gender inequality in health care ana fernandes julian perelman céu mateus meeting of the aachen...
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Gender inequality in
health care Ana FernandesJulian Perelman
Céu Mateus
Meeting of the Aachen Group Sintra, 9-10th April 2006
Universidade Nova de Lisboa
Escola Nacional de Saúde Pública
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
Common Values
Dimensions of inequality
HealthMorbidity
Mortality
Health care provision
Access
Funding
Resources’ source
Resources’ allocation
Vectors
of analisys
Geographic:
- regions
- counties
- municipalities
Use
- Age
- Gender
Socio-economic:
- income
- education
- profession
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
• 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
1. Lower access related to women’s lower socio-economic
status (lower access to private insurance, out-of-pocket
payments, poorer information)
2. Physician’s discrimination
• Subjective
• Objective – due to higher difficulty in interpreting or targeting
symptoms (male-oriented research and guidelines)
3. Higher reluctance by women to follow invasive treatments
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
Women's average pay as % of men's - 2004
Notes: figures are for 2004 except * 2002, ** 2000, *** 2003, **** 1998, ***** 2001 ;
Source: EIRO
Inequity in access to general practitioner
Pro rich
Pro poor
Inequity in access to general specialist
Pro rich
Women’s health
Main priorities when studying women’s health
1. Main causes of death
2. Diseases with a higher prevalence
3. Reproductive health
4. Violence against women
5. Health determinants
Chesney and Ozer, 1995
Women’s health
Main priorities when studying women’s health
1. Main causes of death
2. Diseases with a higher prevalence
3. Reproductive health
4. Violence against women
5. Health determinants
Chesney and Ozer, 1995
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: 481–488, 2005
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
Source: World Health Organization (2004)http://www3.who.int/whosis/menu.cfm www.heartstats.org
Source: Atlas of Health in Europe, 2003http://www.euro.who.int
Source: Atlas of Health in Europe, 2003http://www.euro.who.int
Source: The European Health Report, 2005http://www.euro.who.int/ehr2005
Women’s health
Main priorities when studying women’s health
1. Main causes of death
2. Diseases with a higher prevalence
3. Reproductive health
4. Violence against women
5. Health determinants
Chesney and Ozer, 1995
Diseases with higher prevalence
• Chronic diseases and mental health diseases
Chronic diseases in Portugal
Wom
en
Men
Diabetes 56% 44%
Epilepsy 57% 43%
Asthma 54% 45%
Hypertension 63% 37%
Back pain 61% 39%
Source: National Health Survey, 1998/99, ONSA
Women’s health
Main priorities when studying women’s health
1. Main causes of death
2. Diseases with a higher prevalence
3. Reproductive health
4. Violence against women
5. Health determinants
Chesney and Ozer, 1995
Source: Atlas of Health in Europehttp://www.euro.who.it
Source: Atlas of Health in Europe, 2003http://www.euro.who.int
Source: Atlas of Health in Europe, 2003http://www.euro.who.int
Source: Atlas of Health in Europe, 2003http://www.euro.who.int
Women’s health
Main priorities when studying women’s health
1. Main causes of death
2. Diseases with a higher prevalence
3. Reproductive health
4. Violence against women
5. Health determinants (tobacco and alcohol
consumption, physical activity, etc.)
Chesney and Ozer, 1995
Women’s health
Women’s health is an issue that goes well
beyond gender inequalities in access and
treatment
European Health Report 2005
“Differences across countries and population
groups indicate how much impact policies
to prevent and control major risk factors
could have”
Research Outline for Portugal
• Inpatient administrative data
• Waiting lists
• IMS
• Outpatient administrative data (GP, specialists care)
Waiting times in Portugal: gender bias?
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Months
Ey
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Ey
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Ex
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Women Men
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 women’s health conditions and
assessment of health policies promoting gender equality should
figure in the agenda of a European Institute for Gender Equality.