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.

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.

Why womens health matters

Dale Fisher

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.

The Womens Health Book

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.

Why womens health matters

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.

The sex difference

Biology, anatomy and genetics at every level inuence nearly everything about the way womens and mens bodies work. This inuences the health problems women are more likely to experience, how women experience them, and how women respond to treatment. For example, we know that women tend to develop schizophrenia at a later age, have different symptoms from men, and tend to have a less severe version of the illness. These differences may be due, at least in part, to a protective effect the hormone oestrogen has against schizophrenia. Another example of sex affecting a health problem is the incidence of migraine, which is three times more common in women than in men. Hormones are also one of the main inuences here. When preventing and treating migraine in women, taking each womans life stage for example, adolescence, pregnancy or menopause and hormonal state into account will give the best chance of treatment success. These are just two examples of how sex affects health. For a long time, the basic differences between women and men have been ignored in medical research, but this is slowly beginning to change. More research is starting to focus on womens experiences of health, resulting in better treatments for such conditions as schizophrenia. But we still have a very long way to go. This is partly because the differences between women and

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The Womens Health Book

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.

The gender difference

Women have different economic, social, political and cultural positions and opportunities than men. This is called the gender difference. These gender differences interact with sex differences to impact womens health and wellbeing, often by affecting the health services women are able to access and the outcomes of treatment. One of the key differences is that women are more likely than men to be nancially disadvantaged. This is because women generally have less access to education than men, have lower incomes than men, live in poorer housing, and have less secure employment and less superannuation. Women are also more likely than men to spend time out of the paid workforce while caring for children and/or elderly parents. These factors can also lead to social isolation. According to the 2010 Australian National Womens Health Policy, women who are socially or nancially disadvantaged are more likely to have poor health, and have a high chance of having children with poor health. The reasons for this are many and complex. We know that the most disadvantaged women have the highest exposure to risk factors that can damage their health. They also have more barriers that prevent them from taking up healthy behaviours. A 2008 report from the Australian Institute of Health and Welfare found that these women are more likely to be overweight, to smoke, to experience family violence, to have fewer social networks, to be less physically active and to eat less fruit and vegetables. All these factors increase a womans chance of developing many health problems, including type 2 diabetes, heart disease, certain cancers, respiratory diseases and mental health problems. The Australian Bureau of Statistics reported in 2007 that anxiety and depression are almost twice as common in women than in men, and for women the Institute of Health and Welfare lists these as the leading causes of healthy years of life lost due to disability. Anxiety and depression affect women at all stages of life and affect their ability to function in jobs and in the wider community. These illnesses also have a signicant impact on womens relationships.

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.

Why womens health matters

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

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The Womens Health Book

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.

Demographic differences between women

As well as the differences between women and men, demographic differences between groups of women affect health. Some groups of women experience greater inequalities that increase their exposure to health risks, affect their attitudes to health and reduce their ability to access health information and services. These groups include women living in rural and remote areas, Aboriginal and Torres Strait Islander women, women with disabilities, women from non-English-speaking backgrounds, and lesbian, bisexual and transgender women. Understanding the needs of these women using a social model of health, which takes into account social and environmental factors that affect health as well as sex and gender factors, allows us to continually improve the health information and services we develop. Lets look at some key examples of how demographic differences affect particular groups of women. Women living in rural and remote areas are more likely to be socially and nancially disadvantaged and have less access to general practitioners (GPs), specialist health care, family planning services and counselling services. Where healthcare services are available, many women worry about accessing them condentially because everyone knows everyone in a country town. Aboriginal and Torres Strait Islander women have lower levels of education, lower incomes, higher rates of unemployment and a higher risk of exposure to violence than other Australian women. As a result

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.

Why womens health matters

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

The Womens Health Book

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.

Different needs at different life stages

Womens health needs change throughout their lives and it is very important for them to have access to the right information and services at the right time to achieve the best health. Women have many important transition points in their lives. The social, emotional, economic and hormonal changes women experience at these transition points can make them especially vulnerable to health problems. Having access to the information and services you need at each of these stages can give you better control of your preventative health care and health-management decisions and can help prevent health risk factors from adding up throughout your life. Young women can be under pressure to be successful at school and university, to be popular, to conform to stereotypes and to look attractive. All of this can increase the chance of risky behaviours such as drinking too much alcohol and having unprotected sex, and can lead to an unhealthy body image and eating disorders. The Australian Bureau of Statistics reported in 2007 that nearly one in three young women has a mental health disorder. When women begin to think about having a family, they face a whole new set of health issues. Because these days women are older when they have children, they may not nd it as easy to get pregnant as they hoped. Women who are pregnant or who have recently become mothers have a high risk of depression, and balancing parenting and work responsibilities can affect womens health in many ways. In midlife women often experience more life events and changes than at any other time. This is a time of physical transition, when menopause may cause a range of physical symptoms, depression and anxiety, as well as an increased risk of other health problems such as osteoporosis and heart disease. At the same time, adult children may be leaving home and new opportunities for work and leisure may open up. Many women in this life stage, however, take on the role of caring for an elderly parent, which creates another range of emotional and physical challenges. Women are making up a larger proportion of the old and very old population groups in Australia. Older women have specic health needs

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.

Why womens health matters

11

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?

What does all this mean for you?

Just by reading this book, you are on the right path to enjoying better health. The Womens Health Book has been developed in partnership with women and health professionals. The rst thing we did when we were developing this book was talk to women about what they wanted to see in a womens health book. 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.

12

The Womens Health Book

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.

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Why womens health matters

13

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.