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Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
It sounds obvious, but women are different from men. Women and men experience life differently, both when they are healthy and when they are unwell. What might come as a surprise to you, though, is to learn that nearly all health research, health information and healthcare treatments approach women and men as if they were exactly the same. Think about this for a moment. Health care doesnt take into account that women have menstrual periods and a uterus while men do not; that women have dominantly oestrogen but men have dominantly testosterone; or even that men have a prostate and women do not. It is blindingly obvious that different anatomies, different hormones and different genetics must impact health differently and yet health care treats women and men as if they were exactly the same. As youll read in this chapter, the health differences between women and men and among different groups of women are caused by both biological and social factors. If we dont have health care that takes into account these factors, we wont achieve the best health and wellbeing for women (or men). Medical research provides us with the information we need to prevent, diagnose and treat health problems, but less than one-third of participants in medical research and drug trials are women. This means that most medical research has been done on men and then applied to women. This continues to happen even though we know that women often have different symptoms and experience different outcomes of health problems from men, and that women respond differently to many medicines. As a result, many diagnoses, treatments and even prevention strategies arent as appropriate for women as for men. Women are often treated when there is little evidence supporting that treatment in women. In fact, some medicines that have been shown to be safe for men may be potentially dangerous for women.
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
Research needs to include both women and men, and the results for women and men need to be analysed separately. This is the only way we will begin to answer questions such as why the rate of lung cancer in women is rising while the rate in men is falling, and why women who have heart attacks are more likely than men to die from them. So lets start by outlining the differences between women and men: Women are biologically different from men this is the sex difference. This means that womens anatomy, physiology, hormones and genetics are different. Because of these differences, some health conditions are more likely to affect women (such as osteoporosis, arthritis, migraines and depression), some health conditions affect women differently from men (such as schizophrenia and lung cancer), and women respond differently from men to some medicines (such as those used for anaesthesia, epilepsy and depression). Womens biology also means that some health issues, such as endometriosis, pregnancy, menopause and gynaecological cancers, only affect them. Women are positioned differently in society from men this is the gender difference. This means women are more likely than men to have a lower income, less secure employment, to be carers, and to be exposed to domestic violence. These differences have a profound impact on womens health. For example, women are more likely than men to experience depression and anxiety, and this affects their relationships and ability to function at work and in the community. There are demographic differences between women that affect health. Some women, such as those living in rural areas, Aboriginal and Torres Strait Islander women, and women with disabilities, are at much higher risk of poor health. A womans life stage also has a direct impact on her health. Womens health changes at each life stage, and having access to the right information and services at the right time helps them to make the best choices for their health. All these factors need to be considered together to help women access better health care and experience better health. Reading health information (such as this book) written specically for women by health professionals who specialise in womens health is a good place to start. This book will also point you in the direction of health services that take into account the wide range of factors that affect
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
womens health. This is called taking a gendered approach to health, an approach that results in better health for you as an individual, and that ows on to your family and the wider community. A gendered approach to health is a win-win-win. The rest of this chapter will take a closer look at the ways sex, gender, demographics and life stage affect womens health. And, most importantly, it will help you ask questions, start a conversation and nd more information and services that can lead to better health at any stage of your life. Sex versus gender Many people use the terms sex and gender interchangeably, but the terms mean quite different things, as we have described here. Sex refers to the biological differences between women and men, whereas gender refers to the social differences between women and men. Both sex and gender inuence womens health.
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
men are complex: they involve much more than biological difference. Social or gender differences between women and men have a huge impact on womens health and these also need to be taken into account when research studies are designed and analysed and when new treatments are developed.
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
Inuences on health
A range of gender factors contributes to higher rates of anxiety and depression in women. These include higher levels of nancial disadvantage, lower levels of education, lower rates of working outside the home, the higher burden of being a carer, and higher exposure to discrimination, harassment, and family or intimate partner violence (which used to be called domestic violence). More research is being undertaken to better understand the sex and gender effects on womens mental health. Prevention and treatment programs that take a woman-centred approach and take into account her social, cultural and economic situation will help to ensure the best outcomes for womens mental health. Many people are shocked to learn how common violence against women is in Australia: nearly one in ve adult women is subject to intimate partner violence. A 2004 Australian study found that intimate partner violence is responsible for more ill health, disability and premature death in women under the age of 45 than any of the other well-known risk factors, including high blood pressure, obesity and smoking. Women who have been exposed to violence have a greater risk of developing many health problems, including depression, anxiety, eating disorders and substance abuse. Intimate partner violence also impacts on womens reproductive
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
health, with an increased risk of sexually transmitted infections, abnormal Pap tests, unplanned pregnancies, pregnancy complications, abortions and miscarriage. Violence against women is a complex problem, but we do know that cultural, social and economic factors all play a part. One main underlying factor is the unequal access to power and money between women and men, which has been noted by the World Health Organization. Intimate partner violence is so common and has such an overwhelming effect on womens health, but its rarely discussed or given much publicity. There is emerging recognition that violence against women is more than just a law enforcement issue: just like high blood pressure, smoking and obesity, violence is a major womens health issue. You can read more about family violence and where to get help in chapter 30.
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
of these and other factors, Aboriginal and Torres Strait Islander women have poorer physical and mental health than other Australian women. Women from non-English-speaking backgrounds often have difculty accessing health information in their own language or in accessing information or services that take their cultural needs into account. Women with a disability are more likely to have lower incomes and have more difculties with transport and accessing services. They also have less daily contact with friends and family and are more likely to experience intimate partner violence. According to 2003 gures from the Australian Bureau of Statistics, one in ve Australian women is living with a disability that causes many challenges in her everyday life. Lesbian, bisexual and transgender women experience greater levels of discrimination and violence, which impact on their health and result in higher rates of depression and isolation. The fear of insensitive treatment or discrimination can be a major barrier for these women in accessing health care.
A social model of health A social model of health provides a framework or a big picture way of thinking about health. When we think about health in this way, it becomes clear that better health results from considering the social and environmental factors that affect health as well as the biological and medical factors. This means that you have the best opportunity for good health when you are treated as an individual who is a member of a family and a member of a wider community, which in turn dictates the political, social and economic environment you live in. To do this, we need continued investment in womens health. We need to focus on the social and economic factors that inuence womens health and start making positive changes to the environments in which women live, work and socialise, so that women from all backgrounds have access to tools that can improve their health. Women are the centre of families and communities, and research shows that looking after womens health results in healthier families and a healthier community.
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10
An important rst step in addressing the health needs of women in these different groups is developing health information and services that are sensitive to their needs and are easier for them to access. See the Resources section at the end of this book for information and services that focus on the needs of all women as well as different groups of women.
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
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that are often inuenced by outliving their partners, being less economically secure than men, and having much higher rates of age-related health problems such as dementia, arthritis and osteoporosis than men of the same age. Older women are often invisible in Australian society, and yet this is a time when, with the right support and a positive outlook, they may have many opportunities to enjoy life in ways there wasnt time for when they were younger. This is also the time to enjoy the wisdom that only comes with many years of life experience! Because your experience of life and health is inuenced so heavily by different life stages, we have divided this book into sections that relate to womens four major life stages. The information in each section will help you navigate each life stage, making the most of the opportunities and reducing any health risks you face. Transition points in womens lives Have a look at this list and think about how many of these transition points you have already experienced: starting school adolescence entering the workforce living with a partner pregnancy and childbirth being a new mum returning to the workforce menopause children leaving home leaving the paid workforce caring for ageing parents or a partner death of a partner older age
Did you experience new health challenges and stresses at these times? What advice would you give a younger woman about nding health information and services and looking after herself well at these stages? How do you think you can prepare for the transition points you will experience in the future?
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
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told us that it was important for this book to help them understand more about their bodies and what it means to be healthy. They told us they wanted a book that acknowledges that while we are all women, we are also different groups of women. We are younger women, midlife women, older women, mothers, carers, independent women and women with disabilities. We are single, married, lesbian, divorced and widowed women. We are Aboriginal and Torres Strait Islander women, we are Australians descended from migrants and refugees, from Africa, Asia and Europe. We are professional women and women on low incomes. We are women living with cancer, women managing menopause symptoms and women with mental health problems. Often, we are women dealing with any number of life and health issues at the one time. What unites all women is their need to be respected, to be treated with dignity, and to have access to health information and services that make a clear connection between their health and the lives they lead every day. When we were writing this book, we considered the needs of women from different backgrounds to ensure that all women will nd information and stories in it to which they can relate personally. You will also nd that this book covers many topics you may not nd in other health books but that many women told us are important, such as unplanned pregnancy, drugs and alcohol, violence at home, being a carer and the positive side of getting older. All the information in this book is written by health professionals who specialise in womens health. Working with women every day, they understand the issues that affect women, how health problems affect women differently from men, and how social factors such as employment, income and relationships affect womens health. They also understand the difculties many women face in nding the information and care they need. The Womens Health Book is designed to give you the information you need to participate as an equal partner in your health care. Armed with the real facts, you will be able to ask more questions and make better choices to help improve your health and even prevent future problems. Here are some more practical ideas to head you in the right direction towards better health: Look for women-centred health services and support groups in the community. There are many services and groups for women with specic health needs, and these can help you to feel connected, to make new friends and learn ways to live well.
Copyright The Royal Womens Hospital 2014. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.
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Start a conversation with your mum, daughter, sister or girlfriend. Did they know that women experience many health conditions differently from men? What have their experiences been in dealing with the health system? Talk about your own health and life experiences (good and bad) as openly as you can. When you start talking to a trusted friend or healthcare professional about difcult subjects such as having an abusive partner, or starting to rely on tranquillisers too much, or the tough conditions at work you help other women open up and start talking too. Talking to someone is often the point when we realise things really arent right and we need some extra help to get things back on track. Ask your healthcare professionals more questions. Ask if there is a clinic with a woman-centred approach to your health problem. Ask if the symptoms or treatment of your health problem might be different in women from men. You might not always get a clear answer, but asking questions is a good way to get everyone thinking about these issues. Look at the big picture of your health. As well as seeing a health professional and taking your medicine, think about your lifestyle choices and how your work and family situation inuence your health. How can you start changing some of these factors so you can feel healthier? Perhaps you can ask some friends to start walking with you a couple of times a week. If the changes are more difcult ones, like nding a job with better conditions and less stress, ask for the support you need to make these changes. Celebrate being a woman. Although women have higher rates of certain health problems, women are also better than men at surrounding themselves with good friends and using social networks to stay connected. Make an effort to see friends, talk about important issues and have fun together. Its all good for your health. Remember that taking care of your health is the most important step in creating a healthy, happy family and a thriving community. The best opportunities for good health come from a combination of individual choices such as being more active, eating more fresh vegies and going easy on alcohol and through improving the wider social and economic factors that affect your health. Most importantly, it means putting your own health rst.