COMMISSION OF THE EUROPEAN COMMUNITIES 
Brussels, 22.05.1997 
COM(97) 224 final 
REPORT FROM THE COMMISSION 
TO THE COUNCIL, THE EUROPEAN PARLIAMENT, 
THE ECONOMIC AND SOCIAL COMMITTEE 
AND THE COMMITTEE OF THE REGIONS 
on the state of women's health 
in the European Community 

CONTENTS 
PREAMBLE 4 
EXECUTIVE SUMMARY 5 
1. INTRODUCTION 10 
1.1 BACKGROUND 10 
1.2 WOMEN'S HEALTH 10 
1.3 INDICATORS AND DETERMINANTS OF WOMEN's HEALTH 11 
1.4 INFORMATION SOURCES 12 
1.5 STRUCTURE OF THE REPORT 13 
2. SOCIAL AND DEMOGRAPHIC TRENDS 17 
2.1 POPULATION SIZE AND STRUCTURE 17 
2.2 FAMILY LIFE 17 
2.3 WORKING LIFE 19 
2.4 GENDER-RELATED DEVELOPMENT INDICES 20 
3. SELECTED HEALTH INDICATORS 31 
3.1 LIFE EXPECTANCY 31 
3.2 INFANT MORTALITY 31 
3.3 MATERNAL MORTALITY 32 
3.4 SELF-PERCEIVED HEALTH STATUS 32 
3.5 HEIGHT 33 
4. MORBIDITY 45 
4.1 ACTIVITY LIMITATIONS DUE TO CHRONIC CONDITIONS 45 
4.2 SHORT-TERM ACTIVITY LIMITATIONS 45 
4.3 DOCTOR CONSULTATIONS 46 
4.4 HOSPITALISATIONS 46 
5. CAUSES OF DEATH AND TRENDS IN FEMALE MORTALITY 61 
5.1 MOTOR VEHICLE ACCIDENTS 61 
5.2 SUICIDE AND SELF INFLICTED INJURY 61 
5.3 CANCER AS A CAUSE OF FEMALE MORTALITY 62 
5.3.1 Breast Cancer 62 
5.3.2 Cervical Cancer 64 
5.3.3 Cancer of the Respiratory System 64 
5.4 DISEASES OF THE CIRCULATORY SYSTEM (CARDIOVASCULAR DISEASES) 65 
5.5 ISCHAEMIC HEART DISEASE 67 
5.6 CEREBROVASCULAR DISEASE (STROKE) 68 
6. HEALTH DETERMINANTS AND HEALTH PROMOTION 84 
6.1 SMOKING 84 
6.2 ALCOHOL CONSUMPTION 85 
6.3 DIET AND WEIGHT 86 
6.4 EXERCISE 87 
6.5 HEALTH PROMOTION AND DISEASE PREVENTION 87 
6.5.1 Heart check-up 87 
6.5.2 Cholesterol Testing 89 
6.5.3 Diabetes testing 89 
6.5.4 Osteoporosis testing 90 
6.5.5 Cancer Screening 90 
6.5.5.1 Cervical cancer screening 90 
6.5.5.2 Breast cancer screening 91 
7. SPECIAL ISSUES IN WOMEN'S HEALTH 109 
7.1 EATING DISORDERS 109 
7.2 HIV/AIDS AND WOMEN'S HEALTH 110 
2 
7.3 FAMILY PLANNING Ill 
7.4 ABORTION 112 
7.5 MENOPAUSE 114 
7.5.1 Osteoporosis and Cardiovascular Disease 115 
7.5.2 Prevention and Symptom Control 115 
7.6 VIOLENCE AGAINST WOMEN 116 
7.6.1 Domestic Violence 116 
7.6.2 Rape and sexual assault 118 
7.6.3 Sexual harassment and Stalking 118 
8. CONCLUSION 134 
ANNEX I - GLOSSARY 136 
ANNEX H - LIST OF FIGURES 138 
ANNEX m - LIST OF TABLES 140 
ANNEX IV - BIBLIOGRAPHY 142 
ANNEX V - MEMBER STATE COORDINATORS 148 
PREAMBLE 
The Treaty on the European Union created new responsibilities in public health for the 
European Community. Articles 3(o) and 129 of the Treaty lay down a general objective for the 
Community to contribute towards ensuring a high level of human health protection and make 
provisions for Community action that should be undertaken to meet this objective. 
The Commission Communication on the framework for action in the field of public health 
(COM(93) 559 final of 24 November 1993) sets out how the Commission intends to 
implement this new Community competence. Among proposals made, it was envisaged that a 
health status report should be prepared for the European Community (EC) on a regular basis. 
The aim of these reports is to provide a source of information on particular health topics of 
interest and to promote discussion and initiate debate. 
This is the second such report. The first report (COM(95) 357 final) provided an overview of 
health status in the EC in 1994. It included a description of the main demographic trends and 
patterns of mortality and morbidity, and a discussion of the major determinants of health. 
Because health trends and determinants only change slowly over time, there would be little 
new this year in a report of similar nature. This report, therefore, focuses on a particular topic -
women's health issues - which is emerging as an important issue both of the general public and 
of health care providers and policy-makers in the EC. 
The report contains an overview of major health trends, patterns of mortality and morbidity as 
well as relevant health determinants. In addition, it describes in greater detail a number of 
special health issues for women at various ages. This discussion includes information about 
determinants as well as relevant policies developed in the Member States. 
This report is largely based upon work carried about by the University of Limerick, Ireland, 
using information from national sources, the World Health Organisation's Health For All 
database, the Organization for Economic Co-operation and Development, the Statistical Office 
of the European Communities, and other readily available data. Where possible, the data 
obtained have been verified by national experts in each Member State. 
EXECUTIVE SUMMARY 
1. Introduction 
This report provides an overview of the health of women in the European Community 
(EC), highlighting both differences and similarities within and between the Member States. 
It examines the main causes of mortality and morbidity at different phases of women's 
lives as well as a number of individual and social determinants which influence women's 
health within the context of evolving demographic and social trends. 
The main data sources include the World Health Organization's Health for All (HFA) 
database, various reports and data from the Statistical Office of the European 
Communities (Eurostat), and an EC-wide Eurojbarometer survey, sponsored by DG V and 
carried out in early 1996. The latter survey contained a number of questions on women's 
health which are analysed in this report. 
The data obtained from sources are, despite continuing improvements in quality, 
somewhat limited in their comprehensiveness and comparability. The choice of topics 
included in this report is to a large extent the result of these constraints. The report 
focuses on women aged 15 years and older, because most gender-specific health data at 
the EC level concentrate on this age-group. 
The report consists of 8 sections. Section 1 introduces the report, Section 2 summarises 
the social and demographic trends affecting women, and Section 3 provides an overview 
of selected health indicators. Supplementing this information, Section 4 describes selected 
morbidity measures, while Section 5 concentrates on the main causes of death among 
women. Section 6 contains a discussion of various health determinants, while Section 7 
describes a number of emerging health issues for women. Section 8 concludes the report. 
2. Social and Demographic Trends 
Women - totalling 191 million - constitute 51.2% of the population in the EC. This 
percentage is remarkably stable across the Member States, varying only from a low of 
50.4% in Ireland to a high of 51.8% in Portugal. There is, however, considerable variation 
in the percentage of women across age-groups. In the group of women under 20 years of 
age, there are only 95 women for every 100 men, while among 80-year-olds, there are 
about 221 women for every 100 men. This so-called feminization ratio is particularly high 
in the older age-group because in the EC women on average live over 6 years longer than 
men. 
Women's lives have changed significantly in the EC during the past three decades. The 
rate of marriage has declined (by almost one third) since 1960, while the rate of divorce 
has almost doubled(except in Ireland). At the same time, the average age of first marriage 
and the age at first birth have risen to 26.1 and 28.6 years, respectively. 
At the same time, women's labour force participation has increased tremendously, 
although considerable variations exist in this area across the Member States. Concomitant 
with the increase in labour force participation has been an increase in women's 
unemployment rates, which tend to be higher than those of men. 
When measuring women's position in society relative to men, women in the EC do well in 
comparison with women elsewhere. Within the EC, the Nordic Member States have the 
highest rates of gender equality, in part because of high levels of education and income 
relative to men. 
3. Selected Health Indicators 
Women in the EC enjoy a high level of health as measured by a variety of health 
indicators. Life expectancy has been rising continuously for decades and has reached 80 
years, which is well over 6 years higher than the corresponding average for EC men. This 
average, however, hides considerable variation across the Member States, ranging from a 
high of 81.9 years in France to a low of 77.8 years in Denmark. 
Infant mortality has also been improving to the point that the most recent data (1992) 
indicate that only 6.9 (female) children out of 1000 live births die before the age of 1 year. 
This is a decline of 68% since 1970. Maternal mortality rates have also declined 
significantly (79% since 1970) to 7 deaths per 100,000 women. 
According to ratings of self-perceived health status, women in the EC regard themselves 
as healthy (or very healthy). On average just over 62% report being in good or very good 
health. Rates vary across the Member States and across age-groups, with older women 
reporting lower levels of health, which is to be expected. 
Height measurements indicate that women have been getting considerably taller during the 
past decades. Younger cohorts (18-29 year-olds) are almost 5 cm taller than older cohorts 
(60 years and older). 
4. Morbidity 
Disease-specific morbidity measures are virtually non-existent at the EC level Instead 
aggregate measures, such as short- ana long-term disability and health care utilisation, are 
reported. 
In spite of women's generally good health status, they report significant levels of disability 
due to long-term illness. On average, almost one out of four women report limitations in 
their daily activities to some extent (17.3%) or severely (6.3%) because of long-standing 
illness. This average varies from a high of 30% (in Finland and Portugal) to a low of 15% 
(in Luxembourg) and increases with age. More than half of all women aged 75 years and 
older report such activity limitations. 
On a sLort-term basis, women also report considerable activity limitations. Abput 14% of 
women report having had to cut down on their activities in the past two weeks because of 
illness and injury, while 3% report having experienced such restrictions because of 
emotional or mental health problems. Among women aged 65 years and older, the 
corresponding figures are 25% and 5% respectively. 
While not all chronic and short-term disability necessarily needs a doctor's attention, 
apparently a significant amount does. The results of the 1996 Èurobarometer survey 
indicate that on average one out of three women has consulted with a physician (in person 
or by telephone) in the past two weeks. Not surprisingly, older women report higher rates 
of consultation. 
A small percentage of serious illnesses is likely to require hospitalisations. On average 
10% of EC women report having had one or more (non-birth) hospitalisations in the past 
year, staying about 10 days in the hospital in total. Older women are about twice as likely 
as younger women to have been hospitalised, and they tend to stay longer as well. 
5. Causes of Death and Trends in Female Mortality 
Across all ages, the most frequent causes of death among women are diseases of the 
circulatory system, accounting for 43% of all deaths, and cancer, which accounts for 26% 
of these. Diseases of the respiratory system are responsible for 6% of deaths among 
women, and suicide and accidents for 5%. The remaining 20% of deaths are due to other 
causes. 
As might be expected, the major causes of death vary with age. Motor vehicle accidents 
are the main cause for women under 30 years, while suicide is for the 30-34 age-group. 
Cancer, specifically 'female cancers', such as breast and cervical cancer, is the main cause 
of death for women aged 35-64 years. For elderly women (65 years and older), diseases 
of the circulatory system account for most deaths, approximately half of all deaths in this 
age-group. 
Average mortality (for all women) from motor vehicle accidents is 6.42 deaths per 
100,000, while mortality from suicide and self-inflicted injury is 6.24 per 100,000. 
Mortality from cancer among women of all ages is about 150 deaths per 100,000, while 
mortality from diseases of the circulatory system (heart disease and stroke) is about 248 
deaths per 100,000. Mortality due to ischaemic heart disease alone amounts to about 85 
deaths per 100,000, while stroke mortality is almost 76 per 100,000. 
Breast cancer accounts for 21% of all female cancer deaths in the EC, with a mortality 
rate of about 31 per 100,000. By contrast, cervical cancer is responsible for only about 
2% of all cancer deaths in women, with a mortality rate of about 3 per 100,000. 
Mortality from cancer of the respiratory system - predominantly lung cancer - has 
increased by almost 70% since 1970. It currently accounts for about 9% of all cancer 
deaths in women, with a mortality rate of 14 per 100,000. 
6. Health Determinants and Health Promotion 
To a very large extent the two major causes of mortality (heart disease and cancer) are 
preventable through primary (healthier life styles) or secondary prevention (early detection 
through, for example, screening). The main risk factors associated with much premature 
mortality (death before aged 65 years) include smoking, (excessive) alcohol consumption, 
unhealthy diet, and physical inactivity. 
About 28% of all women in the EC smoke, although the rate varies across the Member 
States. Denmark and Portugal stand out because of their respectively very high (42%) and 
low rates (12%) of smoking among women. There are no data on average alcohol 
consumption by women at the EC level, although it is known that women drink less than 
men. 
While data on diet are scarce, data on the outcome of eating patterns (weight) are 
available from the 1996 Eurobarometer. Specifically, one out of every five women are 
overweight (or severely overweight) as measured by the body mass index (BMI), while 
15% are underweight. Being overweight is a significant risk factor for a number of 
diseases, in particular heart disease and diabetes. 
This survey also provided information about the extent to which, and what types of health 
check-ups EC women receive. These vary by age-group and by country. For example, 
44% of EC women over the age of 65 years has had a heart check-up in the past year, 
about the same percentage as has had a cholesterol test. The rates for the entire 
population of women are, of course, lower. 
Diabetes testing is less frequent, with around 22% having had a diabetes test in the past 
year, although among severely overweight women (aged 40 years and older) the rate is 
44%. As obesity is a risk fector for non-insulin dependent diabetes, this is to be expected. 
About 16% of EC women report having had an osteoporosis test in the past year. In 
contrast, cancer screening rates are much higher. About 40% of women report a cervical 
smear in the past year, the same percentage as reporting having had a breast examination 
by hand. About 18% of women report having had a mammography during the past year. 
Because controversy surrounds the topic of mammography in many Member States, the 
Eurobarometer survey inquired about women's feelings on the subject. Overwhelmingly 
(more than 90%), and with little variation, women endorsed (free) mammography 
screening in the age-groups where it has the potential to reduce mortality. 
7. Special Issues in Women's Health 
Several health issues have emerged during the past decades because of their particular 
relevance to or importance for women. These include eating disorders, which mostly 
afflict teenage and young women; HTV and AIDS, which traditionally has been considered 
a male disease, but to which women have been shown to be more vulnerable; heart 
disease, which also is largely seen as a man's disease in spite of the significant mortality it 
causes to women; and osteoporosis which is much more frequent among women than 
among men. In addition to these issues, family planning and abortion, as well as violence 
against women, should be added to this list of important women's health issues. 
There is a notable lack of data on the incidence and prevalence of eating disorders 
(bulimia and anorexia nervosa), although the perception is that it has been increasing 
throughout the EC during the past two decades Mortality in anorexia sufferers is 
estimated at 6%, double that for those with bulimia. 
With the ageing of society, the incidence of osteoporosis is increasing. Beca?ise of the 
significant morbidity and mortality associated with this disease, osteoporosis is becoming 
a growing concern for many Member States. Hormone replacement therapy (HRT) 
contributes to preventing osteoporosis, but its use is still debated by health care providers. 
Furthermore, women seem to feel less than adequately informed about the costs and 
benefits of this type of therapy (according to results of the 1996 Eurobarometer survey). 
8. Conclusions 
This report has sought to provide as comprehensive an overview of women's health issues 
as possible, given the available data. It is clear that while women live long lives and report 
feeling quite healthy, they also have significant disability due to chronic illness. Health, as 
measured by a variety of indicators, typically varies across Member States as well as 
across age-groups. Not surprisingly, elderly women are in poorer health. 
The report has also pointed to a number of policy initiatives which could help reduce the 
premature mortality among women in the EC. 
1. INTRODUCTION 
1.1 Background 
This report provides an overview of the health of women in the European Community 
(EC), highlighting both differences and similarities within and between the Member States. 
It examines the main causes of mortality and morbidity as well as a number of individual 
and social determinants which influence women's health within the context of evolving 
demographic and social trends. This approach helps to highlight those health issues that 
are more prevalent among women (e.g., eating disorders, breast cancer, osteoporosis, 
sexual abuse, and consequences of domestic violence), those problems that are unique to 
women (e.g., reproductive health, cervical and ovarian cancer, and menopause), and those 
which appear to affect women differently from men (e.g., cardiovascular diseases and 
fflV/AIDS). 
Women's health has improved significantly during this century, as evidenced by a 
considerable increase in life expectancy and a decrease in premature mortality, including 
maternal and child mortality. Women in the EC have a higher life expectancy than men, on 
average between 5 to 7 years. Yet the last two decades have seen a reappraisal of 
women's health and the health policies and services directed towards them, based on the 
growing recognition that women's health needs and concerns are different from those of 
men. A recent survey (Eurobarometer 44.3/1996)a asked women in the EC whether they 
thought that women's health issues received sufficient attention in their country. More 
than one out of three responded negatively (or were uncertain) (Figure 1.1). Not 
surprisingly, the distribution of responses (Figure 1.2) varied across the 15 Member 
States with almost 50% of Irish women indicating that insufficient attention was given to 
women's health issues (Table 1.1), compared to only about 12% of Danish women. These 
results are interesting considering that Danish and Irish women have among the lowest life 
expectancies in the EC (see Section 3.1). Apparently, other factors influence women's 
perceptions of this issue. It should be noted that the Irish government recently has issued a 
special health policy for women, the first of its kind in the EC1. 
The stronger focus on women's health has taken place within a broader context of 
profound societal and demographic changes. These include the post-industrial 
development of Western Europe, women's increased participation in the labour force 
since the 1960s, and changing gender relations within both private and public life. 
Demographic trends highlight the ageing of society (including the feminization of the 
older age-group), declining fertility rates, decreasing family sizes, older ages for first 
marriages, and increasing divorce rates. These features have dramatically changed the face 
of Western society and the position of women and men alike. 
1.2 Women's Health 
Although data on women's health are still incomplete, a clearer picture of their health in 
comparison to men's is emerging. Women experience higher rates of chronic illness and 
See Section 1.4 for further details concerning the Eurobarometer survey. 
Féminisation of older age refers to the fact that due to differing mortality rates, the elderly population 
is predominantly made up of women. See Section 2.1 for further details. 
10 
disability than men, which cannot solely be ascribed to their longevity. They also have a 
more negative perception of their health than do men. Increasingly, evidence indicates that 
much biomedical knowledge of ill health - with the exception of biological health issues 
unique to women - is derived from research based on the male prototype. This has 
overlooked the influences of gender differences in diagnoses, treatments, and health 
outcomes. Women's patterns of disease and mortality are changing as well. Lung cancer, 
for example, is increasingly becoming a cause of female mortality, influenced by higher 
rates of smoking, especially among younger women. 
Women make greater use of health services than do men (both on their own behalf and in 
their role as carers for children and elderly parents), and their participation in the labour 
force of the health sector greatly exceeds that of men. However, they are under-
represented in the higher managerial and medical echelons which limits their influence on 
health policy development. Women are also more involved in and spend more time 
delivering unpaid care for the family, the elderly, and the community. 
Despite their growing paid labour force participation, women continue to spend more time 
carrying out household tasks and have less leisure time than men. Furthermore, women's 
economic and social status is generally worse than that of men, and they experience 
poverty more often and are more frequently financially dependent on men and/or social 
welfare provisions. These conditions constrain their choices in life, including healthy 
lifestyles. The influence of these features on women's health and vice versa is, however, 
not adequately understood. 
Awareness of these issues has contributed to a growing focus on women's health, 
characterised by many efforts to prioritise women's health on the political, social and 
biomedical agenda in the last two decades. The United Nation's (UN) Decade for Women 
(1976-1985) helped to highlight women's health. Similarly, the World Health 
Organization's (WHO) 1978 targets for Health for all by the Year 2000 included a 
specific health target for women. More, recently, the UN's Fourth World Conference on 
Women, in Beijing in 1995, continued this emphasis, adopting an action programme which 
included an objective3 to give priority to educational programmes aimed at, among other 
things, helping women make their own decisions and take responsibility for their health 
and fertility. 
At the Community level a number of activities have been initiated recently related to the 
improvement and protection of women's health; for example adoption of the Council 
Directive on maternity leave2, the priority given to elderly women within the strategy on 
the elderly113, and the network on breast cancer screening of the 'Europe Against Cancer' 
Programme4. 
1.3 Indicators and Determinants of Women's Health 
Effective health policies and programmes (and their evaluation) increasingly rely on 
objective measures to describe the health status of populations and variations in health. 
a This objective is consistent with the major objectives of the European Union before, during, and after 
the Beijing conference. 
b See, for example, European Year of the Older People, in 1993 and the forthcoming year of the United 
Nations International Year of Older People in 19993. 
11 
Comparisons between (sub)populations and nations are also increasingly undertaken in 
order to assess the prevalence of various diseases, to understand the underlying causes, 
and to evaluate the impact of preventive health strategies. 
While efforts towards standardising data to enable European and international 
comparisons have been initiated, truly comparable data are still scarce. This report, which 
utilises existing and new health data and indicators at the EC level, is therefore necessarily 
limited in its choice of topics. It is also limited to women aged 15 years and older because 
most gender-specific health data at the EC level focus on this age-group. Finally, in the 
interest of saving space, comparisons between men and women's health status are made 
only when they are of particular interest. 
1.4 Information Sources 
This report has drawn upon many existing health and health-related primary and 
secondary information sources. The level of aggregation varies, ranging from regional, 
national, to Community and international levels. Although the focus has been on 
quantifiable and comparable health indicators and determinants for women, qualitative 
information has also been used. References to the specific information sources are cited at 
the end of each section as well as in the bibliography at the end of the report. 
The main data sources include the Health for All (HFA) Database (WHO, 1996)5, various 
reports and data published by the Statistical Office of the European Communities 
(Eurostat), as well as data from the first (1994) wave of Eurostat's European Community 
Household Panel (ECHP) survey, The World Women's 1970-1990 statistics6 published by 
the UN, and data provided by different monitoring centres, such as the International 
Agency of Research on Cancer (IARC) in Lyon, and the European Centre for the 
Epidemiological Monitoring of AIDS in Paris. Finally, an important source of data for this 
report is an EC-wide Eurobarometer survey carried out in early 1996. This survey asked a 
representative sample of non-institutionalised persons (about 1000) in each Member State3 
a number of questions on nealth, including attitudinal questions, self-reported health 
status, and preventive health services received in the past year. 
Despite continuing improvements in the availability and comparability of health indicators 
and determinants, many constraints remain. They include the lack of data on many issues 
of importance to women's health, for example, menopause and eating disorders (see 
Section 7), and/or specific groups, e.g., migrant women. There are also many gaps with 
regard to morbidity and survival statistics, and life style determinants both overall and 
gender-related. In addition, there are insufficient health-related data by gender, needed to 
study, for example, the relation between employment, stress, and health. 
Where possible, information has been obtained for all the 15 Member States. In these 
cases results have generally been reported both for the Member States and the EC as a 
whole. Data for Germany before 1990 usually refer to the Federal Republic of Germany, 
and after 1990 to the Federal Republic, including the acceding territories, unless otherwise 
stated. There is, however, one important exception: the Eurobarometer results 
differentiate between the former German Democratic Republic and the pre-unification 
Federal Republic of Germany. This differentiation has been retained because the results 
For the former German Democratic Republic and the pre-unification Federal Republic of Germany 
the sample size was 1000 persons each. 
12 
reflect important continuing differences in certain health and health-related indicators 
produced by the many years of separate statehood. 
In all instances, the most recent data available have been used. In some cases, these data 
are several years old (e.g., the WHO mortality data are from 1992) while in others they 
are current (e.g., the 1996 Eurobarometer data). 
1.5 Structure of the Report 
This report is divided into 8 sections. Section 1 describes the aims, background, methods, 
and structure of the report, while Section 2 summarises the social and demographic trends 
of importance to women at different stages of their lives. Section 3 outlines a number of 
selected health indicators of relevance to women, including life expectancy, infant 
mortality, and self-perceived health status. Supplementing this information, Section 4 
describes selected morbidity measures, including disability due to long-term illness, short-
term restricted activity measures, and hospitalisations. Section 5 reviews causes of death 
for women of different ages. Section 6 contains a discussion of various health 
determinants, e.g., factors such as smoking and drinking as well as various screening 
programmes. Section 7 analyses a number of issues of particular concern for women at 
different stages of their life. Section 8 concludes the report. The Annexes contain a 
glossary of technical terms, a list of tables and figures, as well as the bibliography. 
Throughout the report, numbered references are presented at the end of each section, 
while lettered footnotes appear at the bottom of each page. Figures and tables follow the 
references at the end of each section. 
References 
1 Irish Department of Health (1995), Developing a Policy for Women's Health: A Discussion 
Document, Dublin: Stationary Office. 
2 Commission of the European Communities (CEC), Directive 92/85/EEC, 10 Oct. 1992, Official 
Journal no. L 348 of 28 Nov. 1992. 
3 Dooghe. G. and Appleton, N. (1995). Elderly Women in Europe. Choices & Challenges, Leuven: 
Centrum voor BevoUrings- en Gezinsstudies. 
4 European Journal of Cancer Prevention ( 1994), Vol 3, Supplement 1. 
5 See also for example: WHO (1994), Health in Europe, European Series, No. 56, Regional 
Publications, Copenhagen: WHO, Regional Office for Europe. 
6 United Nations (1991), The Worlds Women 1970-1990, Trends and Statistics, New York: United 
Nations. 
13 
[Figures and Tables ] 
14 
Figure 1.1 
Sufficient Attention for Women's Health 1996 (*) 
Women 15+ Years, EU 15 
Agree strongly 
(25.00 %) Disagree strongly 
(4.70 %) Disagree slightly 
(13.60%) 
Agree slightly 
(41.00%) Uncertain 
(15.70%) 
Source : Eurobarometre 44 3/1996 
(*) : Distribution of responses of rating of the extent to which the respondent agreed/disagreed with the following 
statement : "In (country) sufficient attention is giver to women's health issues, such as breast and cervical cancer" 
Figure 1.2 
Sufficient Attention Given To Women's Health, 1996 (*) 
Women 15+ Years 
EU 15, by Country 
Denmark 
The Netherlands J| 
Finland 
France 
Luxembourg 
Belgium 
Austria 
Italy 
Germany E 
EU 15 
Sweden 
United Kingdom 
Spain 
Germany W 
Greece 
Portugal 
Ireland 
0% 
ranked by % agree response 20% 40% 60% 80% 100% 
Source: Eurobarometer 44.3/1996 
(*) : Distribution of responses of rating of the extent to which the respondent agreed/disagreed with the following 
statement : "In (country) sufficient attention is giver to women's health issues, such as breast and cervical cancer" 
15 
Table LI 
Sufficient Attention Given To Women's Health, 1996(*) 
Women 15+ Years 
Denmark 
The Netherlands 
Finland 
France 
Luxembourg 
Belgium 
Austria 
Italy 
Germany E 
EU 15 
Sweden 
United Kingdom 
Spain 
Germany W 
Greece 
Portugal 
Ireland 3.8 
4.3 
1.7 
1.4 
1.6 
2.5 
1,2 
5.1 
2.6 
4.6 
4.8 
10.1 
3.3 
1.7 
4.6 
5.0 
20.7 8.7 
6.1 
11.0 
12.6 
8.4 
8.8 
8.2 
5.6 
11.1 
13.6 
20.9 
21.6 
17.0 
14.9 
14.7 
19.9 
27.4 2.0 
5.6 
4.5 
11.2 
17.4 
16.9 
21.6 
21.0 
20.3 
16.4 
11.6 
7.1 
21.6 
26.5 
25.8 
23.8 
14.4 33.3 
33.5 
53.3 
54.4 
48.7 
50.3 
36.2 
26.2 
49.5 
42.9 
42.6 
45.0 
40.5 
41.2 
31.5 
45.2 
27.2 52.2 
50.5 
29.6 
20.4 
23.9 
21.5 
32.8 
42.1 
16.5 
22.5 
20.1 
16.2 
17.6 
15.6 
23.4 
6.2 
10.4 
(*) : Respondents were asked to rate the extent to which they agreed (disagreed) with the following statement : "In (country), 
sufficient attention is given to women's health issues, such as breast and cervical cancer" (Eurobarometer 44.3/1996) 
16 
2. SOCIAL AND DEMOGRAPHIC TRENDS 
This Section provides background information about demographic and social trends that 
concern women. Information about life expectancy and infant mortality, often defined as 
part of demographic statistics, is presented in Section 3 which focuses on selected health 
indicators. 
2.1 Population Size and Structure 
When the European Community admitted three new Member States, (Austria, Finland, 
and Sweden), on 1 January 1995, the overall population increased from approx. 350 to 
372 million (6.3%). Women accounted for just over half (50.9%) of this increase, their 
number growing from 179 to 190 million. Thus, as before the expansion, women 
constitute 51.2% of the population in the EC. This percentage is remarkably stable across 
the Member States, varying slightly from a low of 50.4% in Ireland to a high of 51.8% in 
Portugal (see Table 2.1). 
However, women make up varying proportions of the population at different ages. The 
under 20 age-group comprises 95 women for every 100 men. This over-representation of 
men in the population continues through age 39. In the 40 to 59 age-group, there are 100 
women for every 100 men, but from there on the over-representation of women increases 
drastically to reach about 221 women for every 100 men among 80-year-olds, (see Figure 
2.1). 
This so-called feminization ratio is virtually identical for the under 20 year-olds across the 
Member States, but varies considerably in the 60 years and older age-group. Germany and 
Austria have the highest feminization ratio while Greece and Ireland have the lowest (see 
Figure 2.2). 
The high feminization ratio in the older age-group is in part the result of the difference in 
life expectancy between men and women. On average, women in the EC live more than 6 
years longer than men with the result that they are over-represented in the higher age-
groups (for further details on life expectancy see Section 3). 
This tendency for women to live longer than men is also apparent from the age 
distribution of the two sexes. As shown in Table 2.2, 23.6% of women are 60 years or 
older, while the corresponding percentage for men is only 17.8%. This relationship may 
change over time as the population ages, because as also shown in Table 2.2, the 
percentage of men over 60 years is increasing faster than the percentage of women over 
60 years. From 1991 to 1996, the percentage of men over 60 years grew by 5.5%, while 
the corresponding increase for women was 2.7%. 
2.2 Family Life 
At the same time as the population is ageing, changes are also taking place in relation to 
family life. Most noteworthy is the significant decline in the marriage rate, which has 
declined by almost one third, between 1960 and 1995, from about 8 to 5.1 marriages per 
17 
1000 population. This decline has occurred fairly uniformly across all Member States, 
with Germany experiencing the greatest decline and Greece the smallest (see Table 2.3). 
Concomitant with the decline in the marriage rate has been an increase in the age of first 
marriage from 24 to just over 26 years (see Table 2.3). Here Denmark and Sweden are 
notable in the EC for having the highest age at first marriage (28.1 and 28.5 years, 
respectively in 1994) as well as highest increase since 1960 in the age of first marriage. 
Despite the decline in the marriage rate and the increase in the age of first marriage, the 
divorce rate has more than tripled since 1960, from 0.54 to 1.8 per 1000 population. As 
was the case with the marriage rate, the EC average obscures considerable differences 
across the Member States. Ireland stands out from the rest because divorce is illegal8. 
Southern Member States like Greece, Italy, and Spain have lower divorce rates, while the 
Nordic countries - Denmark, Finland, and Sweden, and the United Kingdom (UK) - top 
the list. 
The results of these trends can be seen in Figure 2.3 which shows a large increase in 
single-person households as well as single-parent families between 1960 and 1995. Also 
shown in this figure is the large increase in the percentage of births occurring outside 
marriage, a trend that along with the increasing divorce rates, contributed to the increase 
in single-parent households. 
The increase in bearing children out of wedlock was not the only change to occur during 
this period. Women's total fertility rate declined by 45%, from 2.59 to 1.43 children per 
woman. As a result, the total number of births fell by more than 1.7 million, or almost 
31% to just under 4 million births per year (see Figure 2.3 and Table 2.4). 
While there has been an overall decline in the total fertility rate in all Member States since 
1960, the timing of this decline has varied greatly. As can be seen in Figure 2.4, Ireland in 
particular, has experienced this decline only in the 1990s, while most of the other Member 
States experienced the greatest declines in the 1960s or 1970s. It is also interesting that 
the Nordic countries which for a while had the lowest total fertility rates now have the 
highest. This is particularly curious because, as will be seen below, these countries have 
the highest labour force participation rates, something which traditionally has been 
associated with lower total fertility. 
It is also not possible to attribute this increase in fertility rates in the Nordic countries to 
low levels of contraceptive use, which might have been one of the reason for Ireland's 
relatively recent fertility decline because, as Table 2.5 shows, a greater share of Nordic 
women report using contraception compared to women in the other Member States. 
Table 2.5 also shows the age of first birth, which increased slightly (0.5 years) to 28.7 
years between 1990 and 1994, probably as a result of the increase in the age of first 
marriage. Finally, the table shows the percentage of live births to teenage mothers, which 
varies considerably across the Member States, with the Netherlands reporting the lowest 
percentage (1.38%) and Portugal the highest (7.48%) (see also Section 7.3). 
Legislation to allow divorce under certain circumstances has been introduced in the Irish legislature 
following a referendum in 1995. 
18 
2.3 Working Life 
Changes have also been occurring in the working life of women, both those with children 
and those without. Some Member States, notably the Nordic countries, saw increased 
labour force participation rates as early as the 1960s, while others experienced such trends 
only in the 1970s and 1980s. As shown in Table 2.6, female employment has continued to 
grow into the 1990s, although two countries (Finland and Sweden) with very high rates of 
female labour force participation have actually experienced a decline since the mid-1980s. 
Women are also becoming increasingly active in starting up and running their own 
businesses, up to 30% of all enterprises across the Member States are managed by women 
and approximately a third of all new enterprises are started by women1. 
In spite of the increases in employment (and labour force participation), large differences 
continue to exist between the Member States. The Nordic countries - Denmark, Finland, 
and Sweden - have by far the highest labour force participation rates, (more than 70% of 
women are in the labour force), while Greece, Ireland, Italy, Luxembourg, and Spain have 
the lowest rates (around 40-45%). 
These differences are even greater for part-time employment. As shown in Table 2.7, the 
vast majority (70-90%) of part-time work is undertaken by women. When considered as a 
proportion of total employment, it is clear that the Netherlands far exceeds the rest of the 
EC, with more than 60% of employed women in part-time work. Other countries with a 
large proportion of women in part-time work include the UK (45.2%), Sweden (41.4%) 
and Denmark (36.7%). Greece, Finland, Italy, Portugal, and Spain have the lowest rates 
(less than 15%). 
Figure 2.5 shows the overall increase in part-time work for women (and men) between 
1975 and 1991. During this period, women's part-time work increased from just over 20% 
to about 28%. This figure also shows the development in unemployment and temporary 
work, both of which roughly doubled between 1975-1991. With respect t<~ 
unemployment, women have been much harder hit than men. 
Table 2.8 shows the development in unemployment rates between 1983 and 1993 in all 
the Member States. Only five countries report female unemployment rates in 1993 of less 
than 7% (Austria, Luxembourg, Portugal, Sweden and the UK). Others tend to hover 
around the 10-15% mark, with the notable exception of Spain, where the rate is almost 
30%. In comparison to men, women have higher unemployment rates in all but three 
Member States (Finland, Ireland, and Sweden). 
The situation of young women (under 25 years of age) is worse in the sense that the 
absolute level of unemployment is considerably higher than that for the overall female 
labour force. This is also clear from Figure 2.6 which shows the distribution of activity 
across all the age-groups of the population in 1994. 
2.4 Gender-Related Development Indices 
Existing gender differences among Member States (except Germany) and their relative 
ranking world-wide, based on selected indices from the Human Development Report 
19952, are illustrated in Table 2.9. 
19 
The Human Development Index (HDI) is a way of assessing and ranking countries 
according to a number of selected social and economic indicators (health, income and 
education). Canada, the USA, and Japan are the three highest ranking countries, with two 
Member States, the Netherlands and Finland, in fourth and fifth place. 
When the HDI is adjusted for gender using the Gender Development Index (GDI), 
however, a different picture emerges. The Nordic Member States, Sweden and Finland, 
top the list both within the Community and world-wide. The Netherlands drops 
dramatically on the GDI to ninth place within the Community, thus indicating a relatively 
high level of gender inequality. 
The Gender Empowerment Measure (GEM), another gender-based index, indicates 
disparities related to economic and political decision-making. The Nordic Member States 
are again positioned at the top. However, the GEM does not mirror the GDI for all 
Member States. France, for example, ranking fourth on the GDI scale within the 
Community, occupies the lowest place on the GEM index. This represents the highest 
discrepancy within the Community between women and men with regard to women's 
parliamentary representation, their level of professionalisation, and their earning power. 
Gender equality is highest in the Nordic Member States and is attributable to high female 
educational enrolment rates since the 1970s and relatively low disparity between women 
and men with regard to the percentage of shared earned income. 
Although these indices are not flawless, they do indicate that gender inequality continues 
to exist both within and between the Member States, despite the progress made during the 
second half of this century. These inequalities appear less pronounced in relation to basic 
health and education, but are more strongly visible in the area of income distribution and 
economic and political representation. It should be noted that gender equality does not 
depend on income (GDP), because, as shown in Table 2.9, Luxembourg, which ranks 
highest with respect to basic ourchasing power (real GDP per capita), ranks lowest in the 
Community with respect to GDI. 
References 
1 European Observatory for SMEs, Fourth Annual Report 1996, p. 330. 
2 United Nations Development Programme (1995), Human Development Report 1995, New York. 
Oxford Universitv Press. 
20 
[Figures and Tables ! 
21 
Table 2.1 
Women in the Total Population 
of the European Union 1996 (EU 15) 
Country Total 
Population Number of 
Women Women 
in% 
EU 15 
Portugal 
Austria 
Italy 
Germany 
France 
Finland 
Belgium 
Spain 
United Kingdom 
Luxembourg 
Greece 
Denmark 
Sweden 
Netherlands 
Ireland 372,653,590 
9,920,760 
8,054,800 
57,333,000 
81,817,500 
58,255,880 
5,116,830 
10,143,050 
39,241,930 
58,693,970 
412,800 
10,465,060 
5,251,030 
8,837,500 
15,493,890 
3,615,600 190,739,240 
5,143,280 
4,147,630 
29,515,580 
41,992,680 
29,891,710 
2,625,130 
5,184,260 
20,037,940 
29,908,290 
210,200 
5,300,110 
2,658,800 
4,471,430 
7,831,600 
1,820,600 51.18 
51.84 
51.49 
51.48 
51.32 
51.31 
51.30 
51.11 
51.06 
50.96 
50.92 
50.65 
50.63 
50.60 
50.55 
50.35 
Source : Eurostat 1997 
Note : The countries are in descending order of% women in the population. 
Figure 24 
Féminisation Ratio, 1996 (EU 15) 
Age 
80 and over 
60-79 years 
40-59 years 
20-39 years 
0-19 years 221 
126 
50 100 150 200 
Number of women per 100 men 250 
Source : Eurostat 1997 
22 
Figure 2.2 
Féminisation Ratio in the 0-19 Years and 60+ Years 
Age-Groups, 1996 (EU15) 
EU 15 
• 60 and over 
• 0-19 
20 40 60 80 100 120 
Number of women per 100 men 140 160 
Source : Eurostat 1997 
Table 2.2 
Female and Male Population in the EU (15) 
Age-Group Women 
% 
1991 1996 Men 
% 
1991 1996 
0-19 years 23.9 22.6 26.4 24.9 
20-39 years 29.2 29.2 31.6 31.6 
40-59 years 23.9 24.6 25.0 25.7 
60 and over 23.0 23.6 16.9 17.8 
Total 100 100 100 100 
Source : Eurostat 1997 
23 
Table 2.3 
Marriages and Divorces in the EU (15), 1960-1995 
Country 
EU 15 
Austria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom Marriages 
Number 
in 1995 Difference 
since 
I960 (%) Rate in 
1995 
(o/oo) Difference 
since I960 
(%) 
1,901,000' -24.1 5.1' -54.4 
42,900 -26.6 5.3 -55.6 
51,500 -21.0 5.1 -40.7 
34,700 -3.2 6.6 -18.0 
23,700 -27.7 4.6 -59.5 
254,000' -20.6 4.4' -60.3 
430,500 -37.5 5.3 -79.8 
64,000 10.0 6.1 -14.2 
15,600 1.0 4.4 -25.2 
283,000' -27.0 4.9' -57.4 
2,100 -7.2 5.1 -40.7 
81,500 -8.6 5.3 -47.2 
65,800 -5.3 6.6 -18.2 
196,900' -16.9 5.0' -53.9 
33,600 -32.9 3.8 -75.9 
321,000' -18.4 5.5' -37.1 Average age at First 
Marriage (women> 
in 1994 Difference 
since I960 
(years) 
26.1'* 2.0 
25.8 1.8 
25.2 2.4 
28.9 6.1 
26.7 2.9 
26.7 3.7 
26.3 2.9 
25.6 0.4 
27.02 - 0.6 
26.1' 1.3 
26.3 
27.0 2.8 
24.6 - 0.2 
26.2' 0.1 
28.5 4.6 
25.8' Divorces 
Number 
in 1995 Difference 
since 1960 
(%) Rate in 
1995 
(o/oo) Difference 
since 1960 
(%) 
677,500' 297.7 1.8' 237.7 
18,200 127.2 2.3 99.0 
35,0002 662.3 , 3.52- 586.0 
13,000 94.2 ' 2.5 70.0 
14,000 283.7 2.7 232.S 
117,000' 287.6 2.0' 204.1 
169,400 130.8 2.1 105.9 
11,000 346.4 1.1 255.0 
27,000 - 0.5 
700 375.2 1.8 264.1 
34,200 502.4 2.2 345.4 
12,300 1545.1 1.2 1369.5 
33,100' - 0.8' 
22,500 151.5 2.6 113.1 
170,100' 559.0 2.9' 489.0 
Source : Eurostat 1997 
' provisional data 
1 1993 
2 1992 
* estimate 
Figure 2.3 
Families Past and Present, EU 15 
Single-parent families 
(%) 
Number of children per 
woman 
Crude divorce rate (per 
1000 pop.) 
Live births outside 
marriage (%) 
S ingle-persons 
households (%) :H1995 
i n 1960 
30 
Source : Eurostat 1997 
24 
Table 2.4 
Births and Fertility in the EU (15), 1960-1995 
Country Births 
Number in 1995 Difference 
since 
1960 (%) Percentage of births 
outside marriage 
in 1995 Difference 
since 
1960 (%) Fertility 
Rate in 1995 Difference 
since 
1960 (%) 
EU 15 
Austria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom 3,999,000' 
88,700 
114,700' 
69,800 
63,100 
727,800' 
765,200 
101,500 
48,500 
521,300' 
5,400 
190,500 
107,200 
359,900' 
103,400 
732,000 -30.9 
-29.6 
-25.9 
-8.3 
-23.2 
-10.8 
-39.3 
-35.5 
-20.1 
-42.7 
8.0 
-20.3 
-49.9 
-45.5 
1.2 
-20.3 23.4* 
27.4 
15.0* 
46.5 
33.1 
36.1' 
16.1 
3.0 
23.0 
8.1' 
13.1 
15.5 
18.7 
10.81 
53.0 
33.6 354.5 
110.2 
624.6 
494.2 
719.8 
491.8 
112.4 
145.2 
1347.2 
233.1 
314.2 
1049.6 
97.6 
365.8 
369.5 
543.1 1.43* -44.9 
1.40 
1.55' 
1.80 
1.81 
1.70' 
1.25 
1.32 
1.87' 
1.17* 
1.69 
1.53 
1.40 
1.18* 
1.73 
1.71' -48.0 
-39.5 
-29.1 
-33.5 
-37.7 
-47.3 
-42.1 
-50.3 
-51.5 
-25.9 
-51.0 
-54.8 
-58.7 
-21.4 
-37.3 
Source : Eurostat 1997 
f provisional data 
* estimates 
1 1994 
25 
Figure 2.4 
Trends in the economic indicator of fertility 
over the past 40 years 
c w 
E o 
$ 
k_ 
<u a 
c 
u 
.a 
E 
3 C 
ai a> 
fO 
u. > < • Norway -
• Sweden 
• Denmark 
• Finland 
O) 
Q. 
C 
01 
01 
01 
03 
01 
> < 
8 3 
en O) ut u*> -.o <o «a aocM-raor^i^o o -r 30 33 => 
Observation period (years) Observation period (years) 
(Q 
E o 
a> a. 
cr a* 
u 
at 
-Q E 3 cr a* at <a 
<u 
3 
Observation period (years) Observation period (years) 
Source : The demographic situation in the European Union in 1995. European Communities. Luxembourg / 996 
26 
Table 2.5 
Contraception Usage and Fertility (EU 15) 
Country Women using 
contraception 
1986-93 (%) Average Age of Women at 
Childbirth 
1990 1994 % Live Births to 
mothers under 20 
1995 
EU 15 
Au.stria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom 71 
79 
78 
80 
81 
75 
n/a 
n/a 
78 
n/a 
76 
66 
59 
78 
81 28.2 28.7 
26.7 27.5 
27.9 28.2* 
28.5 29.1 
28.9 29.1 
28.3 28.8P 
27.6 28.2 
27.2 28.0 
30.1 30.3p 
29.0 29.6* 
27.9 28.8 
29.3 29.9 
27.3 27.9 
28.9 29.5* 
28.6 29.2 
27.7 28.1 3.84 
4.39 
2.40 
1.99 
2.48 
2.35* 
3.48* 
4.74 
5.11 
2.511 
2.12 
1.38 
7.48 
3.55' 
2.07 
6.381 
Source : Human Development Report 1995; HFA 1996; and Eurostat 1997 
p provisional data 
* estimate 
1994 
Table 2.6 
Employment EU 15, (1993) 
Women 15-64 years 
Thousands | Change Female participation rate" 
Country 1993 since 1983 
% % T99X 
% % change 
AUSIRIA1 ; 37724" 
BELGIUM1,4 J 4,237 
DENMARK i 2,893 
FINLAND ' 2,508 
FRANCE ! 25,213 
GERMANY1,3 j 38,682 
GREECE 4,118 
IRELAND2 1,334 
ITALY1 22,787 
LUXEMBOURG2 165 
NETHERLANDS1 7,084 
PORTUGAL 4,537 
SPAIN 15,564 
SWEDEN 4,320 
UNITED KINGDOM 28,179 T37T 
2.8 
5.9 
1.9 
6.3 
8.1 
7.2 
4.9 
1.2 
3.1 
0.4 
12.4 
1.3 
5.9 ^4977" 
48.7 
74.2 
72.7 
54.3 
52.5 
40.4 
37.8 
40.3 
41.7 
40.3 
56.7 
33.2 
76.6 
57.2 ~58T0~ 
54.1 
78.3 
70.0 
59.0 
61.3 
43.6 
39.9 
46.5 
44.7 
55.5 
59.4 
42.8 
75.8 
64.8 16./U 
11.09 
5.53 
-3.71 
8.66 
16.76 
7.92 
5.56 
15.38 
7.19 
37.72 
4.76 
28.92 
-1.04 
13.29 
11992 
2 1991 
3FRG to 1990 
41992 1982 
51991 1981 
* defined as female labour-force of all ages divided by female population aged 15-64 (in %) 
27 
Table 2.7 
Part-Time Employment as % of Total Employment 
EU 15, (1993) 
Country 
,1 3 AUSTRIA1 
BELGIUM1 
DENMARK1 
FINLAND 
FRANCE3 
GERMANY 1, 
GREECE1 
IRELAND 2 
ITALY1 
LUXEMBOURG 1 
NETHERLANDS1 
PORTUGAL4 
SPAIN5 
SWEDEN 
imiTPnifiMftnnu^ 
1992 
!1991 
'FRGtoiggO 
'1986 
'n»7 WM 
8 4 
8.1 
23.8 
8.3 
9.6 
12.6 
6.5 
6.6 
4 6 
6.3 
21.4 
6.0 
5.8 
24.8 •<«« 
9.1 
12.4 
22.5 
8.6 
13.7 
14.1 
4.8 
8.4 
5.9 
6.9 
32.8 
7.3 
6.3 
24.9 
-M n WM 
20.0 
19.7 
44.7 
12.5 
20.1 
30.0 
12.1 
15.5 
9 4 
170 
50.1 
10.0 
13.9 
45.9 IQttt 
20.5 
28.1 
36.7 
11.2 
26.3 
30.7 
8.4 
17.8 
11.5 
16.5 
62.9 
11.2 
14.3 
41.4 
AC 7 •Klltt 
1.5 
2.0 
6.6 
4.5 
2.5 
1.7 
3.7 
2.7 
2.4 
1.0 
7.2 
3.4 
2.4 
6.3 
J3 toot 
1.6 
2.1 
10.1 
6.2 
4.1 
2.2 
2.8 
3.6 
2.9 
1.3 
13.4 
4.3 
2.3 
9.1 pt-Um» «nptoyimrt 
% o* tot* port-tim» 
tflta 
88.4 
84.0 
84.7 
71.7 
84.3 
91.9 
61.2 
71.6 
64.8 
88.9 
77.3 
65.9 
71.5 
86.6 i««t 
89.1 
758 
63.1 
83.3 
91.0 
61.3 
71.6 
68.5 
885 
75.0 
67.3 
75.9 
81.3 
_a5_i 
Source - OECD 1994/1995 
Figure 2.5 
Changes in Employment (EU) 
rata (tnmn) 
Part-nnvt work 
(men %) 
Part-um» «wyk 
(woman %) H 1991 
D1975 
Source - COM (96) 60 final 
28 
Table 2.8 
Unemployment Rates 
EU 15, (1993) 
Country 
AUSTRIA 
BELGIUM2 
DENMARK 
FINLAND 
FRANCE 
GERMANY4 
GREECE 
IRELAND 
ITALY 
LUXEMBOURG2 
NETHERLANDS2 
PORTUGAL 
SPAIN 
SWEDEN 
UNITED KINGDOM2 Both sexes 
% of total labour force 
1983 
4.1 
13.2 
11.4 
5.4 
8.3 
7.9 
7.9 
14.0 
9.3 
16.0 
11.S 
7.8 
17.0 
3.5 
11.2 1993 
4.2 
10.3 
10.7 
17.7 
11.6 
8.8 
9.7 
15.7 
10.8 
1.2 
6.7 
5.5 
22.4 
8.2 
10.2 Female 
% of total female 
labour force 
1983 
5.1 
18.3 
12 J 
5.2 
11.2 
8.8 
11.8 
11.1 
15.3 
1.7 
14.0 
12.2 
20.3 
3.5 
8.0 1993 
4.5 
14.2 
11.1 
15.6 
13.7 
10.4 
15.3 
J12.1 
15.1 
2.0 
8.8 
6.5 
28.9 
6.6 
5.4 Male 
% of total male labour 
force 
1983 
3.5 
10.0 
10.7 
5.6 
6.3 
7.3 
5.8 
15.3 
6.2 
1.0 
10.6 
4.7 
15.6 
3.4 
13.3 1993 
4.0 
10.3 
19.5 
9.8 
7.7 
6.4 
J17.3 
8.3 
1.1 
5.3 
4.6 
18.6 
9.8 
13.9 Youth Unemployment rates 
(Under 25) % of youth labour force 
Female 
1983 
28.5 
19.3 
10.8 
25.5 
11.1 
30.0 
16.6 
36.5 
7.4 
18.8 
' 24.6 
43.7 
8.3 
17.3 1993 
19.7 
14.6 
11.3 
28.4 
7.6 
38.6 
20.9 
35.6 
3.8 
6.8 
14.9 
47.4 
14.9 
13.4 Male 
1983 
19.1 
17.8 
10.3 
15.0 
10.2 
17.1 
22.9 
25.5 
6.2 
22.6 
13.2 
33.7 
7.8 
22.2 1993 
17.4 
14.3 
15.4 
21.5 
7.4 
20.1 
24.9 
26.7 
4.2 
6.8 
9.8 
39.9 
21.6 
20.8 
Source - OECD 1994/1995 
'National definition 
21992 
31991 
4FRG to 1990 
Figure 2.6 
Present Demographic Structure and 
Structure of the Active Population 
1994 
• Non-active 
Unemployed 
In employment 
•4.5 1.5 1.5 4.5 
Source : The démographie situation in the European Union in 1993, European Communities, Luxembourg 1996 
29 
Table 2.9 
Gender Related Development Indices 
Country* 
Sweden 
Finland 
Denmark 
France 
Austria 
United Kingdom 
Italy 
Belgium 
Netherlands 
Portugal 
Greece 
Ireland 
Spain 
Luxembourg Gender-related 
development 
index (GDI) 
0.919 (1) 
0.918 (2) 
0.904 (4) 
0.898 (7) 
0.882 (10) 
0.862 (13) 
0.861 (14) 
0.852 (18) 
0.851 (20) 
0.832 (25) 
0.852 (27) 
0.813 (30) 
0.795 (34) 
0.790 (35) Real GDP per 
capita 
(PPP$) 
1992 
18,320 
16,270 
19,080 
19,510 
18,710 
17,160 
18,090 
18,630 
17,780 
9,850 
8,310 
12,830 
13,400 
21,520 Share of earned 
b 
income (%) 
Female 
41.6 
40.6 
39.8 
35.7 
33.6 
30.8 
27.6 
27.3 
25.2 
29.9 
22.2 
22.2 
18.6 
23.1 Male 
58.4 
59.4 
60.2 
64.3 
66.4 
69.2 
72.4 
72.7 
74.8 
70.1 
77.8 
77.8 
81.4 
76.9 Combined 
primary, 
secondary and 
tertiary 
education gross 
enrolment 
ratio 
(%) 1992 
Female 
79.3 
100.0 
85.6 
87.5 
82.0 
77.4 
70.3 
84.3 
86.5 
84.3 
77.6 
84.6 
88.7 
57.4 Male 
76.7 
90.6 
82.3 
83.5 
85.9 
76.1 
69.0 
84.1 
89.4 
70.2 
77.4 
80.6 
83.0 
55.6 Gender 
empowernment 
measure 
(GEM) C 
0.757 (1) 
0.722 (3) 
0.683 (4)' 
0.433 (31) 
0.610 (9) 
0.483 (19) 
0.585 (10) 
0.479 (21) 
0.625 (7) 
0.435 (30) 
0.469 (24) 
0.452 (26) 
0.542 (13) Human 
Development 
Index (HDI) 
10 
5 
16 
8 
14 
18 
20 
12 
4 
36 
22 
19 
9 
27 
Source : Human Development Report, 1995 
*No data for Germany. 
" The figure between brackets relates to the overall GDI ranking. GDI measures development but adjusts for gender. 
b Latest available year. 
e GEM measures gender disparity related to economic and political decision making. 
d HDI measures national development according to social and economic indicators. 
30 
3. SELECTED HEALTH INDICATORS 
The previous chapter provided an overview of social and demographic trends of 
importance to the situation of women within the EC. This section profiles selected health 
indicators, including life expectancy, infant mortality, maternal mortality, self-perceived 
health status, and height. These indicators are unfortunately the only ones currently 
available on a EC-wide basis. They do, however, indicate important differences across the 
Member States which are likely to reflect differences in underlying health status. 
3.1 Life Expectancy 
Life expectancy (at birth) has increased significantly in recent decades in virtually all 
Member States. Between 1970 and 1995 the EC average life expectancy for women at 
birth increased by 5 1/2 years (for men the corresponding increase was almost 5 years). As 
a result, a girl born in 1995 may expect to live well over 80 years, while a boy may expect 
to live well over 73 1/2 years. 
There has been considerable variation within the EC in the degree to which life expectancy 
(at birth) has increased as shown in Figure 3.1. Typically, the countries with the lowest 
life expectancy in 1970 experienced the greatest increase. This is particularly true for 
Portugal. Furthermore, the increase in some countries (e.g., Spain) was so great that they 
now rank towards the top of the distribution of life expectancy. Other countries 
experienced much smaller increases, in particular Denmark, where life expectancy went 
from being among the highest in 1970 to one of the lowest in the EC today due to a 
virtual stagnation in life expectancy since the mid-1970s. One reason for Denmark's low 
(and stagnating) life expectancy is its high premature mortality among women under 65 
years of age2 \ As shown in Figure 3.2, Denmark had the highest reduction in life 
expectancy due to premature death, while Spain and Greece had the lowest. 
In every Member State women live longer than men as Figure 3.3 shows. On average, 
women live 6.4 years longer than men (see Table 3.1) but this ranges from 8.1 years in 
France to 5.1 years in Denmark. With a few exceptions, the gender gap has been relatively 
stable over time. Exceptions include Denmark, the Netherlands, and the UK where it has 
narrowed since the 1980s, and Spain where it has widened2. 
Life expectancy is not limited to being measured at birth. Tables 3.2-3.4 show life 
expectancy at ages 15, 45, and 65. The same patterns of variation across the Member 
States (and between men and women) persist across all age-groups, although the 
difference between average life expectancy of women and men decreases with age. 
3.2 Infant Mortality 
Infant mortality (before the age of 1 year) is another widely reported health indicator. As 
shown in Figure 3.4, infant mortality has declined significantly in recent decades. In 1970, 
female infant mortality in the EC was 21.9 per 1000 live births, whereas in 1992 it was 
only 6.9, a decline of 68%. This decrease has been accompanied by a narrowing of the 
Explanations for the high rate of premature mortality in Denmark include excessive smoking and 
drinking, and high unemployment1. 
31 
range of rates. In 1971, Portugal, which had the highest infant mortality rate, reported 
almost 50 deaths per 1000 live births, while Sweden (in 1970) reported the lowest rate, 
(11 deaths per 1000 live births), a difference of almost 40 deaths per 1000 live births. In 
1992, the highest (female) infant mortality rate, still that of Portugal, was 9.29 whereas 
the lowest rates were found in Sweden and Finland, just above 5 per 1000 live births. The 
difference was only 4.13 deaths per 1000 live births, a small fraction of the difference 22 
years earlier. 
The reasons for this important decline in infant mortality are related to improved health 
status of mothers, higher quality of ante- and neonatal care3, and general social and 
economic improvements over the last three decades. 
3.3 Maternal Mortality 
While there are many maternal deaths in developing countries, there are relatively few 
such deaths in developed countries because of their better health care delivery systems. 
Nevertheless even the EC has experienced a relatively large decline in maternal mortality 
during recent decades. As shown in Figure 3.5, maternal mortality has declined from 
approximately 35 per 100,000 live births in 1970 to just over 7 per 100,000 in 1992, a 
79% decline during this period. In absolute terms, maternal deaths in the EC declined 
from 1,493 in 1970 to 178 in 1992. 
As with infant mortality, the decline in maternal mortality rates has been accompanied by a 
large decline in both range and variation. In 1971 the highest maternal mortality, 
experienced by Luxembourg, was 67.5 per 100,000 while the lowest was found in 
Denmark, 8.47 per 100,000. In 1992, France had the highest maternal mortality with 
12.91 per 100,000 whereas Sweden and Luxembourg had no maternal deaths. 
As shown in Figure 3.5 the greatest rates of decline were experienced by Sweden and 
Luxembourg (100%) while Denmark had the smallest decline (12.9%), one reason being 
that it had already an extremely low rate in 1970. 
3.4 Self-Perceived Health Status 
While life expectancy provides one measure of a population's health status, it says little 
about how its citizens rate their health. Figure 3.6 shows how a random sample of women 
in the EC rated their own health at the beginning of 1996a. (See Tables 3.5-3.7 for the 
distribution of responses for all women and elderly women): Generally, women in the EC 
perceive themselves as being in quite good health. About 62% report being in good or 
very good health during the past year. This percentage is naturally lower for elderly 
women. On average, only about 40% of women aged 65 to 74 years report being in good 
or very good health (Table 3.6). Not surprisingly, women aged 75 years and more 
typically report lower levels of self-perceived health status (see Figure 3.7), although in 
Austria, Luxembourg, Spain, and Portugal women aged 75 years and older report being in 
better health than women aged 65-74 yearsb. 
a Respondents were asked to rate their own health during the past 12 months on a 5-point scale: very 
good, good, fair, bad, very bad 
" The relatively small sample size may account for this somewhat anomalous result. 
32 
As with life expectancy, the EC average belies the large differences between Member 
States. As shown in Table 3.5, the percentage of women in each country reporting being 
in very good health varies from 45.9% in Ireland to 6.9% in Portugal (see also Figure 
3.6). The combined percentage (of women in good and very good health) varies as much, 
ranging from 75.8% in Ireland to 34.7% in Portugal. It should be noted, however, that 
Portuguese women report a considerably lower percentage in good or very good health 
than do Finnish women who have the next lowest percentage (54.9%). Portugal's results 
are consistent with the relatively high level of disability due to long-term illness reported 
in Section 4.1. 
3.5 Height 
It is well known that the average height of the world's population has been increasing 
over the last century, but this has particularly been the case during the past few decades. 
Height in developed countries increasingly has come to be seen as a measure of the health 
status of the population. To capture this dimension of health status, a question about 
height has included in the 1996 Eurobarometer survey. 
On average, European women are 163.5 cm tall but this average varies considerably 
across the Member States. As can be seen in Figure 3.8 and Table 3.8, the Netherlands 
and Denmark have the tallest female population in the EC, with average heights of 167.9 
and 166.3 cm, respectively, while Spain and Portugal have the shortest with average 
heights of 161.0 and 159.6 cm, respectively. Thus, the difference between the shortest and 
the tallest population in the EC is more than 8 cm. 
While average height differs considerably within the EC, all countries have experienced an 
increase in the height of the female population. As shown in Figure 3.9 and Table 3.8, 
older cohorts (i.e., women 60 years and older) are considerably shorter than younger 
cohorts (i.e., women aged 18-29 years), which confirms the increasing height over time. 
This is even more apparent when looking at the distribution of the average height across 
the entire age-span, as depicted in Figure 3.10. Average height of EC women decreases 
uniformly from the youngest cohorts (aged 18-29 years) to the oldest -cohort (aged 60 
years and older), with the youngest age-group being almost 5 cm taller than the oldest 
age-group. 
References 
1 Ministry of Health, Denmark (1994a ), Lifetime in Denmark, Copenhagen, Denmark. 
2 Eurostat (1995a), Women and Men in the European Union, A Statistical Portrait. Luxembourg: Office 
for Official Publications of the European Communities 
3 Abel-Smith, B., Figueras, J., Holland, W., McKee, M, Mossialos, E. (1995), Choices in Health 
Policy. London: Dartmouth. 
33 
[Figures and Tables] 
34 
Figure 3.1 
Life Expectancy at Birth, 1970-1995 
Women, EU (15) 
EU 15 
Denmark 
Portugal 
Ireland 
United Kingdom 
Germany 
Austria 
Belgium 
Finland 
Luxe m bo urg 
Greece 
The Netherlands 
Spain 
Italy 
Sweden 
France 
"Est milt e for Spun. It aly. 
Frince indEUlS m 1995 • 1995 
• 1970 
10 20 30 40 50 60 70 80 90 
Years 
Source : Eurostat 1997. 
Figure 3.2 
Reduction in Life Expectancy Due to 
Premature Death 
eu 15 
DENMARK 
PORTUGAL 
BELGIUM (11 
UNITED KINGOOM 
LUXEMBOURG 
IRELAND 
GERMANY (3| 
cmiwy AUSTRIA 
NETHERLANDS 
FRANCE 
ITALY (2) 
FINLAND 
SWEDEN 
SPAIN 
GREECE 
' 1971 
0 
2 1988 
3 1991 
«FRGto 1990 Reduction of Ha expectancy through daalh before 85 years of age 
Females 
Ranted by 1932 SDR 
1 • 1970 
«1992 
» 100 200 300 400 500 5 00 7 00 S 00 900 10 00 
Y«an Reduction of life expectancy through death before 65, 
Country 
EU 11 
DENMARK 
PORTUGAL1 
BELGIUM2 
UNITED KINGDOM 
LUXEMBOURG1 
IRELAND 
GERMANY4 
AUSTRIA 
NETHERLANDS 
PRANCE 
ITALY5 
FINLAND 
SWEDEN 
SPAIN 
GREECE 1992 * etaage 
since 1970 
3M -M.02 
4.80 -15.79 
4.50 -50.55 
4.30 -29.51 
4.20 -30.00 
4.10 -35.94 
4.10 -39.71 
4.00 -37.50 
3.90 -40.00 
3.80 -24.00 
3 80 -32.14 
3.70 -43.08 
3.70 -30.19 
3.50 -25.53 
3.50 -38.60 
3.40 -43.33 
11971 
21989 
31991 
4FRGto1990 
Source-HFA 1996. Source-HFA 1996 
35 
Figure 3.3 
Life Expectancy at Birth (in Years) 
EU 15 (1995) 
EU AVERAGE ^ 
FRANCE "jj 
SWEDEN y 
ITALY Ijjj 
Country SPAM 
NETHERLANDS 
GREECE § 
BELGIUM i 
LUXEMBOURG 
FINLAND 
AUSTRIA 
GERMANY 
UNITED KINGDOM g 
IRELAND "jjj 
PORTUGAL J 
DENMARK £ D F e m a le s 
• Males 
66 68 70 72 74 76 78 
Expectancy in Years 80 82 
Source: Eurostat 1997 
Table 3.1 
Life Expectancy at Birth (in Years) 
EU 15 (1995) 
Country 
EU AVERAGE 
FRANCE 
SPAIN 
FINLAND 
PORTUGAL 
LUXEMBOURG 
BELGIUM 
ITALY 
AUSTRIA 
GERMANY 
NETHERLANDS 
IRELAND 
SWEDEN 
UNiTED KINGDOM 
GREECE 
DENMARK Males 
73.70* 
73.80* 
73.20* 
72.80 
71.30 
73.00 
73.40 
74.90* 
73.60 
73.30 
74.60 
73.00 
76.20 
74.00 
75.00 
72.70 Females 
80.10* 
81.90* 
81.20* 
80.20 
78.60 
80.20 
80.20 
81.40* 
80.10 
79.70 
80.40 
78.60 
81.40 
79.20 
80.30 
77.80 Difference a 
6.40 
8.10 
8.00 
7.40 
7.30 
7.30 
6.80 
6.50 
6.50 
6.50 
5.80 
5.60 
5.30 
5.20 
5.20 
5.10 
* Estimate 
'ranked by difference 
Source : Eurostat 1997 
36 
Table 3.2 
Life Expectancy at 15 Years (in Years) 
EU 15 (1995) 
Country 
EU AVERAGE 
FRANCE 
FINLAND 
PORTUGAL 
LUXEMBOURG 
SPAIN 
BELGIUM 
GERMANY 
AUSTRIA 
ITALY 
NETHERLANDS 
IRELAND 
SWEDEN 
UNITED KINGDOM 
GREECE 
DENMARK Males 
59.40 
59.50 
58.30 
57.30 
58.60 
60.00 
59.20 
58.90' 
59.20 
60.20 
60.30 
58.70 
61.70 
59.70 
60.90 
58.40 Females 
65.60 
67.50 
65.60 
64.40 
65.70 
67.10 
65.80 
65.30 
65.60 
66.50 
65.90 
64.20 
66.80 
64.80 
66.00 
63.30 Differencea 
6.20 
8.00 
7.30 
7.10 
7.10 
7.10 
6.60 
6.40 
6.40 
6.30 
5.60 
5.50 
5.10 
5.10 
5.10 
4.90 
ranked by difference 
Source - Eurostat 1997 
Table 3.3 
Life Expectancy at 45 Years (in Years) 
EU 15 (1995) 
Country 
EU AVERAGE 
FRANCE 
LUXEMBOURG 
FINLAND 
SPAIN 
BELGIUM 
GERMANY 
ITALY 
NETHERLANDS 
AUSTRIA 
PORTUGAL 
IRELAND 
SWEDEN 
UNITED KINGDOM 
DENMARK 
GREECE Males 
31.30 
31.90 
30.50 
30.40 
32.30 
31.10 
30.70 
32.00 
31.60 
31.20 
30.30 
30.30 
33.00 
31.20 
30.20 
32.70 . Females 
36.50 
38.50 
36.90 
36.50 
38.00 
36.80 
36.20 
37.30 
36.80 
36.40 
35.50 
35.00 
37.50 
35.60 
34.30 
36.80 Differencea 
5.20 
6.60 
6.40 
6.10 
5.70 
5.70 
5.50 
5.30 
5.20 
5.20 
5.20 
4.70 
4.50 
4.40 
4.10 
4.10 
ranked by difference 
Source - Eurostat 1997 
37 
Table 3.4 
Life Expectancy at 65 Years (in Years) 
EU 15 (1995) 
Country 
EU AVERAGE 
LUXEMBOURG 
NETHERLANDS 
FRANCE 
BELGIUM 
FINLAND 
GERMANY 
ITALY 
SPAIN 
IRELAND 
SWEDEN 
AUSTRIA 
UNITED KINGDOM 
PORTUGAL 
DENMARK 
GREECE Males 
15.00 
14.70 
14.70 
16.20 
14.80 
14.50 
14.70 
15.50 
16.00 
13.70 
16.00 
15.20 
14.60 
14.30 
14.10 
16.10 Females 
18.80 
19.20 
19.10 
20.60 
19.10 
18.60 
18.50 
19.30 
19.80 
17.40 
19.70 
18.70 
18.10 
17.70 
17.50 
18.40 Difference a 
3.80 
4.50 
4.40 
4.40 
4.30 
4.10 
3.80 
3.80 
3.80 
3.70 
3.70 
3.50 
3.50 
3.40 
3.40 
2.30 
ranked by difference 
Source - Eurostat 1997 
38 
Figure 3.4 
Infant Mortality Rate * 
EU 15 
PORTUGAL (1) 
GREECE 
BELGIUM (2) 
ITALY (3) 
AUSTRIA 
LUXEMBOURG (1) 
SPAIN 
FRANCE 
IRELAND 
UNITED KINGDOM: 
DENMARK 
NETHERLANDS 
GERMANY (4) 
SWEDEN 
FINLAND Female 
Ranted by 1992SDR 
'1971 
21989 
'1931 
4FRGto1980 Ja 1970 
• 1992! 
20 30 
Rate 50 Female 
Country 
EU 15 
PORTUGAL' 
GREECE 
BELGIUM 2 
ITALY5 
AUSTRIA 
LUXEMBOURG ' 
SPAM 
FRANCE 
IRELAND 
UNITED KINGDOM 
DENMARK 
NETHERLANDS 
GERMANY4 
SWEDEN 
FINLAND '/•change 
1992 since 1970 
6.93 -68.40 
9.29 -81.33 
8.56 -71.08 
8.53 -59.55 
8.22 -72.18 
7.53 -70.92 
7 19 -64.89 
7.05 -66.07 
6.82 -54.95 
6.67 -65.78 
6.58 -64.41 
6.51 -54.12 
6.29 -50.67 
6.17 -73.90 
5.19 -52.82 
5.16 -61.00 
'1971 
21939 
'1991 
4FRGto1930 
•Number of Deaths under 1 Year of age per 1000 live 
births 
Source-HFA 1996 Source - HFA 1996 
Figure 3.5 
Maternal Mortality * 
Maternal deaths (all causes) per 100000 live births 
Source - HFA 1996 Country 1992 % change 
since 1970 
EU 15 7VÏ4 -79.51 
FRANCE 12.91 -54.20 
PORTUGAL' 9.56 -82.46 
DENMARK 7.38 -12.87 
NETHERLANDS 7.12 -46.83 
GERMANY4 6.67 -87.12 
UNITED KINGDOM 6.66 -63.06 
BELGIUM2 6.62 -67.55 
GREECE 5.89 -79.18 
IRELAND 5.82 -81.26 
ITALY1 4.85 -91.10 
SPAIN 4.79 -85.52 
FINLAND 4.50 -63.68 
AUSTRIA 4.20 -83.73 
SWEDEN 0.00 -100.00 
LUXEMBOURG' 0.00 -100.00 
I 
'1971 
21969 
31991 
4FRGto1930 
Source-HFA 1996 
39 
Figure 3.6 
Self-Perceived Health Status, 1996 
Women 15 + Years, EU 15 
Ireland 
Austria 
Denmark 
The Netherlands 
Belgium 
Luxembourg 
Greece 
France 
Germany W 
Germany E 
Sweden 
EU 15 
Spain 
United Kingdom 
Italy 
Finland 
Portugal 
0% 20% 40% 60% 80% 
^^H 900d IBP verV9ood 100% 
Source : Eurobarometer 44.3/1996 
Table 3.5 
Self-Perceived Health Status, 1996 
Women 15+ Years, EU 15 
IRELAND 
AUSTRIA 
DENMARK 
THE NETHERLANDS 
BELGIUM 
LUXEMBOURG 
GREECE 
FRANCE 
GERMANY W 
GERMANY E 
SWEDEN 
EU 15 
SPAIN 
UNITED KINGDOM 
FINLAND 
ITALY 
PORTUGAL Very 
Good 
% 
45.9 
35.3 
45.4 
20.7 
27.2 
24.8 
30.8 
20.6 
19.8 
16.5 
31.9 
23.1 
15.6 
25.5 
18.8 
14.4 
6.9 Good 
% 
29.9 
38.3 
27.4 
48.4 
41.2 
41.0 
32.9 
41.0 
41.7 
44.7 
28.9 
37.5 
44.8 
32.1 
36.1 
40.7 
27.8 Fair 
% 
18.3 
20.0 
19.4 
22.7 
22.8 
27.4 
19.8 
25.0 
28.5 
29.6 
27.3 
27.0 
27.8 
31.2 
36.3 
37.9 
37.6 Bad 
% 
4.5 
5.3 
5.4 
5.8 
7.5 
5.8 
14.3 
10.6 
9.1 
7.0 
10.4 
8.0 
10.2 
8.5 
6.0 
5.6 
20.7 Very 
Bad 
% 
1.4 
0.7 
2.2 
2.4 
1.3 
1.0 
2.2 
2.8 
9.0 
2.0 
1.6 
2.7 
1.5 
2.6 
2.2 
1.4 
6.9 
Source : Eurobarometer 44.3/1996 
40 
Health Assessment, 1996 
Women 65-74 Years, EU 15 
IRELAND 
AUSTRIA 
DENMARK 
THE NETHERLANDS 
BELGIUM 
LUXEMBOURG 
GREECE 
FRANCE 
GERMANY W 
GERMANY E 
SWEDEN 
EU 15 
SPAIN 
UNITED KINGDOM 
FINLAND 
ITALY 
PORTUGAL Very 
Good 
% 
21.6 
15.9 
31.7 
25.0 
16.0 
8.8 
9.0 
6.4 
6.0 
4.7 
21.0 
9.7 
6.9 
17.6 
7.4 
4.2 
0.0 Good 
% 
25.5 
28.6 
33.3 
40.0 
46.0 
32.4 
29.9 
27.7 
34.3 
34.4 
30.6 
29.2 
25.0 
24.4 
23.5 
28.4 
4.3 Fair 
% 
47.1 
41.3 
20.0 
30.0 
30.0 
44.1 
22.4 
36.2 
50.7 
51.6 
33.9 
43.3 
37.5 
41.2 
56.8 
54.7 
52.9 Bad 
% 
5.9 
9.5 
5.0 
0.0 
4.0 
11.8 
37.3 
19.1 . 
7.5 
4.7 
14.5 
14.1 
25.0 
15.3 
6.2 
12.6 
34.3 Very 
Bad 
% 
0.0 
3.2 
10.0 
5.0 
4.0 
2.9 
1.5 
10.6 
1.5 
4.7 
0.0 
3.7 
5.6 
1.2 
4.9 
0.0 
8.6 
Source : Eurobarometer 44.3/1996 
Table 3.7 
Health Assessment, 1996 
Women 75+ Years, EU 15 
IRELAND 
AUSTRIA 
DENMARK 
THE NETHERLANDS 
BELGIUM 
LUXEMBOURG 
GREECE 
FRANCE 
GERMANY W 
GERMANY E 
SWEDEN 
EU 15 
SPAIN 
UNITED KINGDOM 
FINLAND 
ITALY 
PORTUGAL Very 
Good 
% 
5.0 
17.9 
19.2 
30.8 
12.2 
5.9 
0.0 
5.3 
9.1 
0.0 
14.8 
8.6 
9.5 
15.2 
0.0 
7.9 
3.7 Good 
% 
30.0 
39.3 
23.1 
23.1 
28.6 
52.9 
23.5 
26.3 
15.2 
20.8 
18.5 
23.7 
28.6 
24.2 
28.6 
21.1 
7.4 Fair 
% 
45.0 
32.1 
50.0 
' 23.1 
42.9 
17.6 
11.8 
47.4 
48.5 
62.5 
55.6 
43.5 
38.1 
45.5 
42.9 
44.7 
18.5 Bad 
% 
15.0 
10.7 
7.7 
23.1 
14.3 
11.8 
58.8 
15.8 
27.3 
16.7 
7.4 
19.2 
19.0 
6.1 
19.0 
21.1 
51.9 Very 
Bad 
^ % 
5.0 
0.0 
0.0 
0.0 
2.0 
11.8 
5.9 
5.3 
0.0 
0.0 
3.7 
5.1 
4.8 
9.1 
9.5 
5.3 
18.5 
Source : Eurobarometer 44.3/1996 
41 
Figure 3.7 
Self-Perceived Health Status 
Elderly Women, EU 15 (1996) 
Ireland 
Austria 
Denmark 
The Netherlands 
Belgium 
Luxembourg 
Greece 
France 
Germany W 
Germany E 
Sweden 
EU 15 
Spain 
United Kingdom 
Italy 
Finland 
Portugal • 
age 65-74 
age 75+ 
0% 20% 40% 60% 
good/very good 80% 100% 
Source: Eurobarometer 44.3/1996 
Figure 3.$ 
Average Height (in cm) 
Women 18+ Years, EU 15 (1996) 
The Netherlands f 
Denmark -f 
Germany W f 
Sweden -j-
Austria 
Germany E 
Luxembourg -f 
Belgium + 
EU 15 } 
Finland -j-
Ireland -j-
France + 
Greece -f 
United Kingdom — 
Italy --
Spain --
Portugal -*-
155 
ranked by average height 160 165 
height in cm 
42 170 
Source: Eurobarometer 44.3/1996 
Table 3.8 
Average Height (in cm) 
Women 18 + Years by Age-Group, EU 15 (1996) 
THE NETHERLANDS 
DENMARK 
GERMANY W 
SWEDEN 
AUSTRIA 
GERMANY E 
LUXEMBOURG 
BELGIUM 
EU 15 
FINLAND 
IRELAND 
FRANCE 
GREECE 
UNITED KINGDOM 
ITALY 
SPAIN 
PORTUGAL AGE-GROUP 
18-29 
Years 
169.7 
167.8 
168.3 
166.8 
166.7 
165.7 
166.0 
165.8 
165.4 
165.6 
164.8 
164.6 
164.8 
163.6 
164.1 
164.4 
161.6 30-44 
Years 
168.6 
167.8 
167.5 
166.4 
166.2 
166.5 
165.0 
165.3 
164.3 
164.6 
163.5 
163.9 
163.3 
162.1 
162.9 
160.9 
160.7 45-59 
Years 
167.0 
165.6 
165.6 
165.6 
165.8 
165.3 
165.7 
162.8 
162.9 
163.7 
162.9 
162.1 
162.4 
162.4 
161.0 
159.7 
158.4 60 + Years 
164.8 
163.8 
162.7 
164.0 
163.2 
163.0 
163.2 
160.9 
161.4 
160.9 
162.3 
160.9 
159.9 
161.4 
160.7 
158.4 
157.9 Total 
18+ Years 
167.9 
166.3 
166.0 
165.7 
165.6 
165.2 
165.1 
163.7 
163.5 
163.4 
163.4 
163.0 
162.7 
162.3 
162.1 
161.0 
159.6 
Source : Eurobarometer 44.3/1996 
Figure 3.9 
Average Height (in cm) 
Women 18 + Years by Age-Group, EU 15 (1996) 
The Netherlands 
Denmark 
Germany W 
Sweden 
Austria 
Germany E 
Luxembourg 
Belgium 
EU 15 
Finland 
Ireland 
France 
Greece 
United Kingdom 
Italy --
Spain --
Portugal --
150 age 18-29 
—&— 
age 60+ 
ranked by average height 
length 155 160 165 
average height in cm 170 175 
Source: Eurobarometer 44.3/1996 
43 
Figure 3 JO 
Average Height (in cm) 
Women by Age-Group, EU 15 (1996) 
170 
165 
average 
height in cm 
160 -
155-
18-29 30-44 45-59 
Age-Group 60+ 
Source: Eurobarometer 44.3/1996 
44 
4. MORBIDITY 
The previous chapter described various health indicators such as life expectancy, infant 
mortality, and height. This chapter provides a brief overview of various morbidity 
measures. Because disease-specific morbidity indicators at the EC level do not exist, 
indirect measures, such as self-reported disability, both short-term and long-term, and use 
of health services, such as doctor consultations (in the past 2 weeks) and hospitalisations 
(in the past year) are used instead. The data for these measures come from the 1996 
Eurobarometer survey and the 1994 European Community Household Panel survey 
(ECHP). Because the latter survey was undertaken when the EC had only 12 Member 
States, the ECHP data are limited to those countries. 
4.1 Activity Limitations Due to Chronic Conditions 
As shown in Figure 4.1 and Table 4.2, almost one out of four women in the EC reports 
being limited in their daily activities to some extent (17.3%) or severely (6.3%) because of 
long-standing illness. This average ranges from a high of 30% in Finland and Portugal to a 
low of 15% in Luxembourg. While this measure may to some extent be influenced by each 
Member State's criteria for obtaining disability pensions, it is likely that it does reflect 
some underlying differences in the prevalence of disability in the female population. 
Certainly, the high percentage of Portuguese women reporting being hampered in then-
daily activities by long-standing illness corresponds well with the high percentage of them 
reporting being in poor health (see Section 3.4). 
Not surprisingly, the incidence of disability due to long-term illness increases uniformly 
with age. As shown in Figure 4.2, the percentage of women reporting being disabled to 
some extent or severely rises from 10.2% among 15-29 year-old women to 54.3% among 
women aged 75 years or older. The percentage women under 30 years who report being 
severely disabled is 1.5% while it is just over 20% for women aged 75 years and older 
(Table 4.2). 
When looking at older women only, i.e., those aged 65 years and older, it is noticeable 
that about half report being hampered to some extent (36.4%) or severely (12.3%) in their 
daily activities because of long-standing illness (see Table 4.3). Moreover, the ranking of 
disability among elderly women (aged 65 and over) differs from that among the entire 
population of women. This is shown in Figure 4.3, in which the Member States appear in 
the same order as in Figure 4.1, but that no longer corresponds to their relative ranking. 
For example, Greek women are ranked 10th on an overall population basis, just above the 
EC average, but Greece has the second highest percentage of elderly women with 
disability due to long-term illness. Thus, elderly Greek women are relatively more disabled 
than are younger Greek women. Similarly, Irish women have the third lowest percentage 
of disabled women overall, but the third highest among elderly women. 
4.2 Short-Term Activity Limitations 
Short-term activity limitations due to illness and injury are considerably less frequent than 
activity limitations due to chronic conditions. On average, 13.8% of EC women3 report 
Owing to data problems, only 11 of the then 12 Member States are included in this analysis. 
45 
having had to cut down on their usual activities in the past two weeks because of an 
illness or injury, but the range is considerable: only 5.6% of Italian women report having 
to cut down on their usual daily activities compared to almost 20% of Dutch women 
(Figure 4.4 and Table 4.4). 
Not surprisingly, the percentage of women who report short-term activity limitations is 
much greater among elderly women, with an average of almost 25% reporting such 
activity limitation due to illness and injury, and a range from a low in Italy of 12.0% to a 
high in Germany of 31.5%. It is remarkable that Italian women (aged 65 years and older) 
report the lowest frequency of short-term disability when they report one of the highest 
prevalences of disability due to chronic conditions. Apparently, these two measures 
capture different dimensions of disability (Figure 4.5 and Table 4.5). 
The last disability indicator to be reported here is short-term activity restrictions (in the 
past two weeks) because of emotional or mental health problems. As shown in Figure 4.6 
and Table 4.6, only about 3% of women in the EC report having had to reduce their daily 
activities due to an emotional or mental health problem. This ranges from a low in Italy of 
approximately 1% to a high of almost 9% in the Netherlands. 
When looking only at elderly women (aged 65 years and over), the pattern is the same but 
the level of activity restriction is higher. Thus, Italy reports the lowest incidence (2.8%) 
and the Netherlands reports the highest (11.2%), while the EU average is 5.0% (see 
Figure 4.7 and Table 4.7). Thus, the reported incidence of short-term restricted activity 
even among elderly women in the EC is quite low, both absolutely and relative to other 
types of activity restrictions. 
4.3 Doctor Consultations 
While restricted activity days are likely to result in a decline in quality of life, they do not 
necessarily give rise to medical consultations. In view of the cost implications, the 1996 
Eurobarometer survey asked its respondents whether they had consulted a physician in the 
past two weeks (either in person or on the telephone). The results are given in Figure 4.8 
and Table 4.8. On average, about one in three women had consulted a doctor in the past 
two weeks, with some variation between Member States. In Ireland and the Netherlands 
only 25% of women reported doing so, while 38% reported doing so in Spain. 
Not surprisingly, the percentage of women consulting a doctor (during the previous 2 
weeks) increases with age. While a sizeable proportion - almost one in four - seek medical 
help under the age of 30 years, this proportion increases uniformly with age until more 
than two out of five women seek medical help among the 75 and over group (Figure 4.9 
and Table 4.9) 
4.4 Hospitalisations 
Hospital stays (in a one-year period) provide another measure of morbidity in a 
population. As periods in hospital are only necessary for the most severe illnesses, they are 
relatively infrequent, even on an annual basis. As shown in Figure 4.10 and Table 4.10, 
only about 10% of EC women report having been hospitalised. However, hospitalisations 
vary considerably within the EC, only 3.8% of the Danish women asked reported having 
46 
been hospitalised in the previous year compared to nearly 13% in France and Finland3. 
These differences may to some extent reflect differences in the availability of hospital 
beds, which also varies considerably within the EC1. 
When looking at age-group differences, it is apparent that the increasing disability with 
older age also results in increasing hospitalisation. As shown in Figure 4.11 only 6.3% of 
women aged 15-29 years report having been hospitalised in the previous year, compared 
to 18% of women aged 75 years or over (Table 4.11). 
Figure 4.12 shows the average number of nights spent in the hospital for those women 
who had at least one non-birth hospitalisation. On average, women spent about 10 nights 
in the hospital in a 12-month period. Again, there were considerable variations across the 
Member States, with the former German Democratic Republic and the pre-unification 
Federal Republic of Germany reporting the highest number of nights in the hospital (14.9 
and 13.5, respectively) and Spain reporting the lowest (5.9) (see also Table 4.12). Care 
should be taken when interpreting these numbers, because of differences in the types of 
hospitals that exist in the various Member States and the relatively small number of 
hospitalisations that form the basis for these estimates. 
References 
1 Eurostat (1996), Social Portrait of Europe, Luxembourg: Office for Official Publications of the 
European Commoiities. 
Corresponding data from the 1994 ECHP survey yield slightly different results, probably because of 
different sampling methods and sizes. In particular, 15% of women in Luxembourg and 12% of 
women in Denmark report a hospitalisation in the previous year. 
47 
[Figures and Tables] 
48 
Figure 4d 
Percent with Disability Due to Long-Standing Illness 
Women 15 + Years, EU 15 (1996) 
Finland 
Portugal 
Denmark 
France 
United Kingdom 
Germany E 
Sweden 
Germany W 
Greece 
EU 15 
Austria 
Spain 
The Netherlands 
Belgium 
Ireland 
Italy 
Luxembourg • 
0% 20% 40% 60% 
yes 80% 100% 
Source: Eurobarometer 44.3/1996 
Table 4J 
Percent with Disability Due to Long-Standing Illness* 
Women 15+ Years, EU 15 (1996) 
no 
% yes,some 
% yes,severe 
% dk/refuse 
% 
Finland 
Portugal 
Denmark 
France 
United Kingdom 
Germany E 
Sweden 
Germany W 
Greece 
EU 15 
Austria 
Spain 
The Netherlands 
Belgium 
Ireland 
Italy 
Luxembourg 69.8 
69.9 
71.2 
72.4 
74.0 
72.1 
74.9 
73.8 
75.4 
75.7 
75.0 
78.4 
78.8 
80.5 
80.1 
82.4 
83.9 20.1 
17.2 
19.2 
18.4 
20.1 
16.9 
17.1 
17.7 
18.1 
17.3 
18.8 
15.8 
13.6 
15.6 
16.5 
14.6 
10.6 9.5 
12.4 
9.1 
8.6 
5.6 
8.5 
8.0 
7.2 
6.0 
6.3 
4.4 
4.8 
6.9 
3.5 
2.6 
2.8 
4.2 0.6 
0.5 
0.4 
0.6 
0.3 
2.6 
0.0 
1.3 
0.6 
0.8 
1.8 
1.0 
0.7 
0.4 
0.8 
0.2 
1.3 
Source: Eurobarometer 44.3/1996 
* Distribution of réponses to the following question : "Do you have any long-standing illness, health problem or handicap that 
limits, to some extent or severely, your work or daily activities? This includes all types of health problems as well as those due 
to old age. If yes, to some extent or severely ?" 
49 
Figure 4,2 
Percent with Disability Due to Long-Standing Illness 
by Age-Group and Severity, EU 15 (1996) 
100% 
75% 4-
50% I some+severe 
—A— 
severe only 
25% X 
15-29 30-44 45-59 60~-74 75+^ 
Age-Group 
Source: Eurobarometer 44.3/1996 
Table 4J 
Percent with Disability Due to Long-Standing Illness* 
By Age-Group, EU 15 (1996) 
Age-group 
15-29 
30-44 
45-59 
60-74 
75+ some + severe 
% 
10.2 
15.0 
27.4 
43.5 
54.3 severe only 
% 
1.5 
4.1 
8.1 
11.6 
20.3 
Source: Eurobarometer 44.3/1996 
* Distribution of réponses to the following question : "Do you have any long-standing illness, health problem or handicap that 
limits, to some extent or severely, your work or daily activities? This includes all types of health problems as well as those due 
to old age. If yes, to some extent or severely ?" 
50 
Table 4.3 
Percent with Disability Due to Long-Standing Illness* 
Women 65+ Years, EU 15 (1996) 
no 
% yes, some 
% yes, severe 
% dk/refuse 
% 
Finland 
Portugal 
Denmark 
France 
United Kingdom 
Germany E 
Sweden 
Germany W 
Greece 
EU 15 
Austria 
Spain 
The Netherlands 
Belgium 
Ireland 
Italy 
Luxembourg 48.7 
44.3 
57.0 
27.3 
55.1 
46.6 
59.6 
57.0 
34.5 
50.7 
45.1 
44.1 
81.8 
61.9 
42.3 
60.3 
68.6 31.9 
24.7 
26.7 
54.5 
34.7 
34.1 
28.1 
31.0 
48.8 
36.4 
40.7 
40.9 
12.1 
29.9 
45.1 
33.6 
17.6 19.3 
29.9 
15.1 
18.2 
10.2 
17.0 
12.4 
10.0 
15.5 
12.3 
12.1 
15.1 
6.1 
8.2 
11.3 
6.0 
13.7 0.0 
1.0 
1.2 
0.0 
0.0 
2.3 
0.0 
2.0 
1.2 
0.6 
2.2 
0.0 
0.0 
0.0 
1.4 
0.0 
0.0 
Source: Eurobarometer 44.3/1996 
* Distribution of réponses to the following question : "Do you have any long-standing illness, health problem or handicap that 
limits, to some extent or severely, your work or daily activities? This includes all types of health problems as well as those due 
to old age. If yes, to some extent or severely ?" 
Figure 4.3 
Percent with Disability Due to Long-Standing Illness* 
Women 65 + Years, EU 15 (1996) 
Finland 
Portugal 
Denmark 
France 
United Kingdom 
Germany E 
Sweden 
Germany W 
Greece 
EU 15 
Austria 
Spain 
The Netherlands 
Belgium 
Ireland 
Italy 
Luxembourg 
0% 
ranked according to figure 4.1 • 
20% 40% 60% 80% 100% 
Source: Eurobarometer 44.3/1996 yes 
Distribution of réponses to the following question : "Do you have any long-standing illness, health problem or handicap that 
limits, to some extent or severely, your work or daily activities? This includes all types of health problems as well as those due 
to old age. If yes, to some extent or severely ?" 
51 
Figure 4.4 
Percent with Restricted Activity in Past 2 Weeks 
Due to Illness or Injury 
Women 16+ Years, EU 11* (1994) 
Source : European Community Household Panel 1994 
* Excluding France 
Table 4.4 
Percent with Restricted Activity in Past 2 Weeks 
Due to Illness or Injury 
Women 16+ Years, EU 11* (1994) 
EU 11* 
Italy (IT) 
Greece (GR) 
Ireland (IE) 
Belgium (BE) 
Spain (ES) 
Portugal (PT) 
Luxembourg (LU) 
United Kingdom (UK) 
Germany (D) 
Denmark (DK) 
The Netherlands (NL) Percent 
13.8 
5.6 
9.4 
10.9 
11.4 
13.6 
14.6 
14.9 
14.9 
18.6 
19.0 
19.9 
Source : European Community Household Panel 1994 
* Excluding France 
52 
Figure 4,5 
Percent with Restricted Activity in Past 2 Weeks 
Due to Illness or Injury 
Women 65+ Years, EU 11* (1994) 
Source : European Community Household Panel 1994 
* Excluding France 
Table 4,5 
Percent with Restricted Activity in Past 2 Weeks 
Due to Illness or Injury 
Women 65+ Years, EU 11* (1994) 
EU 11* 
Italy (IT) 
Greece (GR) 
Ireland (IE) 
Belgium (BE) 
Spain (ES) 
Portugal (PT) 
Luxembourg (LU) 
United Kingdom (UK) 
Germany (D) 
Denmark (DK) 
The Netherlands (NL) Percent 
24.4 
12.0 
21.6 
19.4 
18.8 
27.7 
29.0 
23.4 
22.7 
31.5 
27.0 
27.8 
Source : European Community Household Panel 1994 
* Excluding France 
53 
Figure 4,6 
Percent with Restricted Activity in Past 2 Weeks 
Due to Emotional or Mental Health Problem 
Women 16+ Years, EU 12 (1994) 
Source : European Community Household Pnnel 1994 
Table 4.6 
Percent with Restricted Activity in Past 2 Weeks 
Due to Emotional or Mental Health Problem 
Women 16+ Years, EU 12 (1994) 
EU 12 
Italy (IT) 
Greece (GR) 
Ireland (IE) 
Belgium (BE) 
Spain (ES) 
Portugal (PT) 
Luxembourg (LU) 
France (FR) 
Germany (D) 
Denmark (DK) 
The Netherlands (NL) 
United Kingdom (UK) Percent 
3.2 
1.2 
2.4 
3.9 
4.3 
3.0 
4.4 
4.5 
1.8 • 
3.7 
5.4 
8.7 
3.8 
Source : European Community Household Panel 1994 
54 
Figure 4.7 
Percent with Restricted Activity in Past 2 Weeks 
Due to Emotional or Mental Health Problem 
Women 65+ Years, EU 12 (1994) 
% 
12 
EU BE DK 
12 DGR ES FR IE IT LU NL PT UK 
Source : European Community Household Panel 1994 
Table 4.7 
Percent with Restricted Activity in Past 2 Weeks 
Due to Emotional or Mental Health Problem 
Women 65+ Years, EU 12 (1994) 
EU 12 
Italy (IT) 
Greece (GR) 
Ireland (IE) 
Belgium (BE) 
Spain (ES) 
Portugal (PT) 
Luxembourg (LU) 
France (FR) 
Germany (D) 
Denmark (DK) 
The Netherlands (NL) 
United Kingdom (UK) Percent 
5.0 
2.8 
4.1 
5.2 
6.8 
5.8 
4.7 
7.5 
3.2 
6.5 
7.8 
11.2 
4.2 
Source : European Community Household Panel 1994 
55 
Figure 4.8 
Percent Women with Doctor Consultation(s) in Past 2 Weeks 
Women 15+ Years, EU 15 (1996) 
Belgium \^L^mvw^^v,m<^-M 
Greece 
h-eland 
The Netherlands Luxembourg ^U^^mttbm^^A 
Germany E p^â^^»àMM«M^y 
Uhited Kingdom 
Austria mmmMmÊummmiâtA 
Sweden I 
0% 20% 40% 60% 80% 100% 
Yes 
Table 4.8 
Percent Women with Doctor Consultation(s) in Past 2 Weeks 
Women 15+ Years, EU 15 (1996) 
Spain 
Italy 
Portugal 
France 
UE15 
Belgium 
Greece 
Germany W 
Finland 
Denmark 
Luxembourg 
Germany E 
Austria 
United Kingdom 
Sweden 
Ireland 
The Netherlands Consultation 
% 
37.8 
36.4 
34.8 
33.3 
31.7 
31.5 
31.0 
30.9 
29.7 
29.7 
28.9 
28.4 
26.7 
26.7 
26.3 
24.6 
24.6 No Consultation 
% 
62.2 
63.6 
65.2 
66.7 
68.3 
68.5 
69.0 
69.1 
70.3 
70.3 
71.1 
71.6 
73.3 
73.3 
73.7 
75.4 
75.4 
Source: Eurobarometer 44.3/1996 
56 
Figure 4.9 
Percent Women with Doctor Consultation^) in Past 2 Weeks 
By Age-Group, EU 15 (1996) 
100% r 
75%4-
50%-r 
yes ; 
+ 
! 
25% +• 
0% ^ i i j 1 j. 1 
15-29 30-44 45-59 60-74 75+ 
age-groups 
Source : Eurobarometer 44.3/1996 
Table 4.9 
Percent Women with Doctor Consultation^) in Past 2 Weeks 
By Age-Group, EU 15 (1996) 
% 
Age-Group 
15-29 23.9 
30-44 25.7 
45-59 32.1 
60-74 39.2 
75+ 41.8 
Source: Eurobarometer 44.3/1996 
57 
Figure 4.10 
Percentage with Non-Birth Hospitalisation(s) in Past Year 
Women 16+ Years, EU 15 (1996) 
France 
Finland 
Ireland 
Austria 
United Kingdom 
Portugal 
Italy 
Sweden 
EU 15 
Germany W 
The Netherlands 
Belgium 
Germany E 
Spain 
Greece 
Luxembourg 
Denmark 
100% 
Source: Eurobarometer 44.3/1996 
Table 4,10 
Percentage with Non-Birth Hospitalisation(s) in Past Year 
Women 16+ Years, EU 15 (1996) 
No Hospitalisation 
% Hospitalisation 
% 
France 
Finland 
Ireland 
Austria 
United Kingdom 
Portugal 
Italy 
Sweden 
EU 15 
Germany W 
The Netherlands 
Belgium 
Germany E 
Spain 
Greece 
Luxembourg 
Denmark 87.3 
87.3 
88.9 
89.5 
89.6 
90.2 
90.5 
90.5 
90.5 
91.5 
92.1 
92.2 
92.3 
92.5 
93.0 
95.4 
96.2 12:7 
12.7 
11.1 
10.5 
10.4 
9.8 
9.5 
9.5 
9.5 
8.5 
7.9 
7.8 
7.7 
7.5 
7.0 
4.6 
3.8 
Source: Eurobarometer 44.3/1996 
58 
Figure 4,11 
Percentage with Non-Birth Hospitalisation(s) in Past Year 
By Age-Group, EU 15 (1996) 
100% 
75% 4-
50% 4-
yes 
25% 4-
0% 
15-29 30-44 45-59 60-74 75+ 
Age-Group 
Source: Eurobarometer 44.3/1996 
Table 4,11 
Percentage with Non-Birth Hospitalisation(s) in Past Year 
By Age-Group, EU 15 (1996) 
No Hospitalisation Hospitalisation 
Age-Group 
15-29 
30-44 
45-59 
60-74 
75+ % 
93.7 
92.8 
90.8 
87.4 
82.0 % 
6.3 
7.2 
9.2 
12.6 
18.0' 
Source: Eurobarometer 44.3/1996 
59 
Figure 4.12 
Average Number of Nights in the Hospital* in Past Year 
Women 15+ Years, EU 15 (1996) 
Germany E 
Germany W 
Austria 
The Netherlands 
Greece 
Luxembourg 
France 
Italy 
EU 15 
Denmark 
Portugal 
Ireland 
Finland 
Belgium 
United Kingdom 
Sweden 
Spain m\ssm\ssmmswi 
EU 
average 
SMMMMMMMM 
10 15 
average nights in hospital 20 25 
Source: Eurobarometer 44.3/1996 
For those women with at least one (non-birth) hospitalisation in the past year. 
Table 4.12 
Average Number of Nigths in the Hospital* in Past Year 
Women 15+ Years, EU 15 (1996) 
Germany E 
Germany W 
Austria 
The Netherlands 
Greece 
Luxembourg 
France 
Italy 
EU 15 
Denmark 
Portugal 
Ireland 
Finland 
Belgium 
United Kingdom 
Sweden 
Spain Number 
nights** 
14.9 
13.5 
12.8 
11.1 
10.7 
10.2 
10.0 
9.8 
9.8 
9.3 
9.2 
9.1 
8.9 
8.8 
6.2 
6.0 
5.9 
Source : Eurobarometer 44.3/1996 
* For those women with at least one (non-birth) hospitalisation in the past year. 
** N= 729; 8 cases (outliers) are excluded (those above 60 days). 
60 
5. CAUSES OF DEATH AND TRENDS IN FEMALE 
MORTALITY 
While the previous section focused on different measures of morbidity, this section 
concentrates on the main causes of death for women in the EC. It also describes the trends 
during the past two to three decades as well as the main risk factors associated with the 
diseases (and conditions) that are the main cause of female mortality in the EC (e.g., 
smoking and drinking). As will become apparent, much of the current premature mortality 
(i.e., deaths among women under 65 years) may be prevented through primary prevention 
(changes in life style) or secondary prevention (early detection of disease). 
The main causes of female mortality (across all age-groups) are illustrated in Figure 5.1. 
The two largest causes of death among women are diseases of the circulatory system, 
which account for 43% of all deaths, and cancer which accounts for 26%. However, the 
major causes of death vary with age. Motor vehicle accidents are the main cause of 
mortality for women under 30 years, while suicide is the main cause for the 30-34 age-
group. Cancer, specifically 'female cancers', such as breast and cervical cancer, is the 
main cause of death for women aged 35-64 years. For elderly women (65 years and 
older), it is diseases of the circulatory system that account for most deaths, approximately 
half of all deaths in this age-group1. 
5.1 Motor Vehicle Accidents 
Approximately 50,000 people are killed annually in the EU on the roads either as 
occupants of motor vehicles or pedestrians. Alcohol abuse is a significant cause of motor 
vehicle accidents. While such accidents are still an important cause of female mortality 
(see Figure 5.1), the rate of mortality has been declining. As can be seen in Figure 5.2, 
women's average mortality from motor vehicle accidents declined by nearly 40% from 
1970 to 1992, to 6.42 deaths per 100,000. The rates range considerably, from a high in 
Luxembourg of 11.39 per 100,000 to a low of 4.14 per 100,000 in the UK. The rates of 
change since 1970 vary to an even greater extent, with all but three Member States 
reporting declining rates of between 25% (in Italy) to 64% (in the Netherlands* 2). 
However, Greece reports an increase of almost 62%, while Luxembourg, Portugal, and 
Spain report smaller increases (4-14%). 
5.2 Suicide and Self-Inflicted Injury 
More than 40,000 people in the EU commit suicide each year3. While men are more likely 
than women to commit suicide, the so-called parasuicide (attempted suicide) rate is higher 
for women4, perhaps because women tend to use less violent methods than do men . 
Overall female mortality from suicide has decreased by 24% since 1970, 6.24 deaths per 
100,000 (see Figure 5.3). Suicide rates vary considerably within the EC, with a tendency 
toward higher rates in the North. Luxembourg has the highest suicide rate with 14.30 per 
a The educational programme implemented by the Traffic Safety Foundation in the Netherlands may 
61 have contributed to the decrease there2. 
100,000, followed by Denmark with a rate of 13.67* 6. Both rates are over twice the EC 
average. Greece has the lowest rate with 1.21 deaths per 100,000. 
Risk factors for suicide and parasuicide include alcoholism, depression, and socio­
economic problems. Women with eating disorders, such as anorexia an4 bulimia, are also 
at higher risk of committing suicide and parasuicide7. Furthermore, women who have 
attempted suicide are much more hkely to try again. Several studies estimates the risk of 
suicide within one to two years after a suicide attempt as several times higher than that for 
the average population8. 
5.3 Cancer as a Cause of Female Mortality 
Cancer is the second leading cause of death for women in the EC after diseases of the 
circulatory system, causing 26% of all female deaths in the Community in 1992 (see 
Figure 5.1). Furthermore, it is the primary cause of death for women 35-64 years of age. 
Figures 5.4 and 5.5 show women's mortality rates from cancer in the Member States. 
The EC average for women under 65 years was 69.74 per 100,000 in 1992, and 150.30 
for women of all ages, indicating that most cancer mortality occurs among elderly women 
(over 65 years of age). 
Cancer mortality for women under 65 years has declined by 13% since 1970, while it has 
declined by only 5% for all women combined. Among Member States there is a clear 
North-South division, with the Northern Member States generally reporting higher rates. 
However, both Sweden and Finland are below the EC average, with Finland having one of 
the lowest cancer rates in the EC. Conversely, Denmark has the highest rates in the EC 
(102.23 per 100,000 among women under 65 years, and 203.73 per 100,000 for all ages). 
Moreover, Denmark is the only Member State to report a (slight) increase (0.28%) since 
1970 among women under 65 years, and one of only four Member States to see an 
increase in cancer mortality across all ages. 
The so-called 'female' cancers (breast, cervix, and uterus) account for more than 23% of 
all cancer deaths. By comparison cancer of the digestive organs accounts for 32% and 
cancer of the respiratory system (trachea, bronchus, and lung) for 9% (see Figure 5.6). 
Importantly, the latter group of cancers have been rising among women but generally 
falling among menb 9, probably because smoking rates have been rising among women and 
falling among men (see Section 6.1). All these cancers are to a high degree related to life 
style and environment and therefore to a large extent preventable. They account for 
considerable premature mortality among women (under 65 years). 
5.3.1 Breast Cancer 
Breast cancer is one of the most common types of cancer among women in the EC, as 
well as in other industrialised countries, such as the United States and Canada. Breast 
cancer was responsible for around 21% of all female cancer deaths in the EC in 1992 (see 
Figure 5.6). It is also the main cause of death for women aged 35-64 years10. It has been 
A Danish study concluded that women there had a greater tendency to use violent methods, which 
may partly explain their relatively greater rates of 'success'6. 
Cancer of the trachea, bronchus, and lung has declined since 1970 by almost 20% among men, while 
it has increased by almost 70% among women in the EC9. 
62 
estimated that a woman in the EC has a 2-3% chance of developing breast cancer during 
her lifetime11. 
The incidence of breast cancer is still rising in many Member States, though this may 
partly be due to the increased level of detection through screening programmes. Survival 
rates are improving because of earlier detection and more effective therapies, although 
survival rates are better for women under 50 years (60% survival after 5 years) than for 
older women (only 40% survival after 5 years)12. Survival rates also vary markedly 
according to whether the cancer is localised or has spread at the point of diagnosis. The 
rate of survival is over 90% when the cancer is localised within the breast, 75% when it 
has spread to adjoining areas, but below 20% when the cancer has reached other distant 
sites13. 
Figures 5.7 and 5.8 detail the EC breast cancer mortality rates in 1992. The average for 
women of all ages was 31.25 deaths per 100,000 (a 16% decline since 1970), while for 
women under 65 years, the mortality rate was 19.80 per 100,000 (a fall of 9.27%). These 
rates vary considerably across the Member States. For all ages Denmark has the highest 
rate (40.56 per 100,000) followed by the UK (39.23 per 100,000), while Greece has the 
lowest rate (21.32 per 100,000). The Greek rate, however, has risen by nearly 57% since 
1970, a rise that is second only to the 73% increase of Spain. 
Among women under 65 years Ireland has the highest rate (25.80 per 100,000), followed 
by Denmark (24.77 per 100,000). The Irish rate increased by 17% since 1970, while the 
Danish rate remained virtually unchanged. As was the case for the mortality rate for all 
ages, Greece has the lowest rate among women under 65 years (14.58 per 100,000), but 
has seen an increase of 45% over the rate in 1970. Spain also reports an increased rate 
(almost 62%). Figure 5.9, which shows how the rates in six EC countries changed 
between 1970 and 1992, clearly demonstrates the rising trend in Spain. 
There is insufficient knowledge about the causes and relevant risk factors for breast 
cancer. Approximately 80% of wo*nen who develop it have none of the known risk 
factors14. The most important known parameters include age (the risk increases with age, 
and 2/3 of cases are in women over 50 years of age), and having a mother and/or a sister 
with breast cancer. Less important risk factors include early menarche (under 11), late 
menopause (over 54 years), being over 30 years at first full term pregnancy, and never 
having had any children. Other risk factors include having had certain breast diseases and 
a history of ovarian and/or endometrial cancer. It has been suggested that living in 
urbanised societies, the consumption of a diet high in animal fat and protein, and having 
high economic status may also be linked with breast cancer. Recent evidence suggests that 
alcohol consumption may also be a risk factor for breast cancer15. 
Given the inadequate knowledge about the causes and associated risk factors of breast 
cancer, secondary prevention through early detection by self-examination, clinical 
examination and mammography is very important. Further research into the causes of 
breast cancer is needed to establish how far it might be preventable. International 
differences in incidence and studies on the development of breast cancer among different 
generations of immigrants support the idea that exposure to certain risk factors plays a 
key role16. 
63 
5.3.2 Cervical Cancer 
Cancer of the cervix is the second most common of the 'female' cancers in the EC, 
responsible for around 2% of all cancer deaths (see Figure 5.6). Cervical cancer develops 
very slowly and, if the cancer is detected while still locaUsed (pre-invasive), the 5-year 
relative survival rate is high, around 88%. However, if the cancer is detected in the later, 
invasive stages the survival rate falls to 13%17. 
Figures 5.10 and 5.11 show that mortality rates for cervical cancer have fallen in most 
Member States since 1970. The EC average mortality rate for women under 65 years has 
decreased to 2.28 per 100,000, corresponding to a decline of nearly 48% (Figure 5.10). 
For women of all ages mortality due to cervical cancer has declined by more than 40% , to 
3.28 per 100,000 (Figure 5.11). Denmark has the highest mortality rate among women 
under 65 years of age (4.64 per 100,000) but has experienced a fall of more than 55% 
since 1970. Only in Spain* 18 and Greece has the rate been rising, but it is still relatively 
low in these countries. Greece has the third lowest rate in the EC (1.31 per 100,000) 
while Spain has the fourth lowest (1.66 per 100,000). Italy has the lowest rate at 0.75 per 
100,000. 
The picture for all ages closely mirrors that of the under 65 age-group. Denmark has the 
highest rate, while Italy has the lowest rate, and Spain and Greece are the only Member 
States to report increases in mortality since 1970 (see Figure 5.11). 
The general reduction in mortality may partly be attributable to effective screening 
programmes. It is now widely accepted that cervical cancer occurs after sexual 
transmission of a carcinogen. The principal known risk factor for cervical cancer is 
infection with the human papilloma virus (HPVI6 and HPV18) and, to a lesser degree, 
with other sexually transmitted diseases (STDs), such as herpes, gonorrhoea, and 
chlamydia. Strong risk factors for this type of cancer are, therefore, 'unsafe' sex in 
general, early age at first intercourse (under 16 years), multiple sexual partners, and a past 
(or present) sexual partner infected with HPV or other STD(s). Other risk factors include 
active and/or passive smoking, infection with HTV, and poor nutrition19. 
5.3.3 Cancer of the Respiratory System 
As can be seen from Figure 5.6, 9% of deaths from cancer among women are attributable 
to lung cancer b. The EC average mortality rate for women of under 65 years has 
increased since 1970 by almost 45% to 66.3 per 100,000 (see Figure 5.13), while the 
corresponding rate for all women has increased by almost 70% since 1970, to 14.05 per 
100,000 (see Figure 5.14). The rate of increase since 1970 has been most marked in the 
Netherlands and Denmark (for all ages as well as for the under 65 year-olds), while Spain 
has actually experienced a decline in lung cancer mortality among women (for all ages as 
well as for the under 65 year-olds). France has also seen a decline in lung cancer mortality 
but only among women less than 65 years old. 
Research in Spain to determine causes for increased mortality from cervical cancer found a 
connection with increased sexual activity associated with increased tourism and a low level of 
education18. 
In this section we refer to lung cancer for the sake of brevity, but this includes other cancers of the 
respiratory system, such as cancer of the trachea and bronchus. 
64 
Within the EC, Denmark stands out as having by far the highest female mortality rates due 
to lung cancer, followed by the UK, Ireland, and the Netherlands. The Danish mortality 
rate is more than three times the EC average among women under 65 years, and more 
than twice the EC average for all ages. In contrast, the Mediterranean countries tend to 
have lower lung cancer mortality rates (see Figures 5.13 and 5.14). These results are 
consistent with the lower levels of smoking among women in the Mediterranean countries 
during the past decades and the high level of smoking among Danish women during the 
past forty years or more20. 
Given the high increases in lung cancer mortality among women, it is not surprising that 
there is considerably uncertainty in the general population (of women) in the EC about 
which gender is more affected by lung cancer. As shown in Figure 5.15 and Table 5.1, 
about half of all women asked in the 1996 Eurobarometer survey, thought that men were 
more affected by lung cancer than women, but more than one third did not know. 
Responses varied considerably within the EC. In particular, in Finland, 80% of those 
asked thought men had a higher incidence of lung cancer, whereas in Sweden 48% did not 
know. This striking difference between neighbouring countries may be partly explained by 
the higher female lung cancer mortality rates in Sweden (above the EC average) than in 
Finland which is below the EC average (see Figures 5.13 and 5.14). 
Lung cancer is typically caused by inhalation of carcinogenic materials, such as tobacco 
smoke and asbestos, and by exposure to ionising radiation21. In particular, tobacco 
smoking is associated with greatly elevated risk of lung cancer. One study estimates that 
the risk of lung cancer is more than 12 times higher among women smokers than among 
non-smokers, and 25 times as great among male smokers as among non-smokers, 
corresponding to about 85 to 90% of all lung cancers being caused by smoking22. Passive 
smoking has also been shown to increase the risk of lung cancer although to a much lower 
degree . Other risk factors include environmental pollution, poor nutrition, overcrowded 
housing, and low socio-economic status24. 
5.4 Diseases of the Circulatory System (Cardiovascular Diseases) 
Diseases of the circulatory system (particularly ischaemic heart disease3 and 
cerebrovascular diseases, or stroke) are disorders of the heart and blood vessels. They are 
the main cause of mortality (as well as morbidity and disability) among women generally 
in the EC (see Figure 5.1) and the second most important cause of premature death 
(under 65 years of age) after cancer. 
These diseases are characteristic of developed Western societies and life style. They are 
also related to social class25. Thus, to a great extent these diseases are preventable through 
life style changes, such as not smoking and eating a diet low in saturated fats, sugar and 
salt26. Women appear to be differently affected by these diseases than men: They develop 
them more often, but at a later age, and particularly after the age of 65 years, when 
incidence and mortality increases rapidly. Another difference is that women have more 
strokes while men have more heart attacks. 
Ischaemic heart disease is frequently used synonymously with coronary heart disease, however, the 
two are not strictly identical, because it is possible to have coronary heart disease without ischaemia 
(poor oxygen flow to the heart). Because death is caused by a lack of oxygen flow to the heart (i.e., by 
ischaemia), ischaemic heart disease is the term used in this report. 
65 
Death rates for circulatory diseases have decreased in all Member States since 1970 
among women under 65 years of age. The EC average mortality rate for this age-group 
has dropped more than 50% since 1970, to 31.56 per 100,000 (Figure 5.1), with a range 
going from 64% decline in Finland to 32% decline in Denmark and Greece. The story is 
similar for women of all ages, except that in this case, the overall decline (since 1970) in 
mortality due to diseases of the circulatory system was only 37%. Furthermore, the 
overall mortality rate is much higher (248.44 per 100,000). Again, the Member States 
vary in the extent to which their mortality rates have declined. In particular, Greece stands 
out because it reports an overall increase (7.54%) in mortality since 1970 (Figure 5.17). 
5.5 Ischaemic Heart Disease 
Ischaemic heart disease is the largest single cause of female mortality in the EC. Despite 
this, it is often perceived by the public and media as a 'male' disease. As shown in Figure 
5.18 and Table 5.2, almost 60% of the women asked during the 1996 Eurobarometer 
survey, indicated that they thought that heart disease affected many more men than 
women. Over the last years some Member States have implemented prevention campaigns 
specifically addressed to women, for example, the campaign organised by the British 
Heart Foundation which referred to heart disease as 'Britain's no. 1 lady killer'27 28. 
Heart disease follows a different pattern for women than for men. Typically men begin to 
develop ischaemic heart disease at an earlier age, often in their 40s and 50s, while women 
tend to be in their 60s, i.e., after menopause. This difference is assumed to be caused 
partly by the protective characteristics of the female oestrogen hormone, but may also be 
the result of lower iron stores in pre-menopausal women29. Data about coronary heart 
disease in women are generally insufficient, in part because many studies are carried out 
on men. Further investigation is required into claims that women more often have 
unrecognised symptoms, different symptoms, and different survival rates than do men30 31 
32 
While there are significant variations in mortality from ischaemic heart disease, rates ha~ „ 
generally been declining since 1970. Among women under 65 years of age, the mortality 
rate has declined by just over one third since 1970, to about 12 per 100,000 (Figure 
5.19). The mortality rate varies from a high of 24.31 per 100,000 in Ireland to 4.51 per 
100,000 in France. The rate of decline also varies, from a high of 60% in Finland to a low 
of about 2% in Greece. 
As already noted, mortality rates are much higher among older women, accounting for the 
much higher rates when this group is included. As shown in Figure 5.20, the EC average 
mortality rate for ischaemic heart disease among women of all ages is 84.75 per 100,000. 
The range varies from a high of 149.75 per 100,000 in Finland to a low of 36.94 per 
100,000 in France. All but three Member States (Greece, Spain, and Germany) report 
declines in overall mortality, ranging from 20% (in Portugal) to 46% (in Sweden). 
The decrease in mortality rates is linked with changes in diet, notably a decrease in 
saturated fat intake, and declining smoking rates in certain groups and Member States. 
Notwithstanding its decline, ischaemic heart disease continues to be one of the main 
causes of premature and overall mortality for women in the EC. Moreover, decreases in 
mortality rates may hide increased rates of morbidity, specifically among elderly women. 
Furthermore, ischaemic heart disease is Unked with chronic disability, high health care 
66 
expenditures and other economic costs, such as loss of working days, and often with a 
decline in quality of life. 
There are many risk factors for heart disease. Some, such as ageing and genetic 
disposition, can not be altered, but the three most important risk factors - smoking, 
hypertension, and high levels of blood cholesterol - may be influenced either by life style 
changes or through medication. 
Smoking is the single most important risk factor. The risk increases with the number of 
cigarettes smoked, in particular, for women over 35 years of age, who take oral 
contraceptives. Women are particularly vulnerable to developing hypertension after the 
age of 50 years. Furthermore, blood cholesterol levels also increase with age. Other risk 
factors for ischaemic heart disease include being overweight (see Section 6.3), diabetic, 
having a sedentary life style, and drinking excessively. Lower socio-economic status and 
occupational stress have also been associated with increased risk of ischaemic heart 
disease33. 
Interestingly, stress is often perceived by the general public as a key risk factor for 
developing heart disease, even though medical evidence to support this notion is lacking, 
except as regards occupational stress. As shown in Figure 5.21 and Table 5.3, almost 
20% of the women asked during the 1996 Eurobarometer survey, rated stress as the main 
risk factor for heart disease. In Greece, Sweden, and the Netherlands over 30% regarded 
stress as a principal risk. In comparison with other (known) risk factors, stress was the 
second most frequently mentioned main risk factor, after smoking but ahead of an 
unhealthy diet, overweight, lack of exercise and excessive alcohol consumption (in that 
order). These results indicate that there is significant ignorance throughout the EC among 
women as to the main risk factors for heart disease. This points to an area where public 
health interventions might be targeted. 
5.6 Cerebrovascular Disease (Stroke) 
Another major disease of the circulatory system is cerebrovascular disease (stroke). The 
risk of this disease for women increases with age, especially after 65, in part because of 
increased rates of high blood pressure among older women. As with ischaemic heart 
disease, the mortality rates for stroke for women under 65 years have declined 
significantly since 1970, dropping almost 43% to an average of 8.73 deaths per 100,000. 
All Member States have experienced declines, ranging from a high of 69% in Ireland to a 
low of 2% in Luxembourg (see Figure 5.22). Among women under 65 years, Portugal 
has the highest mortality rate (18.42 per 100,000) while France has the lowest (5.80 per 
100,000). 
As already mentioned, the highest mortality from stroke occurs among elderly women. As 
a result, the mortality rates for all ages, which include this age-group, are much higher 
than those shown in Figure 5.22. As shown in Figure 5.23, the average mortality for 
women of all ages in the EC is 75.93 per 100,000. This rate varies from a high of 175.63 
per 100,000 in Portugal to a low of 44.11 per 100,000 in France, which has the lowest 
rate in the EC of both ischaemic heart disease and cerebrovascular disease. As was the 
case for younger women, mortality rates for all age-groups combined have declined since 
1970, by almost 43% at the EC level. However, rates have actually increased in 
67 
Luxembourg (10%) and in Greece (1%). In the other Member States, mortality rates have 
declined between 26% (in Portugal) and 60% (in France). 
The main risk factor for cerebrovascular disease is high blood pressure. Other risk factors 
include previous heart disease and/or stroke, diabetes, and excessive alcohol consumption. 
Smoking has also been linked with cerebrovascular disease, although to a lesser extent 
than with ischaemic heart disease34. As with that disease, healthy life styles and 
appropriate health care can contribute to a reduction in female deaths, particularly among 
women under 65. 
References 
1 CEC (1995a) Report from the Commission on the State of Health in the European Community, 1995, 
COM (95) 357 final, Brussel: CEC, and Abel-Smith, B., Figueras, I, Holland, W., McKee, M, 
Mossialos, E. (1995). Choices in Health Policy: London, Dartmouth. 
2 Abel-Smith et al. ( 1995), ibid 
3 Eurostat (1995a). Women and men in the European Union: A Statistical Portrait. Luxembourg: Office 
for Official Publications of the European Communities. 
4 Plans et al. (1992), "WHO/EURO multicentre study on parasuicide". Acta Psychiatrica Scandinavica, 
85: 97-104. 
5 Ministry of Health, Denmark (1994b), Trends in Suicide Mortality in Denmark 1955-1991 (in 
Danish), Copenhagen, Denmark. 
6 Bille-Brahe, U. and G. Jessen (1994) "Suicide in Denmark, 1922-1991: The Choice of Method," Acta 
Psychiatrica Scandinavica 90(2) 91-96. 
7 Weilandt, C. (1996), German Report on Woman's Health, Bonn: Unpublished. 
8 Ministry of Health, Denmark (1994b). Trends in Suicide Mortality in Denmark 1955-1991 (in 
Danish), Copenhagen, Denmark. 
Nordentoft, M., et al. (1993), "High mortality by natural and unnatural causes: A 10 year follow up 
study of patients admitted to a poisoning treatment centre after suicide attempts". British Medical 
Journal, 306: 1637-41. 
Fisher, N.J., Nielsen, P.K. (1993), "Death after previous self-inflicted poisonings. A ten-year study 
from an intensive care unit" (in Danish), Ugeskrift for Lœger, 155: 1857-61. 
9 WHO (1996), Health for All Database, Copenhagen: WHO Regional Office for Europe. 
10 Eurostat (1995a), Women and Men in the European Union, Luxembourg: Office for Official 
Publications of the European Communities. 
11 CEC (1995a), Report from the Commission on the State of Health in the European Community, 
COM(95) 357 final, Brussels: CEC. 
12 Ibid 
13 Scientific American (96), Special Issue: "What you need to know about cancer", Vol. 275, No.3. 
14 The National Women's Health Resource Center (1992), National Women's Health Report, New York: 
The National Women's Health Resource Center. 
15 See for example Le. M.G., et al. (1984), "Alcoholic beverage consumption and breast cancer in a 
French case-control study," Am J Epidemiol., 120:350-357; Rohan, T.E., McMichael, A.J. (1988), 
"Alcohol consumption and risk of breast cancer," Int J Cancer, 41:695-699; and Willett, W.C.. et al 
(1987), "Moderate alcohol censumption and the risk of breast cancer," N Engl J Med., 316:1174-
1180. 
16 See e.g., Kliewer E.V., Smith K.R (1995). "Breast cancer mortality among immigrants in Australia 
and Canada". Journal of the National Cancer Institute 87(15): 1154-1161. 
17 CancerNet from the National Cancer Institute (1996a). Screening for cervical cancer, 208/04728. 
18 Vioque, J., Feenollar J. (1995) "The distribution of mortality by cervical cancer in Spain from 1981 to 
1986. An ecological study," Medicina Clinica; 104 (8): 287-92. 
19 CancerNet from the National Cancer Institute (1996b). Prevention of cervical cancer,208/04734. 
20 Ministry of Health, Denmark (1994a), Lifetime in Denmark, Copenhagen: Ministry of Health. 
21 Burdorf, A. Swuste, P. Maas, P.w.d (1998), "Asbest en gezondheid: van patienbespreking naar 
erkenning van beroepsziekten in Nederland", Ned Tijdschr Geneeskunde, 132:2167-77. 
68 
22 Ministry of Health, Denmark (1994c): Cancer Trends and Cancer Mortality (in Danish), Copenhagen, 
Denmark. 
Schaapveld, K., Hirasing, R.A (1993), Preventiegids, Assen/Maastricht: Van Gorcum. 
23 Smith, G.D. and AN. PhilUps (1996), "Passive smoking and Health: Should we beheve Philip 
Morris's 'experts'?" BMJ\ 313: 929-33. See also: European Working Group (1996): Environmental 
tobacco smoke and lung cancer risk: an evaluation of the risk. Trondheim: European Working Group. 
Law, M.R., Hackshaw, A.K. (1996), "Environmental Tobacco Smoke". Br Med Bull; 52: 22-34. 
Lee, PN (1992). Environmental tobacco smoke and mortality. Bask Karger. 
24 Hein, Suadicani, and Gyntelberg (1992): "Lung Cancer Risk and Social Class," Danish Medical 
Bulletin, 39:173-6. 
25 Hall, EM., Johnson, J.V., Tsou, T. (1993), "Women, Occupation, and Risk of Cardiovascular 
Morbidity and Mortality," Occupational Medicine, Vol. 8, No. 4, 709-719. 
26 Sytkowski, PA, Kunnel, W.B., D'Agostino, R.B. (1990), "Changes in risk factors and the decline in 
mortality from cardiovascular disease," N Eng J Med; 322: 1635-41. 
27 Tunstall-Pedoe, H. et al. (1994). "Myocardial Infarction and Coronary Deaths in the WHO MONICA 
Project", Circulation, 90: 583-612. 
28 British Heart Foundation (1996), personal communication. 
29 Salonen, J.T., et al. (1992), "High Stored iron are associated with excess risk of myocardial infarction 
in eastern Finnish men," Circulation, 86:803-811. 
30 Fiebach, N.H., Viscoli, M., Horwitz, R.I. (1990), "Differences between Women and Men in Survival 
after Myocardial Infarction: Biology or Methodology?" JAMA, Vol. 263, No. 8,1092-10%. 
31 Khan, S. et al. (1990), "Increased Mortality of Women in Coronary Artery Bypass Surgery: Evidence 
for Referral Bias", Annals of Internal Medicine, 112: 561-567. 
32 Lerner, D.J., Kannel, W.B. (1986), "Patterns of coronary heart disease morbidity and mortality in the 
sexes: A 26-year follow-up of the Framingham population," American Heart Journal, Vol.111, No.2, 
383-390. 
33 Davey-Smith, G., Blane, D., and M. Bartley (1994), "Explanations for Socio-economic differentials in 
mortality. Evidence from Britain and elsewhere," European Journal of Public Health, 4:131-144. 
34 Donaldson, R.J. and Donaldson, L.J. (1993), Essential Public Health Medicine, Dordrecht: Kluwer 
Academic Publishers. 
69 
[Figures and Tables] 
70 
Figure 5,1 
Main Causes of Death (1992) 
All Women, EU (15) 
Causes of death, Females all ages, 1M2 (EU15) 
Other Causes of Death 
20% Cancers 
26% 
Suicide and Accidents 
5% 
Diseases of the 
Respiratory system 
6% 
Diseases of the 
Circulatory system 
43% 
Source: HFA 1996 
Figure 5,2 
Motor Vehicle Traffic Accident Mortality (1992) 
All Women, EU 15 
SDR motor vehicle traffic accidents, per 100000 
Ranted by 1982 SCR 
EU 15 
LUXEMBOURG (1) 'fcj 
PORTUGAL (1) 
BB_GUM(2) 
GREECE 
FRANCE 
SPAN 
£• AUSTRIA 
c 
§ FNLAND 
O 
RELAND 
rTALY (3) 
GERMANY (4) 
DENMARK 
NETHERLANDS 
SWEDEN 
UNTIED KNGDOM 
'1971 
!1989 
'1991 
'FRGID1890 )1970 
,1992 SDR motor vehicle traffic accidents, per 100000 
Females 
Country I1992 % change 
since 1970 
EU 15 6.42 -39.55 
LUXEMBOURG' 11.39 5.37 
PORTUGAL1 10.60 4.43 
BELGIUM2 9.14 -39 87 
GREECE 9.05 61.61 
FRANCE 7.45 -38.88 
SPAIN 7.30 13.88 
AUSTRIA 7.04 -51.52 
FINLAND 682 -43.59 
IRELAND 6.79 -24.97 
ITALY' 6.51 -31.97 
GERMANY' 6.19 -59.65 
DENMARK 5.12 -63.79 
NETHERLANDS 4.57 -63.12 
SWEDEN 4.28 -57.07 
UNITED KINGDOM 4.14 -44.95 
'1971 
21989 
31991 
4FRGto1980 
Source-HFA 1996 Source - HFA 1996 
71 
Figure 5,3 
Suicide and Self-Inflicted Injury Mortality (1992) 
All Women, EU 15 
Suicida and Self-inflicted injury, 
per 100,000 • Females 
Rarfcadty 1992 SCR Suicide and Self-inflicted injury, per 100,000 
Females 
Country 1992 % change 
since 1970 
EU 15 
LUXEMBOURG1 
DENMARK 
FINLAND 
BELGIUM 2 
AUSTRIA 
FRANCE 
SWEDEN 
GERMANY 4 
NETHERLANDS 
PORTUGAL * 
ITALY * 
IRELAND 
UNITED KINGDOM 
SPAIN 
GREECE 6.24 -24.27 
14.30 179.30 
13.67 -14.62 
11.QO "13.05 
10.46 -3.33 
10.39 -22.23 
10.01 22.22 
8.90 -32.78 
7.96 -44.84 
6.72 -1.47 
4.23 20.17 
3.63 1.68 
3.61 464.06 
3.36 -46.41 
2.99 26.69 
1.21 -36.32 
'1971 
21989 
51991 
4FRGto1990 
Source - HFA 1996 Source-HFA 1996 
Figure 5.4 
Cancer Mortality (1992) 
Women 0-64 Years, EU 15 
SDR Malignant neoplasms, 0-64, per 100,000, 
Females 
^ankori hy 199? SDR 
EU 15 
DENMARK 
IRELAND 
UNITED KINGDOM 
NETHERLANDS 
BELGIUM(2) 
LUXEMBOURG(I) 
GERMANY(4) 
AUSTRIA 
Country SWEDEN 
ITALY 3) 
PORTUGAL(1) 
FRANCE 
FINLAND 
SPAIN 
GREECE 
'1971 
21989 
31991 
4FRGto1990 J1Q1970; 
1992! 
40 60 
Rate 100 120 SDR Malignant neoplasms, 0-64, per 100,000 
Females 
Country 1992 % change 
since 1970 
EU 15 
DENMARK 
IRELAND 
UNITED KINGDOM 
NETHERLANDS 
BELGIUM ' 
LUXEMBOURG ' 
GERMANY * 
AUSTRIA 
SWEDEN 
ITALY ' 
PORTUGAL' 
FRANCE 
FINLAND 
SPAIN 
GREECE 69.74 -13.02 
102.23 0.28 
86.98 -9.87 
86.23 -874 
76.50 -10.88 
75.06 -9.64 
74.66 -9.19 
72.58 -17.34 
6952 -24.34 
68.27 -12.27 
66.90 -12.63 
61.48 -15.01 
60.04 -13.27 
59.19 -13.46 
56.36 -11.22 
54.77 -7.51 
'1971 
21989 
'1991 
4FRGto1990 
Source - HFA 1996 Source-HFA 1996 
72 
Figure 5,5 
Cancer Mortality (1992) 
All Women, EU 15 
SDR Malignant neoplasms, All ages, per 100,000 
Ranked by 1992 
EU 15 
DENMARK 
IRELAND 
UNITED KINGDOM 
GERMANY (4) 
NETHERLANDS 
LUXEMBOURG(1R 
BELGIUM (2! 
AUSTRIA 
Country ITALY (3) 
SWEDEN 
FINLAND 
FRANCE 
PORTUGAL (1] 
SPAIN 
GREECE 
11971 
21989 
31991 
4FRGto1990 
Source - HFA 1996 SDR Malignant neoplasms, AH ages, per 100,000 
Ranked by 1902 SDR 
Country 1992 % change 
since 1970 
EU 15 
DENMARK 
IRELAND 
UNITED KINGDOM 
GERMANY4 
NETHERLANDS 
LUXEMBOURG ' 
BELGIUM ' 
AUSTRIA 
ITALY' 
SWEDEN 
FINLAND 
FRANCE 
PORTUGAL1 
SPAIN 
GREECE 150.30 -5.05 
203.73 4.57 
186.53 4.39 
182.37 4.66 
162.43 -11.87 
159.99 -9.69 
159.86 -1.93 
159.80 -8.65 
157.23 -17.36 
145.93 -0.67 
143.04 -10.24 
134.66 -9.95 
128.78 -9.65 
125.57 -3.54 
117.42 -6.76 
112.60 9.94 
'1971 
'1989 
'1991 
4FRG101990 
Source - HFA 1996 
Figure 5.6 
Cancer Mortality in Women (1992) 
All Women, EU 15 
Cancer as cause of death by type, Females all ages, (EU15) 1992 
Cervical Cancer 
2% 
Breast Cancer 
21% 
Digestive Organs Cancer 
32% 
Cancer of Trachea 
/bronchus/lung 
9% 
Source-HFA 1996 
73 
Figure 5,7 
Breast Cancer Mortality (1992) 
Women 0-64 Years, EU 15 
SDR Malignant neoplasm female breast, 
0-44 per 100,000 
Ranted by 1902 SCR 
EU 15 
RELAND 
DENMARK 
BELGLM(2) 
UNTTEDKNODOM 
NETHERLANDS 
GERMANY (4) 
£ ITALY (3) 
§ AUSTRIA 
•> FORTUGAL(1) 
FRANCE 
SPAN 
SWEDEN 
LUXEMBOURG (1) 
FNLAND 
GREECE 
'1971 
21939 
'1931 
'FRGtolSeO O1970 
• 1992 
15 
Rate 
Source - HFA 1996 SDR Malignant neoplasm female breast, 0-64 per 100,000 
Country 
EU IS 
IRELAND 
DENMARK 
BELGIUM * 
UNITED KINGDOM 
NETHERLANDS 
GERMANY4 
ITALY ' 
AUSTRIA 
PORTUGAL* 
FRANCE 
SPAIN 
SWEDEN 
LUXEMBOURG ' 
FINLAND 
GREECE 1992 % change 
since 1970 
19.80 9.27 
25.80 17.22 
24.77 -0.84 
24.63 14.77 
24.36 -5.18 
23.86 -3 28 
19.89 10.81 
19.06 10.62 
18.31 9.12 
17.96 20.05 
17.75 11.57 
16.60 62.11 
16.43 -1.56 
15 46 -30.30 
15.12 4.49 
14.58 45.07 
'1971 
J1989 
'1991 
4FRGto1990 
Source-HFA 1996 
Figure 5.8 
Breast Cancer Mortality (1992) 
All Women, EU 15 
SDR Malignant neoplasm female breast All ages, per 100,000 
Ranked by 1992 _• 
EU 15 
DENMARK [ 
UNITED KINGDOM] 
IRELAND] 
NETHERLANDS! 
BELGIUM (; 
GERMANY (4| 
AUSTRIA 
ITALY (3] 
Country FRANCE 
PORTUGAL (1 
SWEDEN 
LUXEMBOURG (1 
SPAIN 
FINLAND 
GREECE 
'1971 
21989 
31991 
«FRGto 1990 0 D1970 
,•1992 SDR Malignant neoplasm female breast. All ages, per 100,00 
Ranted t)Y 1292 SDR 
Country 
EU 15 
DENMARK 
UNITED KINGDOM 
IRELAND 
NETHERLANDS 
BELGIUM1 
GERMANY* 
AUSTRIA 
ITALY1 
FRANCE 
PORTUGAL1 
SWEDEN 
LUXEMBOURG* 
SPAIN 
FINLAND 
GREECE 
'1971 
21989 
31991 
4 FRGto 1990 1992 
31.25 
40.56 
39.23 
39.17 
38.47 
37.93 
31.87 
31.29 
29.83 
28.11 
26.57 
25.66 
24.99 
24.40 
23.82 
21.32 % chang » 
since 197 J 
16.2< 
6.7S 
5.8C 
28.5! 
1.16 
14.8C 
15.6< 
17.9< 
21.0' 
15.6( 
29.8C 
-4.07 
-20.7' 
73.67 
20.5Î 
56 Bt 
Source - HFA 1996 Source-HFA 1996 
74 
Figure 5.9 
Breast Cancer Mortality (1992) 
All Women 1970-1992, EU 15 
SDR Malignant neoplasm female breast, 0-64 per 100,000 
Selected EU Member States 
Ordered by 1970 
—O— DENMARK 
_û_ RELAND 
_x-BaGIUM 
-0-EU15 
-X-FNLAND 
SPAN 
_o_ GREECE 
88 89 90 91 92 
Source- HFA 1996 
Figure 5.10 
Cervical Cancer Mortality (1992) 
Women 0-64 Years, EU 15 
SDR Cancer of the Cervix, 0-64, per 100,000 
Ranked by 1992 
EU 15 mmlmr———1 
DENMARK ag^^—— =3 
IRELAND p^a^— ' 
GERMANY (4) mmmmam ~* 
LUXEMBOURG (1) ^,—- D 
PORTUGAL (1) ^j,— ' 
AUSTRIA ^i— ' 
BELGIUM (2) m^^m => 
ountiy SWEDEN mm^m =* 
NETHERLANDS n— ' 
FRANCE mm—3 
SPAIN Galeae 
GREECE jjjj^g 
F|NLAND ' „. 1 | ^^-
ITALY (3) jjj=> [ ; B 1992 
11971 
21989 
51991 
« FRGto 1990 
Source-HFA 1996 SDR Cancer of the cervix, 0-64, per 100,000 
Country 1992 % change 
since 1970 
EU 15 
DENMARK 
UNITED KINGDOM 
IRELAND 
GERMANY4 
LUXEMBOURG ' 
PORTUGAL ' 
AUSTRIA 
BELGIUM2 
SWEDEN 
NETHERLANDS 
FRANCE 
SPAIN 
GREECE 
FINLAND 
ITALY ' 2.28 -47.71 
464 -55.34 
3.78 -42.02 
3.41 -23.88 
3.20 -50.54 
2.71 -70.61 
2.30 -73.10 
2.26 -56.87 
2.14 -37.97 
2.05 -70.80 
1.84 -67.83 
1.67 -36.26 
1.66 95.29 
1.31 61.73 
0.90 -81.05 
0.75 -55.36 
11971 
21989 
51991 
4 FRGto 1990 
Source-HFA 1996 
75 
Fi2ure5.11 
Cervical Cancer Mortality (1992) 
All Women, EU 15 
SDR Caac*roffl»Mfvtx,Afl ages, per 100 000 
Ranked byJ992 SOR_ 
EU 15 
DENMARK 
JNITED KINGDOM 
GERMANY (4) 
IRELAND 
AUSTRIA 
LUXEMBOURG (1) 
PORTUGAL (1) 
BELGIUM (2) 
NETHERLANDS 
SWEDEN 
SPAIN 
FRANCE 
FINLAND 
GREECE 
ll9fiALY(3) 
21988 
31991 
'FRGto 1990 D197Û 
• 1992 
6 8 
Rate 12 
Source - HFA 1996 SDR Cancer of the cervw, AI ages, per 100,000 
Coantry 
EU1« 
UNITED KMODOM 
OERMANY4 
IRELAND 
AUSTRIA 
LUXEMBOURG1 
PORTUGAL1 
BELGIUM2 
SWEDBI 
NETHERLANDS 
SPAM 
PRANCE 
FINLAND 
GREECE 
ITALY' 
11971 
21989 
31991 
4 FRGto 1980 1892 
7.13 
5.26 
4.62 
4.43 
3.82 
3.58 
3.42 
3.36 
2.98 
2.98 
2.24 
2.23 
1.88 
1.86 
1.11 % cfcaage 
tBhTtHTP 
-40.7» 
-40.88 
-37.38 
-4144 
-22.42 
-41.68 
-64.98 
-«8.38 
-35.14 
-62.28 
-59.73 
88.24 
-34.22 
-70.76 
66.07 
-49.77 
Source-HFA 1996 
Figure 5.12 
Respiratory System Cancer Mortality (1970-1992) 
Women 0-64 Years, EU 15 
SDR Trachea/brondius/lung cancer, Females 0-64 per 100,000 
Selected EU Member States 
Oxtered by 1971 
25 , ?-
20 4 
15 + 
10 4 
5 A LNITBD KINGDOM 
DBJMA.RK 
-X-EU15 
—D— SMN 
O- NETV€RLANDS 
FORTUGAL 
-x-x-x-x-^-5-Q^ x-
o o 'a 
o _x _x —X—X -X —x -X x-x 
_l 1 ! 1 1 1 j 1 j 1 1 , 1 1 1 1 1 1 1 1 1 1 
70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 
Year 
Source-HFA 1996 
76 
Figure 5.13 
Respiratory System Cancer Mortality (1992) 
Women 0-64 Years, EU 15 
SDR Traçhea/bronchus/luns cancer, 
Females 044 per 100,000 
Rated by 1882 
EU 15 
DH*KRK 
UNITED KJNGDOM 
Source - HFA 1996 SDR Trachea/bronchus/lung cancer, 0-64 per 100,000 
Females 
Country 1992 % change 
since 1970 
EU 15 
DENMARK 
UNITED KINGDOM 
NETHERLANDS 
IRELAND 
SWEDEN 
LUXEMBOURG1 
GERMANY * 
BELGIUM 1 
AUSTRIA 
FINLAND 
ITALY* 
GREECE 
FRANCE 
PORTUGAL1 
SPAIN 6.63 44.76 
20.52 218.63 
12.91 19.43 
10.56 269.23 
9.55 12.49 
8.92 163.13 
8.78 155.98 
6.20 80.23 
6.15 86.93 
6.13 49.51 
4.91 78.55 
4.90 33.15 
4.69 -5.06 
4.06 80.44 
2.89 10.31 
2.52 -28.00 
'1971 
21989 
31991 
4 FRGto 1990 
Source - HFA 1996 
Figure 5.14 
Respiratory System Cancer Mortality (1992) 
i All Women, EU 15 
SDR Trachea/bronchus/lung cancer, 
All ages, per 100,000 
Ranked by 1992 
EU 15 
DENMARK! 
UNITED KINGDOB 
IRELAND! 
NETHERLANDS 
SWEDEN) 
LUXEMBOURG (1|j 
AUSTRIA 
GERMANY (4)| 
Country BELGIUM (2 
ITALY (3) 
FINLAND 
GREE' 
FRANCE 
PORTUGAL (1 
SPAIN Q1970! 
iBl992! 
'1971 
'1989 
Source-HFA 1996 SDR Trachea/bronchus/lung cancer, All ages, per 100,000 
F*m»ips 
Country 1992 % change 
since 1970 
EU 15 
DENMARK 
UNITED KINGDOM 
IRELAND 
NETHERLANDS 
SWEDEN 
LUXEMBOURG 1 
AUSTRIA 
GERMANY 4 
BELGIUM 2 
ITALY * 
FINLAND 
GREECE 
FRANCE 
PORTUGAL1 
SPAIN 14.05 67.86 
34.88 175.30 
30.89 73.15 
26.60 85.24 
16.62 207.21 
15.94 126.74 
14.11 156.08 
13.55 57.56 
12.28 74.43 
11.15 73.68 
10.89 61.57 
10.88 90.54 
10.06 15.77 
7.80 62.16 
6.44 39.09 
540 -674 
1 1971 
2 1989 
3 1991 
4 FRGto 1990 
Source - HFA 1996 
77 
Fieure5.15 
Perceptions of which Gender Lung Cancer Affects More* 
All Women, EU 15 (1996) 
Finland 
Greece 
Belgium 
Spain 
Germany W 
France 
Germany E 
Portugal 
Italy 
EU 15 
The Netherlands 
Austria 
Luxembourg 
Ireland 
Denmark 
United Kingdom 
Sweden K\m\\\mmm\\\\Sm^ 
N\\\N\\\\SS\S\\\\\\\\\\^^^^ 
KKKms*^^KKms^m>^ 
is\S\\\S\\\SS\SSS\\\\S^^^^ 
K\S\\^\S\S\\\\\\\SS\\^^^^ 
K\\\S\S\S\\\\\\\S\\SS^^^^^ 
k\v^\^VVVV\^^^^^ Km\\ms\\\\mm\\^^^ 
mssmssmmsN^^^^ 
^^^^^^^^SM»S»M»^^ 
hssmmssmssmsssmss^g: 
KWKm\^m^m\>NKKI 
KmmmsmsmWM 
fcMMMMMMMMMMMMMI 
N\\mmmm\\wi S\mm\\S\\N^SSST 
kwww^wwwç 
0% 20% 40% 60% 80% 100% 
Yes • DK No Source: Eurobarometer 44.3/1996 
Respondents were asked to indicate the extent to which they agreed or disagreed with the following statement : "In (country) lung 
cancer affects many more men than women". Yes indicates that they agreed, no that they disagreed. 
Table 5.1 
Perceptions of which Gender Lung Cancer Affects More 
Women 15+ Years, EU 15 (1996) 
Finland 
Greece 
Belgium 
Spain 
Germany W 
France 
Germany E 
Portugal 
Italv 
EU15 
The Netherlands 
Austria 
Luxembourg 
Ireland 
Denmark 
United Kingdom 
Sweden Yes 
% 
82.9 
60.7 
58.8 
58.3 
56.8 
55.4 
54.0 
53.9 
50.7 
503 
47.1 
45.4 
40.6 
36.8 
36.3 
32.5 
22.6 No 
% 
7.8 
8.9 
8.8 
9.1 
8.6 
11.0 
10.5 
12.2 
8.1 
13.4 
20.3 
11.7 
12.6 
17.1 
29.8 
26.6 
28.9 DK 
% 
9.3 
30.4 
32.4 
32.6 
34.7 
33.6 
35.5 
33.9 
41.2 
363 
32.6 
42.9 
46.8 
46.1 
33.9 
40.8 
48.5 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to indicate the extent to which they agreed or disagreed with the following statement : "In (country) lung cancer affects 
manv more men than women". Yes indicates that they agreed, no that they disagreed. 
78 
Figure 5.16 
Mortality from Circulatory System Diseases (1992) 
Women 0-64 Years, EU 15 
8DR diseases of ekenlatory system, Pénales 0-04 per 100,000 
Rartadby 1932 SCR 
EU1 
IRELAND] 
UNITED Kll 
PORTUGAL{ 
DEN! 
AU: 
GERMANY* 
GREECI 
FINLANI 
CosatSELGIUM 
LUXEMBOURG 
NETHERLANI 
'1971 
31939 
31931 
'FRGto 1930 019 
• 1 
20 40 60 
Rate 80 100 120 
Source-HFA 1996 SDR dm ft at ômÊHory «ytam, rwMi 0-04 par 100.000 
Coeeay Hchang» 
1992 «too* 1970 
EU IS 
IRELAND 
UNITED KMODOM 
PORTUGAL1 
DENMARK 
AUSTRIA 
GERMANY4 
GREECE 
FINLAND 
BELGIUM3 
LUXEMBOURG1 
NETHERLANDS 
SWEDEN 
ITALY ' 
SPAIN 
PRANCE 31 .K .«1.01 
43.81 -57.12 
42.98 -47.23 
39.30 -51.70 
36.80 -31.62 
36.65 -45.97 
36.06 -40.25 
34.16 -31.67 
33.73 -64.47 
32.71 -5237 
3243 -63.66 
30.89 -39.35 
28.85 -37.76 
27.63 -58.76 
24.76 -63.72 
19.01 -57.71 
'1971 
219B9 
31991 
'FRGto 1930 
Source-HFA 1996 
Figure 5.17 
Mortality from Ciculatory System Diseases (1992) 
All Women, EU 15 
SDR diseases of circulatory system, Females 
ail ages per 100,000, 
Ranked by 1992 SDR_ 
EU 15 
PORTUGAL(1) 
AUSTRIA 
IRELAND 
GERMANY (4) 
GREECE 
FINLAND 
LUXEMBOURGfl 
UNrTED KINGDOM 
Country DENMARK 
ITALY (3) 
SWEDEN 
BELGIUM (2) 
SPAIN 
NETHERLANDS 
FRANCE 
'1971 
M989 
'1991 
'FRGto 1990 |D197d 
!• 19921 
300 
Rate 500 600 SDR diseases of circulatory system, Females 
all ages per 100,000 
Country 1992 V*""* since 1970 
EU1S 
PORTUGAL1 
AUSTRM 
IRELAND 
GREECE 
FINLAND 
GERMANY4 
LUXEMBOURG1 
UNITED KINODOM 
DENMARK 
ITALY3 
SWEDEN 
BELGIUM3 
SPAIN 
NETHERLANDS 
FRANCE 316.53 -29.56 
315.53 -33.79 
301.78 -40.35 
299.59 7.54 
289.50 -47.79 
299.71 -31.60 
271.8 -44.52 
26577 -40.52 
263.09 -31.37 
247.74 -40.56 
243.67 -34.91 
239.31 -40.81 
221.80 -43.28 
214.23 -40.42 
150.55 -45.63 
'1971 
21989 
31991 
' FRGto 1990 
Source-HFA 1996 Source -HFA 1996 
79 
Figure 5.18 
Perceptions of which Gender is More Affected by Heart Disease* 
All Women, EU 15 (1996) 
Finland 
Denmark 
Greece 
Sweden 
Italy 
Ireland 
The Netherlands 
Germany W 
EU 15 
Belgium 
Spain 
France 
United Kingdom 
Germany E 
Luxembourg 
Austria 
Portugal 
0% 20% 40% 60% 80% 100% 
Yes • DK No 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to indicate the extent to which they agreed or disagreed with the following statement : "In 
(country) heart disease affects manv more men than women". Yes indicates that they agreed, no that they disagreed. 
Table 5.2 
Perceptions of which Gender is More Affected by Heart Disease* 
EU 15 AH Women (1996) 
Yes 
% No* 
% DK 
% 
Finland 
Denmark 
Greece 
Sweden 
Italy 
Ireland 
The Netherlands 
Germany W 
EU 15 
Belgium 
Spain 
France 
United Kingdom 
Germany E 
Luxembourg 
Austria 
Portugal 81.2 
66.5 
66.1 
63.5 
60.7 
59.6 
58.8 
57.9 
57.8 
57.7 
57.5 
56.8 
55.8 
51.8 
51.0 
48.8 
43.8 9.1 
11.9 
7.9 
10.2 
5.6 
10.4 
17.1 
10.6 
11.9 
8.8 
8.3 
14.0 
20.0 
13.3 
9.7 
11.9 
13.8 9.7 
21.6 
26.0 
26.3 
33.6 
29.9 
24.0 
31.5 
30.2 
33.5 
34.2 
29.2 
24.2 
34.9 
39.4 
39.4 
42.4 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to indicate the extent to which they agreed or disagreed with the following statement : "In (country) heart disease affects many 
more men than women". Yes indicates that they agreed, no that they disagreed. 
80 
Figure 5.19 
Ischaemic Heart Disease Mortality (1992) 
Women 0-64 Years, EU 15 
SDR tocHaente a 
per 100,000 
Ranked by 1992 S0F 
EU 15 
IRELAND 
UNITED KINGDOM 
DENMARK 
FINLAND 
SWEDEN 
AUSTRIA 
GERMANY (4) 
NETHERLANDS 
Countnf BELGIUM (2) 
GREECE 
PORTUGAL (1) 
LUXEMBOURG (1) 
rTALY(3) 
SPAIN 
' 1971 FRANCE 
21989 ^ 
31991 C 
« FRG to 1990 •art disease, Females ages 0-64, 
.. . J 
,'.,,' ' 
Q1970 
BJ1992 
10 20 30 40 50 
Nat* 
Source-HFA 1996 SDR ischaemic heart disease, Females ages 0-64, 
perlOarjQQ. 
Country 
EU 18 
IRELAND 
UNrTED KJNODOft I 
DENMARK 
FINLAND 
SWEDEN 
AUSTRIA 
GERMANY4 
NETHERLANDS 
BELGIUM2 
GREECE 
PORTUGAL1 
LUXEMBOURG1 
ITALY3 
SPAIN 
FRANCE 
11971 
21989 
31991 
4 FRG to 1990 1992 % étang* 
SJafit-iaZP 
12.14 
24.31 
24.12 
17.30 
14.77 
14.20 
14.16 
13.96 
1285 
10.50 
9.71 
9.56 
9.05 
8.21 
6.42 
4,51 -34JK 
-45.0£ 
-28.9Ï 
-34.4^ 
-60.7É 
-31.57 
-23.34 
-25.3Ï 
^JO.67 
-56.91 
-2.31 
-39.91 
-56.47 
-47.17 
-5.87 
-48.8; 
Source-HFA 1996 
Figure 5.20 
Ischaemic Heart Disease Mortality (1992) 
All Women, EU 15 
SDR isactaemic heart disease, Females all ages, per 100,000 
Ranked by 1992 
EU 15 
FINLAND 
IRELANC Ï 
UNITED KING» H 
DENMARI j 
SWEDEJi 
GERMANY (i \ 
AUSTRIA 
NETHERLAN 
Country ITALY (3) 
LUXEMBOURG 
BELGIUM 
GREECI 
PORTUGAL ( 
SPAII 
'1971 
21989 
31991 
'FRG to 1990 FRANCI 
Rati 
Source-HFA 1996 SDR ischaemic heart disease, Females all ages, per 100,000 
(Country 
EU 15 
FINLAND 
«ELAND 
UNITED KINGDOM I 
DENMARK 
SWEDEN 
GERMANY 
AUSTRIA 
NETHERLANDS 
ITALY3 
LUXEMBOURG 
BELGIUM) 
GREECE 
PORTUGAL 
SPAIN 
•WAMftP 1992 
'1971 
21689 
31931 
'FRGto 1990 84.7K 
149.75 
147.19 
138.76 
130.00 
115.33 
110.41 
108.26 
76.36 
6279 
61.49 
59.44 
57.62 
56.08 
46.67 
3R04 % cnajigi > 
junaa-lS2 ) 
-21 .s: 
-22.3-
-24.5: 
-21. H 
-37.0C 
-46.3* 
1.1J 
-31 K 
-43.3J 
-43 3J 
-21.s: 
-44.2< 
24.9' 
-20.0" 
22.0-
Source - HFA 1996 
81 
Figure 5.21 
Perceived Main Risk Factors for Heart Disease (1996)' 
All Women, EU 15 
Portugal 
Spain 
France 
Ireland 
Greece 
Belgium 
^ EU 15 
Luxembourg 
Italy 
United Kingdom 
Germany W 
Germany E 
Sweden 
The Netherlands 
Austria 
Denmark 
Finland 
1 smoking 
4 overweight 100% 
2 stress 
5 lack of ( 3 unhealthy diet 
6 excessive alcohol 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to indicated the main and the second risk factors for heart disease. 
Table 5.3 
Perceived Main Risk Factors for Heart Disease (1996)* 
All Women, EU 15 
smoking 
% unhealthy 
diet 
% lack of 
exercise 
% excessive 
alcohol 
% stress 
% overweight 
% DK 
% 
Portugal 
Spain 
France 
Ireland 
Greece 
Belgium 
EU 15 
Luxembourg 
Italy 
United Kingdom 
Germany W 
Germany E 
Sweden 
The Netherlands 
Austria 
Denmark 
Finland 52.5 
51.5 
51.2 
45.1 
43.3 
42.9 
42.7 
42.6 
42.3 
41.9 
38.7 
38.1 
35.5 
32.4 
31.6 
28.4 
22.3 15.6 
13.1 
12.4 
13.0 
9.3 
8.4 
13.3 
12.3 
13.4 
17.6 
10.9 
7.5 
9.8 
16.9 
18.6 
14.1 
30.0 3.0 
4.1 
5.2 
6.7 
4.4 
4.0 
6.3 
6.8 
3.3 
6.2 
9.6 
9.2 
8.2 
8.4 
10.1 
12.5 
7.4 7.6 
7.1 
10 
3.0 
2.6 
5.2 
6.3 
4.5 
5.6 
2.4 
7.4 
8.5 
2.8 
7.0 
7.1 
2.0 
7.6 8.3 
11.0 
12.6 
15.0 
35.7 
22.6 
18.5 
22.9 
24.6 
12.1 
19.2 
25.2 
30.7 
30.9 
21.3 
24.6 
14.5 8.7 
8.7 
7.6 
14.2 
4.4 
12.3 
10.4 
7.4 
9.3 
14.0 
11.9 
10.1 
11.6 
9.1 
7.3 
16.7 
15.1 4.3 
4.4 
1.0 
3.1 
4.0 
4.6 
2.8 
3.5 
1.4 
5.7 
2.3 
1.5 
1.6 
1.5 
4.1 
1.8 
3.0 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to indicated the main and the second risk factors for heart disease. 
82 
Figure 5.22 
Cerebrovascular Disease Mortality (1992) 
Women 0-64 Years, EU 15 
EU 15 
PORTUGAL (1) 
LUXEMBOURG (1) 
GREECE 
F NLA NO 
UNITED KNGDOM 
DENMARK 
£ RELAND 
g BELGUM(2) 
u 
ITALY (3) 
AUSTRIA 
GERMANY (4) 
NETHERLANDS 
SPAN 
SWEDEN 
FRANCE 
' 1971 
'1989 
'1991 
• FRG to 1990 SDR cerebrovascular diseases, 0-64 per 1C 
Females 
Ranted by 1992 SCR 
,1970 
,1992 
Source-HFA 1996 SDR cerebrovascular diseases. 0-64 per 100,000 
Female 
Country 
EU 15 
PORTUGAL' 
LUXEMBOURG' 
GREECE 
FINLAND 
UNHTED KINGDOM 
DENMARK 
IRELAND 
BELGIUM ' 
ITALY * 
AUSTRIA 
GERMANY' 
NETHERLANDS 
SPAIN 
SWEDEN 
FRANCE 1992 % change 
sine* 1B70 
B.73 -54.05 
18.42 -30.25 
12.98 -2.41 
12.12 -32.85 
11.29 -64.11 
10.88 -55.70 
10.82 -18.65 
9.77 -69.06 
8.92 -53.22 
8.88 -57.14 
8.41 -57.22 
8.17 -50.24 
8.08 -45.41 
7.30 -63.37 
6.97 -49.82 
5.80 -64.81 
'1971 
31969 
31991 
'FRGto 1990 
Source-HFA 1996 
Figure 5.23 
Cerebrovascular Disease Mortality (1992) 
All Women, EU 15 
SDR cerebrovascular diseases, All ages, 
per 100,000, Female 
Ranted by 1992 SCR 
LUXEMBOURG (1) 
FINLAND 
rTALY (3) 
AUSTRIA 
ê UNTTED KNGDOM 
g GERMANY (4) 
O 
FELAND 
SPAN 
BELGUM (2) 
DENMARK 
NETHERLANDS 
SWEDEN 
FRANCE 
M971 
21969 
31991 
«FRGto1990 j1970j 
I 1992 
100 150 
Rate 
Source-HFA 1996 SDR cerebrovascular diseases. All ages, per 100.000 
Female 
Country 
EU 15 
PORTUGAL' 
GREECE 
LUXEMBOURG ' 
FINLAND 
ITALY ' 
AUSTRIA 
UNITED KINGDOM 
GERMANY' 
IRELAND 
SPAIN 
BELGIUM ' 
DENMARK 
NETHERLANDS 
SWEDEN 
FRANCE 1992 % change 
since 1970 
75.93 -42.94 
175.63 -26.34 
125.75 1.35 
101.82 9.85 
82.71 -51.54 
81.27 -35.24 
80.33 -49.92 
79.53 -45.16 
7880 -49.33 
77.96 -51.26 
75.25 -41.39 
66.46 -52.30 
6541 -33.57 
62 75 -42 36 
6134 -30 30 
44 11 -59 68 
1 1971 
7 1989 
3 1991 
'FRG to 1990 
Source-HFA 1996 
83 
6. HEALTH DETERMINANTS AND HEALTH PROMOTION 
The major causes of mortality in women were outlined in the previous chapter. This 
chapter describes the major health determinants of the diseases that affect women, which 
include risk factors, such as smoking, drinking, diet and weight, and physical inactivity. It 
also discusses health promotion and disease prevention activities, such as cancer screening 
programmes. 
6.1 Smoking 
Tobacco smoking is one of the leading causes of morbidity and mortality in the European 
Community1. It is the major causative factor in an estimated 30% of cancers2, including 
lung cancer (85% of which is estimated to be caused by smoking), cancer of the oral 
cavity (lips, mouth, tongue, throat), cancer of the pharynx, larynx, oesophagus, bladder, 
and the kidneys. Respiratory diseases, such as chronic bronchitis, emphysema, and asthma, 
are also attributable to and/or exacerbated by smoking. Furthermore, smoking is a major 
contributor to cardiovascular disease, the risk of developing ischaemic heart disease being 
approximately twice as high among smokers as among non-smokersJ. Passive smoking is 
also considered a risk factor for a number of diseases, in particular lung cancer. 
Besides the generic risks associated with smoking, women smokers face a number of 
additional gender-specific health risks because smoking can influence their hormonal 
balance. Specifically, smoking may contribute to a reduction in fertility4 5 and increase the 
risk of early menopause. Furthermore, it is a contributory factor to calcium loss and 
consequent osteoporosis in post-menopausal women. Smoking when combined with oral 
contraceptive use may also appreciably increase the risk of developing cardiovascular 
disease6. Smoking during pregnancy has been associated with increased risk of 
spontaneous abortion, complications of pregnancy (e.g., bleeding, placenta praevia) 
stillbirth, premature delivery, low birth-weight, and neonatal death. It also increases the 
risk of sudden infant death and is associated with a number of other long-term health 
consequences for the offspring (e.g., reduced lung capacity, increased infection rates)7. 
Traditionally, a greater proportion of men than women smoke. The percentage of men 
who smoke (43%) in the EC has long been higher than the percentage of women who 
smoke (28%)8. However, significantly greater rates of smoking cessation and different 
patterns of smoking initiation among men have narrowed the gap between the two sexes 
in a number of Member States (e.g., Finland, the Netherlands, Spain, Germany, Portugal, 
Italy, and Denmark)9 with the result that if current trends continue, female smokers could 
in a few years outnumber male smokers10. 
As can be seen from Figure 6.1 and Table 6.1, the percentage of women who smoke in 
most Member States is around 25%. Denmark and Portugal are exceptions to this pattern 
with Danish women reporting a much greater percentage of smokers (42%) and Portugal 
a much smaller percentage (12%)n. 
Smoking typically is most frequent among women of lower socio-economic status (except 
in Portugal), among unemployed women, and those with lower educational attainment. 
Smoking among adolescents is a matter of particular concern because evidence suggests 
84 
that in this age-group the proportion of daily smokers amongst women is approaching that 
of men12. Indeed in Denmark, more women than men smoke in the younger age-groups. 
Since tobacco-related diseases usually develop after smoking for 15-20 years or more, the 
results of increasing smoking rates among EC women are only just beginning to be seen. 
Evidence suggests that female mortality from smoking-related cancers during the past 
decade has increased in all Member States, except Portugal and Ireland, with the 
Netherlands having the highest increase (87%) and Belgium, Denmark, Germany and 
France showing increases of over 40%13. According to a calculation based on national 
vital statistics, the highest rate of female tobacco-related mortality is in Ireland and 
Denmark, where it was found that in 1990, 16.2 and 15.3%, respectively, of deaths in 
women aged 35 years and older were attributable to smoking (see Figure 6.2 and Table 
6.2). This is more than 3-1/2 times the average EU rate (5.1%), but at least in Denmark's 
case this rate is consistent with the high rates of smoking among Danish women during 
the past four or five decades14. On the other hand, the same calculations found that France 
had very few such deaths, and Luxembourg, Portugal and Spain had none. The latter 
result is, of course, rather unlikely but is probably an artefact of the extremely 
conservative methods used to calculate smoking attributable death rates15. 
6.2 Alcohol Consumption 
The relation between alcohol consumption and health is complicated. Evidence suggests 
that there is not a straightforward linear relation, but rather that low levels of alcohol 
consumption are associated with lower mortality while higher levels are associated with 
excess mortality. Alcohol abuse has been linked to a variety of diseases and conditions 
resulting in increased mortality. These include cirrhosis of the liver16, alcohol psychosis 
and alcohol poisoning17. It is also associated with raised blood pressure, stroke and heart 
disease1819. 
In addition, alcohol consumption is also a risk factor in a number of cancers, e.g., breast 
cancer20, cancer of the oral cavity, pharynx, larynx, oesophagus, and pancreas21. In several 
of these, there is a synergistic effect between alcohol consumption and tobacco smoking. 
Furthermore, alcohol abuse is associated with threatening behaviour, domestic violence, 
occupational and road accidents, as well as depression, suicide, and parasuicide22 23. 
Finally, excessive alcohol intake by pregnant women may lead to foetal alcohol syndrome 
which can result in physical and mental abnormalities in their children24. 
Recent evidence suggests that the health risks associated with alcohol abuse may be 
greater for women than for men, partly because of differences in how they metabolise 
alcohol25. Despite the potential importance of alcohol consumption for women, there 
currently exist no gender-specific data on alcohol consumption at EC level. Various 
studies provide some information, but these are neither comprehensive nor comparable. 
Available evidence suggests that alcohol consumption among women has been rising in 
Finland, Sweden, Denmark, UK, and the Netherlands26. In Denmark and the UK this 
increase in alcohol consumption among women has been accompanied by an increase in 
death rate from liver diseases (see Figure 6.3). 
Women still consume less alcohol than do men and they tend to drink less beer and spirits. 
However, some Member States, e.g., Sweden27, have noted an increase in consumption of 
spirits by women. In addition, alcohol consumption by young women (aged 12-24 years) 
is also of concern in some Member States. For example, in the Netherlands women in the 
85 
16-19 age-group constituted the highest percentage of heavy drinkers in 1993-199428. 
Since the 1980s, Sweden, has reported a significant increase in alcohol consumption by 
women in the 12-24 age group29; and the UK has set targets to reduce excessive alcohol 
consumption for those aged 15-1630. 
Public health initiatives in the Member States involve education policies on the effects of 
alcohol, the setting of safe consumption levels in units per week (typically 21 units per 
week for men and 14 per week for women)8 31, and promotion of low-alcohol drinks. 
Recent EC legislation on alcohol relate to advertising and minimum rates of alcohol 
taxation32. 
6.3 Diet and Weight 
A nutritious diet is fundamental to good health. In industrialised countries diet-related 
health problems tend to be caused by over-eating or eating the wrong types of food. Over­
eating can lead to obesity which in women is associated with increased risk of diabetes, 
hypertension, ischaemic heart disease, cardiovascular disease, as well as increased risk of 
certain cancers (including cancer of the colon and rectum, and, for women, breast33, 
cervical, and ovarian cancer)34. 
Figure 6.4 and Table 6.3 show the distribution of underweight and overweight women in 
the EC according to body mass index (BMI)b. WHO defines women as being underweight 
when their BMI is between 18 and 20 and as being severely underweight when it is below 
18. Women are defined as overweight with a BMI between .27 and 30 and as severely 
overweight with a BMI of 30 or more. Thus, women of normal weight have BMIs of 
between 20 and 27. Health risks increase considerably when the actual weight exceeds the 
desirable weight by more than 20% ( or when BMI exceeds 27) and increase rapidly with 
a BMI of 30 and over35. The average BMI for women in the EC, which is 24, therefore 
falls within the normal range. However, a significant proportion of women (20%) are 
overweight. A smaller proportion (15%) are underweight. 
Considerable differences exist within the EC. Greece and Portugal have the highest rates 
of obesity (33.2 and 28.5% respectively), while France, Denmark, the pre-unification 
Federal Republic of Germany, and Ireland have the lowest rates (15.5, 16.5, 16.5, and 
16.9% respectively). The BMI of women from the former German Democratic Republic is 
higher than that of women from the pre-unification Federal Republic of Germany, as is the 
proportion of overweight women (20 and 16.5% respectively). 
E^ing the wrong types of food may result in a number of different health problems. A diet 
high in saturated fat is associated with increased cardiovascular disease36, while one low in 
fresh fruit and vegetables is associated with increased risk of a number of cancers, in 
particular cancer of the stomach, colon, rectum, and the intestines37 38. 
Probably owing to different agricultural and cultural traditions, eating patterns in the EC 
are characterised by a north-south divide. The northern EC countries have traditionally 
consumed higher quantities of animal protein and fat, while southern (Mediterranean) EC 
countries have had a diet high(er) in natural fibres due to higher proportions of vegetables, 
a The UK recently increased its recommended limits to 21 for women and 28 for men31. 
b BMI is calculated by dividing a person's weight (in kilograms) by her height (in meters) squared 
(thus, BMI=kg/m2), thereby creating a weight measure that controls for height. 
86 
fruits, cereals, and polyunsaturated fats. However, these eating patterns are becoming less 
delineated with the greater flow of food products within the EC resulting from the internal 
market. Sweden, for example, has adopted a more Mediterranean style diet on a national 
level, consuming higher proportions of fruit, vegetables, cereals, and low fat dairy 
products39. 
Although there are no recent (post-1970) gender-specific data at the EC level on dietary 
habits, most Member States report that women eat more vegetables and fruits than do 
men. 
Public health initiatives within the ECa include the highlighting of the connection between 
healthy diet and disease prevention, including the importance of screening tests for 
cholesterol and diabetes for identified risk groups. In this context, it is surprising that, on 
an EC level, only 17% of women recognised an unhealthy diet as the second main (life­
style-related) risk factor linked to heart disease, while approximately 1 in 2 women 
recognised smoking as the main (life-style-related) risk factor. 
6.4 Exercise 
Regular physical exercise is important for mental and physical well-being. Physical fitness 
reduces death rates from both heart disease and cancer40 because of its ability to reduce 
the effect of stress, maintain an optimum body weight, strengthen the heart and lungs, and 
reduce the risk of heart disease41. Furthermore, load-bearing exercise (e.g., walking, 
running) is particularly important for pre-menopausal women in order to rninimise the risk 
of osteoporosis in later life. 
Although no gender-specific data on physical exercise exist at the EC level, it is generally 
accepted that women, in particular elderly women, exercise less than men and in 
insufficient amounts for optimal health benefits42. 
6.5 Health Promotion and Disease Prevention 
As already noted, Article 129 of the Treaty specifies that the EC is to ensure a high level 
of health protection by means of health promotion and disease prevention. A number of 
questions were included in the 1996 Eurobarometer survey concerning the preventive and 
health promotion services that people receive. This survey also included some attitudinal 
questions to shed light on topics of frequent debate, such as mammography screening. 
The results show wide divergence between the Member States. As the data are self-
reported, the results should be interpreted with care. 
6.5.1 Heart Check-Up 
As discussed in Sections 5.7 and 5.8, heart disease is one of the major sources of 
morbidity and mortality in women, and early detection can play a major role in its 
prevention. The Eurobarometer survey included a question on heart check-ups. The 
results shown in Figure 6.5 and Table 6.4 indicate that about 22% of women in the EC 
had a heart check-up in the past year. Not surprisingly, the rate of heart check-ups is 
highly age-dependent, with older women reporting more check-ups; 44% of women aged 
Programmes on cancer and health promotion. 
87 
65 and over had a heart check-up in the previous year, compared to only 10% of women 
under 35. 
Considerable variation exists within the EC. The highest proportion of heart check-ups 
reported was in Germany (both the former German Democratic Republic and the pre-
unification Federal Republic of Germany) and Portugal (35.3, 31.5, and 32.6% 
respectively) while the lowest rates were reported in the Netherlands and Sweden (9.7 and 
12.8% respectively). 
6.5.2 Cholesterol Testing 
Although controversy surrounds the issue of the desirability of mass screening for 
cholesterol, 1 in 4 women in the EC reports having had their cholesterol checked during 
the previous year. As in the case of heart check-ups, cholesterol testing is very age-
dependent, with almost 43% of women aged 65 or over reporting having had a test in the 
pre^ous year (see Figure 6.6 and Table 6.5). 
These results show large variation across the Member States, with Greece reporting the 
highest percentage (38.1%) of women having had a cholesterol test in the previous year, 
and Denmark reporting the lowest level (7.5%). The variation is even greater among 
women aged 65 and over where 67.9% of Greek women report having had such a test 
compared with only 12.8% of Danish women. 
6.5.3 Diabetes Testing 
The incidence of non-insulin dependent diabetes mellitus (normally referred to as diabetes 
type II) has been increasing for the past several decades43. Women over age 40 are at 
particular risk of the disease, perhaps because of their higher rates of obesity following 
menopause. Evidence suggests that approximately half of all persons with diabetes type II 
are undiagnosed resulting in considerable preventable morbidity and mortality44. 
Figure 6.7 and Table 6.6 show that just over 1 in 5 women in the EC had been tested for 
diabetes in the past year. While the rate is age-dependent, it is surprising that only 25% of 
women aged 40-64 years and 37% of women aged 65 years and older have been tested 
for diabetes. As obese women over the age of 40 years are particularly at risk of 
developing diabetes type II, the rate of diabetes testing in this group was calculated. The 
results indicate that about 39% of overweight women and 44% of severely overweight 
women underwent testing for diabetes in the previous year. These results suggest a need 
to increase diabetes testing in middle-age and older women, particularly among those who 
are overweight. 
As was the case with cholesterol testing, significant variation exists across the Member 
States. The former German Democratic Republic and the pre-unification Federal Republic 
of Germany report the highest rates of testing overall (38.1 and 33.0% respectively), while 
Ireland and Sweden report the lowest overall rates (7.9 and 11.2% respectively) (Table 
6.6) 
88 
6.5.4 Osteoporosis Testing 
Age-related osteoporosis occurs more frequently in women than in men and results in 
both significant morbidity and mortality. Data from the 1996 Eurobarometer survey 
indicate that 17% of women over the age of 50 years have had a test* for osteoporosis in 
the past year. This percentage varies from a high of 28% and 27%, respectively, in Austria 
and the pre-unification Federal Republic of Germany to a low of 5% and 4% in Ireland 
and Finland, respectively (see Figure 6.8 and Table 6.7). 
6.5.5 Cancer Screening 
The third EC action plan against cancer (1996-2000) has assigned priority to early 
detection and screening of cancer. The objective is to help improve and increase the 
possibilities of early detection, in particular through the development and dissemination of 
effective screening programmes and appropriate practices45. For women, two specific 
cancer sites (breast and cervix) have been subject to screening practice for almost two 
decades and proven effective when adequately set up (see below). 
Screening services are only as effective as the quality of the service itself. 
Misinterpretation of, for example, cervical smear tests has resulted in the need for recall 
of women for further assessment. Indeed, the fact that cancer screening results in some 
percentage of false positive and false negative results is for some people an important 
argument against such screening programmes. 
In the screening programmes that do exist effectiveness is strongly influenced by the 
participation rate of the targeted population. A 60% participation rate is acceptable, but 
75% (or greater) is desirable. Desirable rates are typically only achieved in countries with 
systematic screening programmes with personalised invitations. Reasons for non-
participaticn include lack of access to screening facilities, either because of geographic 
isolation or because of (low) socio-economic status, lack of information, or lack of female 
physicians46 47. On this latter point, results from the 1996 Eurobarometer survey indicate 
that just over 36% of women in the EC prefer a doctor of the same sex. Rates vary 
considerably across the Member States, with Danish, Finnish, and Irish women expressing 
the most preference for a female doctor and Sweden, Luxembourg, and the Netherlands 
expressing the least preference for a female doctor (see Figure 6.9 and Table 6.8). 
6.5.5.1 Cervical Cancer Screening 
Cervical cancer may be detected by a Papanicolaou smear test available to women through 
outlets such as GPs, family planning clinics, hospitals, and special women's clinics. 
Assessment of organised screening programmes shows a significant reduction in mortality 
from cervical cancer. For example, studies from Finland report possible mortality 
reductions of 50-80%48, while Sweden reports actual reductions of 34%49. Overall, the 
reduction in incidence of and mortality from cervical cancer is estimated to be sufficient to 
justify mass screening programmes50. 
These data should be interpreted with care because "osteoporosis examination" was not specifically 
defined in the survey. As a result, there is no guarantee that respondents' replies are entirely accurate. 
89 
While facilities for smear testing exist in all Member States, not all of them have mass 
screening programmes" 51. Cervical cancer screening is organised on a national level in 
Denmark, Finland, Sweden, the Netherlands, and the UK, albeit with different 
recommended time intervals52. Denmark and Sweden, for example, call women for a test 
every three years, while Finland and the Netherlands use five-year intervals. In the UK 
women can opt for either three- or five-year intervals. The statutory age for screening also 
varies between Member States with the lower age limit ranging from 18-30 years and the 
upper limit from 59-75 years. Participation rates in these programmes range from 70 to 
83% of the target population. 
On an EC level about 40% of all women aged 15 and over report having had a cervical 
smear in the previous year (Eurobarometer, 1996). This varies from 16.5% among women 
aged 65 and over to about 46% among women aged 35-64 (see Figure 6.10 and Table 
6.9). Considerable variation may be observed across the Member States as well, with 
Danish and German (both the former German Democratic Republic and the pre-
unification Federal Republic of Germany) women reporting the highest overall rates of 
screening (63.5, 53.2, and 52.3% respectively). Ireland and Portugal report the lowest 
rates (15.8 and 22.3% respectively). 
6.5.5.2 Breast Cancer Screening 
Breast cancer screening may be performed by physical examination of the breast or by a 
dedicated x-ray machine (mammography). For decades physical examination of the 
breasts, either by a doctor or other health worker (palpation) or by women themselves, 
has been promoted as a method of early detection. Palpation is carried out fairly often 
either as a separate examination or as part of a general medical examination. However, 
results have been disappointing with not many additional tumours being detected at an 
early stage. Furthermore, because many younger women have benign breast lumps, many 
women end up being unnecessarily referred for further tests or biopsies. Studies 
concerning the effectiveness of self-examination have been equivocal53. Nevertheless, 
almost 40% of all women in the EC report having performed a breast self-examination \Û 
the previous year (Eurobarometer, 1996). The rates vary slightly across the age-groups, 
ranging from 29.8% among women aged 60 and over to 48.4% among women aged 50-
59 years (see Figure 6.11 and Table 6.10). Within the EC, the rates range from a high of 
61.5% in the former German Democratic Republic to a low of 15.6% in Ireland. 
Breast cancers detected through well organised screening among 50-69 year-old women 
are, on average, identified four years earlier than clinical appearance, resulting in 
(gradually) reduced death rates. Although screening programmes with full (100%) 
participation can almost cut in half the risk of dying from breast cancer, observed 
participation rates of around 70 percent reduce the risk of dying by one third54. As breast 
cancer is detected earlier in more women and life expectancy increases through early 
treatment, the number of follow-up checks for cancer will necessarily increase. 
Furthermore, as the breast cancer death rate drops there should be fewer patients with 
distant metastases to be treated. 
Some of the autonomous communities in Spain have screening programmes and in Ireland a national 
programme is in preparation. In Germany women with health insurance are entitled to an annual 
check-up51. 
90 
While screening has been shown to be effective in reducing mortality from breast cancer in 
50-69 year-old women, there is currently insufficient evidence to recommend mass 
screening of women aged 40-49 years55. 
More and more countries are debating the desirability of breast cancer mass screening 
programmes. Those countries with a national screening programme justify their decision 
by arguing that the expense of the screening and the stress caused by false positive results 
or the knowledge that the disease is present are outweighed by the benefits of reduction in 
advanced treatment and mortality due to this disease. 
Much of the debate about the so-called médicalisation of women has taken place without 
actual knowledge about women's feelings about mammography screening. In view of this, 
the 1996 Eurobarometer survey asked women to indicate the extent to which they agreed 
or disagreed with the following statement: 
"Mammography screening, that is breast x-ray, should be offered free of 
charge to all women from a certain age because it may help reduce deaths 
from breast cancer." 
The results, shown in Figure 6.12 and Table 6.11, are unequivocally in favour of mass 
screening. Over 90% of women in the EC agree (slightly or strongly) with this statement. 
Furthermore, and contrary to all the other questions asked in the Eurobarometer survey, 
there is only very limited variation in the range of responses between Member States and 
age-groups. 
Notwithstanding this consensus among women in favour of mammography screening, the 
situation in the Member States varies greatly. Currently, Finland, the Netherlands, 
Luxembourg (for women on social security), Sweden, and the UK have national 
mammography (mass) screening programmes. Denmark, France, and Spain have 
mammography screening programmes in some areas. In Germany, women with health 
insurance are offered an ariual screening which, however, does not necessarily involve a 
mammogram. 
Participation rates in national screening programmes vary. The Netherlands reports 79% 
participation, Finland 89%, Sweden 70-85%, and the UK 72%56. 
Although many Member States do not have national screening programmes, this does not 
mean that women in those countries do not receive mammograms when needed. As 
shown in Figure 6.13 and Table 6.12, 38% of all women aged 50-59 years and 28% of 
women aged 60-69 years report having had a mammogram in the previous 12 months. 
Given the variation in national screening programmes, it is not surprising that there are 
considerable differences between Member States in the percentage of women reporting 
having had a mammogram in the previous year. Sweden and Luxembourg - both countries 
with mass screening programmes - report 71% and 64%, respectively, while Greece and 
Ireland report the lowest rates of mammography screening with rates of 31% and 2%, 
respectively (for the 50-59 years old). 
91 
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2 CEC (1990), Europe against Cancer: 1990-1994, second action plan, Luxembourg. 
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4 Sinkkonen, S. (1996), Finnish Report on Women's Health, Kuopio: Unpublished. 
5 Thomas, C. (1996), British Report on Women's Health, Lancaster: Unpublished. 
6 Ibid. 
7 Thornton, L. (1992), Smoking in pregnancy: behaviour, belief and attitudes of women attending a 
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Policy. Dartmouth. London. 
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19 Marmot, M., Brunner, E. (1991), "Alcohol and cardiovascular disease: the status of the U shaped 
curve," BMJ; 303:565-568. 
20 See, for example, Le, M.G., Hill, C, Kramar, A, Flamant, R (1984), "Alcoholic beverage 
consumption and breast cancer in a French case-control study," Am J Epidemiol, 120:350-357; Rohan, 
T.E., McMichael, A J. (1988), "Alcohol consumption and risk of breast cancer," IntJ Cancer, 41:695-
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EngJMed, 316:1174-1180. 
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Denmark. 
22 Irish Department of Health (1995), Developing a Policy for women's Health: A Discussion Document, 
Dublin: Stationary Office. 
23 CEC (1995a), Report from the Commission on the State of Health in the European Community, 1995, 
COM(95) 357 final, Brussels: CEC. 
24 Thornton, L. (1992), Smoking in pregnancy: behaviour, belief and attitudes of women attending a 
Dublin maternity hospital. Dublin: Ph.D. thesis submitted for Membership of the Faculty of Public 
Health of the Royal College of Physicians of Ireland (unpublished). 
25 See for example Glenn, S.W., Parsons, O.A, Stevens, L. (1989), "Effects of alcohol abuse and familial 
alcoholism on physical health in men and women," Health Psychol, 8:325-341; North, C.S. (19%), 
"Alcoholism in women - more common — and serious — than you might think," Postgrad Med, 
100:221-224: Chou, S.P., Dawson, D.A (1994), "A study of the gender differences in morbidity 
among individuals diagnosed with alcohol abuse and/or dependence," J Subst Abuse, 6:381-392; and 
Thomasson, H.R (1995), "Gender differences in alcohol metabolism. Physical responses to ethanol," 
Recent Dev Alcohol, 12:163-179. 
26 Member State Reports on women's Health (1996), unpublished. 
27 Sundh, M., Renck, B. (1996), Swedish Report on Women's Health, Karlstad: Unpublished. 
28 Vermeulen. M. (1996), Dutch Report on Women s Health , Amsterdam: Unpublished. 
92 
29 Folkhalsoinstitutet & Centralfôrbundet for alkohol- och narkotikaupplysning. Alkohol och 
narkotikautvecklingen i Sverige. Rapport 95. Stockholm, 1995. 
30 Thomas C. (1996), British Report on Women's Health, Lancaster: Unpublished. 
31 Department of Health, United Kingdom (1996), personal communication. 
32 CEC (1995a), Report from the Commission on the State of Health in the European Community, 
COM(95) 357 final, Brussels: CEC. 
33 Ministry of Health, Denmark (1994c), Cancer Trends and Cancer Mortality (in Danish), Copenhagen, 
Denmark. 
34 Pi-Sunyer, F.X. (1993), "Medical Hazards of Obesity," Ann Intern Med, 119:665-660. See also 
Foster, W.R, Burton, B.J. (Eds.) (1985), "National Institutes of Health Consensus Conference: Health 
Implications of Obesity," Ann Intern Med, 103:977-1077. 
35 Blumen-Krantz, M. (19%), "Obesity: The World's Oldest Metabolic Disorder," Mednews. 
36 Ministry of Health, Denmark (1994d), Heart Disease in Denmark (in Danish), Copenhagen, 
Denmark. 
37 CEC (1995a,), Report from the Commission on the State of Health in the European Commuity, 1995, 
COM (95) 357 final, Brussels: CEC. 
38 Ministry of Health, Denmark (1994c), Cancer Trends and Cancer Mortality (in Danish), Copenhagen, 
Denmark. 
39 Sundh, M., Renck, B. (1996), Swedish Report on Women's Health, Karlstad: Unpublished. 
40 Blair, S.N., et al. (1989), "Physical fitness and all-cause mortality, " Journal of American Medical 
Association, 262(17):2395-2401. 
41 CEC (1995a), Report from the Commission on the State of Health in the European Community, 1995, 
COM (95) 357 final, Brussels: CEC. 
42 Member State reports on women's health (19%), unpublished. 
43 See, for example, King, H., Zimmet, P. (1988), "Trends in the prevalence and incidence of diabetes: 
non-insulin-dependent diabetes mellitus," World Health Statistics Quarterly. Rapport Trimestriel de 
Statistiques Sanitaires Mondiales, 41 (3-4) 190-6;Eshoj, O., et al. (1994), "Increased prevalence of 
insulin-treated diabetes mellitus in Funen County, Denmark," Journal of Internal Medicine, 235 (5) 
405-10. 
44 British Diabetic Association (1996), Counting the Cost: The Real Impact of Non-Insulin Dependent 
Diabetes, London: British Diabetic Association. 
45 CEC (1995c)," The fight against canoer: an action plan for 1996-2000", Social Europe: Two years of 
Community social policy: July 1993 - June 1995 Luxembourg: Office of Official Publications of the 
European Communities, pp. 101-10J. 
46 Bentham, G., et al. (1995)," Factors affecting non-response to cervical cytology screening in Norfolk, 
England," Soc Sci Med, 40:131-35. 
47 Gatrell, A, Maddocks, A, Kirwan, M., Garnett, S. (1995),"Making GIS sing and dance to a 
Purchaser's tune," Proceedings AGI '95. 
48 Pukkala (1993), Women and men in FinlandJJving Conditions 1995: 1, Finnish Cancer Registry: 
Cancer Statistics of NAWH. 
49 Laara, E., Day, N. E., Hakama, M. (1987), "Trends in mortality from cervical cancer in the Nordic 
.countries: association with organized screening programmes," Lancet, 8544: 1247-9. 
50 Screening for cervical cancer (1996), Mednews (208/04728). 
51 Sanchis, C. (1996), Spanish Report on Women's Health, Valencia: Unpublished 
Weilandt, C. (1996), German Report on Women's Health, Bonn: Unpublished. 
52 Petersson, B. (1996), Danish Report on Women's Health, Copenhagen: Unpublished. 
Sinkkonen, S. (1996), Finnish Report on Women's Health, Kuopio: Unpublished. 
Sundh, M., Renck, B. (1996), Swedish Report on Women's Health, Karlstad: Unpublished. 
Vermeulen, M. (1996), Dutch Report on Women's Health, Amsterdam: Unpublished. 
Thomas, C. (1996), British Report on Women's Health", Lancaster: Unpublished. 
53 See, for example, Canadian Task Force on the Periodic Health Examination (1986), "The Periodic 
Health Examination: 2, 1985 update," Can Med Assoc J, 134:724-729; Foster, RS., Constanza, M.C. 
(1984), "Breast self-examination practices and breast cancer survival," Cancer, 53:999-1005; and Le 
Geyte, M., Mant, D., Vessey, M.P., et al. (1992), "Breast self-examination and survival from breast 
cancer," Br J Cancer, 66:917-918. 
54 Nystrom, L., Rutqvist, L.E., Wall, S. et al. (1993), "Breast cancer screening with mammography: an 
overview of Swedish randomised trails," Lancet, 341:973-978. 
93 
55 Cancer screening for patients (1995), Mednews (208/05499). 
56 Member State reports on women's health (19%), unpublished 
94 
[Figures and Tables] 
95 
Figure 6.1 
Percentage of smokers (1991)* 
Women 15+ Years, Selected EU Countries 
Denmark 
The Netherlands 
France 
Ireland j 
United Kingdom 
Spain 
Germany W 
Italy 
Luxembourg 
Greece 
Belgium 
Portugal 
60% 
* Belgium: 1989, Spain and Italy: 
1990 —I 1 
80% 100% 
Source: Eurostat '95b 
Table 6.1 
Percentage of Smokers (1991)* 
Women 15+ Years, Selected EU Countries 
Denmark 
The Netherlands 
France 
Ireland 
United Kingdom 
Spain 
West German 
Italy 
Luxembourg 
Greece 
Belgium 
Portugal Percent 
42 
33 
32 
31 
29 
27 
26 
26 
26 
25 
24 
12 
* Belgium 1989; Spain and Italy 1990 
Source: Eurostat 1995b 
96 
Figure 6.2 
Smoking Attributable Mortality (1990) 
Women 35+ Years, EU 15 
6 8 10 12 
% Smoking Attributable Deaths 14 18 
Source: Peto R. Lopez AD, Boreham J, Thun M, Heath C. Mortality from smoking in developed countries. 1950-2000. 
Indirect estimates from vital statistics. Oxford Medical Publications. Oxford. New York, Tokyo, 1994. 
Table 6.2 
Smoking Attributable Mortality * (1990) 
Women 35+ Years, EU 15 
Total Mortality* Percent 
Ireland 
Denmark 
United Kingdom 
Austria 
Netherlands 
Sweden 
Italy 
Germany 
Greece 
Finland 
Belgium 
France 
Luxembourg 
Portugal 
Spain 
EU total (15) 2.3/ 
4.4/ 
48.0/ 
2.1/ 
2.7/ 
2.0/ 
10.1/ 
16.2/ 
1.3/ 
0.7/ 
1.3/ 
2.2/ 
0.0/ 
0.0/ 
0.0/ 
9.3/ 14.2 
28.8 
320.0 
43.3 
60.0 
45.5 
256.0 
487.0 
43.2 
24.9 
50.0 
246.0 
1.8 
47.0 
151.0 
1817.9 16.2 
15.3 
15.0 
4.9 
4.5 
4.4 
4.0 
3.3 
3.0 
2.8 
2.6 
0.9 
0.0 
0.0 
0.0 
5.1 
Source: Peto R, Lopez AD, Boreham J, Thun M, Heath C. Mortality from smoking in developed countries. 1950-2000 
Indirect estimates from vital statistics. Oxford Medical Publications. Oxford, New York, Tokyo, 1994. 
Smoking related deaths over total deaths (in thousands) and in percentages; data were calculated (see source) for two 
age-groups: 35-69 and 70+ years of age and then added. (Estimates were computed for the year 1990). 
97 
Figure fà 
Liver Disease Mortality (1992) 
All Women, EU 15 
SDR chronic liver disease and cirrhotic, Females all ages, per 100000 
RwMbylBDSCR 
EU 15 I 
Source - HFA 1996 SDR chronic Mver disease and cirrhosis, al ages, per 100000 
Females 
Country I Ï992 % change 
since 1070 
EU 15 9.51 -10.88 
AUSTRIA 14.42 10.64 
ITALY' 13.78 -13.11 
PORTUGAL' 13.70 -45.57 
GERMANY4 12.84 -3.31 
LUXEMBOURG ' 10.90 -34.69 
FRANCE 8.98 -53.85 
SPAIN 8.92 -40.97 
DENMARK 8.77 8.54 
BELGIUM ' 8 46 10.59 
FINLAND 601 8048 
GREECE 4.58 -50.22 
UNITED KINGDOM 4.46 9142 
SWEDEN 4.19 -10.85 
NETHERLANDS 3.58 -2.72 
IRELAND | V93 -33.45 
'1971 
J1989 
J1991 
4 FRGto 1990 
Source - HFA 1996 
Figure 6A 
Percent Over- and Underweight, Women 18+ Years 
EU 15 (1996) 
EU 15 
Austria 
Belgium 
Denmark 
France 
Finland 
Greece 
Germany E 
Germany W 
Ireland 
Italy 
Luxembourg 
The Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom wmmmm, wmmmmmsk 
•mmw/M wmmmmsï 
wMmm. mmÉmmm 
40% 
severe underweight (<18 BMI) underweight (18-20 BMI) 
overweignt (27-30 BMI) 20% \ 40% 
severe overweight (30+ BMI) 
Source: Eurobarometer 44.3/1996 
98 
Table 6.3 
Percent Over- and Underweight, Women 18+ Years, 
EU 15 (1996) 
severe 
underweight 
(BMK18) 
% underweight 
18^BMI<20) 
% normal weight 
(20SBMK27) 
% overweight 
(27SBMK30) 
% severe 
overweight 
(BMI^30) 
% mean 
BMI 
% 
EU 15 2.8 
Austria 2.2 
Belgium 4.1 
Denmark 2.4 
France 3.8 
Finland 2.8 
Greece 1.8 
Germany E 2.1 
Germany W 1.4 
Ireland 2.6 
Italy 4.2 
Luxembourg 4.2 
The Netherlands 2.2 
Portugal 1.5 
Spain 3.2 
Sweden 1.7 
United Kingdom 2.5 12.4 
10.1 
10.0 
15.2 
20.5 
7.8 
8.7 
5.8 
11.1 
10.5 
14.7 
14.9 
8.6 
8.1 
10.9 
10.0 
10.1 64.4 
66.7 
67.0 
65.9 
60.1 
64.1 
56.3 
72.1 
71.0 
70.0 
62.0 
61.1 
68.6 
61.9 
62.3 
69.4 
60.6 12.4 
12.4 
8.9 
9.0 
9.9 
13.8 
16.6 
13.6 
12.0 
8.8 
11.9 
10.7 
12.0 
14.8 
15.3 
11.8 
13.8 8.1 
8.5 
10.0 
7.5 
5.6 
11.4 
16.6 
6.4 
4.5 
8.1 
7.2 
9.2 
8.6 
13.7 
8.3 
7.0 
13.1 24.0 
24.1 
24.2 
23.5 
23.0 
24.7 
25.5 
24.2 
23.6 
24.1 
23.5 
23.7 
24.2 
24.9 
24.3 
23.9 
25.2 
Source: Eurobarometer 44.3/1996 
Figure 6.5 
Percent with Heart Check-Up in Past Year 
Women 15+ Years, EU 15 (1996) 
Germany E 
Portugal 
Germany W 
Austria 
Greece 
Finland 
EU 15 
Italy 
Belgium 
Ireland 
Luxembourg 
France 
United Kingdom 
Spain 
Denmark 
Sweden 
The Netherlands 
0% EU 
average 
_l p i h 
20% 40% 60% 80% 100% 
Source: Eurobarometer 44.3/1996 
99 
Table 6.4 
Percent with Heart Check-Up in Past Year 
Women 15+ Years, EU 15 (1996) 
15-34 
years 
% 35-64 
years 
/o 65+ 
years 
% Total 
% 
Germany E 
Portugal 
Germany W 
Austria 
Greece 
Finland 
EU 15 
Italy 
Belgium 
Ireland 
Luxembourg 
France 
United Kingdom 
Spain 
Denmark 
Sweden 
The Netherlands 11.9 
15.1 
9.0 
19.0 
13.1 
8.7 
9.8 
9.9 
6.3 
7.5 
11.6 
10.4 
8.3 
13.3 
5.4 
4.0 
4.8 39.7 
38.6 
35.8 
23.0 
27.6 
22.2 
22.2 
18.6 
21.1 
19.7 
16.7 
19.4 
15.1 
12.8 
14.1 
12.1 
11.5 66.3 
54.2 
61.0 
58.9 
45.7 
47.9 
43.7 
43.5 
45.5 
50.7 
40.0 
32.3 
36.2 
35.2 
31.4 
32.2 
24.2 35.3 
32.6 
31.5 
27.2 
25.4 
23.9 
21.8 
20.7 
20.4 
19.1 
18.5 
17.6 
17.0 
16.9 
14.1 
12.8 
9.7 
Source: Eurobarometer 44.3/1996 
Figure 6.6 
Percent Reporting a Cholesterol Test in Past Year 
Women 15+ Years, EU 15 (1996) 
Greece 
Austria 
Germany W 
Germany E 
Portugal 
Luxembourg 
Spain 
France 
Italy 
Belgium 
EU 15 
Finland 
The Netherlands 
Sweden 
Ireland 
United Kingdom 
Denmark 
0% 20% 
ranked by aver?ge of both age-groups • 
age 65+ 
age 50-64 
40% 60% 
Yes 80% 100% 
Source: Eurobarometer 44.3/1996 
100 
Table 65 
Percent Reporting a Cholesterol Test in Past year 
Women 15+ Years, EU 15 (1996) 
Greece 
Austria 
Germany W 
Germany E 
Portugal 
Luxembourg 
Spain 
France 
Italy 
Belgium 
EU 15 
Finland 
The Netherlands 
Sweden 
Ireland 
United Kingdom 
Denmark 15-34 
years 
17.1 
26.1 
11.7 
14.8 
14.5 
19.0 
20.2 
24.2 
15.5 
11.1 
13.8 
9.2 
5.7 
3.5 
4.5 
3.8 
3.6 35-49 
years 
31.8 
28.6 
22.8 
27.2 
34.2 
33.7 
27.6 
29.8 
24.7 
22.6 
22.8 
21.7 
10.6 
8.9 
12.3 
12.8 
8.0 50-64 
years 
56.3 
48.1 
52.0 
49.3 
51.4 
46.0 
35.0 
38.9 
40.2 
39.0 
37.2 
30.4 
25.8 
22.6 
18.0 
14.9 
8.9 65+ 
years 
67.9 
56.0 
48.0 
50.0 
46.4 
49.0 
58.1 
53.0 
46.6 
41.4 
42.8 
38.7 
27.3 
23.6 
25.4 
16.1 
12.8 Total 
38.1 
35.6 
30.6 
32.7 
33.3 
31.9 
31.7 
33.0 
29.1 
25.1 
26.2 
23.5 
12.5 
12.8 
12.0 
10.6 
7.5 
Source: Eurbarometer 44.3/1996 
Figure 6- 7 
Percent Reporting a Diabetes Test in Past Year 
Women 40 + Years, EU 15 (1996) 
Germany E 
Germany W 
Portugal 
Greece 
Luxembourg 
Austria 
Finland 
EU 15 
Italy 
France 
Spain 
Belgium 
Denmark 
United Kingdom 
Sweden 
The Netherlands 
Ireland 
ranked by average of both age-groups • 
age 65+ 
age 40-64 
80% 100% 
Source: Eurobarometer 44.3/1996 
101 
Table 6.6 
Percent Reporting a Diabetes Test in Past Year 
Women 15+ Years, EU 15 (1996) 
Germany E 
Germany W 
Portugal 
Greece 
Luxembourg 
Austria 
Finland 
EU 15 
Italy 
France 
Spain 
Belgium 
Denmark 
United Kingdom 
Sweden 
The Netherlands 
Ireland age <40 
years 
23.7 
14.2 
17.2 
12.8 
24.7 
20.2 
16.1 
12.5 
7.5 
15.2 
7.3 
10.7 
10.4 
13.3 
5.8 
10.4 
5.8 age 40-64 
years 
42.2 
41.7 
39.5 
33.3 
30.5 
29.5 
29.5 
25.1 
22.2 
19.8 
19.2 
19.9 
14.6 
15.8 
12.1 
13.4 
7.8 age 65+ 
years 
62.5 
58.0 
48.5 
47.6 
45.1 
44.0 
37.8 
36.6 
34.5 
34.9 
30.1 
23.2 
24.4 
19.5 
21.4 
15.2 
15.5 Total 
38.1 
33.0 
31.4 
26.8 
30.0 
27.3 
26.1 
21.6 
18.5 
19,6 
15.4 
16.3 
14.5 
15.4 
11.2 
11.9 
7.9 
Source: Eurobarometer 44.3/1996. 
Figure 6.8 
Percent Reporting an Osteoporosis Examination in Past Year 
Women 50+ Years, EU 15 (1996) 
Austria 
Germany W 
Germany E 
Greece 
Belgium 
France 
Italy 
EU 15 
Denmark 
Spain 
Luxembourg 
Portugal 
The Netherlands 
United Kingdom 
Sweden 
Ireland 
Finland 
0% EU 
average 
20% 40% 60% 80% 100% 
Source: Eurobarometer 44.3/1996 
102 
Table 6.7 
Percent Reporting an Osteoporosis Test in Past Year 
Women 50+ Years, EU 15 (1996) 
Austria 
Germany W 
Germany E 
Greece 
Belgium 
France 
Italy 
EU 15 
Denmark 
Spain 
Luxembourg 
Portugal 
The Netherlands 
United Kingdom 
Sweden 
Ireland 
Finland 50+ 
years 
27.5 
26.7 
22.8 
19.7 
19.5 
19.2 
18.5 
16.8 
14.1 
12.6 
12.3 
11.6 
10.3 
5.7 
5.5 
4.5 
4.4 50-64 
years 
28.9 
27.0 
18.8 
18.2 
24.5 
19.2 
20.7 
16.7 
11.0 
10.5 
19.4 
12.2 
8.5 
5.3 
3.5 
4.7 
2.7 65+ 
years 
25.9 
26.4 
29.5 
21.7 
14.3 
19.4 
16.2 
17.2 
18.3 
14.9 
7.1 
10.6 
15.6 
6.1 
8.0 
4.2 
6.1 Total 
15.7 
13.6 
14.1 
9.0 
10.3 
9.4 
8.2 
8.7 
7.3 
7.9 
14.3 
6.6 
4.7 
3.6 
2.4 
2.2 
2.9 
Source : Eurobarometer 44.3/1996 
Figure 6.9 
Percent Preferring Women Doctors* 
Women 15+ Years, EU 15 (1996) 
Denmark 
Finland 
Ireland 
Germany W 
Italy 
Germany E 
United Kingdom 
Greece 
Austria 
EU 15 
Spain 
Portugal 
France 
Belgium 
The Netherlands 
Luxembourg 
Sweden 
0% 
ranked by % agree k^^\^\v^^ 
k\\V\\\\\\\\\^^^ 
20% 40% 60% 80% 100% 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to rate the extent to which they agreed/disagreed with the following statement :" I would prefer to consult a 
doctor of my own sex for my hearth problems" The tables shows the distribution of responses to this statement 
103 
Table U 
Percent Preferring Women Doctors* 
Women 15+ Years, EU 15 (1996) 
Denmark 
Finland 
Ireland 
Germany W 
Italy 
Germany E 
United Kingdom 
Greece 
Austria 
EU 15 
Spain 
Portugal 
France 
Belgium 
The Netherlands 
Luxembourg 
Sweden disagree 
strongly 
16.1 
8.6 
10.0 
10.8 
21.7 
12.6 
12.5 
15.7 
17.4 
16.7 
9.7 
10.5 
24.0 
15.9 
45.8 
19.7 
15.7 disagree 
slightly 
21.8 
21.4 
22.8 
24.3 
6.2 
26.8 
29.7 
16.5 
20.9 
22.3 
30.1 
26.2 
21.6 
34.4 
15.3 
31.0 
25.3 agree 
uncertain 
2.0 
18.8 
18.7 
22.2 
31.2 
21.1 
18.8 
30.2 
25.2 
25.4 
25.7 
33.3 
31.4 
27.6 
17.9 
29.7 
39.4 agree 
slightly 
25.2 
30.0 
21.7 
27.7 
21.1 
23.1 
21.0 
23.6 
20.7 
21.0 
23.9 
21.3 
14.2 
15.0 
8.9 
13.2 
13.1 agree 
strongly 
34.9 
21.2' 
26.8 
15.0 
19.9 
16.5 
17.9 
14.1 
15.8 
14.6 
10.6 
8.7 
8.8 
7.1 
12.1 
6.5 
6.4 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to rate the extent to which they agreed/disagreed with the following statement :" I would prefer to 
consult a doctor of my own sex for my hearth problems" The tables shows the distribution of responses to this statement. 
Figure 6.10 
Percent Reporting a Cervical Smear Test in Past Year 
Women 15+ Years, EU 15 (1996) 
Denmark 
Austria 
France 
Germany E 
Finland 
Germany W 
Luxembourg 
Belgium 
EU 15 
Greece 
Italy 
United Kingdom 
Sweden 
The Netherlands 
Spain 
Portugal 
Ireland 
ranked by age 35-64 age 15+ • 
age 35-64 
80% 100% 
Source: Eurobarometer 44.3/1996 
104 
Table 6.9 
Percent Reportmg a Cervical Smear Test in Past Year 
Women 15+ Years, EU 15 (1996) 
Denmark 
Austria 
France 
Germany E 
Finland 
Germany W 
Luxembourg 
Belgium 
EU 15 
Greece 
Italy 
United Kingdom 
Sweden 
The Netherlands 
Spain 
Portugal 
Ireland 5-34 
years 
51.8 
49.3 
55.2 
55.7 
38.0 
38.0 
42.5 
41.6 
37.3 
24.4 
22.2 
41.6 
26.7 
20.1 
29.3 
23.2 
14.4 35-64 
years 
73.2 
60.9 
60.4 
58.1 
55.1 
53.2 
52.2 
49.4 
45.9 
43.0 
40.3 
38.0 
36.8 
32.2 
31.3 
27.3 
21.5 65+ 
years 
58.1 
22.0 
21.2 
27.3 
12.8 
18.0 
18.0 
20.Z 
16.5 
15.5 
15.5 
8.6 
11.2 
15.2 
12.9 
7.2 
1.4 Total 
63.5 
50.2 
53.2 
52.3 
40.6 
41.4 
42.8 
41.0 
37.7 
31.9 
29.1 
33.3 
28.8 
26.4 
27.2 
22.3 
15.8 
Source: Eurobarometer 44.3/1996 
Figure 6.11 
Percent Reporting a Breast Examination by Hand in Past Year 
Women 15+ Years, EU 15 (1996) 
Germany E 
Denmark 
Austria 
Luxembourg 
Germany W 
France 
Belgium 
EU 15 
Finland 
Sweden 
Spain 
Italy 
The Netherlands 
United Kingdom 
Portugal 
Greece 
Ireland 
ranked by age 15+ age 15+ • 
age 50-59 
80% 100% 
Source: Eurobarometer 44.3/1996 
105 
Table 6.10 
Percent Reporting a Breast Examination by Hand in Past Year 
Women 15+ Years, EU 15 (1996) 
Germany E 
Denmark 
Austria 
Luxembourg 
Germany W 
France 
Belgium 
EU 15 
Finland 
Sweden 
Spain 
Italy 
The Netherlands 
United Kingdom 
Portugal 
Greece 
Ireland 15-34 
years 
54.2 
41.1 
55.4 
45.8 
48.6 
42.3 
36.3 
32.4 
24.1 
20.4 
27.8 
20.1 
16.3 
20.8 
19.3 
15.9 
11.9 35-49 
years 
71.5 
51.5 
59.7 
66.3 
64.3 
50.9 
58.7 
47.0 
48.6 
38.7 
38.6 
38.4 
39.4 
34.3 
35.8 
29.6 
22.8 50-59 
years 
74.5 
64.7 
62.7 
76.7 
63.1 
58.2 
50.0 
48.4 
54.8 
44.3 
36.2 
37.7 
33.3 
37.7 
34.5 
36.5 
22.2 60+ 
years 
50.8 
62.8 
32.5 
27.3 
38.4 
39.4 
27.0 
29.8 
33.6 
37.9 
21.0 
23.2 
26.0 
18.8 
18.0 
11.5 
9.5 Total 
61.5 
52.8 
52.7 
52.3 
52.0 
46.8 
41.2 
37.9 
37.6 
33.2 
29.9 
28.0 
27.9 
25.8 
24.8 
21.4 
15.6 
Source: Eurobarometer 44.3/1996 
Figure 6.12 
Percent Favouring Mammography Screening 
Women 15+ Years, EU 15 (1996) 
Finland 
Sweden 
France 
United Kingdom 
The Netherlands 
Spain 
Italy 
Greece 
EU 15 
Ireland 
Luxembourg 
Denmark 
Germany E 
Portugal 
Belgium 
Austria 
Germany W 
0% 
ranked by age 15+ age 15+ • 
age 50-59 
EU 
average 
20% 40% 60% 80% 100% 
Source: Eurobarometer 44.3/1996 
106 
Table Ul 
Percent Favouring Mammography Screening 
Women 15+ Years, EU 15 (1996) 
Finland 
Sweden 
France 
The Netherlands 
United Kingdom 
Spain 
Italy 
Greece 
EU 15 
Ireland 
Luxembourg 
Denmark 
Germany E 
Portugal 
Belgium 
Austria 
Germany W 15-34 
years 
97.6 
97.1 
95.4 
92.8 
94.8 
96.5 
93.8 
92.1 
91.3 
91.6 
90.9 
88.1 
86.4 
91.3 
87.9 
82.3 
81.1 35-49 
years 
98.6 
96.8 
93.0 
97.0 
96.6 
96.1 
91.1 
96.2 
91.7 
89.7 
89.1 
89.1 
85.7 
90.0 
87.2 
88.3 
85.0 50-59 
years 
98.6 
98.9 
96.9 
91.2 
94.3 
98.6 
93.5 
93.2 
93.0 
90.9 
90.3 
90.6 
90.4 
79.3 
87.1 
90.7 
88.2 60+ 
years 
97.5 
93.1 
95.7 
98.6 
94.0 
88.7 
86.8 
82.0 
87.4 
84.8 
82.5 
85.8 
90.3 
86.0 
86.9 
71.7 
73.2 Total 
98.0 
96.4 
95.2 
95.0 
95.0 
94.8 
91.2 
90.9 
90.7 
89.6 
88.7 
88.3 
87.9 
87.8 
87.4 
82.8 
81.1 
Source: Eurobarometer 44.3/1996 
Figure 6J3 
Percent Reporting a Mammography in Past Year 
Women 50-69 Years, EU 15 (1996) 
Sweden 
Denmark 
The Netherlands 
Luxembourg 
Finland 
Austria 
United Kingdom 
France 
EU 15 
Germany W 
Portugal 
Spain 
Germany E 
Italy 
Belgium 
Greece 
Ireland 
0% 20% 
ranked by average of both age-groups • 
age 60-69 
age 50-59 
40% 60% 80% 100% 
Source: Eurobarometer 44.3/1996 
107 
Table U2 
Percent Reporting a Mammography in the Past Year 
Women 15+ Years, EU 15 (1996) 
<40 
years 40-49 
years 50-59 
years 60-69 
years 70+ 
years Total 
Sweden 2.4 
Denmark 11.0 
The Netherlands 6.1 
Luxembourg 13.9 
Finland 2.4 
Austria 19.1 
United Kingdom 2.6 
France 6.0 
EU 15 8.1 
Germany W 14.8 
Portugal 10.7 
Spain 12.6 
Germany E 14.2 
Italy 3.4 
Belgium 11.0 
Greece 3.2 
Ireland 2.7 30.3 
34.4 
16.5 
47.0 
11.8 
41.1 
10.5 
23.9 
24.6 
30.4 
21.7 
32.5 
25.5 
27.0 
31.2 
19.3 
10.1 70.5 
51.2 
50.9 
64.3 
58.3 
57.3 
40.0 
34.4 
38.0 
37.4 
35.6 
31.9 
31.2 
36.0 
32.2 
30.6 
1.9 57.4 
57.4 
55.6 
36.4 
33.7 
27.1 
32.5 
32.8 
28.4 
26.1 
22.5 
24.3 
22.8 
19.0 
16.7 
14.8 
6.8 22.4 
45.5 
15.8 
20.0 
9.1 
19.3 
3.2 
22.9 
11.9 
11.8 
10.2 
3.9 
16.0 
9.4 
10.5 
5.1 
4.4 27.9 
31.1 
18.4 
28.3 
17.8 
28.9 
12.9 
18.4 
18.1 
21.8 
18.0 
18.8 
20.7 
15.1 
17.2 
12.0 
4.6 
Source : Eurobarometer 44.3/1996 
108 
7. SPÉCIAL ISSUES IN WOMEN'S HEALTH 
This chapter describes selected issues in women's health of importance to public health 
endeavours at both Community and Member State level. They have been chosen to reflect 
health concerns for women at different stages of their lives. Thus, for young women 
eating disorders and HTV/ATDS are discussed. For women of childbearing age the focus is 
on family planning and abortion issues, and for elderly women menopause and 
menopause-related health issues (e.g., osteoporosis and hormone replacement therapy 
(HRT)). In addition to these issues, violence against women is discussed because of its 
importance to women of all ages. 
It should be pointed out that despite the importance of these issues, national statistics are 
scarce. Furthermore, existing data are of limited comparability because of differences in 
definitions and/or data collection methods. This chapter should therefore be seen as an 
attempt to highlight important, emerging health issues for women, rather than as a 
comparison of these aspects of the state of women's health in the EC . 
7.1 Eating Disorders 
The eating disorders bulimia and anorexia nervosa, which occur primarily in young 
women, are associated with considerable morbidity and even mortality. There is currently 
no national public health policy on these issues anywhere in the EC, and no national 
statistical data are available on their incidence and prevalence. Various estimates of the 
incidence of bulimia/anorexia nervosa indicate that they are increasing in the EC. 
However, with the greater media attention given to them, it is impossible to determine 
whether the apparent increase is real or only the result of greater awareness of the 
problem. An additional difficulty in obtaining reliable data on the incidence of eating 
disorders is that the victims often try to hide their disorders). 
Estimated incidence rates for these eating disorders vary considerably. One source1 
estimates the incidence of anorexia nervosa in western countries to be nearly 1% among 
women aged 14-29. However, other studies have reported much lower rates, ranging 
from 0.45 per 100,000 in Sweden2 to 8.1 per 100,000 in the Netherlands8 3, with the UK 
reporting rates of 0.66-3.77 per 100,0004. Needless to say it is impossible to determine 
which estimate is the most accurate. With respect to bulimia nervosa, estimates for 
Western countries put the incidence at 1-2% of women aged 14-45 years5. Estimates from 
individual studies vary considerably from a low of 11.4 per 100,000 in the Netherlands 6 
to a high of 3-4% in Sweden and Germany7 8. 
As already noted, anorexia and bulimia nervosa are associated with significant morbidity 
and mortality. In particular suicide and suicide attempts are frequent. Unfortunately, there 
is little information about the actual rates of morbidity and mortality from these disorders, 
because other conditions are often listed as the direct cause of death (or illness). For 
example, suicide from depression, or heart failure, both frequent sequellae of anorexia 
nervosa, are often given as the cause of death when anorexia nervosa would be equally (or 
more) correct. One study estimates a mortality rate of 6% for anorexia nervosa and 3.1% 
a In this study, 8.3% of the sample population were men. 
b In this study, 3.5% of the sample population were men. 
109 
for bulimia nervosa9. In addition, many women suffer from partial anorexia/bulimia 
syndrome or other abnormal eating styles, which pose a health risk and put them at 
elevated risk for full eating disorders. 
The causes of eating disorders are unclear, although some blame, at least* in part, society's 
obsession with body weight and appearance. Research suggests that teenagers and young 
women are particularly concerned about their weight and this may be a reason for the 
higher incidence of eating disorders in these age-groups. For example, a Belgian study10 
found adolescent schoolgirls to be preoccupied with body weight, even when they had an 
ideal body mass index, causing them to adopt a restricted eating style which was 
considered a risk factor for developing eating disorders. Similarly, a Dutch study found 
that 41% of the sample's schoolgirls considered themselves too heavy, 33% were dieting, 
11% were suffering from some form of eating disorder, and 1.5% were suffering from 
bulimia/anorexia nervosa11. 
The findings from these and similar studies12 are confirmed by the results of the 1996 
Eurobarometer survey. As indicated in Figure 7.1 and Table 7.1, about 1/3 of EC women 
aged 15-24 report dissatisfaction with their body weight, and about 25% report having 
been on a diet in the previous year (see Figure 7.2 and Table 7.2). Considerable variation 
exists between the Member States, with Greek women reporting the highest level of 
dissatisfaction with their weight and Irish women reporting the lowest, perhaps reflecting, 
at least in part, differing body mass distributions (see Section 6.3). As shown in Figure 
7.3, satisfaction with one's weight is highly correlated with body mass. Women 
considered severely overweight (i.e., those with BMI of 30 and over) are far more likely 
to report being unhappy with their weight than severely underweight women (i.e., those 
with a BMI of less than 18). 
Treatment for eating disorders includes nutritional counselling, psychotherapy, family 
therapy (recommended for anorexia nervosa), and cognitive therapy (recommended for 
bulimia nervosa). Medical/psychiatric help is usually obtained through hospitals with 
specialist out-patient programmes; in-patient care being limited to instances where the 
disorder is life-threatening13. Specialist clinics have been established in some Member 
States (e.g., Sweden, Finland, Belgium, UK) but demand for treatment exceeds supply. 
7.2 HIV/AIDS and Women's Health 
Infection with Human Immunodeficiency Virus (HTV) and Acquired Immune Deficiency 
Syndrome (AIDS) is an important health issue for young women. Since the identification 
of the first AIDS cases in the EC in the early 1980s, the prevention of HTV has become an 
important public health concern. However, because ADDS first became wide-spread 
among gay and bi-sexual men, AIDS has only recently come to be seen as a problem for 
women as well. By 30 September 1996, 167,021 persons had contracted AIDS in the EC, 
of whom 27,355 (17%) were women (see Tables 7.3 and 7.4»)14. Among women, the 
majority (52%) were intravenous (IV) drug users. While the incidence of AIDS among 
gay and bi-sexual men appears to be stabilising, the rate of transmission in the 
heterosexual population (both male and female) is still increasing. Evidence suggests that 
a The total in the two tables are not identical although they come from the same source14. While no 
explanation is provided, the discrepancy is likely to be due to missing data on the sex of the reported 
case(s) in Table 7.3. 
110 
in the EC the majority of cases of heterosexually acquired HTV have resulted from unsafe 
sex with HIV-positive IV drug users15, and that the majority of babies born HIV-positive 
have acquired the virus through perinatal (vertical) transmission (i.e., from mother to 
child) from an TV drug-using mother or a mother with a partner at risk. 
It should be noted, however, that the main transmission routes of HTV in women vary 
somewhat between Member States (see Figure 7.4). In Spain, Italy, Portugal, and Ireland, 
for example, IV drug users account for the largest share of AIDS cases, while in Belgium 
heterosexual transmission is the main route. 
Owing to the higher prevalence of HTV/AIDS among men, knowledge about the natural 
history of HIV in women is relatively limited. It is clear, however, that they are more 
vulnerable to the virus (as well as to other sexually transmitted diseases) than are men. In 
other words, it is easier to transmit the HTV virus from men to women than vice versa. 
Furthermore, women are frequently diagnosed at a later stage, because of a general lack 
of recognition of their symptoms. Sexually-transmitted reproductive tract infections have 
also been identified as associated risk factors for the spread of HIV16. 
In addition, women have other difficulties in safeguarding themselves from infection. They 
are in a weaker position to ensure safer sex, whether in stable, casual, or commercial 
sexual relationships, than are men. At the same time, it is often assumed that they should 
take the responsibility for using condoms. Trends show that women and men have 
changed their sexual behaviour; they use condoms more often and have reduced then-
number of partners. However, unsafe sex practices continue. Prostitutes face particular 
risks of infection, though contrary to public perception, prostitution does not appear to 
have played a significant role in the transmission of HTV in the EC17, indicating the use of 
safer sex practices in that group, encouraged by preventive interventions. 
Notwithstanding the risks faced by women, preventive interventions aimed at women have 
in general been limited. Either women have been targeted indirectly as part of general 
campaigns for the whole population, or there have been particular actions targeted at 
certain groups, notably IV drug users and sex workers. More efforts are needed 
specifically tailored to women, and particularly young women who have, or are likely to 
become part of the group with, the highest HTV incidence. 
7.3 Family Planning 
One of the most important questions for women during their reproductive years is family 
planning. Most women feel that in order to have control over their lives, they must be able 
to control their fertility with regard to the number and spacing of their children, and they 
must be able to express their sexuality without fear of unwanted pregnancy and sexually 
transmitted diseases (STDs). Availability of contraceptives and abortion are therefore 
important issues. 
Widespread availability of effective contraceptives have contributed to rapidly falling 
fertility rates in the EC. Since 1970, fertility has declined in all Member States, except 
Finland and Sweden where fertility rates have increased slightly (see Table 7.5). Data on 
contraceptive use are not available in Greece, Ireland, and Luxembourg, however, the 
majority of Member States report contraceptive use rates between 71 and 81%. Portugal 
and Spain report rather lower rates, 66 and 59%, respectively. 
m 
There are no data on contraceptive use among teenagers, but it is known that teenagers 
are less likely than the adult population to use contraception for a variety of reasons. They 
may be inhibited by ignorance, by fear of parental discovery of their sexual activity, and by 
a lack of access to contraceptives, etc. These factors contribute to the relatively high 
teenage birth rates, which despite recent declines, continue in the EC (see Table 7.5). 
The following methods of contraception are available in the EC: natural methods (e.g., the 
rhythm method, coitus interruptus/withdrawal), hormonal (e.g., birth control pills, 
injectable/transdermal absorption), barrier methods (e.g., male and female condoms, 
diaphragm, cervical cap, intra-uterine devices (IUDs)), surgical techniques (e.g., male and 
female sterilisation), and post-coital contraception (i.e., the morning-after pill). The most 
widely used contraceptives are birth control pills, followed by condoms. Use of condoms 
has increased as a result of efforts to prevent the spread of HTV1819. 
Choice of contraceptive method is likely to be influenced by availability, cost, and access, 
national policies, physical access, cultural and religious considerations, health status, 
partner preferences, and socio-economic status. Another factor influencing choice are the 
health risks and/or side-effects associated with a contraceptive method. For example, 
hypertension and increased thrombosis risk associated with some birth control pills, and 
increased risk of pelvic inflammatory diseases associated with IUDs, make these methods 
unacceptable to some women. Choice of method is also likely to change over a woman's 
fertile life. Younger women may favour the use of birth control pills or condoms, while 
IUDs and surgical sterilisation may be preferred by older women. 
Family planning advice is readily available in all Member States from doctors, family 
planning centres, maternity clinics, and municipal health centres, however, cost varies 
considerably. In some Member States (e.g., Finland, Italy, and the UK) contraceptives are 
provided free of charge20 21, while in others (e.g., Ireland, Germany) certain groups, such 
as the poor22 or the young23 are targeted. Some Member States (e.g., Finland, the 
Netherlands, Sweden, and the UK) provide family planning centres especially for sexually 
active teenagers24. 
7.4 Abortion 
Improved family planning programmes have reduced the number of unwanted pregnancies 
but have not totally eliminated them. As a result, the demand for induced abortion 
persists, not least among teenagers25. Reasons for seeking abortions include failure of 
contraceptive method, completed family size, pregnancy as a result of rape, confirmed 
deformation of the foetus, health risk to the mother, and socio-economic circumstances. 
Abortion is permitted, under varying criteria/conditions, in all Member States except 
Ireland and Northern Ireland*. Since 1995 health care professionals in Ireland may inform 
their clients about legal abortion services within the EC, but only within the context of full 
counselling on all available options and without advocating abortion. The right for Irish 
women to travel within the EC to procure an abortion was established in 1992. 
Abortion is not available in Ireland However, it should be noted that the Irish Supreme Court has 
ruled that an abortion would be permissible where there was a real and substantial threat to the life of 
the mother which could not be obviated by any other means. The Abortion Act of 1967 which applies 
to England, Scotland, and Wales was not extended to Northern Ireland where abortion is only 
permitted when the life of the mother is threatened. 
112 
The criteria for obtaining an abortion differ among the Member States that permit it. All 
include specific time limits which generally allow abortion to be performed within the first 
trimester, but only to a limited extent in the second trimester. Pre-abortion counselling 
with emphasis on alternative options and a period of reflection is mandatory in all Member 
States. Some Member States also specify that a health professional may refuse to perform 
an abortion because of moral objections. Recently, some Member States (Spain, Germany, 
and France) seem to have been liberalising their abortion policies, although not without 
controversy, while others (Italy and Belgium) have been trying to tighten theirs26. 
Abortion rates per 1000 women vary across the EC (see Table 7.6). The highest rates are 
in Sweden (18.3 per 1000 women), Denmark (14.3 per 1000 women), and France (13.0 
per 1000 women). Italy, the Netherlands, and Spain report substantially lower rates: 8.6, 
6.0, and 5.4 per 1000 women, respectively. Another frequently reported abortion statistic 
is the ratio of abortion to 1000 live births. Not surprisingly, this ratio also varies within the 
EC, with the highest ratios reported in Sweden, Italy, Denmark, France, and the UK27, 
and the lowest in the Netherlands, Luxembourg, and Spain (see Table 7.6). The ratios in 
the latter countries are only one third of those in the former group. 
Complications associated with abortions done under good medical conditions are very 
rare. One study estimates the mortality rate for legal abortions before 8 weeks to be 0.5 
per 100,00028. This compares with a maternal mortality rate of 7 per 100,000 for 
childbirth (see Section 3.3). 
Identification of trends in abortion over time is complicated by a dearth of data and lack of 
comparability. However, inspection of the data from the UK, the Netherlands, and Spain 
seems to indicate that there may be a typical pattern of development following legalisation 
of abortion in a Member State: first the abortion rate increases, often substantially, then as 
time passes the rate stabilises and may even decrease. 
7.5 Menopause 
Menopause - literally the cessation of monthly menstruation - signifies the end of a 
woman's fertile period but usually refers to the extended period (20 or more years) in 
which a woman's body adjusts to a lower hormonal climate, before and after the end of 
menstruation. The average age at menopause is 50-52 years, thus women in the EC can 
expect to live at least one third of their lives after menopause. 
The effect of menopause on women's health varies. Estimates indicate that 75% of 
menopausal women experience some problems or discomfort, but only 10-20% seek 
medical help29. Short-term effects of menopause include vasomotor symptoms (hot flushes 
and night sweats), genito-urinary symptoms, and mood swings. These symptoms may be 
attributed to the effect of declining hormone (oestrogen) levels associated with 
menopause. 
The increasing longevity of women in the EC has intensified the debate about the possible 
long-term consequences of menopause. Although there is currently no proof of a causal 
relation between post-menopausal hormone levels and post-menopausal health, morbidity 
statistics reveal increased incidence of cardiovascular disease and osteoporosis in post­
menopausal women. 
113 
7.5. / Osteoporosis and Cardiovascular Disease 
Age-related osteoporosis occurs in both women and men, but is greater in women because 
of the accelerated bone loss that occurs in women during and after menopause. Post­
menopausal osteoporosis is a cause of concern throughout the EC because of the high 
incidence of bone fracture, especially hip and vertebral fracture, which leads to 
considerable mortality, morbidity, reduced mobility, and decreased quality of life. 
Research suggests that osteoporosis is increasing. A Greek study estimated that 9% of 
women over 45 years have symptoms of osteoporosis30. A Finnish study calculated that 
women aged 50 and over have nearly 40% chance of sustaining an osteoporotic fracture 
during their life time31. Other studies show that hip fractures are associated with a 20% 
mortality during the first year and 40% during the three years after the fracture. 
Furthermore, more than half of those with hip fractures never regain full mobility32. 
Preventive initiatives have focused on ways to maintain quality of life into old age and 
methods to reduce the costs associated with osteoporosis. There are currently no national 
osteoporosis screening programmes in the EC, although local screening facilities exist in 
most countries. Further research is needed to determine the cost-effectiveness of 
prevention methods, which include primary prevention involving increased exercise and 
greater calcium consumption among teenage and pre-menopausal women; secondary 
prevention emphasising early detection (and treatment) through screening; and tertiary 
prevention, which typically involves accident management and rehabilitation of 
osteoporotic women. 
Cardiovascular disease has long been regarded as a disease of men primarily because of its 
low incidence in pre-menopausal women. Among women under 50 the incidence is only 
one quarter of that among similarly aged men. However, the risk of cardiovascular disease 
increases significant as women age. By the age of 60, the incidence has risen to half that 
of men33. When looking at women across their entire lives, cardiovascular disease emerges 
as the primary cause of death. Furthermore, with women's increased longevity, it is 
rapidly becoming an important source of morbidity throughout the EC. 
7.5.2 Prevention and Symptom Control 
Research into the causes of and treatments for osteoporosis and cardiovascular disease in 
post-menopausal women continues in many Member States. Since the 1980s, many 
doctors have begun to recommend hormone replacement therapy (HRT) because of its 
potential for preventing both osteoporosis, cardiovascular disease, and, as documented 
recently, Alzheimer's disease34. However, the debate about the relative costs and benefits 
of HRT is far from settled. Precise rates of HRT usage in Member States are not 
available, but estimates range from 2% in Italy35, 4% in Spain36, 15% in the Netherlands37, 
20% in Austria38 and Sweden39, to 56% in Finland40. 
Evidence suggests that HRT use is associated with higher socio-economic status and city 
residence41. More educated women are also more likely to use HRT, suggesting that 
information about the potential benefits (and side effects) of HRT may be insufficient 
among the general population. To address this issue, the 1996 Eurobarometer survey 
asked women whether they felt well (or poorly) informed about HRT. The results appear 
in Figure 7.5 and Table 7.7 which show that 61% feel insufficiently informed about 
HRT. When analysed by age-groups, this conclusion holds although on women aged 50-
64 years appear slightly better informed than women of other ages. This is perhaps 
114 
understandable as this is the age-group for whom HRT is particularly relevant. Figure 7.5 
also reveals considerable variation between Member States. Portugal, Ireland, Spain and 
Greece report the highest percentage of poorly informed women while Finland and 
Luxembourg report the lowest, to some extent mirroring the usage rates in these 
countries. Altogether these results clearly point to the need for more (or better) HRT 
information in the EC. 
7.6 Violence against Women 
Violence against women - defined by the UN General Assembly as "any act of gender-
based violence that results in, or is likely to result in, physical, sexual or psychological 
harm or suffering to women, including threats of such acts, coercion or arbitrary 
deprivation of liberty, whether occurring in public or in private life"42- is an issue of 
growing concern in the ECa 43. Owing to the lack of national statistics on the subject, it is 
impossible to determine whether the perceived increase in violence against women reflects 
a true increase, or whether it is due to a higher level of reporting because of a greater 
awareness and acceptance of the problem. 
Violence against women, which was initially seen as a human rights concern, has gradually 
been recognised as a public health issue. Indeed, the European Women's Health Network, 
established in Vienna in 1994, included violence against women as one of 6 major health 
concerns. Although violence against women is known to cut across socio-economic, 
cultural, religious, and racial boundaries, there is concern that some groups of women, 
such as the elderly, migrants and poor women, may be especially vulnerable. 
The causes of violence against women are unclear, but alcohol and drug abuse, poverty, 
and overcrowded conditions are factors known to exacerbate violent attacks on women44. 
It has also been suggested that changes in society aimed at improving the status of women 
(relative to men) may have contributed to increased assaults and sexual violence against 
them45. 
7.6.1 Domestic Violence 
Although data are scarce, it is now recognised in all Member States that violence against 
women by a male partner is the most endemic form of violence46 4 . In general, available 
data differentiate between domestic and sexual violence, although there is considerable 
overlap since rape within an intimate relationship is also viewed as a form of domestic 
violence. Information on the long-term health consequences of domestic violence on 
women is very limited. The few studies that exist tend to focus on psychological rather 
than physical consequences. For example, it is estimated that battered women are four to 
five times more likely to require psychiatric treatment and five times more likely to 
attempt suicide than non-battered women48. A Danish study of women who attempted 
suicide found that they had been subjected to a high degree of psychological and physical 
violence49. More recently, in a number of Member States studies have been conducted to 
provide base-line data on the number of women exposed to domestic violence. Estimates 
differ and range from 1 in 5 women in Ireland50, 1 in 4 in the UK51, to 1 in 3 in Portugal52 
and Germany5'. 
The European Commission has recently proposed a Community action programme to fight the 
trafficking in women for the purposes of sexual exploitation44. 
115 
7.6.2 Rape and Sexual Assault 
Rape and sexual assault may result in physical injury and profound emotional trauma. 
Furthermore, rape victims are also frequently exposed to a variety of health risks ranging 
from death/suicide to unwanted pregnancy, STDs, including HTV, long-term chronic 
conditions, as well as psychological symptoms, such as depression, anger, guilt, sleeping 
and eating disturbances, fear of sex, and inability to concentrate54. 
It is acknowledged throughout the EC that rape is a very under-reported crime. In 
Finland, for example, the average number of reported rape cases per year in the 1980s was 
345, although the police estimates that the actual number was between 6000 and 10,000 
per year55. Other reports of the number of rapes per year vary from 125 in Portugal 
(1992), 1381 in Sweden (1995), 1599 in Spain (1992), to 5082 in UK (1994). In the 
Netherlands, which reports rape on a population basis, the rate increased from 7 to 10 per 
100,000 women between 1980 and 198856. 
7.6.3 Sexual Harassment and Stalking 
Awareness of sexual harassment - undesired sexual advances - as well as stalking -
persistent annoyance of someone - has been increasing throughout the Member States 
during recent years Although national statistics are unavailable, a number of studies 
suggest that the prevalence of sexual harassment of women is substantial. In Finland, for 
example, one study estimated that among 18-to-24-year-olds, 26% of women (compared 
with 4% of men) experience sexual harassment57. In the Netherlands reports indicate that 
1 in 3 girls under the age of 16 years experienced some form of unsolicited sexual 
advance, ranging from sexual harassment to rape58. 
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2 Ibid 
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Hospital District) No 22/1995, Kuopio. 
32 Stray-Pedersen, B. (1996), "Osteoporosis - The Silent Thief in: European Institute of Women's 
Health, Women in Europe: Towards Healthy Ageing, Conference Report, 16 October 1996, Dublin: 
European Institute of Women's Health. 
33 Llewellyn-Jones, D., and Abraham, S. (1988), Menopause, Oxford: Penguin Books. 
34 See, for example, Paganini-Hill, A. (1995), "The risks and benefits of estrogen replacement therapy: 
leisure world," Int J Fertil Menopausal Stud, 40(suppl l):54-62; see also Boulton, A. (1996), 
"Hormone therapy may protect against Alzheimer's disease," BMJ, Vol. 313, p. 442. 
35 Bailey, J., Kraft van Ermel, L. (1995), "Hormone replacement therapy, current practice and future 
trends," European Menopause Journal, 2(1), 4-7. 
36 Martinez, F.J., Varela E., Suarez S. (1994), "The menopause and hormone replacement therapy: its 
prevalence in the town of Lugo," Atenciôn Primaria, 14(9); 1052-7. 
37 Vermeulen, M. (1996), Dutch Report on Women's Health, Bonn: Unpublished 
38 Birbaumer, A. (1996), Austrian Report on Women's Health, Vienna: Unpublished 
39 Sundh, M., Renck, B. (1996), Swedish Report on Women's Health, Karlstad: Unpublished 
40 Sinkkonen, S. (1996), Finnish Report on Women's Health, Kuopio: Unpublished 
41 Topo Pâivi, Klaukka Timo, Hemminki Elina ja Uutela Antti (1991), "Use of hormone replacement 
therapy in 1976-89 by 45-64 year-old Finnish women, " Journal of Epidemiology and Community 
Health, 45: 277-280. 
42 United Nations (1994), A/RES/48/104. 
43 CEC (1996b), Communication from the Commission to the Council and the European Parliament on 
Traficking in women for the purpose of sexual exploitation, COM(96) 567 final, Brussels: CEC. 
44 WHO ( 1995b). Jnvesting in women's health: Central and Eastern Europe, Copenhagen:WHO 
Regional Publications, 55. 
45 Sundh, M., Renck, B. (1996), Swedish Report on Women's Health, Karlstad: Unpublished 
46 Heise, L. (1993), "Violence against women: the missing agenda,", in: Koblinsky, M., Timyan, J., and 
Gay, J., (Eds), The health of women: a global Perspective. Colorado: Westview Press. 
117 
47 Romkens, R (1992), Gewoon Geweld? Amsterdam/Lisse: Swets & Zeitlinger. 
48 Heise, L., (1993). Violence against women: the missing agenda. In: Koblinsky, M, Timyan, J., and 
Gay, J., (eds.) The health of women: a global Perspective. Colorado: Westview Press. 
49 Arcel, L.T., Mantonakis J., Petersoon, B., et al. (1992), "Suicide attempts among Greek and Danish 
women and the quality of their relationships with husbands or boyfriends," Acta Psychiatr 
Scandinavica, 85(3), 189-95. 
50 Moloney, E. (19%), "Domestic violence 'suffered by 1 in 5 women'," Irish Independent, 30 April, 5. 
51 Mooney K. (1993), The Hidden Figure : Domestic Violence in North London, Islington: Islington 
Council. 
52 Silva, L. (1995). "Entre Marido e Mulher Alguém Meta a Colher". À Bolina: Colecçâo das Mulheres e 
dos Homens. 
53 Weilandt, C. (19%), German Report on Women's Health, Bonn: Unpublished 
54 Heise, L. (1993), "Violence against women: the missing agenda,", in: Koblinsky, M, Timyan, J., and 
Gay, J., (Eds.), The health of women: a global Perspective. Colorado: Westview Press. 
55 Sinkkonen, S. (19%), Finnish Report on Women's Health, Kuopio: Unpublished 
56 Member State reports on women's health (19%), unpublished 
57 Haavio-Mannila, E., Kontula K_ (toim.) (1993), Suomalainen seksi. Tietoa suomalaisten 
sukupuolielâman muutoksesta, WSOY. 
58 Vermeulen, M (1996), Dutch Report on Women's Health, Amsterdam: Unpublished 
118 
[Figures and Tables] 
119 
Figure 7d 
Percent Dissatisfied with Body Weight* 
Women 15+ Years, EU 15 (1996) 
Greece 
United Kingdom 
France 
Finland 
The Netherlands 
Denmark 
EU 15 
Spain 
Sweden 
Germany W 
Luxembourg 
Belgium 
Portugal 
Italy 
Austria 
Germany E 
Ireland 
ranked by age 15-24 • 
age 15+ 
*age15-24 
80% 100% 
Source: Eurobarometer 44.3/1996 
* Respondents were asked to rate the extent to which they agreed/disagreed with the following statement: "I am very satisfied 
with my body weight." The figure shows the percentage of respondents who disagreed (either slightly or strongly) with this 
statement. 
Table U 
Percent Dissatisfied with Body Weight* 
Women 15+ Years, EU 15 (1996) 
15-24 
years 25-34 
years 35-64 
years 65+ 
years Total 
Greece 
United Kingdom 
France 
Finland 
The Netherlands 
Denmark 
EU 15 
Spain 
Sweden 
Germany W 
Luxembourg 
Belgium 
Portugal 
Italy 
Austria 
Germany E 
Ireland 46.5 
45.0 
40.0 
39.5 
35.7 
33.4 
33.3 
32.7 
30.5 
30.2 
29.7 
28.5 
26.9 
24.3 
23.0 
20.0 
18.9 35.3 
43.6 
41.2 
52.3 
28.7 
32.7 
30.6 
31.2 
38.2 
18.1 
38.8 
40.5 
27.4 
19.1 
28.0 
23.9 
27.1 45.9 
56.9 
43.7 
60.0 
38.0 
43.8 
40.1 
37.8 
49.3 
33.3 
42.3 
35.8 
31.0 
28.3 
33.1 
41.2 
34.2 33.7 
47.9 
28.8 
45.4 
42.4 
31.4 
30.7 
31.5 
39.3 
19.4 
26.5 
28.5 
12.6 
26.8 
40.7 
22.1 
26.8 42.1 
50.4 
40.6 
52.2 
35.6 
38.0 
35.4 
34.4 
42.6 
26.9 
36.9 
34.3 
26.5 
25.8 
28.3 
31.7 
28.6 
Source : Eurobarometer 44.3/1996 
* Respondents were asked to rate the extent 
with my body weight." The table shows the 
statement to which they agreed/disagreed with the following statement: "I am very satisfied 
percentage of respondents who disagreed (either slightly or strongly) with this 
120 
Figure 7r2 
Percent Dieting during the Past Year 
Women 15+ Years, EU 15 (1996) 
Greece 
Luxembourg 
United Kingdom 
Denmark 
The Netherlands 
EU 15 
France 
Spain 
Belgium 
Italy 
Germany W 
Finland 
Sweden 
Austria 
Ireland 
Germany E 
Portugal 
ranked by age 15-24 • 
age 15+ 
age 15-24 
80% 100% 
Source: Eurobarometer 44.3/1996 
Table 7J 
Percent Dieting during the Past Year 
Women 15+ Years, EU 15 (1996) 
Greece 
Luxembourg 
United Kingdom 
Denmark 
The Netherlands 
EU 15 
France 
Spain 
Belgium 
Italy 
Germany W 
Finland 
Sweden 
Austria 
Ireland 
Germany E 
Portugal 15-24 
years 
43.7 
40.7 
39.0 
35.8 
31.4 
23.6 
22.5 
22.1 
20.2 
19.2 
19.1 
18.6 
16.7 
15.2 
14.2 
11.7 
7.7 25+ 
years 
34.1 
34.8 
33.7 
26.4 
23.8 
24.7 
26.0 
24.6 
23.7 
26.1 
17.8 
18.5 
19.4 
18.6 
22.7 
17.4 
22.8 Total 
35.7 
35.8 
34.6 
27.7 
24.8 
24.5 
25.4 
24.1 
23.1 
24.8 
17.9 
18.5 
19.0 
18.1 
20.9 
16.7 
20.0 
Source: Eurobarometer 44.3/1996 
121 
FÎ2ure 73 
Percent Dissatisfied with Body Weight by Weight Category' 
Women 18+ Years, EU 15 (1996) 
Sweden 
Germany W 
Finland 
France 
Greece 
" United Kingdom 
Denmark 
Spain 
EU 15 
The Netherlands 
Germany E 
Ireland 
Austria 
Luxembourg 
Portugal 
Italy 
Belgium 304-BMI 
severe overweight • <18BM 
severe underweight 
EU 
average 
0% 
ranked by severe overweight 20% 40% 60% 80% .100% 
Source: Eurobarometer 44.3/1996 
* See note to Figure 7.1. 
Table 7.3 
Cumulative Number of AIDS Cases* 
by Transmission Group, EU 15 (1996) 
Transmission Group 
Homo/bisexual male 
Injecting drug user (IDU) 
Homo/bisexual IDU 
Haemophiliac/Coagulation disorder 
Transfusion recipient *** 
Heterosexual contact 
Other ****/Undetermined 
TOTAL Females 
Cumulative 
Total** 
N 
14 049 
71 
1439 
10 199 
1597 
27 355 Cumulative 
Total** 
% 
51.4 
0.3 
5.3 
37.3 
5.8 
100 Males 
Cumulative 
Total** 
N 
59 260 
51535 
2 535 
2 806 
1635 
12 869 
6 344 
136 984 Cumulative 
Total** 
% 
43.3 
37.6 
1.9 
2.0 
1.2 
9.4 
4.6 
100 
* Aged 13 years and older 
** From the beginning of the epidemic to 30 September 1996, unadjusted for reporting delays. 
*** Includes recipients of blood components or tissue 
**** Includes transsexual subjects 
Source : European Centre for the Epidemiological Monitoring of AIDS, Quarterly Report No. 36, 30 September 1996. 
122 
Figure 7.4 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups 
1985-1995 
Austria 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases- Caa 
90 -. 
80-
70-
60-
50-
40-
30-
"J ........./•">-^^"«'^> 
0 J""'?1*' i r-ia! 1 1 1 1 1 1 
85 86 87 88 89 90 91 92 93 94 95 
Year of diagnosis - Année de olagnostic 
Belgium 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases - Cas 
120 -» 
100-
80-
60-
40-
20- -*•"" .*'* S 
,wili«HHf,T r****¥—i—i—T~-\—i—i—i—» 
85 86 87 88 89 90 91 92 93 94 95 
Year of diagnosis - Année da diagnostic 
IDU-UDI Heterosex. 
•13 years or over 
••Adjusted for reporting delays (1993-1995) 
123 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
Denmark 
Number of cases** by year of diagnosis 
Women-Femmes 
Casas-Cas 
160-1 
140-
120 -
100 -
80-
60-
40-
20- . — .-.. 
"t rwrtrA,g/f;'rTîlA'i*Sf—i i \ 
86868788 89 90 9192939495 
Year of Diagnosis - Armée de diagnostic 
Finland 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
30-j 
25-
20 
15-
10-
5-
85 86 87 88 89 90 91 92 93 94 95 
Year of diagnosis - Année de diagnostic 
IDU-UDI Heteroses 
•13 years or over 
••Adjusted for reporting delays (1993-199S) 
124 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
France 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
2500-1 
2000-
1600-
1000-
600- _.-•-•-• 
i 1 1 1 1 1 1 I 1 1 
85 86 87 88:89 90 91 92 93 94 95 
Year of rJegnosts - Année de Diagnostic 
Germany 
Number of cases** by year of diagnosis 
Women * Femmes 
Cases-Cas 
1400-1 
1200 
1000-
800-
800 
400-
200-
85 86 87 88 89 90 91 92 93 94 95 
Year of diagnosis - Année de Diagnostic 
IDU-UDI • Heterosex. 
*13 years or over 
**Adjusted for reporting delays (1993-1995) 
125 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
Greece 
Number of cases** by year of diagnosis 
Women > Femmes 
Cases-Ces 
140-i 
120 
100 H 
80 
60 
40 
86 86 87 98 89 90 91 92 93 94 95 
Year of dtegnos» - Année de diagnostic 
Ireland 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
30-1 
25-
20-
15 
10 
S-l 
••**V 
1 I - " 'I " 1"'—V "I1 1 \ I '" » I 
65 85 87 88 89 90 91 92 93 94 95 
Year of Diagnosis - Armée de Diagnostic 
IDU-UDI - • - • Heterosex. 
•13 years or over 
**Adjusted for reporting delays (1993-1995) 
126 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
Italy 
Number of cases** by year of diagnosis 
Women-Femmes 
Cases-Cas 
3000i 
2500 
2000 
1500-
1000-
500-.»••«• ,.••• 
0-futfM& 'fm* «^1 111 y" illiÉI M ll»M»yIHIM | y«M»^M. 
85 86 87 88 89 90 91 92939495 
Year of Diagnosis - Année de Diagnostic 
Luxembourg 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
12 
10-
8-
6-
4-
2-
K^ A 
• •< 
i > r r1" T '"i T—i—m-
86 86 87 88 89 90 91 92 93 94 95 
Year of diagnosis - Armée de diagnostic 
IDU-UDl Heteroses 
•13 years or over 
••Adjusted for reporting delays (1993-1995) 
127 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
Netherlands 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
400 
350-
300-
250-
200-
150 
100-
50 -I 
'ifTw—i 1—-T 1 1 r—i 
65 86 87 88 89 90 91 92 93 94 95 
Year of diagnosis - Année de Diagnostic 
Portugal 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
300-
250-
200-
150-
100-
Q - —*<II'II «• |imM<y* « i ii. » ii i • m • i 
858687888990 91 92 939495 
Year of Diagnosis - Année de diagnostic 
IDU-UDI Heterosex. 
*13 years or over 
** Adjusted for reporting delays (1993-1995) 
128 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
Spain 
Number of cases** by year of diagnosis 
Women-Femmes 
Cases-Cas 
4000 -j 
3500-
3000 
2500 
2000 
1500-
1000-
500 
0 „hmm»atftt\ mJ, mtmtr.'J 
85 86 87 88 « 7—~i \ 1 rr—r» 
90 91 92 93 94 95 
Year of diagnosis - Année de Diagnostic 
Sweden 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
120-1 
100 -
80-
60-
40-
20 
T1 JUttàS* ••».•; 
T T rr—r 1 1 r 
65 86 87 88 89 90 91 92 93 94 95 
Year of Diagnosis - Armée de Diagnostic 
1DU-UDI Heterosex. 
*13 years or over 
**Adjusted for reporting delays (1993-1995) 
129 
Adult/Adolescent* AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
United Kingdom 
Number of cases** by year of diagnosis 
Women - Femmes 
Cases-Cas 
1200-j 
1000-
800 
600-
400-
200 
85 66 87 88 89 90 91 92 93 94 95 
YearofdlagrwQis-Am^o^cfiagnosfc 
IDU-UDI —-• Heterosex. 
*13 years or over 
••Adjusted for reporting delays (1993-1995) 
130 
Table 7.4 
Cumulative Number of AIDS 
Cases for both Sexes*, EU 15 (1996) 
Country Cumulative Total* 
30.9.1996 
Austria 1 609 
Belgium 2 203 
Denmark 1 957 
Finland 248 
France 43 451 
Germany 15 308 
Greece ' 1422 
Ireland 549 
Italy 35 949 
Luxembourg 114 
Netherlands 4 199 
Portugal , 3 575 
Spain 41 598 
Sweden 1445 
United Kingdom 13 394 
TOTAL EC I 167 021 
* Since the beginning of the epidemic until 30 September 1996, unadjusted 
for reporting delays. 
Source : European Centre for the Epidemiological Monitoring of AIDS, 
Quarterly Report No. 36. 30 September 1996. 
Table 7.5 
Contraceptive Use and Fertility Rates among 
Women, EU 15 
Fertility rate per 1000 
women 15-19 years 
1970 1990 Country Women using 
contraception (%) 
1986-93 Total fertility rate 
1970 1993 % Live births to 
mothers under 
20 latest 
available year 
Austria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom 71 
79 
78 
80 
81 
75 
n/a 
n/a 
78 
n/a 
76 
66 
59 
78 
81 2.30 
2.20 
1.90 
1.80 
2.50 
2.10 
2.30 
3.90 
2.40 
n/a 
2.60 
2.80 
2.80 
1.90 
2.40 1.50 
1.70 
1.70 
1.90 
1.70 
1.30 
1.40 
2.10 
1.30 
1.70 
1.60 
1.60 
1.20 
2.10 
1.80 5.76(1992) 
3.69(1986) 
2.73(1988) 
2.70(1992) 
2.40(1991) 
3.36(1991) 
5.82(1992) 
4.35(1987) 
3.00(1994) 
2.62(1989) 
1.87(1992) 
10.35(1985) 
5.20(1989) 
3.11 (1986) 
8.13(1989) 61.4 
31.1 
32.4 
32.2 
26.4 
n/a 
36.5 
16.9 
42.8 
28.0 
22.6 
29.4 
14.1 
34.0 
49.7 21.3 
12.2 
9.1 
12.1 
9.0 
n/a 
26.3 
16.0 
10.0 
11.6 
8.3 
26.3 
16.7 
12.7 
33.0 
Source : Human Development Report 1995/HFA. 1996. 
131 
Table 7.6 
Abortion, EU (15) 
Country 
Austria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom Abortion 
Legislation 
Year 
1975 
1990 
1970 
1975 
1992/1996 
1986 
Illegal 
1978 
1979 
1984 
1984 
1985 
1938 
1968 Abortion Rate 
per 1000 women 
n/a 
n/a 
14.3 (1993) 
7.9 (1994) 
13.0 (1990) 
n/a 
n/a 
n/a 
8.6 (1994) 
n/a 
6.0 (1994) 
n/a 
5.38 (1994) 
18.3 (1994) 
12.18 (1994)* Ratio of abortions 
to 1000 live births 
all ages 
n/a 
n/a 
278.00 (1992) 
157.34 (1993) 
254.00 (1990) 
146.60 (1992) 
108.25 (1991) 
n/a 
287.30 (1991) 
99.00 (1992) 
98.70 (1992) 
200.00 (1994) 
92.70 (1990) 
290.00 (1993) 
227.48 (1988) Ratio of abortions to 1000 
live births under 20 
n/a 
n/a 
1856.07 (1988) 
961.22 (1991) 
1058.00 (1990) 
n/a 
86.47 (1992) 
n/a 
n/a 
n/a 
558.50 (1988) 
n/a 
n/a 
1701.40 (1993) 
663.52 (1988) 
Source : Human Development Report 1995/HFA, 1996. 
132 
Figure 7.5 
Percent Not Well Informed about HRT 
Women 35+ Years, EU 15 (1996) 
Portugal 
Ireland 
Spain 
Greece 
Italy 
The Netherlands 
United Kingdom 
EU 15 
Germany E 
Germany W 
Austria 
Sweden 
France 
Denmark 
Belgium 
Finland 
Luxembourg 
0% age 50-64 • 
age 35-49 
20% 40% 60% 
% not informed 
ranked by age 50-64 years 80% 100% 
Source: Eurobarometer 44.3/1996 
Table 7J 
Percent Not Well Informed about HRT 
Women 15+ Years, EU 15 (1996) 
Portugal 
Ireland 
Spain 
Greece 
Italy 
The Netherlands 
United Kingdom 
EU 15 
Germany E 
Germany W 
Austria 
Sweden 
France 
Denmark 
Belgium 
Finland 
Luxembourg <35 
years 
77.3 
69.8 
72.7 
76.7 
89.7 
67.9 
70.1 
71.7 
64.5 
67.2 
64.7 
77.0 
66.0 
71.4 
55.8 
54.6 
53.7 35-49 
years 
69.2 
64.4 
62.2 
75.8 
71.2 
65.7 
60.8 
59.3 
59.2 
51.2 
59.7 
57.3 
55.3 
53.6 
33.1 
36.4 
44.6 50-64 
years 
67.9 
67.4 
67.0 
65.2 
61.6 
50.5 
50.5 
47.1 
42.1 
40.7 
39.4 
36.5 
28.6 
26.8 
26.0 
15.2 
10.8 65+ 
years 
67.0 
74.7 
71.0 
81.0 
69.0 
51.5 
62.7 
58.5 
65.9 
54.0 
58.2 
46.1 
45.5 
41.9 
32.3 
32.8 
21.6 Total 
71.5 
68.5 
68.7 
74.6 
75.2 
62.9 
62.8 
60.9 
57.5 
54.7 
57.6 
57.4 
51.4 
51.6 
39.9 
36.7 
40.3 
Source: Eurobarometer 44.3/1996 
133 
8. CONCLUSION 
This report was prepared in order to provide an overview of issues related to women's 
health and women's health status. Its aim is to help clarify women's health issues using the 
most recent Community-wide data available to promote discussion. The report is not 
intended to form the basis for a new Community action programme on women's health, 
however, its findings will be incorporated into existing programmes where relevant. 
Although the available data are far from ideal, it has nonetheless still been possible to 
gather enough data to provide a picture of (some of) the many different dimensions of 
women's health. In particular, it is clear that women in the EC are quite healthy, both in 
terms of life expectancy, which currently equals 80 years, and in terms of self-perceived 
health status. On average, more than 60% of women in the EC report being in good or 
very good health. 
This situation is the result of several decades of improvements in women's health, in part 
as a result of general improvements in living conditions throughout the EC, in part as a 
result of improvements in the status of women in society. Needless to say, the health of 
women varies across the Member States, in part because of different starting points, in 
part because of different rates of progress. What is clear is that some of the Member 
States with the poorest health status twenty years ago have achieved the greatest 
improvements, while other Member States with historically good levels of health have had 
more modest results. 
In spite of the improvements seen, there is still cause for concern about women's health. 
Almost one out of every four women in the EC reports some degree of disability due to a 
long-term illness. Furthermore, a large number (and percentage) of women report 
unhealthy life styles (e.g., smoking, drinking, sedentary life styles, and unhealthy diets). 
Combined, these factors contribute to (much of) the disability, morbidity, and premature 
mortality among women in the EC. 
The main causes of death for women are cardiovascular disease and cancer. Both of these 
diseases also result in significant amounts of premature mortality, which to a considerable 
extent may be prevented either through primary prevention, improved life styles, or 
secondary prevention (early detection of disease through, for example, screening). 
Unfortunately, there seems to be considerable misconception among women about the 
extent to which they are at risk for heart disease and what are the main risk factors for the 
disease. 
Data on health promotion and disease prevention activities indicate large variations across 
the Member States in the extent to which women receive needed services. In particular, it 
is noteworthy that less than half of obese women over 40, who are at elevated risk for 
diabetes type II, have been screened in the previous year for a disease that is rapidly rising 
and that causes significant mortality and morbidity. It is also notable that most women, 
regardless of age feel insufficiently informed about the potential advantages and 
disadvantages of hormone-replacement therapy. These and other findings make it clear 
that there are a number of important health concerns for women which have yet to be 
addressed. 
The final part of the report has attempted to highlight aspects of emerging health issues of 
importance to women at different stages of their life cycle. In particular, it is apparent that 
134 
HTV and ADDS are no longer health concerns specific to (homosexual) men. In fact, 
women are more vulnerable to contracting the disease than are men, even if they still 
represent a minority of AIDS victims. Efforts to prevent the spread of this disease should 
therefore also target women. Eating disorders among young women appears to be an 
increasing health problem with potentially serious consequences. 
Among elderly women, one of the chief concerns is the rising incidence of osteoporosis 
which is due in part to the ageing of society, in part to insufficient attention to prevention 
and treatment opportunities. 
In closing, it is important to emphasise that this report on women's health is not intended 
to imply that greater emphasis should be placed on women's health compared to men's 
health but rather, that for biological, social, and other reasons, their health concerns are 
different from those of men, and that deserves recognition. Women may live longer than 
men today, but they do so with significant illness and disability. Recognition of women's 
unique health problems is a first step towards improving their situation. 
135 
Annex I 
Glossary 
Anorexia nervosa: 
An eating and psychological disorder which affects mostly women. It involves extreme 
dieting, weight loss, and starvation, and is accompanied by a disturbed body image and 
loss of control and can lead to mortality1. 
Bulimia nervosa: 
An eating and psychological disorder which affects mostly women. It involves 
consuming large quantities of food in a short period of time (bingeing), accompanied 
by a sense of lack of control and recurrent compensatory behaviour in order to prevent 
weight gain, e.g., by vomiting2. 
Diseases of the circulatory system: 
These include acute myocardial infarctions and other ischaemic myocardiopathies. 
Ischaemia is the localised stoppage of the blood supply3. 
Incidence: 
the number of new cases of a disease recorded over a given period (usually a year)4. 
Infant mortality rate: 
The yearly number of deaths of children aged less than one year per 1000 live births5. 
Life expectancy: 
The mean number of years which a person of a given age can expected to live, 
assuming the current age-specific mortality rates remain constant. Life expectancy at 
65 years for instance, indicates the mean number of years for which a person reaching 
the age of 65 can expect to live6. 
Maternal mortality: 
Deaths related to childbirth; usually reported per 100,000. 
Menopause: 
The cessation of monthly menstruation which signifies the end of a woman's fertile 
period. The average age at the menopause in the EC is 50-52 years. 
Prevalence: 
The number of existing cases of a disease in a population at a give time or period7. 
136 
Reduction of life expectancy (in years) through death before age 65 years: 
The hypothetical increase in life expectancy if mortality in age-group 0-64 years were 
completely eliminated8. 
Standardised death rate (SDR): 
The number of deaths per 100,000 adjusted to the age structure of a standard 
European population. Standardised death rates allow comparability between countries 
over time as they measure death rates independently of different age structures of 
populations. The death rates applied in this report are calculated by the WHO9. 
Total fertility rate: 
The average number of children that would be born alive to a woman during her 
lifetime, if she were to bear children at each age in accordance with prevailing age-
specific rates10. 
References 
1 American Psychiatric Association (1987A Diagnostic and Statistical Manual of Mental Disorders 
(DSMIII-R), Washington, D.C.: American Psychiatric Association. 
2 Ibid 
3 Eurostat (1995b), Yearbook 1995, Luxembourg: Office for Official Publications of the European 
Communities. 
4 CEC (1995a,), Report from the Commission on the Status of Health in the European Community, 
7PP5,COM(95) 357 final, Brussels: CEC. 
5 Ibid 
6 CEC (1995b), The demographic situation in the European Union, 1994, Luxembourg: Office for 
Official Publications of the European Communities. 
7 CEC (1995a,), Report from the Commission on the Status of Health in the European Community, 
7PP5,COM(95) 357 final, Brussels: CEC. 
8 WHO (1996), Health for All Database, Copenhagen: WHO Regional Office for Europe. 
9 CEC (1995a,), Report from the Commission on the Status of Health in the European Community, 
7PP5,COM(95) 357 final, Brussels: CEC. Eurostat (1995b), Yearbook 1995, Luxembourg: Office for 
Official Publications of the European Communities. 
10 CEC (1995a), Report from the Commission on the Status of Health in the European Community, 
/PP5,COM(95) 357 final, Brussels: CEC. 
137 
Annex II 
List of Figures 
Figure 1.1: Sufficient Attention for Women's Health 1996, Women 15+ Years, EU 15 
Figure 1.2: Sufficient Attention Given To Women's Health, 1996, Women 15+ Years 
Figure 2.1 : Féminisation Ratio, 1996 (EU 15) 
Figure 2.2: Féminisation Ratio in the 0-19 Years and 60+ Years Age-Group, 1996 (EU 
15) 
Figure 2.3: Families Past and Present, EU 15 
Figure 2.4: Trends in Economic Indicator of Fertility over the Past 40 Years 
Figure 2.5: Changes in Employment (EU) 
Figure 2.6: Present Demographic Structure and Structure of the Active Population 
Figure 3.1: Life Expectancy at Birth, 1970-1995, Women, EU (15) 
Figure 3.2: Reduction in Life Expectancy Due to Premature Death 
Figure 3.3: Life Expectancy at Birth (in Years), EU 15 (1995) 
Figure 3.4: Infant Mortality Rate 
Figure 3.5: Maternal Mortality 
Figure 3.6: Self-Perceived Health Status, 1996, Women 15+ Years, EU (15) 
Figure 3.7: Self-Perceived Health Status, Elderly Women, EU 15 (1996) 
Figure 3.8: Average Height (in cm), Women 18+ Years, EU 15 (1996) 
Figure 3.9: Average Height (in cm), Women 18 + Years by Age-Group, EU 15 (1996) 
Figure 3.10: Average Height (in cm), Women by Age-Group, EU 15(1996) 
Figure 4.1: Percent with Disability Due to Long-Standing Illness, Women 15+ Years, 
EU 15 (1996) 
Figure 4.2: Percent with Disability Due to Long-Standing Illness by Age-Group and 
Severity, EU 15 (1996) 
Figure 4.3: Percent with Disability Due to Long-Standing Illness, Women 65+ Years, 
EU 15 (1996) 
Figure 4.4: Percent with Restricted Activity in Past 2 Weeks Due to Illness or Injury, 
Women 16+ Years, EU 11 (1994) 
Figure 4.5: Percent with Restricted Activity in Past 2 Weeks Due to Illness or Injury, 
Women 65+ Years, EU 11 (1994) 
Figure 4.6: Percent with Restricted Activity in Past 2 Weeks Due to Emotional or 
Mental Health Problem, Women 16+ Years, EU 12 (1994) 
Figure 4.7: Percent with Restricted Activity in Past 2 Weeks Due to Emotional or 
Mental Health Problem, Women 65+ Years, EU 12 (1994) 
Figure 4.8: Percent Women with Doctor Consultation(s) in Past 2 Weeks, Women 15+ 
Years, EU 15 (1996) 
Figure 4.9: Percent Women with Doctor Consultation(s) in Past 2 Weeks, By Age-
Group, EU 15 (1996) 
Figure 4.10: Percentage with Non-Birth Hospitalisation(s) in Past Year, Women 16+ 
Years, EU 15 (1996) 
Figure 4.11: Percentage with Non-Birth Hospitalisation(s) in Past Year By Age-Group, 
EU 15 (1996) 
Figure 4.12: Average Number of Nights in the Hospital in Past Year, Women 15+ 
Years, EU 15 (1996) 
Figure 5.1: Main Causes of Death ( 1992), All Women, EU ( 15) 
Figure 5.2: Motor Vehicle Traffic Accident Mortality (1992), All Women, EU 15 
Figure 5.3: Suicide and Self-inflicted Injury Mortality (1992), All Women, EU 15 
Figure 5.4: Cancer Mortality (1992), Women 0-64 years, EU 15 
138 
Figure 5.5: Cancer Mortality ( 1992), All Women, EU 15 
Figure 5.6: Cancer Mortality in Women (1992), All Women, EU 15 
Figure 5.7: Breast Cancer Mortality (1992), Women 0-64 Years, EU 15 
Figure 5.8: Breast Cancer Mortality (1992), All Women, EU 15 
Figure 5.9: Breast Cancer Mortality (1992), All Women 1970-1992, EU 15 
Figure 5.10: Cervical Cancer Mortality (1992), Women 0-64 Years, EU 15 
Figure 5.11: Cervical Cancer Mortality (1992), All Women, EU 15 
Figure 5.12: Respiratory System Cancer Mortality (1970-1992), Women 0-64 Years, 
EU 15 
Figure 5.13: Respiratory System Cancer Mortality (1992), Women 0-64 Years, EU 15 
Figure 5.14: Respiratory System Cancer Mortality ( 1992), All Women, EU 15 
Figure 5.15: Perceptions of which Gender Lung Cancer Affects More, All Women, EU 
15(1996) 
Figure 5.16: Mortality from Circulatory System Diseases (1992), Women 0-64 Year, 
EU 15 
Figure 5.17: Mortality from Circulatory System Diseases (1992), All Women, EU 15 
Figure 5.18: Perceptions of which Gender is More Affected by Heart Disease, All 
Women, EU 15 (1996) 
Figure 5.19: Ischaemic Heart Disease Mortality (1992), Women 0-64 Years, EU 15 
Figure 5.20: Ischaemic Heart Disease Mortality ( 1992), All Women, EU 15 
Figure 5.21: Perceived Main Risk Factors for Heart Disease ( 1996), AU Women, EU 15 
Figure 5.22: Cerebrovascular Disease Mortality (1992), Women 0-64 Years, EU 15 
Figure 5.23 : Cerebrovascular Disease Mortality ( 1992), All Women, EU 15 
Figure 6.1: Percentage of smokers ( 1991 ), Women 15+ Years, Selected EU Countries 
Figure 6.2: Smoking Attributable Mortality ( 1990), Women 35 + Years, EU 15 
Figure 6.3: Liver Disease Mortality (1992), All Women, EU 15 
Figure 6.4: Percent Over- and Underweight, Women 18+ Years, EU 15 (1996) 
Figure 6.5: Percent with Heart Check-Up in Past Year, Women 15+ Years, EU 15 
(1996) 
Figure 6.6: Percent Reporting a Cholesterol Test in Past Year, Women 15+ Years, EU 
15(1996) 
Figure 6.7: Percent Reporting a Diabetes Test in Past Year, Women 40+ Years, EU 15 
(1996) 
Figure 6.8: Percent Reporting an Osteoporosis Exarnination in Past Year, Women 50+ 
Years, EU 15 (1996) 
Figure 6.9: Percent Preferring Women Doctors, Women 15+ Years, EU 15 (1996) 
Figure 6.10: Percent Reporting a Cervical Smear Test in Past Year, Women 15+ Years, 
EU 15 (1996) 
Figure 6.11: Percent Reporting a Breast Examination by Hand in Past Year, Women 
15+Years, EU 15 (1996) 
Figure 6.12: Percent Favouring Mammography Screening, Women 15+ Years, EU 15 
(1996) 
Figure 6.13: Percent Reporting a Mammography in Past Year, Women 50-69 Years, 
EU 15 (1996) 
Figure 7.1 : Percent Dissatisfied with Body Weight, Women 15+ Years, EU 15 ( 1996) 
Figure 7.2: Percent Dieting during the Past Year, Women 15+ Years, EU 15 (1996) 
Figure 7.3: Percent Dissatisfied with Body Weight by Weight Category, Women 18+ 
Years, EU 15 (1996) 
Figure 7.4: Adolescent/Adult AIDS Cases in the Two Main Transmission Groups, 
1985-1995 
Figure 7.5: Percent Not Well Informed about HRT, Women 35+ Years, EU 15 (1996) 
139 
Annex III 
List of Tables 
Table 1.1: Sufficient Attention Given To Women's Health, 1996, Women 15+ Years, 
EU 15 
Table 2.1: Women in the Total Population of the European Union 1993 (EU 15) 
Table 2.2: Female and Male Population in the EU (15) 
Table 2.3: Marriages and Divorces in the EU (15), 1960-1995 
Table 2.4: Births and Fertility in the EU (15), 1960-1995 
Table 2.5: Contraception Usage and Fertility (EU 15) 
Table 2.6: Employment EU 15, (1993) 
Table 2.7: Part-Time Employment as % of Total Employment EU 15, (1993) 
Table 2.8: Unemployment Rates EU 15, (1993) 
Table 2.9: Gender Related Development Indices 
Table 3.1: Life Expectancy at Birth (in Years) EU 15 ( 1995) 
Table 3.2: Life Expectancy at 15 Years (in Years) EU 15 (1995) 
Table 3.3: Life Expectancy at 45 Years (in Years) EU 15 (1995) 
Table 3.4: Life Expectancy at 65 Years (in Years) EU 15 (1995) 
Table 3.5: Self-Perceived Health Status, 1996, Women 15+ Years, EU 15 
Table 3.6: Self-Perceived Health Status, 1996, Women 65-74 Years, EU 15 
Table 3.7: Self-Perceived Health Status, 1996, Women 75+ Years, EU 15 
Table 3.8: Average Height (in cm), Women 18 + Years by Age-Group, EU 15 (1996) 
Table 4.1: Percent with Disability Due to Long-Standing Illness, Women 15+ Years, 
EU 15 (1996) 
Table 4.2: Percent with Disability Due to Long-Standing Illness By Age-Group, EU 
15 (1996) 
Table 4.3: Percent with Disability Due to Long-Standing Illness Women 65+ Years, 
EU 15 (1996) 
Table 4.4: Percent with Restricted Activity in Past 2 Weeks Due to Illness or Injury, 
Women 16+ Years, EU 11 (1994) 
Table 4.5: Percent with Restricted Activity in Past 2 Weeks Due to Illness or Injury 
Women 65+ Years, EU 11 (1994) 
Table 4.6: Percent with Restricted Activity in Past 2 Weeks Due to Emotional or 
Mental Health Problem Women 16+ Years, EU 12 (1994) 
Table 4.7: Percent with Restricted Activity in Past 2 Weeks Due to Emotional or 
Mental Health Problem, Women 65+ Years, EU 12 (1994) 
Table 4.8: Percent Women with Doctor Consultation(s) in Past 2 Weeks, Women 15+ 
Years, EU 15 (1996) 
Table 4.9: Percent Women with Doctor Consultation(s) in Past 2 Weeks, By Age-
Group, EU 15 (1996) 
Table 4.10: Percentage with Non-Birth Hospitalisation(s) in Past Year, Women 16+ 
Years, EU 15 (1996) 
Table 4.11: Percentage with Non-Birth Hospitalisation(s) in Past Year By Age-Group, 
EU 15 (1996) 
Table 4.12: Average Number of Nights in the Hospital in Past Year, Women 15+ 
Years, EU 15 (1996) 
Table 5.1: Perceptions of which Gender Lung Cancer Affects More, Women 15+ 
Years, EU 15 (1996) 
Table 5.2: Perceptions of which Gender is More Affected by Health Disease, All 
Women, EU 15 (1996) 
140 
Table 5.3: Perceived Main Risk Factors for Heart Disease ( 1996), All Women, EU 15 
Table 6.1: Percentage of Smokers ( 1991 ), Women 15+ Years, Selected EU Countries 
Table 6.2: Smoking Attributable Mortality (1990), Women 35+ Years, EU 15 
Table 6.3: Percent Over- and Underweight, Women 18+ Years, EU 15 (1996) 
Table 6.4: Percent with Heart Check-Up in Past Year, Women 15+ Years, EU 15 
(1996) 
Table 6.5: Percent Reporting a Cholesterol Test in Past Year, Women 15+ Years, EU 
15(1996) 
Table 6.6: Percent Reporting a Diabetes Test in Past Year, Women 15+ Years, EU 15 
(1996) 
Table 6.7: Percent Reporting an Osteoporosis Test in Past Year, Women 50+ Years, 
EU 15 (1996) 
Table 6.8: Percent Preferring Women Doctors, Women 15+ Years, EU 15 (1996) 
Table 6.9: Percent Reporting a Cervical Smear Test in Past Year, Women 15+ Years, 
EU 15 (1996) 
Table 6.10: Percent Reporting a Breast Examination by Hand in Past Year, Women 
15+Years, EU 15 (1996) 
Table 6.11: Percent Favouring Mammography Screening Women 15+ Years, EU 15 
(1996) 
Table 6.12: Percent Reporting a Mammography in the Past Year, Women 15+ Years, 
EU 15 (1996) 
Table 7.1 : Percent Dissatisfied with Body Weight, Women 15+ Years, EU 15 (1996) 
Table 7.2: Percent Dieting during the Past Year, Women 15+ Years, EU 15 (1996) 
Table 7.3: Cumulative Number of AIDS Cases by Transmission Group, EU 15 (1996) 
Table 7.4: Cumulative Number of AIDS Cases for both Sexes, EU 15 ( 1996) 
Table 7.5: Contraceptive Use and Fertility Rates among Women, EU 15 
Table 7.6: Abortion, EU (15) 
Table 7.7: Percent Not Well Informed about HRT, Women 15+ Years, EU 15 (1996) 
141 
Annex IV 
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147 
ANNEX V 
Member State Coordinators 
on The Member State Coordinators prepared unpublished national reports 
women's health which were used as input in the preparation of this report. 
Austria 
Ms. Andrea Birbaumer 
Technische Universitat Wien 
Inst.f. Gestaltungs- und Wirkungsforschung 
Abteilung fur CSCW 
Vienna 
Belgium 
Mrs. Katrien Bruggeman 
Prof. Mieke van Haegendoren 
Nederlandstalige Nationale Vrouwenraad 
'De Amazone 
Brussel 
Denmark 
Dr. Birgit Petersson 
Department of Social Medicine 
Medical Female Research Unit 
University of Copenhagen 
Panum Institute 
Copenhagen 
Finland 
Prof. Sirkka Sinkkonen 
Prof. Katri Vehvilainen-Julkunen 
Department for Health Policy and Management 
University of Kuopio 
Kuopio 
France 
(Collaboration based on: Saurel-Cubizolles, M.J., Blondel, B. (1996), La Sante des 
Femmes. Paris: Flammarion Médecine-Sciences, see bibliographical reference, this 
publication is not initiated by the European Women's Health Project). 
Dr. Beatrice Blondel 
INSERM 
Unité de Recherches Epidemiologiques sur la Santé des Femmes et des Enfant-U 149 
Villejuif Cedex 
France 
148 
Germany 
Dr. Caren Weilandt 
Ms. Adrienne Zeir 
WissenschaftUches Institut der Arzte Deutchslands (WIAD) 
Bonn 
Greece 
Dr. George KalUnikos 
Prof Anastasia RoumeUotou 
National School of Public Health 
Athens 
Ireland 
Drs. H. Riper 
Mrs. H. Cowley 
University of Limerick 
Limerick 
Italy 
Prof. Francesco Grigoletto 
Dr. Anna Chiara Frigo 
Universita' degli Studi di Padova 
Instituto di Igiene 
Padova 
Luxembourg 
Drs. H. Riper 
University of Limerick 
Limerick 
The Netherlands 
Ms. Mary Vermeulen 
Foundation Augustus 
Amsterdam 
Northern Ireland 
Dr.Monica Mc Williams 
Dr. Ann Marie Gray 
University of Ulster 
Belfast 
149 
Portugal 
Prof. Luisa Ferreira Da Silva 
Comissao Para a Igualdade e Para os Direitos das Mulheres 
(Commission for EquaUty and Women's Rights) 
Ministry of Employment and Social Security 
Porto 
Spain 
Mrs. Carmen Sanchis 
Institute of PubUc Health of Valencia 
Generahtat Valenciana (ConseUeria de Sanitat i Consum) 
Institut Valencia d'Estudis en Salut Publica (IVESP) 
Valencia 
Sweden 
Ms. Mona Sundh 
Ms. Barbro Renck 
Centrum for Folkhalsoforskning 
Centre for PubUc Health Research 
Karlstad 
United Kingdom 
Dr. Carol Thomas 
University of Lancaster 
Dept. of Applied Social Science 
Lancaster 
150 
ISSN 0254-1475 
COM(97) 224 final 
DOCUMENTS 
EN 05 
Catalogue number : CB-CO-97-214-EN-C 
ISBN 92-78-19698-3 
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