Women's health is an example of population health, where health is defined by the World Health Organization (WHO) as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".[1] Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.
While the rates of the leading causes of death, cardiovascular disease, cancer and lung disease, are similar in women and men, women have different experiences. Lung cancer has overtaken all other types of cancer as the leading cause of cancer related death in women, followed by breast cancer, colorectal, ovarian, uterine and cervical cancers. While smoking is the major cause of lung cancer, amongst nonsmoking women the risk of developing cancer is three times greater than among nonsmoking men. Despite this, breast cancer remains the most common cancer in women in developed countries, and is one of the major chronic diseases of women, while cervical cancer remains one of the most common cancers in developing countries, associated with human papilloma virus (HPV), a sexually transmitted infection. HPV vaccine together with screening offers the promise of controlling these diseases. Other important health issues for women include cardiovascular disease, depression, dementia, osteoporosis and anemia.
In 176 out of 178 countries for which records are available, there is a gender gap in favor of women in life expectancy. In Western Europe, this has been the case at least as far back as 1750.[2] Gender remains an important social determinant of health, since women's health is influenced not just by their biology but also by conditions such as poverty, employment, and family responsibilities. Women have long been disadvantaged in many respects such as social and economic power which restricts their access to the necessities of life including health care, and the greater the level of disadvantage, such as in developing countries, the greater adverse impact on health.
Women's reproductive and sexual health has a distinct difference compared to men's health. Even in developed countries, pregnancy and childbirth are associated with substantial risks to women with maternal mortality accounting for more than a quarter of a million deaths per year, with large gaps between the developing and developed countries. Comorbidity from other non-reproductive diseases such as cardiovascular disease contribute to both the mortality and morbidity of pregnancy, including preeclampsia. Sexually transmitted infections have serious consequences for women and infants, with mother-to-child transmission leading to outcomes such as stillbirths and neonatal deaths, and pelvic inflammatory disease leading to infertility. In addition, infertility from many other causes, birth control, unplanned pregnancy, rape and the struggle for access to abortion create other burdens for women.
Definitions and scope
Women's experience of health and disease differ from those of men, due to unique biological, social and behavioral conditions. Biological differences vary from phenotypes to the cellular biology, and manifest unique risks for the development of ill health.[3] WHO defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".[4] Women's health is an example of population health, the health of a specific defined population.[5]
Women's health has been described as "a patchwork quilt with gaps".[6] Although many of the issues around women's health relate to their reproductive health, including maternal and child health, genital health and breast health, and endocrine (hormonal) health, including menstruation, birth control and menopause, a broader understanding of women's health to include all aspects of the health of women has been urged, replacing "Women's Health" with "The Health of Women".[7] WHO considers that an undue emphasis on reproductive health has been a major barrier to ensuring access to good quality health care for all women.[3] Conditions that affect both men and women, such as cardiovascular disease, osteoporosis, also manifest differently in women.[8] Women's health issues also include medical situations in which women face problems not directly related to their biology, such as gender-differentiated access to medical treatment and other socioeconomic factors.[8] Women's health is of particular concern due to widespread discrimination against women in the world, leaving them disadvantaged.[3]
A number of health and medical research advocates, such as the Society for Women's Health Research in the United States, support this broader definition, rather than merely issues specific to human female anatomy to include areas where biological sex differences between women and men exist. Women also need health care more and access the health care system more than do men. While part of this is due to their reproductive and sexual health needs, they also have more chronic non-reproductive health issues such as cardiovascular disease, cancer, mental illness, diabetes and osteoporosis.[9] Another important perspective is realising that events across the entire life cycle (or life-course), from in utero to aging effect the growth, development and health of women. The life course perspective is one of the key strategies of the World Health Organization.[10][11][12]
Global perspective
Gender differences in susceptibility and symptoms of disease and response to treatment in many areas of health are particularly true when viewed from a global perspective.[13][14] Much of the available information comes from developed countries, yet there are marked differences between developed and developing countries in terms of women's roles and health.[15] The global viewpoint is defined as the "area for study, research and practice that places a priority on improving health and achieving health equity for all people worldwide".[16][17][18] In 2015 the World Health Organization identified the top ten issues in women's health as being cancer, reproductive health, maternal health, human immunodeficiency virus (HIV), sexually transmitted infections, violence, mental health, non communicable diseases, youth and aging.[19]
Life expectancy
Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the Industrial Revolution. [8] Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.[20]
Despite these differences, the leading causes of death in the United States are remarkably similar for men and women, headed by heart disease, which accounts for a quarter of all deaths, followed by cancer, lung disease and stroke. While women have a lower incidence of death from unintentional injury and suicide, they have a higher incidence of dementia.[8][21]
The major differences in life expectancy for women between developed and developing countries lie in the childbearing years. If a woman survives this period, the differences between the two regions become less marked, since in later life non-communicable diseases (NCDs) become the major causes of death in women throughout the world, with cardiovascular deaths accounting for 45% of deaths in older women, followed by cancer (15%) and lung disease (10%). These create additional burdens on the resources of developing countries. Changing lifestyles, including diet, physical activity and cultural factors that favour larger body size in women, are contributing to an increasing problem with obesity and diabetes amongst women in these countries and increasing the risks of cardiovascular disease, kidney disease and other NCDs.[13][22] The prevalence of kidney disease is less common in women due to the estrogen-mediated protection from ferroptotic cell death.[23]
Women who are socially marginalised are more likely to die at younger ages than women who are not.[24] Women who have substance abuse disorders, who are homeless, who are sex workers, and/or who are imprisoned have significantly shorter lives than other women.[25] At any given age, women in these overlapping, stigmatised groups are approximately 10 to 13 times more likely to die than typical women of the same age.[25]
Social and cultural factors
Women's health is positioned within a wider body of knowledge cited by, amongst others, the World Health Organization, which places importance on gender as a social determinant of health.[26] While women's health is affected by their biology, it is also affected by their social conditions, such as poverty, employment, and family responsibilities, and these aspects should not be overshadowed.[27][28]
Women have traditionally been disadvantaged in terms of economic and social status and power, which in turn reduces their access to the necessities of life including health care. Despite recent improvements in Western nations, women remain disadvantaged with respect to men.[8] The gender gap in health is even more acute in developing countries where women are relatively more disadvantaged. In addition to gender inequity, there remain specific disease processes uniquely associated with being a woman which create specific challenges in both prevention and health care.[20] Women's health is widely under researched even in the medical profession meaning many women who struggle with diseases such PCOS, endometriosis, PMDD and so on often go undiagnosed and untreated. Furthermore there is a lack of knowledge of how modern medicine reacts to women's bodies compared to men as most drug trials and formulas are catered to a males.
In low- and middle-income countries, women’s diets, often rich in staple foods, are frequently poor in vitamins and minerals, with consequences for health.[29] Low dietary diversity jeopardizes nutrient adequacy.[29]
Deeply ingrained cultural, religious, and patriarchal systems within the MENA region perpetuate gender-based power dynamics within communities and lead to discrepancies in healthcare access. In a speech, UNFPA executive director Thoraya Ahmed Obaid outlined these difficulties and emphasized the need to change cultural and societal norms in order to improve the health of women in the area.[30]
Even after succeeding in accessing health care, women have been discriminated against,[31] a process that Iris Young has called "internal exclusion", as opposed to "external exclusion", the barriers to access. This invisibility effectively masks the grievances of groups already disadvantaged by power inequity, further entrenching injustice.[32]
Behavioral differences also play a role, in which women display lower risk taking including consume less tobacco, alcohol, and drugs, reducing their risk of mortality from associated diseases, including lung cancer, tuberculosis and cirrhosis.[33] Other risk factors that are lower for women include motor vehicle accidents. Occupational differences have exposed women to less industrial injuries, although this is likely to change, as is risk of injury or death in war. Overall such injuries contributed to 3.5% of deaths in women compared to 6.2% in the United States in 2009. Suicide rates are also less in women.[34][35]
The social view of health combined with the acknowledgement that gender is a social determinant of health inform women's health service delivery in countries around the world. Women's health services such as Leichhardt Women's Community Health Centre which was established in 1974[36] and was the first women's health centre established in Australia is an example of women's health approach to service delivery.[37]
Women's health is an issue which has been taken up by many feminists, especially where reproductive health is concerned and the international women's movement was responsible for much of the adoption of agendas to improve women's health.[38]
Biological factors
Factors that specifically affect the health of women compared to men are most evident in those related to reproduction, but sex differences have been identified from the molecular to the behavioral scale. Some of these differences are subtle and difficult to explain, partly due to the fact that it is difficult to separate the health effects of inherent biological factors from the effects of the surrounding environment they exist in. Women's XX sex chromosomes compliment, hormonal environment, as well as sex-specific lifestyles, metabolism, immune system function, and sensitivity to environmental factors are believed to contribute to sex differences in health at the levels of physiology, perception, and cognition. Women can have distinct responses to drugs and thresholds for diagnostic parameters.[39] All of these necessitate caution in extrapolating information derived from biomarkers from one sex to the other.[8] Young women and adolescents are at risk from STIs, pregnancy and unsafe abortion, while older women often have few resources and are disadvantaged with respect to men, and also are at risk of dementia and abuse, and generally poor health.[19]
Reproductive and sexual health
Women experience many unique health issues related to reproduction and sexuality and these are responsible for a third of all health problems experienced by women during their reproductive years (aged 15–44), of which unsafe sex is a major risk factor, especially in developing countries.[19] Reproductive health includes a wide range of issues including the health and function of structures and systems involved in reproduction, pregnancy, childbirth and child rearing, including antenatal and perinatal care.[40][41] Global women's health has a much larger focus on reproductive health than that of developed countries alone, but also infectious diseases such as malaria in pregnancy and non-communicable diseases (NCD). Many of the issues that face women and girls in resource poor regions are relatively unknown in developed countries, such as