_Hlk4594081

the well-being at all ages. This goal recognises

acknowledges gender is a determinant of health,

‘access to good health and wellbeing as a human

alongside social and environmental determinants,

right for all men and women’. Goal 5 in contrast

and identifies gender mainstreaming as a

is focused on achieving gender equality and

mechanism to achieve gender equity. The Strategy

empowering women.

focuses on the determinants of women’s health,

without necessarily making comparisons between

The recognition of women’s health and the link

women and men.

between gender and health can be traced back

to the early 1970’s. Alvarez-Dardet and Vives-

Gender inequalities and possible areas of focus:259,260

Cases256 in their work recognise three main waves

in the development of clear gender and health

links. The first wave was the “visibility and

From 2000 to 2012, life expectancy has — —

legitimatisation” of gender issues and women’s

improved for women across the European

health as objects of scientific study and possible

Region, but with fewer years lived without

policy action; the second involved acceptance

disability or activity restriction.

255 United Nations. (2015). Sustainable Development Goals. Retrieved from: https://sustainabledevelopment.un.org/?menu=1300

256 Avarez-Dardet, C., and Vives-Cases, C. (2012) ‘Three waves of gender and health.’ Eurohealth incorporating Euro Observer. (18)2:4-8. Retrieved from: http://www.euro.who.int/__data/assets/pdf_file/0007/169531/Eurohealth-Vol-18-No-2.pdf

257 World Health Organisation. (2012). Health 2020: the European policy for health and well-being. Retrieved from: http://www.euro.who. int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being/about-health-2020

258 World Health Organisation Europe. (2016). Strategy on women’s health and well-being in the WHO European Region. Copenhagen: WHO. http://www.euro.who.int/en/health-topics/health-determinants/gender/publications/2016/strategy-on-womens-healthand-well-being-in-the-who-european-region-2016

259 This review of services is focused on the WHO European Region as the region that is most relevant to the Irish context.

260 WHO (2016) Strategy on women’s health and well-being in the WHO European Region .

Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan

—Women see themselves as less healthy than —

—Recent studies show that social media has —

men and report more illness.

been associated with serious health effects

among young women as a result of activities

—Women forego care for financial reasons. —

such as cyberbullying.267

—Equal access to health services has not been —

—Women’s increasing exposure to risk factors —

achieved for rural, minority, migrant, refugee

for non-communicable diseases (NCDs)

or asylum-seeking women, or for women in

increases the risk of developing diseases

detention.261

and disabilities earlier in life. More than

—Physical health conditions dominate in early —

50% of women in the European Region are

life, while depressive and anxiety disorders

overweight, with higher prevalence of obesity

develop among young women moving into

among women with lower levels of education

adult life. In older age lower back pain,

than is the case for men. In addition,

ischaemic heart disease and cancers are more

adolescent girls have reduced physical

prevalent.262

activity and, in many countries, are catching

up with males in their use of tobacco and

—There is a marked decline in subjective well- —

alcohol, abetted by the tobacco and alcohol

being among girls during adolescent years.263

industries through marketing that specifically

—Gender inequalities in employment, quality of —

targets young people.268 It should be noted

work and job segregation continue to exert a

that Ireland has stringent restrictions on

negative influence on health.

alcohol marketing and the marketing of

tobacco products is not permitted. Ireland is

—Gender stereotypes have consequences for —

also the first country in Europe to introduce

women’s health in terms of self-confidence

standardized packaging for all tobacco

and well-being in particular; concerns about

products (not just cigarettes and roll-your-

physical appearance may cause girls and

own).

young women to develop eating disorders and

other mental illnesses, such as depression and

—Major depressive disorders are the main —

anxiety264.

cause of disease among adolescent girls and

women across the Region, and dementia

—Stereotypes and sexism pave the way for —

and Alzheimer’s disease are main causes of

certain forms of oppression, such as sexual

ill health among older women in western

harassment and gender-based violence.265

European countries.269 The impact of

—Gender stereotypes affect health systems —

socioeconomic inequalities has a huge

responses, such as in under- and over-

influence on women’s mental health both

diagnosis of certain conditions.266

as patients and informal providers of care.

—Violence against women persists in all —

Treatment gaps experienced by young women

countries and among all population groups.

affected by depression and anxiety disorders

261 Economic and Social Council. (2014). Beijing + 20 regional review of progress: regional synthesis. Geneva: United Nations Economic Commission for Europe. 2014 (ECE/AC.28/2014/3; Retrieved from: https://www.unece.org/fileadmin/DAM/Gender/documents/ Beijing%2B15/ECE.AC.28.2014.3.E.pdf

262 World Health Organisation. (2015). Beyond the mortality advantage: investigating women’s health in Europe. Copenhagen: WHO Regional Office for Europe. Retrieved from: http://www.euro.who.int/en/health-topics/health-determinants/gender/ publications/2015/beyond-the-mortality-advantage.-investigating-womens-health-in-europe

263 Gavin, A., Keane, E., Callaghan, M., Molcho, M., Kelly, C, and Nic Gabhainn, S. (2015) The Irish Health Behaviour in School-aged Children (HBSC) Study 2014. Galway: NUIG and Department of Health. Retrieved from: https://health.gov.ie/wp-content/ uploads/2015/12/HBSC2014web2.pdf

264 World Health Organisation. (2015). Beyond the mortality advantage: investigating women’s health in Europe.

265 European Commission. (2015). Forum on the future of gender equality in the European Union: report. Retrieved from: http://ec.europa. eu/justice/events/future-of-gender-equality-2015/index_en.htm

266 Govender, K., Penn-Kekana, L. (2008). ‘Gender biases and discrimination: a review of health care interpersonal interactions’. Glob Public Health. 3(S1):90–103. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/19288345

267 World Health Organisation. (2015). Beyond the mortality advantage: investigating women’s health in Europe.

268 Ibid.

269 Ibid.

upon reaching maturity need particular

their knowledge, competences and skills in

attention given the high prevalence of these

detecting and preventing these practices

conditions.

without further discriminating against or

stigmatizing women.

—Differences between women and men in —

sensitivity to toxic substances, combined with

—Women’s risk of contracting NCDs may be —

gender division of labour, may increase the

increased by health system biases: while

exposure and vulnerability of girls and women

cardiovascular disease is the major cause of

to chemicals and pollution.

death for women in the European Region, it

is still perceived as a men’s health issue. The

—In areas where domestic heating are met by —

risk to women is often underestimated owing

burning solid fuels (e.g. wood) on open fires

to the perception that they are physiologically

women and young children who spend a

protected against it. While women are indeed

significant amount of time indoors at home

at lower risk during their fertile years,

are disproportionally exposed to high levels

protection fades after menopause, when risk

of household air pollution, which includes a

increases. Assessment and management of

range of health-damaging pollutants such

cardiovascular risk in women often ignores

as fine particles and carbon monoxide.270 It is

factors that are particularly important, such

estimated that 117,200 deaths per year in the

as diabetes, obesity, physical inactivity and

European Region are attributable to household

smoking.

air pollution.

—Despite increased inclusion of women in —

—Women are over-represented as care providers —

clinical trials, participation is especially low

in the formal and informal sectors. Women

in studies in which safety, safe dosage range

are also over-represented as care recipients

and side effects are determined. This results

among those aged 65 and over in institutions

in a lack of awareness among health care

and at home. Formal care alternatives in many

professionals about the importance of sex-

countries are few and may be inaccessible,

specific differences in disease manifestation

unaffordable and/or of low quality. This puts

and response to treatment throughout the

pressure on women of all ages, for whom the

life-course, which can cause problems in

expectation of providing intergenerational

diagnosis and treatment, including delays

support is high.271

in diagnosing women in the early stages of

—The links between migration, female-headed —

coronary disease because the symptoms seem

households, feminization of poverty in rural

atypical.

areas and access to health services need to

—Services need to be aware that women are —

be better explored. In particular, the specific

also 1.5 times more likely than men to develop

health needs of migrant women and women

adverse reactions to prescription drugs.

left behind by migrant partners should be

addressed.

—The internationalization of long-term care —

has brought growing staff migration, mostly

involving women.

The needs of health services (meeting the health needs of women):272

—Developments of women only services as well —

as the implementation of gender-specific

—Health care providers are often ill equipped —

approaches in routine care are underway and

to understand and address the causes and

need to be evaluated, amended and expanded.

manifestations of practices such as gender

Training as well as research requirements are

biased sex selection and female genital

numerous and urgent.273

mutilation; it is therefore crucial to increase

270 World Health Organisation. (2014). Burden of disease from household air pollution for 2012. Geneva. Retrieved from: http://www.who. int/phe/health_topics/outdoorair/databases/HAP_BoD_results_March2014.pdf?ua=1

271 World Health Organisation. (2015). Beyond the mortality advantage: investigating women’s health in Europe.

272 Ibid.

273 Amering, M. (2017) ‘The needs of women users of mental health services and their families’. European Psychiatry. 41(Supplement):8-9. Retrieved from: https://www.europsy-journal.com/article/S0924-9338(17)30082-2/abstract

Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan

of out of pocket costs for primary and secondary

Barriers to accessing services

care services with ‘the price faced by users a strong

International research has found that some

determinant of health care utilisation’ (Introduction

barriers to care are gender specific. According to

Section).277 According to Ma and Nolan (2017)278

the WHO274, some of the key sociocultural factors

this ‘use of direct out-of-pocket payments to finance

that prevent women and girls benefiting from

general practitioner (GP) care by the majority is

quality health services and attaining the best

unusual in a European context’.

possible level of health include:

Research using the Irish sample of the EU-

—Unequal power relationships between men and —

Statistics on Income and Living Conditions survey

women;

(EU-SILC) found that almost four per cent of

—An exclusive focus on women’s reproductive —

survey respondents reported an unmet need for

roles; and

medical care.

—Potential or actual experience of physical, —

Overall, women, lower income groups, those with poorer health status and those without a medical card or private insurance were more likely to report an unmet healthcare need.

sexual and emotional violence.

Poverty can also be an important barrier to

positive health outcomes for both men and

women, but it tends to disproportionality impact

women and girls’ health.

3.1.2 National literature on women’s engagement with health services

The majority of those reporting an unmet need

noted that their unmet healthcare need was due

to affordability issues (59 per cent) or waiting lists

In Ireland (just as in other jurisdictions) health

(25 per cent).279 The review estimated that unmet

care utilisation depends on many factors that

need due to cost was likely to reflect the high out-

relate both to the health care system and to the

of-pocket cost for primary care; while unmet need

characteristics of individual patients. In a time

due to waiting lists reflected the relatively long

of social and economic transition, characterised

waits for hospital care in the public system.

by increased life expectancy, population ageing,

changing expectations and the re-structuring

Data on individual’s engagement with the

of health services, it is important to be able to

health service is collected in a variety of ways.

disentangle the complex patterns and drivers of

The largest national, continuous data source

health service use275.

on utilisation of health services is however the

Hospital In-Patient Enquiry (HIPE). Unfortunately,

Ireland also has a complex set of entitlements

this has not been examined from the point of view

to health care. At the end of Sept 2018, 1,578,015

of gender differentials in utilisation patterns. This

individuals (approx. 33% of the 2016 Census of

lack of this type of examination acts as a barrier

population) had a medical card, while 500,234

to understanding women’s use of health services

individuals (approx. 10.5% of the 2016 Census of

and is a limitation in relation to the development

population) had a GP visit card.276 . This means

of good Irish health research.

that 67% of the population were paying some level

274 World Health Organisation. (2008). Women’s Health. Retrieved from: https://www.who.int/topics/womens_health/en/