Gender inequality in health care

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Gender inequality in health care
Universidade Nova de Lisboa Escola Nacional de
Saúde Pública

• Ana Fernandes
• Julian Perelman
• Céu Mateus
• Meeting of the Aachen Group Sintra, 9-10th
  April 2006

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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

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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
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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

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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

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Cardiovascular disease causes for gender
inequalities in treatment

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

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Socio-economic inequality related to gender

• 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

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Women's average pay as of men's - 2004
Notes figures are for 2004 except 2002,
2000, 2003, 1998, 2001
Source EIRO
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Inequity in access to general practitioner
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Inequity in access to general specialist
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Womens health

• Main priorities when studying womens health
• Main causes of death
• Diseases with a higher prevalence
• Reproductive health
• Violence against women
• Health determinants

Chesney and Ozer, 1995
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Womens health

• Main priorities when studying womens health
• Main causes of death
• Diseases with a higher prevalence
• Reproductive health
• Violence against women
• Health determinants

Chesney and Ozer, 1995
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Main causes of death

• 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
  481488, 2005

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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
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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
16
Source Atlas of Health in Europe,
2003 http//www.euro.who.int
17
Source Atlas of Health in Europe,
2003 http//www.euro.who.int
18
Source The European Health Report,
2005 http//www.euro.who.int/ehr2005
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Womens health

• Main priorities when studying womens health
• Main causes of death
• Diseases with a higher prevalence
• Reproductive health
• Violence against women
• Health determinants

Chesney and Ozer, 1995
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Diseases with higher prevalence

• Chronic diseases and mental health diseases

Chronic diseases in Portugal
Source National Health Survey, 1998/99, ONSA
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Womens health

• Main priorities when studying womens health
• Main causes of death
• Diseases with a higher prevalence
• Reproductive health
• Violence against women
• Health determinants

Chesney and Ozer, 1995
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Source Atlas of Health in Europe,
2003 http//www.euro.who.int
Source Atlas of Health in Europe http//www.euro.
who.it
23
Source Atlas of Health in Europe,
2003 http//www.euro.who.int
24
Source Atlas of Health in Europe,
2003 http//www.euro.who.int
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Womens health

• Main priorities when studying womens 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
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Womens health

• Womens health is an issue that goes well beyond
  gender inequalities in access and treatment

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European Health Report 2005

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

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Research Outline for Portugal

• Inpatient administrative data
• Waiting lists
• IMS
• Outpatient administrative data (GP, specialists
  care)

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Waiting times in Portugal gender bias?
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Discussion

• 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 womens health
  conditions and assessment of health policies
  promoting gender equality should figure in the
  agenda of a European Institute for Gender
  Equality.

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Gender inequality and socio-economic inequality

• Inequity in access to care
• gender socio-economic inequalities
• gender inequalities in access to care?
• Reducing gender inequality in access should start
  with reducing socio-economic inequality in access!