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Gender inequality in health care

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Universidade Nova de Lisboa Escola Nacional de Sa de P blica Gender inequality in health care Ana Fernandes Julian Perelman C u Mateus Meeting of the Aachen Group – PowerPoint PPT presentation

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Title: Gender inequality in health care


1
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

2
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

3
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
4
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

5
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

6
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

7
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

8
Women's average pay as of men's - 2004
Notes figures are for 2004 except 2002,
2000, 2003, 1998, 2001
Source EIRO
9
Inequity in access to general practitioner
10
Inequity in access to general specialist
11
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
12
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
13
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

14
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
15
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
19
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
20
Diseases with higher prevalence
  • Chronic diseases and mental health diseases

Chronic diseases in Portugal
Source National Health Survey, 1998/99, ONSA
21
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
22
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
25
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
26
Womens health
  • Womens health is an issue that goes well beyond
    gender inequalities in access and treatment

27
European Health Report 2005
  • Differences across countries and population
    groups indicate how much impact policies to
    prevent and control major risk factors could
    have

28
Research Outline for Portugal
  • Inpatient administrative data
  • Waiting lists
  • IMS
  • Outpatient administrative data (GP, specialists
    care)

29
Waiting times in Portugal gender bias?
30
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.

31
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!
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