Western Australian Women s Health Strategy

Transcription

1 Western Australian Women s Health Strategy Women and Newborn Health Service Department of Health DRAFT Delivering a Healthy WA 1

2 Women s Health Policy and Projects Unit Women and Newborn Health Service August 2011 Delivering a Healthy WA

3 INDEX Introduction... 2 Policy Framework... 3 Policy and Planning Context... 3 National Women s Health Policies... 4 WA Health Strategic Intent Community Based Women s Health Services... 6 The Impact of Gender... 6 Guiding Principles... 7 The Western Australian Women s Health Strategy Purpose... 9 Priority Areas... 9 The Way Forward Key Outcomes and Activities for Action Plans Setting the Scene Life Expectancy Mortality Work and Income Women as Carers Access to Health Services Burden of Disease Cancer Tobacco, Alcohol and Illicit Drugs Chronic Illness and Injury Diabetes Arthritis Osteoporosis Mental Health Sexual, Reproductive and Maternal Health Child Birth Experiences Caesarean Sections Induced Abortions Sexually Transmitted Infections Sexual Assault, Abuse and Violence Experiences of Family and Domestic Violence Appendix Gender Analysis: Making Policies, Programs and Services Gender-Aware Definitions References

4 Introduction The Western Australian Women s Health Strategy is a whole of health policy framework that can create changes for better health outcomes. The Strategy works on the basis that women contribute to our community in many ways and have influential roles in keeping our families, social groups and society functioning. The World Health Organisation notes that to achieve the highest standard of health, health policies have to recognise that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities (World Health Organisation 2002, 2). Gender continues to be the most significant human characteristic that affects the life chances available to an individual. A person s gender plays a major role in their health. The difference between men and women affects illness and disease and the nature of intervention. In most societies there are differences and inequalities in responsibilities, activities, access to and control over resources, as well as decision-making opportunities (World Health Organisation 2002, 3). This can result in different social, economic and political exposure to some risk factors. Social, environmental, biological and psychological factors need to be addressed in order to maximise health outcomes. The central approach of the Western Australian Women s Health Strategy is based on gender as a determinant for women s health. Women have complex lives revolving around culture, financial circumstances, sexual orientation, where they live, impacting disabilities, age and the demands of various roles. Aboriginal and Torres Strait Islander women s view of health in its broadest sense is not just the physical wellbeing of the individual but the social, emotional and cultural wellbeing of the whole community (B Fredricks et al. 2010, 5). The trajectory of a woman s life is very different to that of a man. Biological differences mean that women physically bear children (their attachment to the workforce is often interrupted), they have specific reproductive conditions and cancers and experience adverse sexual health outcomes at greater rates than men. Women live longer and experience higher burdens of illness and disease than men in certain areas such as mental health. 2 Delivering a Healthy WA

5 Policy Framework The purpose of the Strategy is to provide a policy framework for WA Health to undertake initiatives that improve and promote the health of Western Australian women and particularly women at most risk. It promotes substantive equality and social inclusion by focusing on priority areas and particular high risk groups of women. Aboriginal and Torres Strait Islander women 1 experience poorer health across almost all health areas compared to non-aboriginal women. As such, the health of Aboriginal women in Western Australia is the starting benchmark for all women in the State. Policy and Planning Context WA Health is guided by broader frameworks, policies and action plans in areas such as drug and alcohol, sexual health, mental health, maternal health and family and domestic violence. The Western Australian Women s Health Strategy will not duplicate current work but will highlight and promote the specific needs of women in service delivery. An important aspect of service delivery are the Health Networks that were established in WA Health after a major review of health services in The aim was to enable a new focus across all clinical disciplines towards prevention of illness, injury and maintenance of health. Each Health Network is led by one or two leads and a small advisory group. The major functions of Health Networks are to plan and develop: Evidence based policy and practice State-wide clinical governance Transformational leadership and engagement Strategic partnerships Evaluation and monitoring systems Currently there are 17 Health Networks that cover a range of health areas including aged care, diabetes, mental health and women and newborn health. Some key health documents and related material, that provides a context for this work and from which health outcomes can be best achieved, include but are not limited to the following: Department of Health Disability Access and Inclusion Plan, Department of Health, Western Australia, March Equal Opportunity and Diversity Policy, Department of Health, Western Australia. Family and Domestic Violence Policy, Department of Health, Western Australia, 2007 (updated 2010). Improving Maternity Services: Working together across Western Australia A Policy Framework, Department of Health, Western Australia. WA Health Equity and Diversity Plan , Department of Health, Western Australia. WA Health Aboriginal Cultural Respect Implementation Framework Department of Health, Western Australia. WA Aboriginal Health Impact Statement and Guidelines. Office of Aboriginal Health, Department of Health, Western Australia. Substantive Equality Policy, Department of Health, Western Australia, Women s Health Matters - A 10 Point Plan of Action: For Western Australian Women s Health and Wellbeing (Developed by the Western Australian Peak of Women s Health Services). Closing the Gap in Indigenous Life Outcomes, Western Australia, Department of Indigenous Affairs, From this point, reference to Aboriginal women will also be inclusive of Torres Strait Islander women as per WA Health Operational Directive 0329/11 3

6 National Women s Health Policies In 2007, the Australian Government committed to the second National Women s Policy and a nation-wide consultation was conducted during The new National Women s Health Policy 2010 adopts two policy priorities to improve the health of women, especially those at greatest risk of poor health. The first priority is a focus on prevention and targeting specific health conditions which can have the greatest impact over the next 20 years. The second priority is to address the inequalities in the social determinants of health. The following health areas have been prioritised: Prevention of chronic disease through the control of risk factors Mental health and wellbeing Sexual and reproductive health Healthy ageing The Australian Government has also identified five policy goals to address the social determinants of health. These are to: Highlight the significance of gender as a key determinant of women s health and wellbeing. Acknowledge that women s health needs differ according to their life stage. Prioritise the needs of women with the highest risk of poor health. Ensure the health system is responsive to all women, with a clear focus on illness prevention and health promotion. Support effective and collaborative research, data collection, monitoring, evaluation and knowledge transfer to advance the evidence base on women s health (Department of Health and Ageing 2010, 9). Last year also marked the release of the National Aboriginal and Torres Strait Islander Women s Health Strategy This Strategy clearly articulates the need for Aboriginal women to be involved in planning, design, development, implementation and evaluations of health services and have some influence on what a health system should look like in order to improve and empower women (B Fredricks et al. 2010). The following areas of action in the National Aboriginal and Torres Strait Islander Women s Health Strategy 2010 were developed from the Talking Circle consultations: Supportive Environments To build women s involvement, sense of belonging and feelings of safety and status in the community. Issues such as housing, employment, education and caring commitments need to be addressed; and women need to be involved in the design and development of health services. Health Service Access and Equity This includes cultural competency and cultural safety accreditation audits, responding to premature ageing and chronic health conditions, availability of social/cultural opportunities and sexual health concerns, including cultural safety measures. Indigenous women in the health workforce Work practices, promotion of women working and studying in women s health services and overall increase in employment, especially at decisionmaking levels (B Fredricks et al. 2010, 20). 4 Delivering a Healthy WA

7 WA Health Strategic Intent In 2010 WA Health released the WA Health Strategic Intent for It sets out four core elements of the Department s business activities for the next five years: Caring for individuals and the community Caring for those who need it most Making best use of funds and resources Supporting the health team The Department s Strategic Intent focuses on people who are most at risk, acknowledging diversity by caring for individuals and identifying the use of resources in a way that can maximise health outcomes. The Women and Newborn Health Service Strategic Intent follows on from the WA Health plan and has five key strategic areas: Leadership Education and Research Indigenous Health Safe, High Quality, Evidence Based Care Efficient Clinical Facilities and Resources Substantive Equality Policy The WA Health Substantive Equality Policy is based on the Policy Framework for Substantive Equality developed by the Western Australian Equal Opportunity Commission. The objective of this Framework is to achieve substantive equality and equitable outcomes in the Western Australian public sector by: Eliminating systemic racial discrimination in the provision of public services. Promoting sensitivity to the different needs of client groups (Western Australian Equal Opportunity Commission 2005). WA Health is accountable to the Equal Opportunity Commission to meet substantive equality outcomes, focused on the needs of Aboriginal people and people from culturally and linguistically diverse backgrounds. A priority under the Leadership strategic area is the development of the Western Australian Women s Health Strategy. 5

8 Community Based Women s Health Services Western Australia s women s community based health services play an important role in improving the health and wellbeing of women. WNHS works closely with these services and has created a relationship of trust and confidence to sustain a long term partnership and common vision that ensures WA Health is responsive to changing local community needs. WNHS also acknowledges the first ever Women s Health Matters A 10 Point Plan of Action for Western Australia s Women s Health and Wellbeing , developed by the Western Australian Peak of Women s Health Services, whose Plan of Action forms part of a broader vision in Western Australia to prioritise the health of all women. The Impact of Gender An analysis of gender and its impact on health conditions and service provision is strongly advocated by the World Health Organisation. It has been introduced in many countries as well as several Australian states. There are various tools that can be implemented to review the impact of gender in health. The application of these tools can occur during the initial health service design, before implementation, during service delivery or evaluation. Both traditional and non-traditional methods can be used. Appendix one provides a summary of a gender analysis tool developed by the Department for Communities, Office for Women s Policy, Western Australia. Another example of a gender impact analysis process can be found in the Women s Health Matters A 10 Point Plan of Action for Western Australia s Women s Health and Wellbeing There are many other tools available and as the Western Australian Women s Health Strategy develops, so will the ability to address the impact of gender in health and the process this will take in WA Health. 6 Delivering a Healthy WA

9 Guiding Principles The principles below guide the development of annual action plans. The principles are well documented in both national and international literature as important guides to realising better health outcomes. The WA Aboriginal Health Impact Statement and Guidelines provide a valuable tool and checklist to ensure that programs and services have properly considered the health needs and interests of Aboriginal people and in particular, women. Equality Substantive Equality Substantive equality is the actual experience of equality in real life. It recognises that rights, entitlements, opportunities and access are not necessarily distributed equally throughout society; equal or the same application of rules to unequal groups can have unequal results; where service delivery agencies cater to the needs of the majority group, other people with different needs may miss out on essential services. Equal treatment is not about treating people the same; it is about treating people differently in order to cater for different needs (Department of Health 2010). A gender equality approach recognises the different challenges that women and men face in managing their health, including their different health requirements and the different barriers they face in accessing services (Department of Health and Ageing 2008). Increase Service Availability and Access that Embraces Diversity Holistic Promoting a Social Model of Health Health and wellbeing is influenced by economic position, access to employment and education, housing and transport and other critical factors including gender, culture, age, race, disability and geographic location. Improving the health of women will improve the health of families and communities and increase women s ability to participate in the paid workforce, enhance productivity and decrease the demand for government-funded health services (Australian Women s Health Network 2009). Aboriginal people have a holistic approach to health that includes the significance of their environment. It is important that there is integration and implementation of Aboriginal models of health that work together with the social model of health to highlight all aspects of what is important for good health and wellbeing. Prevention and Early Intervention The prevention and early intervention of illnesses requires the identification of causes so that they can be modified, reduced or eliminated and protective factors can be built and strengthened (Department of Health and Ageing 2008). Many health conditions are related to each other and often share common factors that if addressed, particularly in the early stages, have the potential to reduce a number of adverse health outcomes. Access to and availability of service delivery that ensures health responses reflect the diversity of our community, including consideration of Western Australia s unique geographic landscape. 7

10 The Way Forward The Western Australian Women s Health Strategy The Western Australian Women s Health Strategy National Women s Health Policy 2010 To continue to improve the health and wellbeing of all women in Australia, especially those at greatest risk of poor health. National Aboriginal and Torres Strait Islander Women s Health Strategy 2010 The cultural and human rights of Aboriginal women are tied to the health and wellbeing as Aboriginal women. Western Australian Women s Health Strategy A policy framework for WA Health to undertake initiatives that improve the health of Western Australian women and particularly women at most risk. WA Health Collaboration Partner Commitment Continuous Improvement Guiding Principles Equality-Holistic-Inclusive-Transparent P A R T N E R S Women and Newborn Health Service WA Health Senior Officers Group Plan, Monitor and Review Action Plans 1. Annual Action Plans Based on 5 priority areas 2. Key Outcomes 3. Key Activities 4. Performance Indicators 5. Review and Report 8 Delivering a Healthy WA 9

11 Purpose The purpose of the Strategy is to provide a policy framework for WA Health to undertake initiatives that improve the health of Western Australian women and particularly women most at risk. Priority Areas The priorities are based on consultations from the National Women s Policy as well as information relevant to Western Australia. The priorities are listed below with some information as to why they are important. 1. Mental health Since 2005, women in Western Australia were twice as likely to report having a doctordiagnosed current mental health problem compared with men (R Pozzi et al. 2008, 31). It is predicted that by 2016, mental health will rank higher than cancer as the major burden of disease for women in Western Australia (S Nowrojee 2005). 2. Health responses to family and domestic violence In Western Australia nearly a tenth of women aged 18 and over were victims of either physical and/or threatened violence in 2009 (Department for Communities 2009). For all interpersonal violence hospitalisations in Western Australia from July 2002 to December 2003, 48 per cent were due to intimate partner violence. Women were over-represented where the relationship between the victim and perpetrator was a spouse/partner/ex (A L Gavin and C Gillam 2005). In women represented 72 per cent of admissions to WA Health hospitals for domestic-related injuries. This has risen to 73.5 per cent in while for men representation has decreased (Department of Health 2010). 74 per cent of repeat hospital admissions due to interpersonal violence, that was not related to the first episode, involved Aboriginal people with the majority being female (65 per cent) (L Meuleners et al 2008). 3. Sexual, reproductive and maternal health In 2009 it is estimated that approximately 22.3 per cent of all pregnancies in Western Australia resulted in induced abortions (A Joyce and B Tran 2011). The crude notification rate for chlamydia and gonorrhoea experienced by women in Western Australia has been two to three times higher than national rates (Draper, G. et al. 2005, 179). Between 13 and 25 per cent of women experience a clinically significant episode of mental illness during or after a pregnancy (SR Priest et al. 2008). 9

12 Nationally one in five women experience sexual violence in their lifetime with most violence against females taking place in the home and by a person known to them (Department of Health and Ageing 2010, 91). Breast cancer is the most common new cancer diagnosed in women (Cancer Council Western Australia 2007). Aboriginal women have double the rate of cervical cancer and more than four times the death rate than other women (Department of Health and Ageing 2010, 46). 4. Chronic illness and injury Obesity has been identified as the primary cause of chronic illness in Australian women (Department of Health and Ageing 2010, 47). Diabetes was the third leading cause of death for Aboriginal women in Western Australia in (Department for Communities 2006). Women in Western Australia were more than three times as likely to report doctordiagnosed osteoporosis and more likely to record doctor diagnosed arthritis than men (R Pozzi et al. 2008, 57-59). 5. Access to health services and equality of health outcomes for: Aboriginal women Women who are particularly disadvantaged, specifically Aboriginal women and those who are socially and economically disadvantaged; live shorter and less healthy lives on average than other women in Western Australia (Department for Communities 2009). The difference in life expectancy between Aboriginal and non-aboriginal women is largest in Western Australia, compared to other states (ABS 2009a). Women living in regional, rural and remote areas Australian women living in rural and remote areas have poorer health than women living in urban areas. Women under 65 years experience higher rates of lung, melanoma and cervical cancer in rural and remote areas (Department of Health and Ageing 2010, 4). In 2006, the life expectancy for women in Australia was lowest in the Kimberley (ABS 2006). In , hospital admissions for domestic-related violence were greater for women in regional areas of Western Australia, with women in the Kimberley experiencing the highest rate overall (Department of Health 2010). 10 Delivering a Healthy WA

13 Women from culturally and linguistically diverse backgrounds, particularly for newly arrived refugee and migrant women Western Australia has the highest proportion of overseas-born people in Australia (G. Draper, et al. 2005, 18). Newly arrived refugee women are in poorer health and experience higher rates of illness overtime than the general female population (Department of Health and Ageing 2010, 94). Women with disabilities Women with disabilities undertake fewer Pap smears and women with intellectual disabilities living at home appear to have little awareness of preventable health (S Jenkinson 2010). In 2006 over half (56.2 per cent) of Aboriginal women in Western Australia had a disability or long term health condition compared to 41 per cent of non-aboriginal women (Department for Communities 2006, 21). Women who are socially and economically disadvantaged Western Australian women in the most socio-economically disadvantaged groups are less likely to report an excellent or very good health status compared with women in the least socio-economically disadvantaged groups (R Pozzi et al. 2008). Western Australia has the largest gender pay gap in Australia (Department of Commerce 2010). Women who identify as lesbians, bisexual or transgender Lesbian and bisexual women in Western Australia are more likely to be overweight and experience higher rates of obesity than the general female population. Lesbian and bisexual women consume fast food more frequently than other women and there is a significant proportion who are insufficiently active for health benefits (Z Hyde et al. 2007, 21). Of 1000 lesbian or bisexual women surveyed in 2006, three in ten women reported being smokers (Z Hyde et al. 2007, 27). 11

14 The Way Forward The Western Australian Women s Health Strategy has a dedicated life span of four years, after which time the priorities and performance indicators will be reviewed to ensure the work is focussing on the right areas. Senior Officers Group and Action Plans The Senior Officers Group, including consumer representatives, coordinates and drives the Western Australian Women s Health Strategy. The Group is responsible for initiating, monitoring and reporting on key achievements. The Strategy is implemented through annual planning, monitoring, review and reporting cycle. This is based on the principles of collaboration, partner commitment and continuous improvement. Each year, an action plan is identified with a range of activities from across WA Health. Each plan will be reviewed at the end of the cycle and will be published in an Annual Action Plan Statement by Women and Newborn Health Service, Women s Health Policy and Projects Unit. The number and selection of outcomes and activities undertaken in the priority areas will be informed through stakeholder forums, analysis of emerging issues and the Senior Officers Group. WA Health recognises that the improvement of health for women is a shared responsibility between government, non-government agencies, tertiary education institutions, private health agencies and consumers. The community-based women s health services provide an important link to women and are key stakeholders to participate in the Senior Officers Group. These services are local and are well-connected to other services in their community. They are crucial partners in improving women s health. Key Outcomes and Activities for Action Plans The Senior Officers Group directs the work related to the Strategy. Each year an action plan outlines two to three key outcomes, activities for those outcomes and performance indicators. Each outcome in the action plan will relate to a priority area. Key Outcomes 1. Partnerships that focus on communication and coordination of service delivery between health services, across government and with the non-government sector provides better health outcomes for women. Key Activities Foster and maintain partnerships that have a focus on gender and substantive equality; within WA Health and between WA Health and other government and non-government agencies. Collaboration with a focus on communication and coordination of service delivery with local, State, Commonwealth Governments and Aboriginal communities to close the gap between Aboriginal and non-aboriginal women s health. Advocate for an increase in resources to primary health providers such as women s health services. 12 Delivering a Healthy WA

15 2. Women are integral to planning, delivery and evaluation of health services and inform all stages of the service development process. 3. The Women and Newborn Health Service provides leadership to achieve better health outcomes for women. 4. Best practice and intervention provided by services that promotes prevention and improves health outcomes for women. 5. Health workers have knowledge, skills and an understanding of how gender, equality and diversity impact on health and how best to respond. Women and key stakeholders participate in decisions on health service access, delivery and availability. Completion of cultural competency and safety audits. To coordinate and support the Senior Officers Group. To publish the annual action plan and review. To promote the social model of health. To promote analysis of gender. Data from health services and collection of literature reviews that provide information on health conditions for women to inform policy, program and service delivery. Collect sex aggregated data that informs service delivery in priority areas e.g. Family and domestic violence. Undertake evaluation with attention to the impact of gender in order to determine service effectiveness and inform service planning. Undertake workforce initiatives to build better responses, expertise and knowledge of the connection between health, gender and diversity, particularly in high risk areas for women. The performance indicators that will be reported on are: Number of partnerships developed to improve women s health, including promotion of prevention and achievement of substantive equality. Number of activities undertaken to advocate for increase in resources to health services for women, particularly for community based agencies. Number of gender specific data collection activities and analysis of data within WA Health that inform policy and program development. Number of new and existing policies and programs where women participate in decisions, and the impact of gender is considered on service design, including access and availability. Number and amount of funding (or variance in funding) for targeted services that address needs of women. Number of evaluations conducted to determine program and service effectiveness, including an analysis of the impact of gender that inform policy and program development. Number of activities undertaken to improve knowledge and skills in the workforce, including cultural competency and safety audits. 13

16 Life Stages A life stage approach explores the roles and experiences that a person has from birth to death. It recognises key transition points in women s lives and cumulative effects of experiences over time (Department of Health and Ageing 2010). Equitable access to services and quality of life at any stage of living builds strength and resilience for the next stage and allows people to reach their potential. Inclusive Developing and Maintaining Partnerships The best outcomes can be achieved through sharing of knowledge and working together. This includes being aware of what is happening and working together at local, regional, State and National levels so that women s health policy and strategies are appropriately aligned across government and the non-government sector. Transparent Supporting Best Practice and Improved Knowledge Activity Based Funding WA Health is responsible for high quality care to the people of Western Australia. Activity Based Funding provides a link between resources and the services the Department provides to patients and the community to ensure this quality of care. The principles of activity based funding are that: The patient, family and carers are the central focus of the care system. Funding is transparently linked to health services and outcomes. Evidence is available to ensure that performance can be managed. Clinical leadership and partnership is required at all program levels. Risks are identified, controlled and managed in a consistent manner. It is about the best use of money and, where gender and diversity play a significant role in some health conditions, the focus on the patient as a woman in the health care system is key to meeting equitable outcomes. Service responses for women must be based on accurate data that is gender specific. Research and evaluation of services must acknowledge the diversity of women s experiences. Targeted policy and programs focus on areas of service delivery that have the greatest impact on the health of women. It is also to promote and apply programs and models of service delivery that have been successful. 14 Delivering a Healthy WA

17 Setting the Scene This section provides a snapshot of Western Australian women and includes the impact of: The social determinants of health income, employment, education, social/ physical environment, health practices and culture. The diversity of women. Health conditions at different life stages. Health service access and availability. How men and women differ. A range of information is available that gives some insight into health conditions for women. As the impact of gender becomes more apparent through data collection and analysis, the ability to identify and address health inequalities will increase. Data on Aboriginal women is highlighted because of the poorer health experienced across almost all areas in comparison to non-aboriginal women in the State. Some information specifically states that it relates to Aboriginal women, otherwise the information relates to all women. This does not detract from the other groups of women who also experience poor health and these women are considered for targeted action in priority areas. Snap Shot Western Australia has the largest land area of any Australian State or Territory and only accounts for 10.2 per cent of the total Australian population. In 2009 women accounted for 49 per cent of the population with the proportion of women outnumbering men in the 65 years and over age group (ABS 2010). In 2010 Western Australia recorded the largest population growth (2.1 per cent) of all States and Territories. This was due to natural increase (46 per cent) and immigration (54 per cent) (ABS 2011). Across Western Australia the sex ratio (number of males for every 100 females) has been increasing due to a higher rate of male migration into the State. Areas with resource activity have the highest ratios, while the western suburbs of Perth have the lowest ratio (ABS 2010). By 2012 the projected approximate population for Aboriginal people in Western Australia is expected to be 76,607 (ABS 2009). It is estimated that 42 per cent of Aboriginal Western Australians live in remote or very remote areas, while 34 per cent live in major cities. This differs significantly to the national distribution of Aboriginal people; where only a quarter live in remote or very remote locations (Department of Indigenous Affairs 2010). In 2001, most Aboriginal women resided in Perth, followed by Narrogin, Geraldton and South Hedland (Department for Communities 2006). Western Australia has a higher proportion of overseas-born people than any other State or Territory in Australia (Draper, G. et al. 2005, 18). In the top three countries of origin of settler arrivals to Western Australia were from the United Kingdom, New Zealand and South Africa. Overall, there were slightly more women than men in the settler arrivals, with strong representation of women in the Family Stream but less than half in the Skill and Humanitarian streams (Department for Immigration 2005). 15

18 Newly arrived refugee women arrive in poorer health and this continues to deteriorate as they experience higher rates of illness overtime than the general female population (Department of Health and Ageing 2010, 94). Life Expectancy In 2009, the life expectancy of a non- Aboriginal female child born between 2007 and 2009 was estimated to be 84.1 years (Department for Communities 2009). Whilst women live longer than men, they carry the burden of financial sustainability and living longer with chronic illnesses. Women who are particularly disadvantaged, specifically Aboriginal women and those who are socially and economically disadvantaged, live shorter and less healthy lives on average than other women in Western Australia (Department for Communities 2009). The life expectancy of a Western Australian Aboriginal female child, based on data from , is 70.4 years (ABS 2008). A gap of over ten years life expectancy exists between Aboriginal and non-aboriginal women in the State. Change in life expectancy is slow to occur in Aboriginal communities, while the non-aboriginal life expectancy continues to increase (Department of Indigenous Affairs 2010). Mortality The top three causes of death in Western Australia for non-aboriginal women in 2006 was heart disease, cerebrovascular diseases and dementia and Alzheimer disease (Department for Communities 2009). There is low awareness amongst women that cardiovascular disease is the leading cause of death for all women (Department of Health and Ageing 2010, 43). Dementia is the third leading cause of death for non-aboriginal women and ranked the second as a major burden of disease for women aged 65 years and over (JM Katzenellenbogen et al. 2000, 10). The leading cause of death for Aboriginal women in Western Australia ( ) was heart disease and stroke, malignant cancer and diabetes. The cancer rate of the digestive organs and lungs is substantially higher among Aboriginal women than non-aboriginal women (Department for Communities 2006). External causes, endocrine, metabolic, nutritional disorders and then respiratory system failure account for causes of death at a higher proportion for Aboriginal women than for non-aboriginal women (Australian Institute of Health and Welfare 2011). The difference in life expectancy between Aboriginal and non-aboriginal people is greatest in Western Australia (females 12.5 years, males 14 years) and the Northern Territory (females 11.9 years, males 14.2 years) compared to other States ( ABS 2009a). In 2006, the life expectancy for women in Australia was lowest in the Kimberley (ABS 2006). 16 Delivering a Healthy WA

19 Table 1 - Ten leading causes of death, by sex in Western Australia (JM Katzenellenbogen et al. 2000, 10). Causes Males No. of Deaths % of Total Causes Females No. of Deaths 1 Ischaemic Heart Disease Ischaemic Heart Disease Lung Cancer Stroke Stroke Alzheimer s and Other Dementias Colorectal Cancer Lung Cancer Chronic Obstructive Pulmonary Disease Breast Cancer Prostate Cancer Colorectal Cancer Suicide Chronic Obstructive Pulmonary Disease Road Traffic Accidents Type 2 Diabetes Mellitus Type 2 Diabetes Mellitus Lower Respiratory Tract Infection Alzheimer s and Other Dementias Other Cardiovascular Disease % of Total Nationally there has been an increase overtime in deaths of women from kidney and urinary tract diseases and this is now ranked ninth as a cause of death. Dementia and Alzheimer s disease related deaths have also increased by 99 per cent since In per cent of deaths from dementia or Alzheimer s related disease in Australia were women (ABS 2009). Work and Income More women are now working in paid employment than they were 20 years ago (Department for Communities 2006). Paid employment has been found to improve health, including mental health. Yet for women, combining the various roles of caring and working can also lead to adverse health conditions. Approximately 46 per cent of all working women are employed part-time (Department for Communities 2009). The Department of Commerce in Western Australia highlights the trend that Western Australia has the largest gender pay gap in Australia (Department of Commerce 2010). The gender pay gap refers to the difference in average earnings of men and women. In Western Australia the gap is 25 per cent. It is based on full time adult ordinary time earnings figures compiled by the Australian Bureau of Statistics. Part time and casual employees are not included, nor are overtime payments (Department of Commerce 2010). 17

20 Table 2 - Gender pay gap and proportions of female employment by industry in Western Australia (Department of Commerce 2010) Industry Gender pay gap Proportion of female employment Wholesale Trade 33.8% 2.4% Professional, Scientific and Technical Services 32.9% 7.7% Rental, Hiring and Real-estate Services 23.0% 2.0% Financial and Insurance Services 29.5% 3.1% Administrative and Support Services 25.5% 3.4% Health Care and Social Assistance 22.9% 3.4% Mining 25.5% 3.1% Construction 23.5% 3.1% Electricity, Gas, Water and Waste Services 18.3% 0.7% Transport, Postal and Warehousing 20.6% 2.9% Arts and Recreation Services 12.4% 1.8% Manufacturing 9.2% 3.8% Education and Training 12.2% 12.9% Accommodation and Food Services 11.0% 8.1% Public Administration and Safety 11.5% 6.6% Retail Trade 12.5% 13.7% Western Australian women in the most socioeconomically disadvantaged groups are less likely to report an excellent or very good health status compared with women in the least socio-economically disadvantaged groups (R Pozzi et al. 2008). In 2009, people with a disability were not gaining the same employment outcomes as people without a disability (ABS 2009). 18 Delivering a Healthy WA

21 Women as Carers Women are more likely than men to maintain the primary carer role in families (Australian Women s Health Network 2007, 11). In 2003, nearly three quarters of primary carers in Western Australia were women (Department for Communities 2009, 5). An estimated 246,800 Western Australians, 12.6 per cent of the population, were carers for people with disabilities in 2003 (Disabilities Services Commission 2003). Access to Health Services Availability, access and equality of service delivery in Western Australia are ongoing hurdles. The diversity of our population, as well as the geographic expanse of the State, creates difficulties in providing services to meet needs. Australian women living in rural and remote areas have poorer health than women living in urban areas. For example women under 65 years experience higher rates of lung, melanoma and cervical cancer in rural and remote areas (Department of Health and Ageing 2010, 4). A Western Australian consultation project examining women with disabilities and access to health care identified several barriers. These related to transport, difficulty in seeing a doctor who knows them and has knowledge of their condition; and access to physical premises, examination beds and support workers. There was also in a low trend in women undertaking Pap smears (S Jenkinson 2010). Women with intellectual disabilities living at home were identified as a specific group who appeared to have little awareness of preventable health (S Jenkinson 2010). 19

22 Burden of Disease Burden of disease is a summary health measure that includes both mortality and nonfatal health outcomes. When exploring burden of disease, pathways for prevention and treatment have been identified for policy and program development. One such pathway is for health service policies and programs to consider and take into account factors that can lead to inequality such as in Aboriginality and gender considerations (P Somerford et al. 2004). Many of the causes of avoidable illness and death, including cancer, cardiovascular and respiratory disease and Type 2 diabetes, share risk factors which include obesity, tobacco use, physical inactivity, high cholesterol, high blood pressure and harmful use of alcohol. Table 3 - Top three causes of disease burden for Western Australian females and males by age (P Somerford et al 2004). Age Groups Burden of disease Female (DALY) (2000) Asthma Other neonatal causes Depression Attention deficit disorder Depression Road traffic accidents Bipolar affective disorder Alcohol dependence/abuse Depression Generalized anxiety disorders Breast cancer Suicide and self inflicted injuries Osteoarthritis Breast cancer Diabetes mellitus Depression Ischemic heart disease Dementia Stroke Lung cancer Burden of disease Male (DALY) (2000) Asthma Attention deficit disorder Other neonatal causes Autism and asperger s syndrome Road traffic accidents Alcohol dependence/abuse Suicide and self inflicted injuries Heroin dependence/abuse Suicide and self inflicted injuries Depression Road traffic accidents Alcohol dependence and abuse Ischemic heart disease Diabetes mellitus Hearing loss Lung cancer Ischemic heart disease Stroke Lung cancer Dementia There are high rates of mental disorders for females aged 0-44 years indicating the importance of promotion/prevention, early detection and intervention for children and young people. The year age group is a transition phase in disease burden where the impact of chronic illnesses occurs, whilst mental health conditions for women continue to remain the same (P Somerford et al 2004). 20 Delivering a Healthy WA

23 Cancer In 2007, there were 9,572 new cases of cancer diagnosed in Western Australia and of these 42 per cent were women. Bowel cancer was the second most common diagnosed cancer for women and breast cancer was the most common new cancer diagnosed in women (Cancer Council Western Australia 2007). Breast Cancer An increase in numbers for breast cancer is considered to be due to population growth and an increase in the ageing population (Cancer Council Western Australia 2007). Despite the increase in incidence, mortality rates have declined. The lifetime risk of a woman in Western Australia dying as a result of breast cancer before the age of 75 years has fallen from 1 in 46 in 1982, to 1 in 56 in 2003 (G Draper et al. 2005, 135). BreastScreen WA is a statewide, free breast cancer screening program. The aim of the Program is to reduce the mortality and morbidity from breast cancer. BreastScreen WA provides screening mammograms to women 40 years and over with no breast symptoms, and specifically targets women aged 50 to 69 years. BreastScreen WA encourages women aged 50 to 69 years to have a free screening mammogram every two years, as the benefit is the greatest for women in this age group. Over 75 percent of breast cancers occur in women over 50 years of age. Specific strategies are developed to meet the needs of women from Aboriginal and culturally and linguistically diverse backgrounds. The number of deaths from breast cancer remained relatively constant between showing better treatment outcomes when cancer is found earlier (Cancer Council Western Australia 2007), whilst the survival rate for lung cancer remains poor (Department of Health and Ageing 2010, 46). Lung Cancer For both males and females in Western Australia, lung cancer incidence was highest in the most socio-economically disadvantaged group and lowest in the least socio-economically disadvantaged group in (R Pozzi et al. 2008, 23) In , whilst breast cancer was the most common cancer experienced by Aboriginal women, it was less likely to be diagnosed in Aboriginal women than all other women (69 and 103 new cases per 100,000 women respectively) (Breast Cancer Care WA 2010). Cervical Cancer The Western Australian Cervical Cancer Prevention Program (WACCPP), established in 1992 as part of the National Cervical Screening Program, aims to reduce cervical cancer cases (incidence), as well as illness and death (mortality) resulting from cervical cancer in Western Australia through an organised approach to cervical screening. In the two-year period , 58.1% (365,172 women) of eligible Western Australian women aged years participated in cervical screening. Despite this, in 2009 there were 92 new cases and 30 deaths attributable to cervical cancer for women of all ages (WA Cancer Registry, 2011). It should be highlighted that between , the incidence and mortality rates from cervical cancer in Western Australia has fluctuated (WA Cancer Registry, 2011). For the same ten-year period ( ) incidence rates of cervical cancer were 2.2 times higher and mortality rates 4.6 times higher for Aboriginal women when compared to non-aboriginal women (WA Cancer Registry, 2011). 21

24 The WACCPP works collaboratively with target groups such as women from culturally and linguistically diverse backgrounds, women with disabilities and Aboriginal women. The WACCPP is committed to developing new and innovative strategies appropriate for all women, to raise awareness and improve cervical screening uptake among unscreened and underscreened women in Western Australia. Tobacco, Alcohol and Illicit Drugs National data indicates that alcohol consumption for young women at high risk levels is increasing. High risk drinking creates a relatively high burden of disease and injury and also places women at greater risk of sexual violence (Department of Health and Ageing 2010, 36). Figure 1 - High risk alcohol consumption %(a) 20% 15% 10% 5% 0% males females National Health Survey (a) Age-standardised percentage Source: BS National Health Survey: Summary of Results, Australia, (4364.0) Women and men in the middle age groups (45-54 years) had the highest rates across the board of risky/ high risk drinking in the period. However, the increase in high risk alcohol consumption has been greater for women than men. In per cent of women (45-54 years) were drinking at such a level, compared to 10 per cent in 2001 and 6.7 per cent in 1995 (ABS 2006). Figure 2 - High risk alcohol consumption , females 20% 15% 10% 5% 0% Indigenous Females Non-Indigenous Females Age group (years) Source: ABS National Aboriginal and Torres Strait Islander Health Survey, (4715.0) Whilst the general proportion of Aboriginal women drinking at high risk levels is similar to that of non-aboriginal women, there is a marked increase for Aboriginal women in the age group (ABS 2006). The rate of smoking for women in Western Australia is consistently lower than for men from the age of 35 years and over. However, there is national evidence that women between years have a higher rate of daily smoking than young men (Department of Health and Ageing 2010, 36). Women who have experienced violence, Aboriginal women and women in rural and remote areas have higher rates of smoking. Over half of Aboriginal women in Western Australia aged 18 years and over have reported being smokers (Department for Communities 2006, 29). Of 1000 women surveyed in 2006 who identified as lesbian or bisexual, three in ten reported being smokers (Z Hyde et al. 2007, 27). 22 Delivering a Healthy WA

25 Nationally in , hospital separations were related to drug use in the age group. Young women made up nearly 60 per cent of this group, with intentional self-harm by drugs or medication involved in three out of five female hospital separations. Women aged years and years had the highest drug related hospital separation rates among all age groups (ABS 2008). Amongst other issues, smoking and use of alcohol and illicit drugs have been linked to low birth weights for pregnant women and onset of chronic health conditions. Chronic Illness and Injury The top three long term health conditions for females aged 16 years and over in Western Australia in 2007 was arthritis, injury (that required treatment from a health professional) and mental health conditions (diagnosed depression, anxiety, stress-related or other mental health condition) (Department for Communities 2009, 8). Some of the most important and preventable risk factors contributing to chronic conditions are being overweight and obese, as well as being physically inactive, and tobacco smoking (Department of Health and Ageing 2010, 7). In fact, obesity has been identified as the primary cause of chronic illness in Australian women and known consequences of being obese include depression, anxiety and social dysfunction (Department of Health and Ageing 2010, 47). Western Australian women who identify as lesbian and bisexual are more likely to be overweight and experience higher rates of obesity than the general female population. Key findings in a Western Australian study reveal that lesbian and bi-sexual women consumed fast food more frequently than other women (Z Hyde et al. 2007, 21). Aboriginal women were also more likely to be classified more obese in each age group than non-aboriginal women (Department for Communities 2006). In 2006, over half (56.2 per cent) of Aboriginal women in Western Australia had a disability or long term health condition, including, sensory (especially sight), physical and intellectual disabilities, compared to 41 per cent of non-aboriginal women (Department for Communities 2006, 21). Premature ageing of Aboriginal women is a particular concern as it relates to younger onset of chronic conditions and has been acknowledged as a barrier to accessing appropriate care (B Fredericks et al 2010). Diabetes Diabetes is a significant chronic condition and in 2008, 44 per cent of all hospital separations for the Western Australian Aboriginal population were due to encounters for dialysis (R Pozzi et al. 2008, 57). Diabetes is ranked as the third most common cause of death among Aboriginal women in Western Australia (Department for Communities 2006). Diabetes not only causes a significant number of deaths but it is also a major complicating factor for a number of other avoidable conditions such as ischaemic (coronary) heart disease. 23