Policy cycle in health

Health statistics measure both objective and subjective aspects of a population's health. They cover different kinds of health-related issues in different parts of everybody's life, including key indicators on the functioning of the healthcare systems. Equality indicators made available by Eurostat relate to gender issues include indicators for life expectancy, life expectancy by highest level of education attained, healthy life years, causes of death, and hospital discharges by diagnosis. Disaggregations by sex are available. The health dimension refers to both drivers and outcomes as well as the aspect of access to healthcare. Health outcomes include data on life expectancy as well as data on self-perceived physical and mental health. ‘Drivers’ refer to (un)healthy behaviours and include data on smoking, alcohol consumption, physical activity, and body mass index (BMI). Access to healthcare is operationalised by self-reported unmet medical needs.

These aspects include:

Health status and health determinants

The section presents data on various aspects of the health status of a population and its non-medical determinants, lifestyles and health behaviour. The data enable an analysis of public health issues as well as demographic and socio-economic patterns and disparities in health status and its determinants, and provide a tool for monitoring the effects of health policies. Statistics on self-reported health and morbidity, functional and activity limitations, injuries, overweight and obesity, physical activity, dietary habits, risky behaviours such as tobacco and alcohol consumption data are included.

Healthcare

The section presents data on various aspects of healthcare systems:

• healthcare expenditure
• human and technical healthcare resources
• healthcare activities in hospitals and outside hospitals (covering treatment and prevention)
• use of medicines
• unmet needs for healthcare.

The indicators can be used for evaluating the functioning and performance of healthcare systems including quality and access to healthcare services, healthcare expenditure, healthcare resources (staff and facilities) and activities (hospital and ambulatory services).

Disability

Disability statistics provides data on the number of disabled persons as well as on their involvement in society, through data related to living conditions, social inclusion, labour market, health, or education. Prevalence of disability, employment of disabled persons, barriers to the social integration of disabled persons data are included.

Causes of death

Statistics on causes of death (COD) provide information on mortality patterns and form a major element of public health information.

Health and safety at work

This section provides data on accidents at work, work-related health problems and exposure to risk factors.

The European Health interview Survey (EHIS) collects a large variety of data on health status, health determinants and healthcare activities on a non-annual basis. It consists of 4 modules on health status, healthcare use, health determinants and socio-economic background variables. EHIS targets the population aged at least 15 and living in private households. Disaggregation by sex are available.

It represents one of the major sources of data and statistics on health status, health determinants and healthcare activities at the EU-28 level, used for populating the Eurostat statistics on health.

The 4 modules cover the following topics:

• Background variables on demography and socio-economic status such as sex, age, household type
• Health status such as self-perceived health, chronic conditions, limitation in daily activities, disease specific morbidity, physical and sensory functional limitations
• Healthcare use such as hospitalisation, consultations, unmet needs, use of medicines, preventive actions
• Health determinants such as height and weight, consumption of fruit, smoking, alcohol consumption.

The main source for the compilation of statistics on income, social inclusion and living conditions at the EU-28 level is the European Union living conditions survey (EU-SILC). EU-SILC provides cross-sectional and longitudinal information on income, poverty, social exclusion and living conditions, disaggregated by sex, age, nationality, education level, activity status and type of household. The EU-SILC contains 7 annual variables on health status and healthcare use:

• self-perceived health
• chronic morbidity
• activity limitation
• self-reported unmet needs
• medical care
• dental care
• main reasons for unmet needs.

Breakdowns are given by: sex, age, labour status, educational attainment level, and income quintile group. It represents one of the major sources of data and statistics on health status, used for populating the Eurostat Statistics on Health.

This provides the main aggregated statistics on labour market outcomes in the European Union. The EU-LFS is the main data source for employment and unemployment. Tables on population, employment, working hours, permanency of job, professional status etc. are included. It provides disaggregated statistics by sex, age groups, economic activity, education attainment and field of education, from which the characteristics of the labour force of women, by age, can be measured. Numbers of women and men in the labour force by economic activities related to human health and social work activities are available. Periodically LFS ad-hoc modules cover employment of disabled people and accidents at work and work-related health problems.

This database produces and publishes data, indicators and analysis on the operation, evolution and impact of education from early childhood through formal education to learning and training throughout life. Data and indicators disseminated include:

• participation rates at different levels of education
• enrolments in public and private institutions
• third-level education graduates
• pupil-teacher ratios
• foreign language learning
• expenditure on education per student
• relative GDP.

Data are disaggregated by sex, age, educational level and field of education. The data collection on education statistics is based on the International Standard Classification of Education (ISCED). For data on educational attainment based on the EU Labour Force Survey (EU-LFS) the International Standard Classification of Education 2011 (ISCED 2011) is applied as from 2014. Numbers of women and men by education attainment and field related to health (e.g. health, health and welfare, medicine nursing and caring, dental studies, medical diagnostic and treatment technology, therapy and rehabilitation) are available.

EIGE assists EU institutions and the Member States in the collection, analysis and dissemination of objective, reliable and comparable information and data on equality between women and men. The gender statistics database provides statistics on the indicators established and implemented for monitoring the BPfA critical areas of concern. Indicators related to health are included in Area C – women and health.

Measuring gender equality in the European Union 2005 – 2012

EIGE’s gender equality index compiled 2 main indicators for monitoring gender in health, referring to health status, health behaviours and access to health structures. You can find the results for the EU and the 28 Member States in EIGE's gender equality index website.

Health workforce data sources

This database contains the latest and trending data on core health indicators from WHO sources, including the annual World Health Statistics Report and the statistical annexes of the World Health Report.

It comprises more than 100 indicators, including those on human resources for health.

This database provides data and statistics on health status and health risks, disaggregated by sex.

Saxony and Saxony-Anhalt. Technische Universität Dresden, Dresden, Germany.

Data and Information on Women’s Health in the European Union

This report presents an overview of the state of women’s health in the European Union. The report focuses on women aged 15 years and older in the 27 EU Member States, as well as the EEA countries Norway, Iceland, and Liechtenstein, and occasionally Switzerland. The report shows there is persistent evidence that sex and gender differences are not only relevant for reproductive health issues, but also for the prevalence of diseases, risk factors and healthcare among women. It is essential to acknowledge that differences in health between women and men are due to interactions between environmental, behavioural, and biological factors.

Gender equality and sustainable development

Coming on the heels of the UN Secretary-General’s climate summit in September 2014, the report focuses on the theme of gender equality and sustainable development by examining a select range of issues that are fundamental to women’s lives and are strategic for achieving gender equality and sustainability, including:

• patterns of growth, employment generation and the role of public goods
• food production, distribution and consumption
• population dynamics and women’s bodily integrity
• water, sanitation and energy.

The report makes concrete recommendations also related to the health sector. In particular, it calls on Member States to ensure that sustainable population policies are grounded in sexual and reproductive health and rights. This includes the provision of universally accessible quality sexual and reproductive health services, information and education.

A conceptual framework for action on the social determinants of health.

This report pursues a comprehensive discussion of conceptual frameworks for science and policy for health equity. The report summarises the evidence on how the structure of societies, through social interactions, norms and institutions, are affecting population and health, and what governments and public health can do about it. A review and summary of different frameworks for understanding the social determinants of health were carried out. This review was summarised and synthesised into a single conceptual framework for action on the social determinants of health.

Beyond the mortality advantage. Investigating women’s health in Europe.

The report presents some of the preliminary findings of the investigation, focusing on broad causes of mortality and morbidity during 4 age stages. This covers the girl child, adolescents, adult women and older women, and emphasises how factors that influence health cut across the stages. It shows how gender and socio-economic determinants affect opportunities for girls and women in the European Region to realise their right to health and well-being across the life-course. It also provides a basis for prioritising actions for all sectors of governments and societies.

Today’s evidence – tomorrow’s agenda

This report uses available data to take stock of the health of girls and women around the world. It draws attention to the consequences and costs of failing to address health issues at appropriate points in their lives. In particular, the study notes the importance of women’s multiple contributions to society in their productive and reproductive roles, and both as consumers and – just as importantly – as providers of healthcare. In recognition of this, the report calls for primary healthcare reforms to be implemented in ways that ensure health systems better meet the needs of girls and women.

Women’s health in the European Union

This paper presents the analysis of the European women’s lobby (EWL) regarding the issues of health and well-being (both physical and mental), considered as crucial conditions for the full development of every human being. It calls for national and European decision-makers for public policies in the health sector to fully address women’s health needs.

Facts and figures across the European Union.

The report captures the state of women’s health across the enlarged European Union (EU) of 25 Member States. The study acknowledges that gender is a key determinant of health and equally important as the social, economic or ethnic background of any individual in relation to that individual’s health. The report is divided into 3 sections: demographic and socio-economic trends; women’s health issues; policy recommendations and suggestions for future research in the field of women’s health at the EU level.

Gender, health, and cultures: networking for a better future for women.

This book gives an overview of gender and health in the EU with a strong focus on Eastern European countries. The specific country cultures are not only different with regard to their health systems, but also in integrating gender aspects in research, policy and practice. The very definitions of health, illness and health-related social problems are different. If networks focus on gender-specific aspects of health and illness, the necessity for transnational communication is evident. Instruments for bringing gender aspects into health-related research, prevention and healthcare are introduced. The increasing importance of the internet is shown. Central elements in the process of intercultural networking are described.

RinGs is a new initiative funded by the UK Department for International Development. It brings together 3 health systems into Research Programme Consortia (RPC): future health systems, ReBUILD and RESYST in a partnership to galvanise gender and ethics analysis in health systems. On 8 September 2015 RinGs held a cross-RPC webinar on How to do gender analysis within health systems research. Gender analysis is important for all health systems research and there are multiple ways in which gender analysis can be incorporated, all of which will help to strengthen research evidence and recommendations. The webinar drew upon research evidence and examples to explore ways in which health systems researchers can incorporate gender analysis into their research.

Gender analysis in health: a review of selected tools.

This critical review examines the content of 17 widely-used gender tools and their usefulness for gender analysis in health. The review is a useful resource for those working on gender and health.

Closing the gap in a generation – health equity through action on the social determinants of health.

The study deals with systematic differences in health that can be avoidable by reasonable action in order to contribute to remedy differences in health between and within countries. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative. Social injustice is killing people on a grand scale. The study dedicates chapter 13 to the improvement of gender equity for health.

A manual for integrating gender into reproductive health and HIV programmes.

The manual is a companion to the guide for incorporating gender considerations in USAID’s family planning and reproductive health RFAs and RFPs. It complements the guide by orienting programme designers, managers, and technical staff on how to integrate gender issues into programme design, implementation and evaluation. The manual promotes greater understanding of how gender relations and identities affect the capacity of individuals and groups to make informed choices about their sexual and reproductive health.

Rising to the challenge: sex‑ and gender‑based analysis for health planning, policy and research in Canada

Sex‑ and gender‑based analysis (SGBA) rests on the understanding that both biology (sex) and the social experience of being a man or a woman (gender) affect people’s lives and their health. Taking into consideration these biological and social differences between women and men, and analysing how they relate to a particular health problem, is the crux of sex‑ and gender‑based analysis.

Integrating the gender perspective in Irish health policy: a case study.

This entails integrating attention to sex and gender differences in all stages of health policy development: problem definition and agenda setting; policy design; decision-making; policy implementation and monitoring. This case study aimed to describe the extent to which gender was included in the national cardiovascular health policy and its follow-up reports, and to assess the extent to which gender was taken into account in the development of the strategy.

The Blackwell Companion to Medical Sociology

The health experiences of women differ from those of men. These differences primarily reflect gender roles relating to the social, cultural and economic circumstances of women’s and men’s lives. The study explores how gender roles and relationships affect health, and points to some of the ways in which changes in gender roles over time and between societies influence gender differences in health.

Women’s health policies and programmes and gender mainstreaming in health policies, programmes and within health sector institutions.

The paper reviews published literature in English on experiences in mainstreaming gender within the health sector since the 1990s. It has a focus on policies, programmes, research and health provider training, and institutional changes within health sector organisations.

How to assess policy coherence

This tool is designed to support countries as they design and implement national health sector strategies in compliance with obligations and commitments. The tool focuses on practical options and poses critical questions for policy makers to identify gaps and opportunities in the review or reform of health sector strategies, as well as other sectoral initiatives. It is expected that using this tool will generate a national multi-stakeholder process and a cross-disciplinary dialogue to address human rights and gender equality in health sector activities. The tool aims to operationalise a human rights-based approach and gender mainstreaming through their practical application in policy assessments.

Gender impact assessment of the specific programmes of the Fifth Framework Programme: an overview.

This report presents a synthesis of the key findings and recommendations of 7 studies carried out as part of the gender impact assessment exercise, launched by the European Commission in June 2000. These studies were undertaken with a view to assessing the way in which gender issues are being addressed within the Fifth Framework Programme (FP5). Each study focused on one specific programme or sub-programme of the FP5, assessing whether and how gender issues have been taken into account. It also provided recommendations for a better integration of the gender dimension in future Community research in that area. A review of research in the field of gender and health is also included.

Guide to developing a gender impact assessment.

The Australian not-for-profit organisation focused on improving the lives of Victorian women has produced topic-based gender impact assessments. These analyse the extent to which existing or proposed policy and practice is based on gendered evidence, and responds appropriately to gender. They highlight policies and practices that are gender blind, and make recommendations that promote gender equity and improved outcomes for women. The content emphasises the social model of health, and has an Australian focus.

Health Equity Impact Assessment (HEIA)

The Health Equity Impact Assessment (HEIA) is a decision support tool that walks users through the steps of identifying how a programme, policy or similar initiative will impact population groups in different ways. The end goal is to maximise positive impacts and reduce negative impacts that could potentially widen health disparities between population groups for more equitable delivery of the programme, service, policy etc.

In 2005 the World Health Organisation set up the Commission on Social Determinants of Health. This was formed to marshal the evidence on what can be done to promote health equity, and to foster a global movement to achieve it. Its Commission on the Social Determinants of Health (CSDH) has identified principles and recommendations to tackle health inequities: the factors responsible for avoidable health inequalities, which persist globally and in the European Union.

This is a non-governmental organisation set up to promote gender equity in public health, research and social policies across Europe.

The European Women’s Lobby, among its several working areas, increasingly requests a stronger position and expertise in the area of health. Thus the network developed actions to push for gender equality principles to be fully embedded into European health policies in order to ensure and reach an improvement of women’s health status.

This network was developed by a project funded by the European Commission, EUGENMED. The project identified focal areas of work where sex and gender play a major role and set timelines for the generation of materials. All materials together constitute the road map for specific target audiences by the consortium and experts. All partners will contribute to the dissemination of the road map.

During the project, 6 meetings with key stakeholders were organised in order to produce recommendations, guidelines and teaching materials. The drafted materials will be disseminated through a European gender health portal. The aim is to create a truly multi-sectoral sourcing of knowledge, a key factor for building consensus and helping close the participatory governance gaps.

This is the European platform bringing together public health organisations representing health professionals, patient groups, health promotion, disease specific NGOs, academic groupings and other health associations. EPHA’s mission is to protect and promote public health in Europe. EPHA brings together organisations across the public health community, to share learning and information and to bring a public health perspective to European decision-making. Its aim is to ensure health is at the heart of European policy and legislation. On October 2011 it launched the European Charter for Health Equity, inviting all relevant stakeholders, organisations and institutions to sign it. The Charter calls for action from the civil society to all relevant stakeholders and in particular decision-makers, relevant governmental and civil society partner organisations, and other regulatory bodies. The aim is to protect and promote people’s health by acting on health inequalities between and within countries in Europe.

The Institute of Gender and Health (IGH)’s mission is to foster research excellence regarding the influence of gender and sex on the health of women and men throughout life, and to apply these research findings to identify and address pressing health challenges.