European Institute of Women’s Health

EU Manifesto for Womens Health

2018

Europe “Can Do More”


A special thanks to Members of the Board, our Advisory Board, EIWH Membership and our Anniversary Conference participants for their insights and input.


Healthy Women—Healthy Europe

Introduction

The promotion of sex and gender equity has been a long-standing theme in the philosophy and operations of the EU.1 In line with Articles 160 and 168 of the Treaty on the Functioning of the European Union and the UN Sustainable Development Goals (SDGs), the EIWH calls on the EU to commit to the reduction of health inequalities and provide equitable health for all.

Concerted action must be taken to improve women’s health in Europe by:

  • Integrating sex and gender in research, data disaggregated by sex, gender and age.

  • Translating sex and gender differences into regulatory and healthcare practice.

  • Including health in all policies as socioeconomic, political, educational, transport, environment, cultural and ethnicity differences impact patterns of behaviour and access to resources for women and their families.

  • Investing in a life-course approach to health promotion and disease prevention at critical points from pre-conception to childhood through older age.

  • Ensuring equity of opportunities for women and men in all policies.

Women’s Health: Facts and Figures

  • By 2050, the GDP in the EU would increase by 6-10% or €2-3 trillion if gender equality is improved. Gender policies have been shown to have a stronger impact on GDP growth than labour market and education policies.2

  • Health inequalities result in an economic loss of about €980 billion per year in the EU.3

  • Women in Europe have lower paid, often less secure and informal occupations. Women earn 16% less and receive pensions that are 40% lower than do men.4

  • Women are in the main the caregivers and perform the majority of household chores. In the EU, 80% of care is provided informally, and 75% of informal carers are women.5

  • Vaccination prevents 2 to 3 million deaths globally each year. Yet, 1.5 million deaths could be prevented by improved immunisation.6

  • Annually, 25,000 people in the EU die from antibiotic-resistant bacterial infection, which costs €1.5 billion in healthcare services and lost productivity.7

  • 1/10 women in Europe do not have access to care during the first months of pregnancy.8 2/3 of newborn deaths could be prevented with appropriate care.9

  • As of 2014, 52% of the EU population was overweight or obese.10 There is a strong relationship between advertising of non-nutritious foods and childhood obesity.11

  • Most of the 5 million babies born in Europe every year have been exposed to medications during the pregnancy.12Women outlive men by more than five years, but their healthy life expectancy advantage is less than nine months.13

    • The burden of cancer is projected to nearly double by 2030.

    • Cardiovascular disease in women is under diagnosed. As women and men utilise healthcare services in different ways, services must be adapted to better meet everyone’s needs.14

    • Women are underrepresented in STEM (Science, Technology, Engineering, and Mathematics), with a European averaging at 17%. Closing this gender gap in STEM by 2050 would increase GDP by an estimated €610 to €820 billion while increasing female labour participation and improving health through diversity.15,16

    • For the 2014-2020 period, overall about 0.6% of EU funding appropriations were allocated to gender equality measures. For example, for projects funded at September 2016 by Horizon 2020, only 0.007% in total addressed gender equality.17

    • Sex and gender biases have been documented in eight out of ten of the major disciplines in health research.18

    • Women are the heaviest medicine users, yet they are under-represented in research. Women have more than a 50% greater risk of developing adverse drug reactions compared to men.19

    • Very few, less than one-tenth, of health publications specifically examine sex and gender.20

    • The Council of Europe estimates that in Europe 20-25% of women suffer from physical violence and more than 10% suffer from sexual violence at least once in their adult lives.21

  • The European Institute of Women’s Health (EIWH): Setting the Agenda in Women’s Health

    Founded in 1996, the European Institute of Women’s Health (EIWH) is a non-governmental organisation that uses an evidence-based to advocate for an equitable, sex- and gender-sensitive approach in health policy, research, promotion, treatment and care. The Institute promotes biomedical and socio-economic research that addresses sex and gender-based differences to ensure access to quality treatment and care for women across their lifespan. The EIWH strives to reduce inequities by drawing policymaker’s attention to the obstacles that women in minority, migrant, refugee and socio-economic disadvantaged groups face. The Institute works to empower individuals to play an active part in their health management.

    Enact and Enforce

    Tackle the pay and pension gap.

    • The Equal Treatment Directive (2006/54/EC), the Equal Pay Recommendation (2014/124/EU) and European Pact for Gender Equality must be evaluated and enforced.

    Adopt the Work Life Balance Directive.

    • The Work Life Balance Directive for Parents and Carers (2017) must be adopted in order to address women’s underrepresentation in the labour market as well as to support women as patients, employees and vital caregivers.

    Support the Clinical Trials Regulation (536/2014).

    • The Clinical Trials Regulation must be implemented in order to combat the systematic underrepresentation of women in clinical trials. At national level, Ethics Committees must develop guidelines to include women.

    Support

    Prioritise women’s health in all funding mechanisms.

    • Women’s health must be a theme in the future 4th Public Health Framework Programme. Member States must make women’s health a priority in multiannual financial frameworks.

    Explicitly fund health research on sex and gender.

    • Research on sex and gender in health must be explicitly funded at EU level. Sex and gender should be included as a priority in the future Horizon Europe and Horizon 2020 Research Programmes, including funding digital health and e-health programmes.

    Promote a positive approach to ageing and health.

    • In light of an increasingly ageing Europe, a multidisciplinary Network on Women and Alzheimer’s disease should be established to bring together researchers, policymakers, patients, caregivers, healthcare professionals and other relevant stakeholders.

    Protect

    Support an EU system on the safe use of medicines during pregnancy and lactation.

    • A publicly-funded comprehensive European Pharmacovigilance system should be established at European level to collect data on the safe use of medicines during pregnancy and lactation.

    Combat women’s cancer by improving access to treatment and care.

    • A European Alliance on Women’s Cancer should be established to better prevent and combat women’s cancers in Europe and to support those living with as well as caring for those with cancer, including mental health.

      Europe Can Do More

      Partner and Share

      Establish an EU coalition for sex and gender in healthcare professional education.

      • A European coalition for the integration of sex and gender into healthcare professional education should be established to exchange best practice and drive the agenda across EU Member States with the first workstream focusing on immunisation.

      Advocate for and implement European standards of maternal care.

      • Member States should implement high quality maternal services that comply with evidence-based guidelines for the provision of high-quality clinical care, including the provision of antenatal, intrapartum and postpartum care, induction of labour and caesarean section. The EU should fund a European-wide initiative to determine and share best practice.

      Support a pilot programme to create a multi-stakeholder network tackling obesity, including maternal obesity, which impacts future generations.

      • A pilot programme should bring together diverse stakeholders to contribute to the awareness of preconception and maternal obesity and support better nutrition for women across the life course through.

      Research

      Ensure that data is sex, gender and age-disaggregated.

      • All future EU Research programmes, including Horizon Europe and Horizon 2020 Research Programme, must require sex, gender and age-specific data disaggregation as a funding criterion. Data disaggregation by sex, gender and age must be referenced in the guide for applicants, the proposal application form and the evaluation guide.

      Evaluate the state of play for women’s health.

      • The European Parliament should commission an own initiative report on women’s health in the EU to determine what progress has been achieved, what inequities persist and how to move forward together to improve the health of women and consequently, all those in Europe, including chronic disease.

      Increase women’s involvement in STEM.

      • Tailored programming needs to be implemented to encourage and support women in Science, Technology, Engineering and Mathematics (STEM).

      To sign the EIWH Manifesto, contact info@eurohealth.ie

References

1.  European Institute of Women’s Health. 2000. Gender Equity in Public Health in Europe. https://eurohealth.ie/reports/ [Accessed 12 September 2018].

2.  European Institute for Gender Equality. 2017. Economic case for gender equality in the EU. https://eige.europa.eu/gender-mainstreaming/policy-areas/economic-and-financial-affairs/economic-benefits-gender-equality [Accessed 30 August 2018].

3.  EuroHealthNet. 2015. What do EU Member States need from the EU health policy? https://eurohealthnet.eu/sites/eurohealthnet.eu/files/2015_04_17_Letter%20for%20informal%20EPSCO%20Council_final.pdf [Accessed 1 September 2018].

4.  European Parliament. 2017. The 40% gender pension gap: how Parliament wants to narrow it (interview). http://www.europarl.europa.eu/news/en/headlines/society/20180503STO03029/eye2018-photo-contest-winners-revealed [Accessed 23 May 2018].

5.  European Commission. 2018. Informal Care in Europe. http://ec.europa.eu/social/BlobServlet?docId=19681&langId=en [Accessed 30 August 2018].

6.  World Health Organization. 2018. Immunization Coverage. http://www.who.int/news-room/fact-sheets/detail/immunization-coverage [Accessed 12 September 2018].

7.  DG Health and Food Safety 2017. EU Action on Antimicrobial Resistance. http://ec.europa.eu/health/amr/antimicrobial-resistance_en [Accessed 30 August 2018].

8.  Alliance for Maternal Health Equality. 2015. Maternal Mortality in the EU. http://www.maternalhealthalliance.eu/pdf/Alliance_infographic_A4_270815.pdf [Access 12 September 2018].

9.  WHO Europe. Health at key stages of life – the life-course approach to public health. http://www.euro.who.int/__data/assets/pdf_file/0019/140671/CorpBrochure_lifecourse_approach.pdf Accessed 1 September 2018].

10. Eurostat. 2018. Overweight and obesity – BMI statistics. https://ec.europa.eu/eurostat/statistics-explained/index.php/Overweight_and_obesity_-_BMI_statistics [Access 14 September 2018]/

11. “The impact of food advertising on childhood obesity.” American Psychological Association. American Psychological Association.

12. Kristel Van Calsteren, Ksenija Gersak, Hildrun Sundseth, Ingrid Klingmann, Lode Dewulf, André Van Assche, Tahir Mahmood. 2015. Position Statement from the European Board and College of Obstetrics & Gynaecology (EBCOG): The use of medicines during pregnancy—Call for Action. https://www.ebcog.org/single-post/2016/05/09/position-paper-medicines-pregnancy.

13. Eurostat. 2017. Healthy life years statistics. http://ec.europa.eu/eurostat/statistics-explained/index.php/Healthy_life_years_statisticsᄃ [Accessed 22 May 2018].

14. European Institute of Women’s Health. 2018. Right from the Start: Resetting the Agenda in Women’s Health Conference Executive Report. https://eurohealth.ie/report-21st-anniversary-expert-conference/ᄃ [Accessed 5 June 2018].

15. WISE (Women into Science and Engineering). 2012. Engaging girls in science, technology, engineering and maths: What works? https://www.wisecampaign.org.uk/uploads/wise/files/wise_report_july_2012_for_bae_systems_what_works_summary.pdf [Accessed 23 May 2018].

16. European Institute for Gender Equality. 2018. How gender equality in STEM education leads to economic growth? [Accessed 23 May 2018]. http://eige.europa.eu/gender-mainstreaming/policy-areas/economic-and-financial-affairs/economic-benefits-gender-equality/stem.

17. Director General for Internal Policies. 2016. The use of funds for gender equality in select Member States. http://www.europarl.europa.eu/RegData/etudes/STUD/2016/571393/IPOL_STU(2016)571393_EN.pdf [Accessed 1 September 2018].

18. Beery, A. K., & Zucker, I. (2011). Sex bias in neuroscience and biomedical research. Neuroscience & Biobehavioral Reviews35(3), 565-572.

19. Rademaker, M., 2001. Do women have more adverse drug reactions?. American journal of clinical dermatology, 2(6), pp.349-351, https://www.ncbi.nlm.nih.gov/pubmed/11770389 [Accessed 5 June 2018].

20. Oertelt-Prigione S, Parol R, Krohn S, Preißner R, Regitz-Zagrosek V. Analysis of sex and gender-specific research reveals a common increase in publications and marked differences between disciplines. BMC Med. 2010;8:70.

21. Europa. 2008. International Women’s Day – The Commission’s campaign to stop violence against women. http://europa.eu/rapid/press-release_IP-09-368_en.htm?locale=en