Women, ageing and health
Three basic considerations impel the greater recognition of
health of ageing women as a major health and development issue for
the future:
- The numbers of ageing women are increasing worldwide;
- Women’s life course beyond age 50 extends for a significant
period and is increasing everywhere in the world; and
- There is a very significant scope for improving the health of
ageing women and thus ensuring that they remain a resource for
their families and communities.
Most ageing women are living in the developing regions
of the world
Currently, more than half of the world’s women aged 60 years and
over are living in developing regions, 198 million compared with 135
million in the developed regions. And the percentage of older women
living in developing regions will grow dramatically in the future,
since two-thirds of the women in the age group 45-59 currently live
in developing countries as compared with only one third in the
developed countries.
There are significant differences in life expectancy
of women and men
In the developed nations of the world, women live on average six
to eight years longer than men. Life expectancy for women now
exceeds 80 years in at least 35 countries and is approaching this
threshold in several other countries. However, the life expectancy
of women in countries at different levels of development is markedly
different, ranging from just over 50 years in the least developed
countries through the 60s and 70s in those undergoing rapid economic
development.
But life expectancy at birth alone can be misleading, disguising
the duration of women’s lives in developing countries. For women in
developing countries who survive the early lifespan stages to reach
middle age, life expectancy approaches that of women in developed
countries. At age 65, women in developing countries now have about
three quarters of the remaining life expectancy of their
counterparts in developed countries, and the gap will narrow in the
future as mortality steadily declines at younger ages.
Longer lives are not necessarily healthier lives
Since the likelihood of disability increases with age, it is
hardly surprising that national surveys reveal increasing numbers of
disabled women among the older populations. In a few developed
countries, however, recent data reveals that the rates of disability
among the older population are steadily declining. The available
data, on the other hand, is still insufficient to assess the real
extent of disability among the world's older women.
The term "healthy life expectancy" has been developed to describe
the number of years one can expect to live in relatively good
health. Healthy life expectancy is not necessarily life expectancy
free of disease. Rather, the concept of healthy life expectancy as
normally used refers to life expectancy without limitation of
functions that may be the consequence of one or more chronic
conditions.
More than forty-five countries now have estimates of healthy life
expectancy. One general conclusion is warranted based on these
studies: women can generally expect to spend more years of their
lives with some functional limitations than men. This is valid for
developed as well as developing countries.
Among the types of disability, mobility disability, in particular
walking disability, is currently acknowledged as one of the most
important quality of life and public health concerns of older women.
Slow walking speed is a risk factor for falls and other accidents,
resulting in fractures, further disability and loss of independence.
In developing countries, loosing the ability to walk may be
associated with even greater risks of adverse outcomes as walking is
often the most common means of transportation.
While older women may suffer more functional
limitations than men, it is inaccurate to say that older women are
generally frail
It must be emphasised that the vast majority of older women and
men are in generally good health, especially during the "young-old"
ages. Recent studies in developed countries have shown that the
prevalence of disability for both women and men to be less than 5
per cent for persons aged 60 to 64, less than 10 per cent for
persons aged 70 to 74, and then rising to slightly more than 20 per
cent among those aged 85 and over. And in developed countries, the
rates of nursing home use are generally very low for persons under
the age of 80. But with more and more women reaching 80 plus there
is concern about the quality of their extended lives.
There are powerful economic, social, political and cultural
determinants which influence how women age, with far-reaching
consequences for health and quality of life, as well as costs to the
health care systems. For example, poverty at older ages often
reflects poor economic status earlier in life and is a determinant
of health at all stages of life. Countries that have data on poverty
by age and sex (mostly the developed countries) show that older
women are more likely to be poor than older men. But in many
developing countries there are often simply no reliable data on
poverty tabulated by sex and age.
Poverty is also linked to inadequate access to food and nutrition
and the health of older women often reflects the cumulative impact
of poor diets. For example, years of child bearing and sacrificing
her own nutrition to that of the family can leave the older woman
with chronic anaemia.
Another determinant of health is education; levels of education
and literacy among current cohorts of older women in developing
countries are low. Increased literacy for older women will bring
health benefits for them and their families.
Lack of safe drinking water, a gender-based division of domestic
chores (including the carrying of water), environmental hazards,
such as contact with polluted water, agricultural pesticides and
indoor air pollution, all have a cumulative negative impact on the
health of women as they age in many developing countries.
Older women everywhere are far more likely to be widowed than
older men and most women can expect widowhood to be a normal part of
their adult daily lives. While most women adjust both emotionally
and financially to their changed situation, traditional widowhood
practices in some countries result in situations of violence and
abuse and pose a serious threat to older women's health and
well-being.
Widowhood is often being preceded by a period of caregiving to
the deceased spouse combined in many cases with caregiving to
dependent parents, grandchildren and other dependent family members.
Older women are an important source of caregiving and such
activities are most often unremunerated.
In many countries, access to health care is tied to coverage by
national social security and health insurance systems which in turn
is linked to employment in the formal sector of the economy. As many
older women in developing countries have worked all of their lives
in the informal sector or in unpaid activities, access to health
care often remains unaffordable and difficult at best.
What is a gender-sensitive life course approach to
older women's health?
Because the major preventable causes of morbidity and mortality
all take effect over the life course, prevention strategies will be
most effective when initiated as early in the life course as
possible. For example, the health benefits of exercise and physical
activities are well known and exercise should be promoted in all age
groups from children to centenarians. Barriers for girls and women
to exercise should be removed and culturally appropriate strategies
for exercise should be put into place. This would help prevent
functional dependence in old age and maintain mobility of older
women at an adequate level for management of daily life.
Other modifiable risk factors associated with poor mobility in
old age include smoking and deviance from normal weight. Cessation
of smoking, promotion of exercise and improved diet are in fact
primary prevention strategies for many causes of death and
disability. In addition, it is of paramount importance that younger
women have the opportunity to build and maintain strong bones in
order to maintain bone density and prevent osteoporosis at later
ages.
Another example of preventable diseases is heart disease and
stroke which are the major causes of death and disability in ageing
women, accounting for close to 60% of all adult female deaths. The
common view of heart disease and stroke as men’s health problems has
tended to overshadow the recognition of their significance for
ageing women’s health. Half of all deaths of women over 50 in
developing countries are due to these conditions. Although
communicable diseases are not yet fully controlled in these
countries, they are no longer important causes of sickness and death
in old age.
For many types of cancer, particularly breast cancer and cervical
cancer, early detection is the main strategy for prevention. For
breast cancer early detection include physical examination of the
breasts by trained health workers, breast self examination and
mammography. As general screening programmes by mammography are
still far beyond the resources of developing countries, there is an
urgent need to improve the effectiveness of breast self examinations
strategies.
WHO's response to maintain the health of older
women
WHO's Ageing and Health Programme (AHE) recognises that gender is
one of the major determinants of health. In addition to biological
differences, a gender approach to health includes an analysis of how
different social and economic roles, decision-making power and
access to resources affect the health status of men and women at
older ages.
The AHE Programme is committed to apply the gender perspective in
all of its activities, notably in the areas of research, information
dissemination, training, advocacy and policy development. Moreover,
the Programme promotes the concept of Active Ageing which stresses
that older people are a resource for their families and communities
and that policies should be developed which enable older people to
remain active for as long as possible in their later years. To
facilitate the implementation of Active Ageing policies and
strategies at all levels -- national and community -- gender
sensitive guidelines and strategies are being developed. The AHE
Programme works in close partnership with Governments, academic
institutions and civil society organisations.
________________________________________________________________________________________________
|