Copenhagen Conference 2012 Gender and Health through Life Getting it Right Dorota Sienkiewicz European Public Health All

1. Copenhagen Conference 2012 Gender and Health through Life Getting it Right Dorota Sienkiewicz European Public Health Alliance (EPHA)

2. EPHA Gender(ed) health inequalities Gender equity and wider social determinants of health Gender and Life-course in disease prevention and health promotion Economic and social case for getting it right Public health, advocacy and Civil Society Recommendations – Getting it Right Outline

3. EPHA is the European Platform bringing together public health organisations representing health professionals, patients groups, health promotion and disease specific NGOs, academic groupings and other health associations. Our membership includes representatives at international, European, national, regional and local level. As the largest network of European NGOs working in the field of public health with a mission to protect and promote public health in Europe, we facilitate shared learning and information and bring a public health perspective to European decision-making. Our aim is to ensure health is at the heart of European policy and legislation. European Public Health Alliance (EPHA)

4. Members specifically focused on issues of gender, lifecourse and health: European Institute of Women’s Health, European men’s Health Forum, ECCO, IPPF-EN, AGE Platform Europe, European Child Safety Alliance, European Alcohol Policy Alliance, EHN, MHE, SmokeFreePartnership and others but also issues related to “female face of” health workforce – EFN European Public Health Alliance Gender and Health members

5. Health inequalities: differences in health status or in the distribution of health determinants between different population groups (sex, age); when not attributable to a chance or biological variations but rather to the external environment and conditions of systematic uneven distribution of power and resources, and therefore unnecessary, avoidable and unfair we call them health inequities (WHO 2005); Gender/sex and age, although attributable to biological variations and unavoidable health differences, much often social roles and norms, economic position assigned to them and governing laws and policies behind are of greater impact on differentiated health outcomes for men and women, along their lifespan – “from a cradle to a grave”; Gender(ed) health inequalities and inequities

6. Quantity and quality of life: Life expectancy vs. healthy life expectancy (6 y gender gap EU15, 8 y gender gap EU12 & 2 y gender gap HLE & 4 y gender gap years lived with activity limitations) Disease and conditions such as e.g. CVDs (single leading death cause in the EU for women: 45% of female mortality), asthma, cancers, suicides (76% of suicides committed by men) and depression, communicable disease (TB & HIV+ increase under the crisis among (young) men, Sexual and Reproductive Health - STIs (chlamydia, HPV) or teenage and unwanted pregnancies; injuries and (road) accidents (no.1 killer of children, esp. boys, carries on to adulthood) – among others Gender(ed) health inequalities and inequities

7. Factors behind – wider key determinants of health such as tobacco smoking (Europe men 40% vs. 22% women vs. 31% of population, the highest in the world; teen smoking increase (19%) and girls uptake alarming, alcohol consumption (more boys drink on average but in IC, LV, SE it’s more girls), diets (fats, salt and sugar), physical inactivity, physical and social health-promoting/harming environments Factors behind factors – conditions in which people are born, grow up, live, work and age; health-promoting or hampering political choices in virtually all areas of human life, distribution of power and resources, access, empowerment and participation in social life – that nuance “gender through life” health risk or help-seeking behaviour, knowledge, self-esteem and self-efficacy Gender(ed) health inequalities and inequities

8. Poverty and social exclusion put people in biological and social vulnerability (along the lifecourse); women most likely to live longer, in disability and in poverty and deprivation (“female face of poverty”), men more likely to die younger and fall into homelessness/sleeping rough/addictions One of the key determinant of health is gender and economic equality and it is generally acknowledged that “there’s a strong correlation between a country’s level of economic inequality and it’s social outcomes” (Wilkinson & Pickett “The Sprit Level” 2009) Gender(ed) health inequalities and inequities

9. Inequality related losses in the EU are estimated at 1 trillion euro or 9.5% of GDP For every 0.05 more in GINI coefficient of income inequality, 7.8% rise in mortality for both genders with estimated 1.5 mln excess deaths over the last 30 years in OECD countries In 2010, World Economic Forum estimated that NCDs will cost us 197 trillion $ until 2050 if left uncontrolled Violence against women (45% of all women in Europe) - domestic violence alone costs EU Member States as much as 16 billion euro every year – or one million euro every half hour Economic and social costs of inequalities

10. Health promotion policies and initiatives taking women’s and men’s, boys’ and girls’ differential biological and social vulnerability to health risks (as well as their unequal access to power) into account are more likely to be successful and cost-effective Multi-sectoral approach - gender health promotion within the wider social and economic arena (finance, taxes, labour market, social services, housing, environmental protection, water and sanitation, transport, road safety, education, research) beyond the reach of the health sector but led by it, providing evidence when policies, systems, programmes planned and implemented so that an action brings equal results for both genders (however, sometimes need for positive discrimination..) EPHA examples – EU Budget, Horizon 2020, Communications/Consultations/Directives on Child Poverty, Agriculture and RD, Environment, Audio-media, Roma, Health workforce, maternity leave… Gender in Health Promotion

11. Men and women have different social and economic resources available to shape their health outcomes, maintain health or fall into disease (access to and usage of healthcare, affordability, responsiveness to advertising, health-risk & help-seeking behaviours, self-efficacy, self-esteem, stress) – and these change along one’s life-course (children, pregnant women, the elderly, middle-aged) These are known and utilised to a “very good” extent by the industry (tobacco, alcohol, pharma, food and drink, marketing), but public health professionals can act upon these by adequate and targeted interventions to prevent specific disease and promote concrete pro-health behaviours across genders and age-groups Disease prevention and health promotion gender and life-course

12. Many health promotion strategies aim at reducing risky behaviours, such as smoking, but ignore the material, social and psychological conditions within which the targeted behaviours take place. There is a strong association between smoking prevalence, material hardship, low SES, stressful work or life. Gender roles and linked health-related behaviours in many strategies led to focusing on behavioural change at the individual level (eg. Different specific stress coping strategies for both genders to be learnt instead of taking up risky behaviour) However, the individual level is not enough and on a longer run generic strategies aimed at population and macroeconomics level are needed, eg. Smoking bans, plain packaging Another good practice is monitoring and collecting gender aggregated data to inform planning, implementation and evaluation of gender health promotion and disease prevention programmes Examples

13. Help-seeking behaviour, accessing and utilizing healthcare services (incl. preventive and SRH) diff./lower for men than women (frequency, late, co-payment) - men visit GP 20% less than women Health risk behaviours diff. for men and women (tobacco, alcohol, infectious disease, stress and workload) Admission to hospital (for all type disease and health problems) - higher for men than women; enrolling in and participation in risk reduction programmes (men and adolescents lower) Level of knowledge/awareness of health and risk factors, efficacy to apply knowledge to achieve a result Message content, mode (visual, audio), sender (credibility, trust – sport organisations, local pharmacy), channel (TV – soap operas, internet - men) Female sources of support – dieticians, nurses, family members, social/religious groups vs. male sources - GP Disease prevention and health promotion gender and life-course

14. Current focus and attention shift to Healthy and Active Ageing due to alarming demographic changes on account of lack of attention to early years of human development – no specific action on Children’s Health and Wellbeing as such at EU-level It is never too early to prevent and tackle chronic diseases. Healthy practices, health capital and resilience to diseases begin in infancy or even in utero. Lifecourse approach would not only benefit patients who already developed a disease but mainly protect healthy people from early on from developing it in the first place (salutogenic vs. pathogenic approach) Early years development and interventions/prevention in this crucial period are 20-80 cost effective, build up resilience and health capital, literacy, empowerment Why lifecourse?

15. Advocacy is one of the main activities of organised Civil Society – collective voice of the affected by political choices towards those who make the choices Communication and exchange of useful information, advocacy strategies, entry points to different levels of political arena – for coordinated and complimentary actions (‘many drops of water make a hole in a rock’) Not only delivering “sub-contracted” services (a case of health sector) but also pariticipating in policy development, impact assessment, funding allocation, accountability check Access to local, national, European and international organisations Putting public interests before private benefits - Bringing evidence from the ground to policy makers for good public health outcomes that are gender sensitive from a lifecourse perspective Role of Civil Society and organised actions

16. Partnership between civil society and academic institutions enable firsthand knowledge of the most pressing research needs of health problems and SDOH neglected or emerging, connected to hard-to-reach groups CSOs and user organisations’ involvement ensure that real needs and problems are addressed, developed policies/solutions of increased acceptability, sustainability and accessibility when entering ‘the market’; increase the sense of ownership and trust Representing public health voice in many non-health fora which might be discussing gender-related issues not realising its importance for health Role of Civil Society and organised actions

17. Building “healthy” public policy that recognises gender and lifecourse, and balances ‘care’ with ‘prevention’ (health in all policies, gender and lifecourse in all health and non-health policies) Creating supportive, health and gender-promoting social, economic and physical environments at places where gender/lifecourse spend the most of their times (school, creche, workplace, club..) Strengthening individuals in capacity to respond to, control determinants of, gaining access to economic and social resources Strengthening communities and civil society which main function is to provide a collective mutual support and benefit Re-orienting and integrating health services, pro-active holistic public health approach to enhance good health and prevent illness and disability Gender equality and diversity in research topics, urgency and importance, application, accessibility Going beyond health sector, beyond care and treatment, beyond adulthood (early life and pregnancy) Putting extra pressure on adequate gender and health through lifecourse in times of economic crisis and austerity (gendered austerity, cuts to prevention and public health, social services and social protection, unemployment and falling into material deprivation) Getting it right

18. Dorota Sienkiewicz Health Equity and Policy Coherence Coordinator European Public Health Alliance (EPHA) Email: d.sienkiewicz@epha.org Web: www.epha.org Thank you for your attention