

  • Waiting lists

  • IMS

  • Outpatient administrative data (GP, specialists care)



Discussion
Discussion latest available year

  • To reduce gender inequality in health care, socio-economic inequalities have to be addressed

  • To tackle gender-related inequalities, health policies will vary according to relevant inequalities

    • a strong effort should be put on ascertaining causes and relevance of differences

  • Research on gender inequalities in health care related to access and to treatment is not conclusive

  • Systematic comparison of women’s health conditions and assessment of health policies promoting gender equality should figure in the agenda of a European Institute for Gender Equality.