The European Institute of Womens Health Submission to the EU Commission's consultation on the new EU Health Strategy.

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1 The European Institute of Womens Health Submission to the EU Commission's consultation on the new EU Health Strategy. The EIWH welcomes the opportunity to contribute to the development of the EU Health Strategy and is committed to working with and supporting the Commission in achieving better health for all, through future the New Public Health strategy The promotion of gender equity has been a long-standing theme in the philosophy and operations of the EU. The mainstreaming of gender was formalised in the Treaty of Amsterdam with the pursuit of equality between women and men. The Treaty also included a statement to the effect that human health should be protected in all Community policies and activities. There is an opportunity for the EU Commission to continue its commitment to gender equality by including the gender perspective in the proposed EU Health Strategy. The European Institute believes that despite considerable progress in recent years at both national and international levels, gender inequalities in health remain in many areas across Europe. Strategies for promoting the health of women at the community level have not yet been introduced in any systematic way to the enlarged European Union. Neither has a systematic analysis been undertaken of how the healthcare sector could, or should, respond with greater sensitivity to the varying healthcare needs of women across all 27 Member States. Gender is equally as important as the social, economic or ethnic background of any individual. As women are important in relation to all aspects of society, and on average may live more than 30 years after the menopause, there needs to be a major shift in direction to take account of the health needs of women across the lifespan. Although women generally live longer than men, the quality of life that many women experience can be less than satisfactory. The incidence and prevalence of some diseases are higher in women, whilst others affect men and women differently. To ensure gender mainstreaming in health, it is necessary to make explicit how women s physical, psychological and social health should be addressed at every stage of their lives. The EIWH welcomes the opportunity to contribute to this consultation.

2 QUESTIONS Question( 3)Are there issues where legislation would be appropriate? What other non-legislative instruments should be used-for example, a process similar to the Open Method of Coordination? How can we make better use of Impact Assessment? The EIWH supports the Commissions suggestions In the communication entitled Modernising social protection for the development of high-quality, accessible and sustainable health care and long-term care: support for the national strategies using the open method of co-ordination the Commission suggests to apply the OMC to health care systems to include: ensuring access to highquality care based on the principles of universal access, fairness and solidarity; the promotion of high quality care; providing a safety net against poverty or social exclusion associated with ill health, accident, disability or old age for both the beneficiaries of care and their families; the financial sustainability of high- quality care accessible to all. OMC would provide a multi -sectoral platform, involving wide partnership opportunities that would increase information exchanges, knowledge of models of best practice and the necessary integrated approaches required by health care systems and their positive development in times where there are growing pressures on the quality and level of care and a background of reducing resources. Impact Assessment The aim of gender equity in health is for men and women to be treated equally where they have common needs, while at the same time addressing their differences in an equitable manner. Yet there is currently a lack of sex-disaggregated information available Although calls for sexdisaggregated data have been made for decades, it is necessary for this to become embedded in all EU policies, using for example, Gender Impact Assessment tools to facilitate this process. In 2001, a series of Gender Equality Impact Assessment (GIA) studies were commissioned by the European Commission as part of the Research Framework Programme (FP5) Gender Watch System, to examine earlier Programmes for gender awareness. On their release in 2002, the new FP6 framework texts reflected many of the recommendations made by the GIA studies, and consequently gender mainstreaming became a prime focus in policy development across the EU. In 2007 the principles of GIA should continue to be rigorously applied to all current and future policy and public health and research documents. Information systems/data collection Studies on prevalence often have to rely on either self-reports of a diagnosis or on extracting data from general practitioners or hospital records. Both these methods are limited because they omit cases of undiagnosed conditions and the criteria used by healthcare professionals in making diagnoses can vary. In addition, more research is necessary regarding women s access to, and utilisation of, health services and health-seeking behaviour. The following are areas where public health policy requires concrete data to to develop effective health strategis:

3 Data on diabetes, diet and nutrition and violence against women is patchy for all EU countries. Health surveys are limited on musculoskeletal diseases but would be a valuable source of information. Reporting on HIV infections is also incomplete although considerable progress is being made. Some of the countries with the largest HIV/AIDS epidemics, such as Italy and Spain, do not yet have national reporting systems; and this problem is common across a range of conditions and for both older and newer Member States. One problem with official reporting systems, such as those for drug or alcohol use, is that not all cases are diagnosed and reported, thereby leading to a misrepresentation of the situation. Tackling cases of under-reporting and improving the collection and collation of data across national and community systems ought to become a priority, and will lead to more equitable polices for both women and men Existing health care systems have historically underestimated the importance of gender differences in terms of their impact on morbidity and mortality. Less money has been invested on research into women specific illnesses and diseases, and insurance coverage for their treatment is often denied. On 1 and 2 June 2006 (9658/06 Presse148) the Council adopted a Conclusion on Women s Health noting that reliable, compatible, comparable data on the status of women s health is essential to improve information to the public and develop appropriate strategies, policies and actions to ensure a high level of health protection, and that gender-specific data and reporting are essential for policy making. Question (4) How can different approaches be used and combined, for example approaches to different health determinants, life cycle approaches, and strategies on key settings(education, the workplace, health care settings) Lifestyle Addressing health inequalities through health promotion, disease prevention and multi-sectoral actions should be at the heart of public health policy both at national and European Union levels. Different population groups' uptake and understanding of health information requires specific targeting of health promotion messages. Health information is not simply processed but, instead is met by a barrage of preconceived ideas which mediate the way that the information is interpreted (. Although significant resources are put into promoting increased physical activity, participation is declining, particularly among girls.a 2003 Eurobarometer survey showed that around 60 % of Europeans had no vigorous physical activity at all in a typical week, and more than 40 % did not even have moderate physical activity in a typical week. Europe-wide, only about one third of schoolchildren appear to be meeting recognised physical activity guidelines (EU Green Paper on Obesity,2005). Given the low success of treatment for adult obesity, increased understanding of the early determinants of childhood obesity may eventually lead to effective solutions to combat further increases in childhood and adult overweight. Socio-economic factors have a significant influence on the health of children. Children and adolescents from families of low socio-economic position have more health problems than those in high socio-economic position, e.g. in mortality, injury, self-rated health and subjective health complaints, and risk behaviour.

4 Gender differences emerge in adolescence. For example, girls are more likely than boys to take up smoking as a means of weight control, and to continue smoking, rather than risk putting on weight. Yet, among 13 year olds, obesity is higher in girls than boys. Evidence suggests that being overweight during adolescence compromises long-term health, as it is associated with increased mortality. Young women who are prepared to make healthy lifestyle choices related to nutrition, exercise, tobacco, alcohol and drug use, and sexual health will have enhanced physical and mental health, and may avoid major diseases later in life. Public perception of risk and its meaning is largely dependent upon prior levels of knowledge, experience, beliefs and culture. This includes the recognition that the prevalence of chronic conditions related to diet and physical activity can vary between men and women, age groups, and between socio-economic strata. Thus, approaches aimed at promoting healthy diets and physical activity need to be sensitive to gender, socio-economic and cultural differences, and to include a life-span perspective. Consistent, coherent, simple and clear messages need to be developed, and disseminated through multiple channels and in forms appropriate to local culture, age and gender. Health and education policy should promote the concept of physical activity that can be generalised to everyday lives. We must find ways for the media, health services, civil society and relevant sectors of industry to support health education efforts made by schools, and ensure physical activity is not only associated with looking sexy but with feeling healthy and empowered. Although women s health issues cannot be addressed without the collation and analysis of genderspecific data, very little information is currently available. The dearth of data on women leaves many questions unanswered, for example: Statistics on mental health disorders often conceal the considerable differences that exist between men and women in the prevalence of specific types of mental disorders and at different stages of the life-cycle. The causes of the higher rates of depression and mental illness are not known..knowledge about the two main eating disorders anorexia nervosa and bulimia nervosa - has increased in recent years; however much remains unknown. Sexually transmitted infections are a major public health problem across Europe. The Van Lancker Report of the European Parliament concludes that rates of sexually transmitted infections (STIs) such as Chlamydia, are still unacceptably high in Europe, mainly because sexual education for young people is unsatisfactory. For example, Estonia, Latvia and Lithuania had high rates of gonorrhea in 2000 but there are downward trends in gonorrhea in England and Wales, France, the Netherlands and Sweden. There have been upsurges in rates of lung cancer in both younger and older women in almost all EU countries, more women specific health promotion messages need to be developed. Diseases related to birth and reproductive organs such as ovarian and cervical cancer, and endometriosis affect women exclusively. Cancer of the cervix is the second most common female cancer in the EU. Early screening and detection can improve survival rates, but only about 40% of all women over the age of 15 report having had a cervical smear in the previous

5 year. The EU has recognised the potential of population-based cancer screening programmes in its Council Recommendation adopted in 2003 (Official Journal of the EU L327, ). Recent findings suggest that many women experience heart disease in a form different from men and harder to detect. Improved prevention, diagnosis and treatment strategies are needed to ensure that that these differences are addressed Men and women use health care services in different ways. The use of health care services can be substantial at several stages of life; explanations for these differences include differences between men and women in health care seeking behaviour and biases in the provision of care to male and female patients, more information is needed in this area. Because women tend to have a dominant role in caring for children, arranging for the healthcare needs of children often brings them into contact with healthcare professionals, leading to increased opportunities for the use of services. Implementation of Strategy Question (7) Involving other Stakeholders Ensure the EU Health Portal, in consultation with relevant organisations provides reliable and informative health information for women Ensure the EU Health Policy Forum has representation from women s health organisations, who are working at EU level to promote women s health Support the exchange of information, experience and good practice between organisations in order to build a rigorous evidence-base on gender-related health issues; a first step is to establish a database of good practice examples. Support the inclusion of women's health groups in the EU Obesity initiative as an acknowledgement that women play key roles as family nutritionists Encourage greater collaboration on gender and health issues with European and international health organisations, such as the EU Gender Institute, ECDC and WHO In conclusion The new public health strategy should consider the following: Take a more strategic approach to public health policy-making that focuses on the interrelationship of health and other social determinants that interact with gender, education, living and working conditions, equal opportunity, lifestyle issues and gender roles, for specific population groups Examine the existing health inequalities within and between Member States under current and future Public Health programmes and devise strategies to minimise disparities, and ensure equity and equality of treatment and access to care. Introduce gender sensitive strands to Public Health programmes in relation to information, health education and promotion, disease prevention and screening Take differences in patterns between women s and men s health into account when designing national public health policies to ensure that the health needs of the entire population are included. Pay particular attention to marginalised groups of women and men such as the disabled, elderly,

6 migrants, and ethnic minorities. Ensure that a gender sensitive approach be included in the training of healthcare professionals who should be educated to give women the same level of care and attention as men. Institute equitable policies to avoid that differing healthcare financing options impact on gender inequalities in access to care. Ensure that service planning takes account of the cultural and ideological differences that limit women s access to, and utilisation of, services. Encourage new Member States to make greater use of structural funds for investing in health, such as supporting implementation of the Council Recommendation on Cancer Screening Target information and education campaigns about health and lifestyle choices at young girls of school age in all EU member states. For further information contact Peggy Maguire European Institute of Women s Health 33 Pearse Street Dublin 2, Ireland info@eurohealth.ie Tel: About the European Institute of Women s Health (EIWH) The European Institute of Women s Health, EIWH,is a non-governmental organisation set up to promote gender equity in public health, research and social policies across Europe. In striving to achieve the highest standard of health for all, our society s health policies must recognise that women and men due to their biological differences, their access to and control over resources and their gender roles have different needs and are faced with different obstacles and opportunities. This requires a gender-sensitive approach to health policy. The EIWH uses evidence-based arguments to influence the policy environment. Over the years, the Institute has worked closely with the European Commission, Member States and the World Health Organisation to place gender-mainstreaming on the public health and research agenda. The EIWH is supported in its work by a European Advisory Council (EAC) composed of key organisations and individuals from across Europe,specialised in health policies and women s health issues in particular.

7 This paper represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.