Women and Health, WPC
Political Association of Women
Special Event
WOMEN & HEALTH
Aigaleo City Hall, November 22, 2017
European Health Policies
Anna Karamanou
The health sector does not fall under the exclusive competences of the EU. In other words, it is not among the sectors where the EU alone can legislate and adopt binding acts. The EU’s competences are divided into three main categories:
- Exclusive competences1
- Shared competences
- Supporting competences
According to the Treaty of Lisbon, public health falls under shared competences 2, where EU countries can legislate and adopt legally binding acts, while the protection and improvement of human health belong to supporting competences, where the EU may only intervene to support, coordinate, or complement the actions of EU countries.
The protection of public health and, specifically, healthcare systems themselves remain primarily the responsibility of Member States. However, the EU still plays a significant role in improving public health, preventing and managing diseases, mitigating threats to human health, and harmonizing the health strategies of Member States.
The EU has successfully implemented a comprehensive policy through the “Together for Health” strategy and its action program for the period 2014-2020. The current institutional framework includes Health and Food Safety, as well as specialized agencies such as the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA).
The three strategic goals of the EU for health policy are as follows:
1.Promotion of good health. Disease prevention and the promotion of healthy lifestyles. through addressing issues related to nutrition, physical activity, alcohol, tobacco and drug consumption, environmental risks, and injuries.
2. Protection of citizens from health threats – improving surveillance and preparedness to tackle epidemics and bioterrorism, as well as enhancing the capacity to address new challenges such as climate change.
3. Promotion of dynamic healthcare systems, capable of responding to the challenges of an aging population, increasing citizens’ expectations, and the mobility of patients and healthcare professionals.
Despite the lack of a clear legal basis, public health policy had been developed in various areas even before the current EU Treaty began to be applied (from December 1, 2009). Research programs in the fields of medicine and public health started in 1978 and have addressed issues related to age, the environment, lifestyle, radiation risks, and the analysis of the human genome, with particular emphasis on major diseases.
Among the most significant initiatives undertaken are the “Europe Against Cancer” program in 1987 and “Europe Against AIDS” in 1991. Further initiatives are being implemented under the Horizon 2020 program.
The role of the European Parliament, as the decision-making body (which co-decides with the Council), is very strong on health, environmental, and consumer protection issues.
The European Parliament has systematically worked to create a cohesive policy on public health issues. It has also actively supported the health strategy with numerous opinions, research, discussions, written statements, and reports on topics such as the risks of radiation, patient safety undergoing medical treatment, health information and statistics, respect for life and care for terminally ill patients, the European Charter for Hospitalized Children, key health determinants, biotechnology, including cell, tissue, and organ transplantation, surrogacy, rare diseases, blood supply safety and self-sufficiency in the EU, cancer, hormones and endocrine-disrupting substances, electromagnetic fields, drugs and their impact on health, ionizing radiation, Alzheimer’s disease and other forms of dementia, complementary and alternative medicine, telemedicine, antibiotic resistance, biotechnology and its medical applications, the European Health Card, nutrition, tobacco and smoking, breast cancer, and specifically women’s health.
In 2013, the European Parliament called for the approval of legislation for cross-border healthcare and the revision of the legal framework for medical devices and advanced therapies3. The report of the Committee on Women’s Rights and Gender Equality (FEMM, November 9, 2016) examines the issue of mental disorders and emphasizes the need for more resources to be allocated for research. It specifically highlights the fact that gender inequality, violence, and sexism expose women to greater risks of depression, anxiety, and mental disorders.
For many years, there was a general belief that there were no gender-based discriminations in treatment and healthcare from the medical system. However, in recent years, it has become recognized that there is differential treatment between men and women in medical and healthcare services, and that gender is an important and determining health factor.
At the United Nations global conferences in Cairo in 1994 and Beijing in 1995, the relationships between gender and health were included on the agenda. However, despite the existence of these international initiatives for the protection of women’s health, there were no significant reforms, either at the national or international level. The European Commission followed up on the Beijing Platform to some extent, but did not focus its attention on developing a gender policy within the health sector.
Women’s health is often considered synonymous with sexual and reproductive health. However, despite women living longer than men, they are generally perceived to have worse health and require more treatment. The occurrence of osteoporosis is four times more likely in women than in men. This is partly explained by the complex relationship between biological and social factors, but research is needed in this area to understand the greater degree of poor health and need for medical care.
The fact that women have a longer life expectancy means that the majority of the elderly population is made up of women. In addition to being the largest group of the aging population, elderly women are more frequently affected by certain age-related conditions, such as rheumatoid pain and Alzheimer’s disease, compared to men.
According to a recent European scientific study by the Institute for Applied Systems Analysis of Austria, approximately one in five Greek women (21%) and one in six Greek men (17%) over the age of 65 currently live with some physical disability that limits their daily movements and activities, such as cooking, dressing, bathing, or going shopping.
Older women, due to income and property inequalities earlier in their lives, have fewer pension benefits and fewer financial resources for healthcare and treatment. These are some of the reasons why we need a well-developed and state-funded healthcare system and geriatric care. Otherwise, a large number of elderly women will not have any necessary care and treatment. It is now also known that the patient’s gender is a critical factor in how doctors and nursing staff perceive symptoms, make diagnoses, and recommend treatment – even when the symptoms of women and men are exactly the same and no biological factor justifies any difference.
The gender dimension in medicine also refers to the manifestation of poor health caused by unequal power relations between genders, such as male violence against women. Medical research on gender has been crucial in highlighting the health impacts of violence and abuse suffered by women from their partners, as well as issues of human trafficking and prostitution.
Despite the fact that violence against women is such a widespread public health problem, it has remained an invisible issue in medical education and practice. For example, patients are asked about their smoking habits, but most female patients are not asked whether they are experiencing violence, despite studies showing that violence against women occurs more frequently and with worse consequences than, for example, smoking4. Violence against women causes higher mortality in women aged 15 to 44 than cancer, malaria, road accidents, or war. The World Health Organization estimates that at least one in five women worldwide has suffered physical or mental abuse in her lifetime. 5
An analysis conducted at the hospital Danderyd in Stockholm, Sweden showed wide inequalities between men and women in terms of prescription, treatment, and costFor example, men received twice as many mild body treatments for eczema or psoriasis diagnoses compared to women, despite these conditions being equally common in both genders. The conclusion of the study, in terms of cost, is that if women were to follow the same intensive treatment regimen as men, the resources spent on treating women would increase by 61%. On the other hand, if men were to undergo less extensive treatment, as is the case with women, there would be a cost-saving of about 33% in treatment resources.6
Women’s coronary diseases manifest differently to some extent, and when hospital care is required, they are not treated as quickly as men. Women with acute cardiovascular conditions are forced to wait longer for ambulance transport, and when they are taken to a hospital, their reception is not the same. More time is needed before they undergo heart X-rays, and they are not as frequently given immediate treatment in the form of angioplasty or coronary bypass surgery. A study on ophthalmological care shows that women have more difficulty accessing cataract surgeries.
Women more frequently suffer from side effects of cardiovascular medications, likely due to incorrect dosage. However, no research has been conducted to determine the cause7. Medications work differently on men and women. Despite the fact that women consume more medications than men, men still often serve as the standard in medical research and the development of new drugs. Statistics show that men have quicker access to new medications and modern treatments. 8
Breast cancer is one of the most common types of cancer among women in the EU and other industrialized countries, such as the US and Canada. Little research has been conducted on the causes and risk factors of breast cancer. Existing research shows that the risks increase with age, that heredity is an important factor, yet many women develop cancer without any of these factors.
Eating disorders, such as bulimia nervosa and anorexia, have increased, particularly among young women. This is often linked, by the fashion industry and media obsession, with weight loss and appearance. Few scientific studies have been conducted on eating disorder issues. Some of these studies indicate that they may be connected to abuse and domestic violence9. There is a need for research to understand and thus prevent these disorders and, with appropriate measures, to help young women who have already been affected.
A major issue exists with cesarean sections 10. Most are not necessary but are a result of being scheduled for a predetermined date, despite the serious risks they entail for both the mother and the child. Certainly, the increase in cesarean section cases results in high costs for national health systems, as well as health risks.
Good health for all should be a primary goal in all political and economic decision-making processes. To achieve this goal, we must focus on disease prevention strategies that include adequate public information and guaranteed access to sufficient healthcare for all. The gender dimension must be taken into account in all health policies and decision-making processes, both in the public health strategies of member states and in the EU health strategy.
Finally, it is worth noting that women employed in the healthcare sector are clearly more numerous than men, but they are significantly underrepresented in leadership positions. Therefore, it is essential to promote gender equality in leadership roles in the medical field and eliminate all gender and age-related biases. This is one of the key goals of the European Gender Strategy (EGS).
Anna Karamanou
Vice President of the European Gender Strategy (EGS).
PhD in Political Science & Public Administration, NKUA
Former MEP – President of the Committee on Women’s Rights and Gender Equality of the European Parliament.
1 These include: customs union, competition rules, monetary policy, preservation of biological marine resources, common fisheries policy, trade policy, and the conditional conclusion of international agreements.
3 Directive 2011/24/EU codifies patients’ rights to reimbursement for healthcare received in another EU Member State
4 Lundgren, Heimer, Westerstrand, Kallioski: ‘Captured Queen – men’s violence against women in ‘equal’ Sweden – a prevalence study’, Fritzes 2001.
5 World Health Organisation: Violence against Women Fact Sheets WHO/FRHWHD/97.8, 1997.
6 Osika, Ingrid: ‘Ett konkret exempel på ojämställd vård’ (A specific example of unequal care), Linköping University.
7 Asplund. Wigzell: ‘Jämställd vård?’ (Equal care?), National Board of Health and Welfare (2004), pp. 55-57.
8 ibid. p. 74.
9 WHO World Report on Violence and Health 2002, Heise Lori et al Population Report: Ending Violence against women, John Hopkins School of Public Health 1999.
10 The World Health Organization defines a medically acceptable cesarean section rate as 15% of deliveries. In EU countries, the average cesarean rate does not exceed 30%. In Greece, nearly 58% of deliveries are by cesarean section, a percentage that is only rivaled by Turkey, with 51% of deliveries. Health Minister Andreas Xanthos has requested the Central Health Council to establish a framework of guidelines and protocols for determining when a cesarean section should be performed.