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
Date: 1997-05-22
Institutions: European Commission
Subjects: EU situation, health policy, public health, report, woman

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 

EXECUTIVE  SUMMARY 

1. INTRODUCTION 

1.1  BACKGROUND 
1.2  WOMEN'S  HEALTH 
1.3  INDICATORS AND DETERMINANTS OF WOMEN's HEALTH 
1.4  INFORMATION SOURCES 
1.5  STRUCTURE OF THE REPORT 

2.  SOCIAL AND DEMOGRAPHIC  TRENDS 

2.1  POPULATION  SIZE AND STRUCTURE 

2.2  FAMILY LIFE 
2.3  WORKING LIFE 
2.4  GENDER-RELATED DEVELOPMENT INDICES 

3.  SELECTED  HEALTH  INDICATORS 

3.1  LIFE EXPECTANCY 
3.2  INFANT MORTALITY 
3.3  MATERNAL MORTALITY 
3.4  SELF-PERCEIVED HEALTH  STATUS 
3.5  HEIGHT 

4.  MORBIDITY 

4.1  ACTIVITY LIMITATIONS DUE TO CHRONIC CONDITIONS 
4.2  SHORT-TERM ACTIVITY LIMITATIONS 
4.3  DOCTOR CONSULTATIONS 
4.4  HOSPITALISATIONS 

5. CAUSES  OF DEATH  AND  TRENDS  IN FEMALE  MORTALITY 

5.1  MOTOR VEHICLE ACCIDENTS 
5.2  SUICIDE AND SELF INFLICTED INJURY 
5.3  CANCER AS A CAUSE OF FEMALE MORTALITY 

5.3.1 Breast  Cancer 
5.3.2  Cervical  Cancer 
5.3.3  Cancer  of the Respiratory  System 

5.4  DISEASES OF THE CIRCULATORY  SYSTEM (CARDIOVASCULAR DISEASES) 

5.5  ISCHAEMIC HEART DISEASE 
5.6  CEREBROVASCULAR DISEASE (STROKE) 

6. HEALTH  DETERMINANTS  AND HEALTH  PROMOTION 

6.1  SMOKING 
6.2  ALCOHOL CONSUMPTION 
6.3  DIET AND WEIGHT 
6.4  EXERCISE 
6.5  HEALTH PROMOTION AND DISEASE PREVENTION 

6.5.1 Heart  check-up 
6.5.2  Cholesterol  Testing 
6.5.3 Diabetes  testing 
6.5.4  Osteoporosis  testing 
6.5.5  Cancer  Screening 

6.5.5.1 Cervical cancer screening 

6.5.5.2 Breast cancer screening 

7. SPECIAL  ISSUES  IN WOMEN'S  HEALTH 

7.1  EATING DISORDERS 
7.2  HIV/AIDS  AND WOMEN'S HEALTH 

2 

4 

5 

10 

10 
10 
11 
12 
13 

17 

17 

17 
19 
20 

31 

31 
31 
32 
32 
33 

45 

45 
45 
46 
46 

61 

61 
61 
62 
62 
64 
64 
65 

67 
68 

84 

84 
85 
86 
87 
87 
87 
89 
89 
90 
90 
90 

91 

109 

109 
110 

7.3  FAMILY PLANNING 

7.4  ABORTION 

7.5  MENOPAUSE 

7.5.1 Osteoporosis  and Cardiovascular  Disease 
7.5.2 Prevention  and Symptom  Control 

7.6  VIOLENCE AGAINST WOMEN 
7.6.1 Domestic  Violence 
7.6.2 Rape  and sexual  assault 
7.6.3 Sexual  harassment  and Stalking 

8. CONCLUSION 

ANNEX I -  GLOSSARY 

ANNEX H -  LIST OF  FIGURES 

ANNEX m  -  LIST OF TABLES 

ANNEX IV  -  BIBLIOGRAPHY 

ANNEX  V  -  MEMBER STATE COORDINATORS 

I ll 

112 

114 
115 
115 
116 
116 
118 
118 

134 

136 

138 

140 

142 

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 
the  post-industrial 
profound  societal  and  demographic  changes.  These 
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. 

include 

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 
the  World  Health 
to  highlight  women's  health.  Similarly, 
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. 

to  enable  European  and 

towards  standardising  data 

While  efforts 
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 
results 
differentiate  between  the  former  German  Democratic  Republic  and  the  pre-unification 
Federal  Republic  of  Germany.  This  differentiation  has  been  retained  because  the  results 

important  exception: 

the  Eurobarometer 

is,  however,  one 

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%) 

Uncertain 
(15.70%) 

Agree  slightly 
(41.00%) 

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% 

20% 

40% 

60% 

80% 

100% 

ranked by % agree response 

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 

EU 15 
Portugal 
Austria 
Italy 
Germany 
France 
Finland 

Belgium 
Spain 
United  Kingdom 

Luxembourg 
Greece 
Denmark 
Sweden 
Netherlands 
Ireland 

Total 
Population 

Number of 
Women 

Women 
i n% 

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 

Source  : Eurostat  1997 

221 

126 

50 

100 

150 

200 

250 

Number  of women per  100  men 

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 

140 

160 

Number  of w o m en  per 100 men 

Source  : Eurostat  1997 

Table 2.2 
Female and Male Population in the EU (15) 

Women 
% 

Age-Group 
0-19  years 

20-39 years 

40-59 years 

60 and over 
Total 
Source  : Eurostat  1997 

1991 
23.9 

29.2 

23.9 

23.0 
100 

1996 
22.6 

29.2 

24.6 

23.6 
100 

Men 
% 

1991 
26.4 

31.6 

25.0 

16.9 
100 

1996 
24.9 

31.6 

25.7 

17.8 
100 

23 

Table 2.3 
Marriages and Divorces in the EU (15), 1960-1995 

Country 

Marriages 

Average age at  First 
Marriage (women> 

Divorces 

Number 
in  1995 

Difference 
since 
I960 (%) 

Rate in 
1995 
(o/oo) 

Difference 
since I960 
(%) 

in  1994  Difference 
since I960 
(years) 

Number 
in  1995 

Difference 
since 1960 
(%) 

Rate in 
1995 
(o/oo) 

Difference 
since 1960 
(%) 

EU  15 

1,901,000'  -24.1 

5 . 1' 

- 5 4 .4 

26.1'* 

2.0 

677,500' 

297.7 

1.8' 

237.7 

Austria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United  Kingdom 

42,900 
51,500 
34,700 
23,700 
254,000' 
430,500 
64,000 
15,600 
283,000' 
2,100 
81,500 
65,800 
196,900' 
33,600 
321,000' 

-26.6 
-21.0 
-3.2 
-27.7 
-20.6 
-37.5 
10.0 
1.0 
-27.0 
-7.2 
-8.6 
-5.3 
-16.9 
-32.9 
-18.4 

5.3 
5.1 
6.6 
4.6 
4 . 4' 
5.3 
6.1 
4.4 
4 . 9' 
5.1 
5.3 
6.6 
5.0' 
3.8 
5.5' 

-55.6 
-40.7 
-18.0 
-59.5 
-60.3 
-79.8 
-14.2 
-25.2 
-57.4 
-40.7 
-47.2 
-18.2 
-53.9 
-75.9 
-37.1 

25.8 
25.2 
28.9 
26.7 
26.7 
26.3 
25.6 
27.02 
26.1' 
26.3 
27.0 
24.6 
26.2' 
28.5 
25.8' 

1.8 
2.4 
6.1 
2.9 
3.7 
2.9 
0.4 
- 0.6 
1.3 

2.8 
- 0.2 
0.1 
4.6 

18,200 
35,0002 
13,000 
14,000 
117,000' 
169,400 
11,000 

27,000 
700 
34,200 
12,300 
33,100' 
22,500 
170,100' 

, 
' 

127.2 
662.3 
94.2 
283.7 
287.6 
130.8 
346.4 

- 
375.2 
502.4 
1545.1 
- 
151.5 
559.0 

2.3 
3.52- 
2.5 
2.7 
2.0' 
2.1 
1.1 

0.5 
1.8 
2.2 
1.2 
0.8' 
2.6 
2.9' 

99.0 
586.0 
70.0 
232.S 
204.1 
105.9 
255.0 

264.1 
345.4 
1369.5 

113.1 
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  (%) 

Source : Eurostat 1997 

:H1 9 95 
i n  1960 

30 

24 

Table 2.4 
Births and Fertility in the EU (15), 1960-1995 

Country 

Births 

Number in 1995  Difference 

Percentage of births 
outside marriage 
in 1995  Difference 

since 
1960 (%) 

since 
1960 (%) 

Fertility 

Rate in 1995  Difference 

since 
1960 (%) 

EU  15 

3,999,000' 

-30.9 

23.4* 

354.5 

1.43* 

-44.9 

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 

-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 

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 

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 

1.40 
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 

Austria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom 

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 

•  Norway -
•  Sweden 
•  Denmark 
•  Finland 

O) 
Q. 

C 
01 

01 

01 

03 

01 
> 
< 

8 
en 

3 
O) 

Observation  period  (years) 

Observation  period  (years) 

ut 

u*> 

-.o 

<o 

a o c M -
«a 

r a o r ^ i ^o 

30 

33 

o 

=> 

-r 

c 
w 
E 
o 
$ 
k_ 
<u 
a 
c 

u 

.a 
E 
3 
C 
ai 
a> 
fO 
u. 
> 
< 

(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 

%  Live Births to 
mothers under 20 
1995 

1990 

1994 

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 

26.7 
27.9 

28.5 
28.9 

28.3 
27.6 

27.2 
30.1 
29.0 
27.9 
29.3 
27.3 
28.9 
28.6 

27.7 

28.7 

27.5 
28.2* 

29.1 
29.1 
28.8P 
28.2 

28.0 
30.3p 
29.6* 
28.8 
29.9 
27.9 
29.5* 
29.2 

28.1 

Source  : Human  Development  Report  1995; HFA  1996; and Eurostat  1997 
p provisional  data 
* estimate 

1994 

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 

Table 2.6 
Employment EU 15, (1993) 

Women  15-64  years 

Thousands  |  Change 

Female  participation  rate" 

Country 

1993 

A U S I R I A1 
BELGIUM1 ,4 
DENMARK 
FINLAND 
FRANCE 
GERMANY1 ,3 
GREECE 
IRELAND2 
ITALY1 
LUXEMBOURG2 
NETHERLANDS1 
PORTUGAL 
SPAIN 
SWEDEN 
UNITED  KINGDOM 

37724" 
; 
4,237 
J 
2,893 
i 
' 
2,508 
!  25,213 
j  38,682 
4,118 
1,334 
22,787 
165 
7,084 
4,537 
15,564 
4,320 
28,179 

since 1983 
% 
T 3 7T 
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 

T 9 9X 
% 

~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 

%  change 

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 
AUSTRIA1 
BELGIUM1 
DENMARK1 

,1  3 

FINLAND 
FRANCE3 
GERMANY  1, 
G R E E C E1 
IRELAND  2 
ITALY1 
LUXEMBOURG  1 
NETHERLANDS1 
PORTUGAL4 
S P A I N5 

SWEDEN 

i m i T P n i f i M f t n n u^ 

WM 

• < «« 

WM 

IQttt 

•Klltt 

toot 

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 

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 

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 

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 

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 

p t - U m»  «nptoyimrt 

% o* t o t*  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 

7 58 

63.1 

83.3 

91.0 

61.3 

71.6 

68.5 

8 85 

75.0 

67.3 

75.9 

81.3 

_a5_i 

1992 
!1991 
' F R G t o i g gO 
'1986 
' n »7 
Source  - OECD  1994/1995 

Figure 2.5 
Changes in Employment  (EU) 

rata  (tnmn) 

Part-nnvt  work 

( m en  %) 

Part-um»  «wyk 

( w o m an  %) 

Source  - COM (96) 60 final 

H  1991 

D1975 

28 

Table 2.8 
Unemployment Rates 
EU  15, (1993) 

Both sexes 

Female 

Male 

Youth  Unemployment  rates 

% of total labour force 

% of total female 
labour force 

% of total male labour 
force 

(Under 25) % of youth labour force 

Female 

Male 

Country 

1983 

1993 

1983 

1993 

1983 

1993 

1983 

1993 

1983 

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 

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 

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 

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 

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 

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 

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 

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 

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 

AUSTRIA 
BELGIUM2 
DENMARK 
FINLAND 
FRANCE 
GERMANY4 
GREECE 
IRELAND 
ITALY 
LUXEMBOURG2 
NETHERLANDS2 
PORTUGAL 
SPAIN 
SWEDEN 
UNITED KINGDOM2 

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 

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* 

Gender-related 
development 

index  (GDI) 

Real GDP  per 
capita 
(PPP$) 
1992 

Share of  earned 
b 

income  (%) 

Sweden 
Finland 
Denmark 
France 
Austria 
United  Kingdom 
Italy 
Belgium 
Netherlands 
Portugal 
Greece 
Ireland 
Spain 
Luxembourg 

(1) 
0.919 
(2) 
0.918 
(4) 
0.904 
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) 

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 

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 

Human 
Development 

Index  (HDI) 

(1) 
0.757 
(3) 
0.722 
0.683 
(4)' 
0.433  (31) 
(9) 
0.610 
0.483  (19) 
0.585  (10) 
0.479  (21) 
0.625 
(7) 
0.435  (30) 

0.469  (24) 
0.452  (26) 
0.542  (13) 

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 

Source  : Eurostat  1997. 

•  1995 

•  1970 

10 

20 

30 

40 

50 

60 

70 

80 

90 

Years 

Figure 3.2 
Reduction in Life Expectancy Due to 
Premature Death 

Reduction of Ha expectancy through daalh before 85 years of age 
Females 
Ranted by  1932 SDR 

eu 15 

DENMARK 

PORTUGAL 

BELGIUM (11 

UNITED KINGOOM 

LUXEMBOURG 

IRELAND 

GERMANY ( 3| 

c m i wy 

AUSTRIA 

NETHERLANDS 

FRANCE 

ITALY (2) 

FINLAND 

SWEDEN 

SPAIN 

GREECE 

1 

•  1970 

«1992 

'  1971 

2 1988 

3 1991 

«FRGto  1990 

» 

0 

100 

2 00  300  400 

500  5  00 

7 00 

S  00  900  10  00 

Y«an 

Source-HFA  1996. 

35 

Reduction of  life expectancy through death before 65, 

1 9 92 

*  etaage 
since 1970 

3M 
4.80 
4.50 
4.30 
4.20 
4.10 
4.10 
4.00 
3.90 
3.80 
3 80 
3.70 
3.70 
3.50 
3.50 
3.40 

-M.02 
-15.79 
-50.55 
-29.51 
-30.00 
-35.94 
-39.71 
-37.50 
-40.00 
-24.00 
-32.14 
-43.08 
-30.19 
-25.53 
-38.60 
-43.33 

Country 

EU 11 
DENMARK 
PORTUGAL1 
BELGIUM2 
UNITED  KINGDOM 
LUXEMBOURG1 
IRELAND 
GERMANY4 
AUSTRIA 
NETHERLANDS 
PRANCE 
ITALY5 
FINLAND 
SWEDEN 
SPAIN 
GREECE 

11971 
21989 
31991 
4FRGto1990 
Source-HFA  1996 

Figure 3.3 
Life Expectancy at Birth (in Years) 
EU 15 (1995) 

D F e m a le s 

•  Males 

EU AVERAGE  ^ 

FRANCE  "jj 

SWEDEN 

y 

ITALY  Ijjj 

SPAM 

NETHERLANDS 

GREECE  § 

BELGIUM 

i 

LUXEMBOURG 

FINLAND 

AUSTRIA 

GERMANY 

Country 

UNITED KINGDOM  g 

IRELAND  "jjj 

PORTUGAL  J 

DENMARK  £ 

66 

68 

70 

72 

74 

76 

78 

80 

82 

Expectancy 

in  Years 

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 
* Estimate 
'ranked  by  difference 
Source  : Eurostat  1997 

Males 

Females 

Difference  a 

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 

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 

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 

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 
ranked by  difference 
Source  - Eurostat  1997 

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 

Differencea 

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 

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 

Table 3.3 

Life Expectancy at 45 Years (in Years) 
EU 15 (1995) 

Country 

Males 

.  Females 

Differencea 

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 

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 

EU AVERAGE 
FRANCE 
LUXEMBOURG 
FINLAND 
SPAIN 
BELGIUM 
GERMANY 
ITALY 
NETHERLANDS 
AUSTRIA 
PORTUGAL 
IRELAND 
SWEDEN 
UNITED KINGDOM 
DENMARK 
GREECE 
ranked by  difference 
Source  - Eurostat  1997 

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 

37 

Table 3.4 
Life Expectancy at 65 Years (in Years) 
EU 15 (1995) 

Country 

Males 

Females 

Difference  a 

EU AVERAGE 
LUXEMBOURG 
NETHERLANDS 
FRANCE 
BELGIUM 
FINLAND 
GERMANY 
ITALY 
SPAIN 
IRELAND 
SWEDEN 
AUSTRIA 
UNITED KINGDOM 
PORTUGAL 
DENMARK 
GREECE 
ranked by  difference 
Source  - Eurostat  1997 

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 

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 

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 

38 

Figure 3.4 

Infant Mortality Rate * 

Female 
Ranted by 1992SDR 

EU 15 

PORTUGAL (1) 

GREECE 

BELGIUM (2) 

ITALY (3) 

AUSTRIA 

LUXEMBOURG (1) 

SPAIN 

FRANCE 

IRELAND 

UNITED KINGDOM: 

DENMARK 

NETHERLANDS 

GERMANY (4) 

SWEDEN 

FINLAND 

'1971 
21989 
'1931 
4FRGto1980 

Ja 1970 
•  1992! 

50 

20 

30 

Rate 

'/•change 

1 9 92 

since 1970 

6.93 
9.29 
8.56 
8.53 
8.22 
7.53 
7  19 
7.05 
6.82 
6.67 
6.58 
6.51 
6.29 
6.17 
5.19 
5.16 

-68.40 
-81.33 
-71.08 
-59.55 
-72.18 
-70.92 
-64.89 
-66.07 
-54.95 
-65.78 
-64.41 
-54.12 
-50.67 
-73.90 
-52.82 
-61.00 

Female 

Country 

EU 15 

PORTUGAL' 

GREECE 
BELGIUM 2 
ITALY5 

AUSTRIA 

LUXEMBOURG  ' 

SPAM 

FRANCE 

IRELAND 

UNITED KINGDOM 

DENMARK 

NETHERLANDS 
GERMANY4 

SWEDEN 

FINLAND 

'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 * 

1992  % change 
since  1970 

7VÏ4 

12.91 

9.56 

7.38 

7.12 

6.67 

6.66 

6.62 

5.89 

5.82 

4.85 

4.79 

4.50 

4.20 

0.00 

0.00 

-79.51 

-54.20 

-82.46 

-12.87 

-46.83 

-87.12 

-63.06 

-67.55 

-79.18 

-81.26 

-91.10 

-85.52 

-63.68 

-83.73 

-100.00 

-100.00 

Country 

EU 15 

FRANCE 

PORTUGAL' 

DENMARK 

NETHERLANDS 
GERMANY4 
UNITED KINGDOM 
BELGIUM2 
GREECE 

IRELAND 
ITALY1 
SPAIN 

FINLAND 

AUSTRIA 

SWEDEN 

LUXEMBOURG' 

'1971 
21969 
31991 
4FRGto1930 

I 

Source-HFA  1996 

39 

Maternal  deaths (all causes) per  100000 live births 

Source  - HFA  1996 

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% 

100% 

^^H 900d 

I BP  verV9ood 

Source  : Eurobarometer  44.3/1996 

Table 3.5 
Self-Perceived Health Status, 1996 
Women 15+ Years, EU 15 

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 

IRELAND 
AUSTRIA 
DENMARK 
THE NETHERLANDS 
BELGIUM 
LUXEMBOURG 
GREECE 
FRANCE 
GERMANY W 
GERMANY E 
SWEDEN 
EU 15 
SPAIN 
UNITED KINGDOM 
FINLAND 
ITALY 
PORTUGAL 

Source  : Eurobarometer  44.3/1996 

Good 

Fair 

Bad 

% 

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 

% 

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 

% 

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 

40 

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 

Health Assessment, 1996 
Women 65-74 Years, EU 15 

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 

Fair 

Bad 

% 

% 

% 

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 

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 

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 

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 

Source  : Eurobarometer  44.3/1996 

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 

IRELAND 
AUSTRIA 
DENMARK 
THE NETHERLANDS 
BELGIUM 
LUXEMBOURG 
GREECE 
FRANCE 
GERMANY W 
GERMANY E 
SWEDEN 
EU 15 
SPAIN 
UNITED KINGDOM 
FINLAND 
ITALY 
PORTUGAL 

Source  : Eurobarometer  44.3/1996 

Good 

Fair 

Bad 

Very 

Bad 

% 

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 

% 

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 

% 

^ 

% 

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 

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 

41 

Figure 3.7 
Self-Perceived Health Status 
Elderly Women, EU 15 (1996) 

• age 65-74 

age 75+ 

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% 
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 

160 

165 

170 

ranked by average height 

height in cm 

42 

Source: Eurobarometer 44.3/1996 

Table 3.8 
Average Height (in cm) 
Women 18 + Years by Age-Group, EU 15 (1996) 

AGE-GROUP 

18-29 
Years 

30-44 
Years 

45-59 
Years 

60 +  Years 

Total 

18+ 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 

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 

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 

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 

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 

THE  NETHERLANDS 
DENMARK 
GERMANY  W 
SWEDEN 
AUSTRIA 
GERMANY  E 
LUXEMBOURG 
BELGIUM 
EU 15 
FINLAND 
IRELAND 
FRANCE 
GREECE 
UNITED  KINGDOM 
ITALY 
SPAIN 
PORTUGAL 

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  --

age  18-29 

—&— 

age 60+ 

150 

155 

160 

165 

170 

175 

ranked by average  height 
length 

average height  in cm 

Source: Eurobarometer  44.3/1996 

43 

Figure 3 JO 

Average Height (in cm) 
Women by Age-Group, EU 15 (1996) 

average 
height in cm 

170 

165 

160  -

155-

18-29 

30-44 

45-59 

60+ 

Age-Group 

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% 

80% 

100% 

yes 

Source: Eurobarometer 44.3/1996 

Table 4J 
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 

no 
% 

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 

yes,some 
% 

yes,severe 
% 

dk/refuse 
% 

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 

25% X 

some+severe 

—A— 

severe only 

15-29 

30-44 

45-59 
Age-Group 

60~-74 

75+^ 

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) 

Finland 

Portugal 

Denmark 

France 

United Kingdom 

Germany E 

Sweden 

Germany W 

Greece 

EU  15 

Austria 

Spain 

The Netherlands 

Belgium 

Ireland 

Italy 

Luxembourg 

no 
% 

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 

yes,  some 

% 

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 

yes,  severe 
% 

dk/refuse 
% 

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 

ranked according to figure 4.1 

yes 

Source: Eurobarometer  44.3/1996 

0% 

20% 

40% 

60% 

80% 

100% 

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) 
Source  : European  Community  Household  Panel  1994 
*  Excluding  France 

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 

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) 
Source : European Community Household Panel  1994 

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 

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) 
Source  : European  Community  Household  Panel  1994 

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 

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 

Luxembourg 

^U^^mttbm^^A 

Germany E  p ^ â ^ ^ » à M M « M ^y 

Uhited Kingdom 

Austria  mmmMmÊummmiâtA 

Sweden  I 

h-eland 

The  Netherlands 

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) 

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 

Spain 
Italy 
Portugal 
France 
UE15 
Belgium 
Greece 
Germany  W 
Finland 
Denmark 
Luxembourg 
Germany E 
Austria 
United  Kingdom 
Sweden 
Ireland 
The  Netherlands 

Source: Eurobarometer 44.3/1996 

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 

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 
15-29 

i 
30-44 

j 
45-59 
age-groups 

1 
60-74 

1 

j. 
75+ 

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 
30-44 
45-59 
60-74 
75+ 

Source: Eurobarometer  44.3/1996 

% 

23.9 
25.7 
32.1 
39.2 
41.8 

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 
Age-Group 

60-74 

75+ 

Source: Eurobarometer  44.3/1996 

Table 4,11 
Percentage with Non-Birth Hospitalisation(s) in Past Year 
By Age-Group, EU 15 (1996) 

Age-Group 

15-29 
30-44 
45-59 
60-74 
75+ 

No Hospitalisation 
% 

93.7 
92.8 
90.8 
87.4 
82.0 

Hospitalisation 

% 

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 

20 

25 

average nights in hospital 

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 

have contributed to the decrease there2. 

61 

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) 

ischaemic  heart  disease3  and 
Diseases  of  the  circulatory  system  (particularly 
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, P A,  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  d e a t h,  F e m a l es  all  ages,  1 M2  (EU15) 

Other  Causes  of  Death 
2 0% 

Cancers 
26% 

Suicide  and  Accidents 
5% 

Diseases  of  the 

Respiratory  s y s t em 

6% 

Diseases  of  the 

Circulatory  s y s t em 

4 3% 

Source:  HFA  1996 

Figure 5,2 
Motor Vehicle Traffic Accident Mortality (1992) 
All Women, EU 15 

S DR  motor  v e h i c le  t r a f f ic  a c c i d e n t s,  p er  100000 

Ranted by 1982 SCR 

EU  15 

LUXEMBOURG (1)  ' f cj 

PORTUGAL (1) 

BB_GUM(2) 

GREECE 

FRANCE 

SPAN 

AUSTRIA 

FNLAND 

RELAND 

rTALY  (3) 

£• 
c 
§ 
O 

GERMANY (4) 

DENMARK 

NETHERLANDS 

SWEDEN 

UNTIED KNGDOM 

'1971 

!1989 

'1991 

'FRGID1890 
Source-HFA  1996 

SDR  motor  vehicle  traffic  accidents,  per  100000 

Females 
Country 

EU  15 

LUXEMBOURG' 

PORTUGAL1 

BELGIUM2 

GREECE 

FRANCE 

SPAIN 

AUSTRIA 

FINLAND 

IRELAND 

I T A L Y' 

GERMANY' 

DENMARK 

NETHERLANDS 

SWEDEN 

UNITED  KINGDOM 

I 1 9 92 

%  c h a n ge 

s i n ce  1970 

6.42 

11.39 

10.60 

9.14 

9.05 

7.45 

7.30 

7.04 

6 82 

6.79 

6.51 

6.19 

5.12 

4.57 

4.28 

4.14 

-39.55 

5.37 

4.43 

-39  87 

61.61 

-38.88 

13.88 

-51.52 

-43.59 

-24.97 

-31.97 

-59.65 

-63.79 

-63.12 

-57.07 

-44.95 

)1970 

,1992 

'1971 
21989 
31991 
4FRGto1980 
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 

1992 

% change 

since 1970 

6.24 

14.30 

13.67 

11.QO 

10.46 

10.39 

10.01 

8.90 

7.96 

6.72 

4.23 

3.63 

3.61 

3.36 

2.99 

1.21 

-24.27 

179.30 

-14.62 

"13.05 

-3.33 

-22.23 

22.22 

-32.78 

-44.84 

-1.47 

20.17 

1.68 

464.06 

-46.41 

26.69 

-36.32 

Females 

Country 

EU 15 
LUXEMBOURG1 
DENMARK 

FINLAND 
BELGIUM  2 
AUSTRIA 

FRANCE 

SWEDEN 
GERMANY  4 
NETHERLANDS 

PORTUGAL * 

ITALY * 

IRELAND 

UNITED KINGDOM 

SPAIN 

GREECE 

'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 

Source - HFA  1996 

J1Q1970; 

1992! 

40 

60 

100 

120 

Rate 

72 

SDR Malignant neoplasms, 0-64, per 100,000 

1992 

% change 
since 1970 

69.74 

102.23 

86.98 

86.23 
76.50 

75.06 

74.66 

72.58 

6952 

68.27 

66.90 

61.48 

60.04 

59.19 

56.36 

54.77 

-13.02 

0.28 

-9.87 

-874 
-10.88 

-9.64 

-9.19 

-17.34 

-24.34 

-12.27 

-12.63 

-15.01 

-13.27 

-13.46 

-11.22 

-7.51 

Females 
Country 

EU  15 

DENMARK 

IRELAND 

UNITED KINGDOM 

NETHERLANDS 

BELGIUM  ' 

LUXEMBOURG  ' 

GERMANY * 

AUSTRIA 

SWEDEN 

ITALY  ' 

PORTUGAL' 

FRANCE 

FINLAND 

SPAIN 

GREECE 

'1971 
21989 
'1991 
4FRGto1990 

Source-HFA  1996 

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 

1992 

150.30 

203.73 

186.53 

182.37 

162.43 

159.99 

159.86 

159.80 

157.23 

145.93 

143.04 

134.66 

128.78 

125.57 

117.42 

112.60 

% change 
since 1970 
-5.05 

4.57 

4.39 

4.66 

-11.87 

-9.69 

-1.93 

-8.65 

-17.36 

-0.67 

-10.24 

-9.95 

-9.65 

-3.54 

-6.76 

9.94 

Ranked by 1902 SDR 
Country 

EU 15 

DENMARK 

IRELAND 

UNITED KINGDOM 
GERMANY4 
NETHERLANDS 

LUXEMBOURG  ' 

BELGIUM ' 

AUSTRIA 

ITALY' 

SWEDEN 

FINLAND 

FRANCE 
PORTUGAL1 
SPAIN 

GREECE 

'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 

2 1% 

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  f e m a le  breast, 

S DR  M a l i g n a nt  n e o p l a sm  f e m a le  b r e a s t,  0 - 64  p er  1 0 0 , 0 00 

0-44  per  1 0 0 , 0 00 

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 

Source  - HFA  1996 

15 

Rate 

O1 9 70 

•  1992 

1 9 92 

1 9 . 80 

2 5 . 80 

2 4 . 77 

2 4 . 63 

2 4 . 36 

2 3 . 86 

19.89 

19.06 

18.31 

17.96 

17.75 

16.60 

16.43 

15  46 

15.12 

14.58 

%  c h a n ge 
s i n ce  1 9 70 

9.27 

17.22 

-0.84 

14.77 

- 5 . 18 

-3  28 

10.81 

10.62 

9.12 

2 0 . 05 

11.57 

6 2 . 11 

-1.56 

- 3 0 . 30 

4 . 49 

4 5 . 07 

Country 

EU  IS 

IRELAND 

DENMARK 

BELGIUM  * 

UNITED  KINGDOM 

NETHERLANDS 

G E R M A N Y4 

ITALY  ' 

AUSTRIA 

PORTUGAL* 

FRANCE 

SPAIN 

SWEDEN 

LUXEMBOURG  ' 

FINLAND 

GREECE 

' 1 9 71 
J1989 

' 1 9 91 
4F R G t o 1 9 90 

Source-HFA  1996 

Figure 5.8 
Breast Cancer Mortality (1992) 
All Women, EU 15 

S DR  M a l i g n a nt  n e o p l a sm  f e m a le  b r e a st  All  a g e s,  per  1 0 0 , 0 00 

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 

Source  - HFA  1996 

D1970 

, • 1 9 92 

74 

S DR  Malignant  neoplasm  female  breast.  All  ages,  per  100,00 

Ranted t)Y 1292 SDR 
C o u n t ry 

EU  15 

D E N M A RK 

U N I T ED  K I N G D OM 

I R E L A ND 

N E T H E R L A N DS 
BELGIUM1 

GERMANY* 

A U S T R IA 
I T A L Y1 

F R A N CE 
PORTUGAL1 

S W E D EN 

LUXEMBOURG* 

S P A IN 

F I N L A ND 

G R E E CE 

1992 

3 1 . 25 

4 0 . 56 

3 9 . 23 

39.17 

38.47 

3 7 . 93 

31.87 

3 1 . 29 

2 9 . 83 

28.11 

2 6 . 57 

2 5 . 66 

2 4 . 99 

2 4 . 40 

2 3 . 82 

2 1 . 32 

%  c h a ng » 
s i n ce  197 J 

16.2< 

6.7S 

5.8C 

2 8 . 5! 

1.16 

14.8C 

15.6< 

17.9< 

2 1 . 0' 

15.6( 

29.8C 

-4.07 

- 2 0 . 7' 

73.67 

20.5Î 

56  Bt 

' 1 9 71 
21 9 89 
31 9 91 
4 F R G to  1990 
Source-HFA  1996 

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 - B a G I UM 

- 0 - E U 15 

- X - F N L A ND 

SPAN 

_ o_  GREECE 

Source- HFA  1996 

88  89  90  91  92 

Figure 5.10 

Cervical Cancer Mortality (1992) 
Women 0-64 Years, EU 15 

SDR  Cancer of the cervix, 0-64,  per 100,000 

SDR Cancer of the Cervix, 0-64, per  100,000 

Ranked by 1992 

EU 15 

mmlmr———1 

DENMARK  a g ^ ^ —— 

=3 

IRELAND p ^ a ^— 

' 

GERMANY (4)  mmmmam 
LUXEMBOURG  (1) ^ , —- 

PORTUGAL (1)  ^

j

,— 

~* 

D 

' 

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)  j j j => 

[ 

11971 
21989 
51991 
« FRGto 1990 

Source-HFA  1996 

|  ^ ^-

;  B  1992 

75 

1992 

% change 
since  1970 

2.28 

4 64 

3.78 

3.41 

3.20 

2.71 

2.30 

2.26 

2.14 

2.05 

1.84 

1.67 

1.66 

1.31 

0.90 

0.75 

-47.71 

-55.34 

-42.02 

-23.88 

-50.54 

-70.61 

-73.10 

-56.87 

-37.97 

-70.80 

-67.83 

-36.26 

95.29 

61.73 

-81.05 

-55.36 

Country 

EU 15 

DENMARK 

UNITED  KINGDOM 

IRELAND 
GERMANY4 
LUXEMBOURG  ' 

PORTUGAL  ' 

AUSTRIA 
BELGIUM2 
SWEDEN 

NETHERLANDS 

FRANCE 

SPAIN 

GREECE 

FINLAND 

ITALY  ' 

11971 
21989 
51991 
4 FRGto 1990 

Source-HFA  1996 

Fi2ure5.11 
Cervical Cancer Mortality  (1992) 
All Women, EU 15 

SDR C a a c * r o f f l » M f v t x , A fl ages, per 100 000 
Ranked byJ992 SOR_ 

SDR Cancer of the cervw, AI ages,  per 100,000 

EU 15 

DENMARK 

JNITED KINGDOM 

GERMANY (4) 

IRELAND 

AUSTRIA 

LUXEMBOURG (1) 

PORTUGAL (1) 

BELGIUM (2) 

NETHERLANDS 

SWEDEN 

SPAIN 

FRANCE 

FINLAND 

GREECE 

l l 9f i A L Y ( 3) 

21988 
31991 
'FRGto  1990 

D197Û 
•  1992 

6 

8 

Rate 

12 

1892 

% cfcaage 
tBhTtHTP 

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 

-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 

Coantry 

EU1« 

UNITED KMODOM 
OERMANY4 

IRELAND 

AUSTRIA 
LUXEMBOURG1 
PORTUGAL1 
BELGIUM2 

SWEDBI 

NETHERLANDS 

SPAM 

PRANCE 

FINLAND 

GREECE 

ITALY' 

11971 
21989 
31991 
4 FRGto 1980 

Source - HFA  1996 

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 - E U 15 

—D— S MN 

O-  NETV€RLANDS 

FORTUGAL 

- x - x - x - x - ^ - 5 - Q^  x-

_x _x — X —X -X —x -X 

x-x 

o  o 'a 

o 

_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 

Source-HFA  1996 

Year 

76 

Figure 5.13 
Respiratory System Cancer Mortality (1992) 
Women 0-64 Years, EU 15 

SDR Traçhea/bronchus/luns  cancer, 
Females 0 44  per  100,000 
Rated by 1882 

EU 15 

D H * K RK 

UNITED KJNGDOM 

Source  - HFA  1996 

SDR Trachea/bronchus/lung cancer, 0-64 per  100,000 
Females 
Country 

1992 

%  change 
since  1970 
44.76 
218.63 
19.43 
269.23 
12.49 
163.13 
155.98 
80.23 
86.93 
49.51 
78.55 
33.15 
-5.06 
80.44 
10.31 
-28.00 

6.63 
20.52 
12.91 
10.56 
9.55 
8.92 
8.78 
6.20 
6.15 
6.13 
4.91 
4.90 
4.69 
4.06 
2.89 
2.52 

EU 15 
DENMARK 
UNITED  KINGDOM 
NETHERLANDS 
IRELAND 
SWEDEN 
LUXEMBOURG1 
GERMANY * 
BELGIUM  1 
AUSTRIA 
FINLAND 
ITALY* 
GREECE 
FRANCE 
PORTUGAL1 
SPAIN 

'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 
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 

34.88 

30.89 

26.60 

16.62 

15.94 

14.11 

13.55 

12.28 
11.15 

10.89 

10.88 

10.06 

7.80 

6.44 

540 

67.86 

175.30 

73.15 

85.24 

207.21 

126.74 

156.08 

57.56 

74.43 
73.68 

61.57 

90.54 

15.77 

62.16 

39.09 

-674 

1 1971 
2 1989 
3 1991 
4 FRGto  1990 
Source  - HFA 1996 

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 

'1971 
'1989 

Source-HFA  1996 

Q1970! 

iB l 9 9 2! 

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\\\\\\\\\\^^^^ 
K K K m s * ^ ^ K K m s ^ m >^ 
Km\\ms\\\\mm\\^^^ 
is\S\\\S\\\SS\SSS\\\\S^^^^ 
K\S\\^\S\S\\\\\\\SS\\^^^^ 
K\\\S\S\S\\\\\\\S\\SS^^^^^ 
k\v^\^VVVV\^^^^^ 
mssmssmmsN^^^^ 
^ ^ ^ ^ ^ ^ ^ ^ S M » S » M » ^^ 
hssmmssmssmsssmss^g: 
KWKm\^m^m\>NKKI 
K m m m s m s m WM 
fcMMMMMMMMMMMMMI 
N\\mmmm\\wi 
S\mm\\S\\N^SSST 
kwww^wwwç 

0% 

20% 

Yes • DK 

40% 

60% 

80% 

100% 

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 
3 63 
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 

E U1 

IRELAND] 

UNITED Kll 

PORTUGAL{ 

DEN! 

AU: 

GERMANY* 

GREECI 

FINLANI 

CosatSELGIUM 

LUXEMBOURG 

NETHERLANI 

'1971 
31939 
31931 
'FRGto 1930 

20 

40 

60 
Rate 

80 

100 

120 

Source-HFA  1996 

0 19 
• 1 

SDR dm  ft  at ômÊHory «ytam, r w Mi  0-04 par 100.000 

Hchang» 
1992  «too* 1970 

31 .K 
43.81 

42.98 

39.30 

36.80 

36.65 

36.06 

34.16 

33.73 

32.71 

3243 

30.89 

28.85 

27.63 

24.76 

19.01 

.«1.01 
-57.12 

-47.23 

-51.70 

-31.62 

-45.97 

-40.25 

-31.67 

-64.47 

-5237 

-63.66 

-39.35 

-37.76 

-58.76 

-63.72 

-57.71 

Coeeay 

EU  IS 

IRELAND 

UNITED KMODOM 
PORTUGAL1 
DENMARK 

AUSTRIA 
GERMANY4 
GREECE 

FINLAND 
BELGIUM3 
LUXEMBOURG1 
NETHERLANDS 

SWEDEN 

ITALY ' 

SPAIN 

PRANCE 

'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 
all ages per  100,000 

1 9 92 

V * " "* 
since 1970 

316.53 

315.53 

301.78 

299.59 

289.50 

299.71 

271.8 

26577 

263.09 

247.74 

243.67 

239.31 

221.80 

214.23 

150.55 

-29.56 

-33.79 

-40.35 

7.54 

-47.79 

-31.60 

-44.52 

-40.52 

-31.37 

-40.56 

-34.91 

-40.81 

-43.28 

-40.42 

-45.63 

Country 

EU1S 
PORTUGAL1 
AUSTRM 

IRELAND 

GREECE 

FINLAND 
GERMANY4 
LUXEMBOURG1 
UNITED KINODOM 

DENMARK 
ITALY3 
SWEDEN 
BELGIUM3 
SPAIN 

NETHERLANDS 

FRANCE 

'1971 
21989 
31991 
'  FRGto  1990 

Source -HFA  1996 

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  D E N M A RK 

ITALY (3) 

SWEDEN 

BELGIUM (2) 

SPAIN 

NETHERLANDS 

FRANCE 

'1971 
M989 
'1991 
'FRGto  1990 

Source-HFA  1996 

|D197d 
!• 19921 

500 

600 

300 

Rate 

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 
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. 

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 

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 

9.7 
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 

80 

Figure 5.19 
Ischaemic Heart Disease Mortality (1992) 
Women 0-64 Years, EU 15 

S DR 

tocHaente  a 

• a rt  d i s e a s e,  F e m a l es  a g es  0 - 6 4, 

SDR ischaemic heart disease, Females ages 0-64, 

p er  1 0 0 , 0 00 

Ranked by  1992 S0F 

EU 15 

IRELAND 

UNITED KINGDOM 

..  . 

J 

DENMARK 

FINLAND 

SWEDEN 

AUSTRIA 

GERMANY (4) 

NETHERLANDS 

C o u n t nf  BELGIUM (2) 

GREECE 

PORTUGAL (1) 

LUXEMBOURG (1) 

rTALY(3) 

SPAIN 

'  1971 

FRANCE 

21989 
31991 
« FRG to  1990 

^ 
C 

Source-HFA  1996 

,'.,,' 

' 

Q1970 

BJ1992 

10 

20 

30 

40 

50 

Nat* 

perlOarjQQ. 

Country 

1992  % étang* 
SJafit-iaZP 

EU  18 

IRELAND 

UNrTED KJNODOft I 

DENMARK 

FINLAND 

SWEDEN 

AUSTRIA 
GERMANY4 
NETHERLANDS 
BELGIUM2 
GREECE 
PORTUGAL1 
LUXEMBOURG1 
ITALY3 
SPAIN 
FRANCE 

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; 

11971 
21989 
31991 
4 FRG to 1990 
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 

SDR  ischaemic 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 

FRANCI 

'1971 
21989 
31991 
'FRG to 1990 

Source-HFA  1996 

(Country 

EU  15 
FINLAND 
«ELAND 

UNITED KINGDOM I 
DENMARK 
SWEDEN 
GERMANY 
AUSTRIA 
NETHERLANDS 
ITALY3 
LUXEMBOURG 
BELGIUM) 

GREECE 
PORTUGAL 
SPAIN 
•WAMftP 

1992 

% cnajigi > 
junaa-lS2 ) 

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 

-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-

Rati 

'1971 
21689 
31931 
'FRGto 1990 
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 

2 stress 

3 unhealthy diet 

4 overweight 

5 lack of ( 

6 excessive alcohol 

Source: Eurobarometer 44.3/1996 
* Respondents were asked to indicated the main and the second risk factors for heart disease. 

100% 

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 

SDR  cerebrovascular  diseases, 0-64 per 1C 
Females 

Ranted by  1992 SCR 

,1970 

,1992 

EU  15 

PORTUGAL (1) 

LUXEMBOURG (1) 

GREECE 

F NLA NO 

UNITED KNGDOM 

£ 

g 
u 

DENMARK 

RELAND 

BELGUM(2) 

ITALY  (3) 

AUSTRIA 

GERMANY  (4) 

NETHERLANDS 

SPAN 

SWEDEN 

FRANCE 

'  1971 
'1989 
'1991 
•  FRG to 1990 

SDR cerebrovascular diseases. 0-64  per  100,000 

1992 

% change 
sine*  1B70 

B.73 

18.42 

12.98 

12.12 

11.29 

10.88 

10.82 

9.77 

8.92 

8.88 

8.41 

8.17 

8.08 

7.30 

6.97 

5.80 

-54.05 

-30.25 

-2.41 

-32.85 

-64.11 

-55.70 

-18.65 

-69.06 

-53.22 

-57.14 

-57.22 

-50.24 

-45.41 

-63.37 

-49.82 

-64.81 

Female 
Country 

EU  15 

PORTUGAL' 

LUXEMBOURG' 

GREECE 

FINLAND 

UNHTED KINGDOM 

DENMARK 

IRELAND 

BELGIUM  ' 

ITALY * 

AUSTRIA 

GERMANY' 

NETHERLANDS 

SPAIN 

SWEDEN 

FRANCE 

'1971 
31969 
31991 
'FRGto 1990 

Source-HFA  1996 

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 

UNTTED KNGDOM 

GERMANY  (4) 

ê 

g 
O 

FELAND 

SPAN 

BELGUM (2) 

DENMARK 

NETHERLANDS 

SWEDEN 

FRANCE 

M971 
21969 
31991 
«FRGto1990 

Source-HFA  1996 

j1970j 

I  1992 

100 

150 

Rate 

SDR  cerebrovascular  diseases.  All  ages,  per  100.000 

1992 

%  change 
since  1970 

75.93 

175.63 

125.75 

101.82 

82.71 

81.27 

80.33 

79.53 

7 8 80 

77.96 

75.25 

66.46 

6 5 41 

62  75 

6 1 34 

44  11 

-42.94 

-26.34 

1.35 

9.85 

-51.54 

-35.24 

-49.92 

-45.16 

-49.33 

-51.26 

-41.39 

-52.30 

-33.57 

-42  36 

-30  30 

-59  68 

Female 
Country 

EU  15 

P O R T U G A L' 

G R E E CE 

L U X E M B O U RG  ' 

F I N L A ND 

ITALY  ' 

A U S T R IA 

UNITED  K I N G D OM 

G E R M A N Y' 

I R E L A ND 

SPAIN 

B E L G I UM  ' 

D E N M A RK 

N E T H E R L A N DS 

S W E D EN 

F R A N CE 

1  1971 
7  1989 
3  1991 
' F RG 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 

References 

1  Abel-Smith,  B.,  Figueras,  J.,  Holland,  W.,  McKee,  JvL,  Mossialos,  E.  (1995),  Choices  in  Health 

Policy.  London Dartmouth. 

2  CEC (1990), Europe  against  Cancer: 1990-1994, second  action plan,  Luxembourg. 
3  Ministry of Health, Denmark (1994a), Lifetime  in Denmark.  Copenhagen, Denmark. 
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 
7  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 Medicine of the Royal College of Physicians of Ireland (unpublished). 

Ibid. 

8  Eurostat  (1996),  Social  Portrait  of  Europe,  Luxembourg:  Office  for  Official  Publications  of  the 

European  Communities. 

9  Member State reports on women's health (1996), unpublished. 
10  Sinkkonen  S. (19%), Finnish Report  on  Women's Health,  Kuopio: Unpublished. 
11  Eurostat  (1995a)  ,  Women  and  Men  in  the  European  Union: A  Statistical  Portrait,  Luxembourg: 

Office  for Official  Publications of the European  Communities. 
12  Member  State reports on women's health (1996), unpublished. 
13  European  Bureau  for  Action  on  Smoking  Prevention  (1994),  Tobacco  and  Health  in  the  European 

Union, an overview,  Brussels: BASP. 

14  Ministry of Health, Denmark  (1994a), Lifetime  in Denmark,  Copenhagen: Ministry of Health. 
15  Peto, R_, et al,  (1994), Mortality  from  smoking  in  developed  countries.  1950-2000. Indirect  estimates 

from  vital statistics.  Oxford:Oxford  Medical Publications. 

16  Abel-Smith,  B.,  Figueras,  J.,  Holland,  W.,  McKee,  M.,  Mossialos,  E.  (1995),  Choices  in  Health 

Policy.  Dartmouth. London. 

17 Ministry of Health, Denmark (1994a), Lifetime  in Denmark,  Copenhagen, Denmark. 
18  CEC (1995a), Report  from  the  Commission  on the State  of Health  in the European  Community,  1995, 

COM(95) 357 final, Brussels: CEC. 

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-
699;  Willett,  W.C.,  et  al.  (1987),  "Moderate  alcohol  consumption  and  the  risk  of  breast  cancer,"  N 
EngJMed,  316:1174-1180. 

21  Ministry of Health Denmark  (1994c), Cancer  Trends and  Cancer Mortality  (in Danish),  Copenhagen, 

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 

* Belgium: 1989, Spain and Italy: 
1990 

60% 

—I 
80% 

1 

100% 

Source: Eurostat '95b 

Table 6.1 
Percentage of Smokers (1991)* 
Women  15+ Years, Selected EU Countries 

Percent 
42 
33 
32 
31 
29 
27 
26 
26 
26 
25 
24 
12 

Denmark 
The Netherlands 
France 
Ireland 
United Kingdom 
Spain 
West German 
Italy 
Luxembourg 
Greece 
Belgium 
Portugal 

* Belgium  1989; Spain and Italy  1990 

Source: Eurostat  1995b 

96 

Figure 6.2 
Smoking Attributable Mortality (1990) 
Women 35+ Years, EU 15 

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. 

6 

8 

10 

12 

14 

18 

%  Smoking Attributable Deaths 

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 

SDR chronic Mver disease and cirrhosis, al ages, per 100000 

RwMbylBDSCR 

EU 15  I 

Females 
Country 

I 

Ï992 

EU 15 
AUSTRIA 
ITALY' 
PORTUGAL' 
GERMANY4 
LUXEMBOURG  ' 

FRANCE 

SPAIN 

DENMARK 

BELGIUM ' 

FINLAND 

GREECE 

UNITED KINGDOM 
SWEDEN 

NETHERLANDS 
IRELAND 

| 

9.51 
14.42 
13.78 
13.70 
12.84 
10.90 

8.98 

8.92 

8.77 

8 46 

601 

4.58 

4.46 
4.19 

3.58 
V93 

%  change 
since 1070 
-10.88 
10.64 
-13.11 
-45.57 
-3.31 
-34.69 

-53.85 

-40.97 

8.54 

10.59 

8048 

-50.22 

9142 
-10.85 

-2.72 
-33.45 

Source  - HFA  1996 

'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% 

20% 

\ 

40% 

severe underweight (<18 BMI) 

overweignt (27-30 BMI) 

Source: Eurobarometer 44.3/1996 

underweight (18-20 BMI) 

severe overweight (30+ BMI) 

98 

Table 6.3 
Percent Over- and Underweight, Women  18+ Years, 
EU 15 (1996) 

severe 
underweight 
(BMK18) 
% 

EU  15 
Austria 
Belgium 
Denmark 
France 
Finland 
Greece 
Germany E 
Germany W 
Ireland 
Italy 
Luxembourg 
The Netherlands 
Portugal 
Spain 
Sweden 
United Kingdom 
Source:  Eurobarometer  44.3/1996 

2.8 
2.2 
4.1 
2.4 
3.8 
2.8 
1.8 
2.1 
1.4 
2.6 
4.2 
4.2 
2.2 
1.5 
3.2 
1.7 
2.5 

underweight 
18^BMI<20) 

% 

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 

normal weight 
(20SBMK27) 
% 

overweight 
(27SBMK30) 

% 

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 

severe 
overweight 
(BMI^30) 

% 

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 

mean 
BMI 

% 

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 

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 

EU 
average 

0% 

20% 

40% 

_l 

p 
60% 

i 
80% 

h 

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 
Source: Eurobarometer  44.3/1996 

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 

Figure 6.6 
Percent Reporting a Cholesterol Test in Past Year 
Women 15+ Years, EU 15 (1996) 

• 

age 65+ 

age 50-64 

Greece 
Austria 
Germany  W 
Germany  E 
Portugal 
Luxembourg 
Spain 
France 
Italy 
Belgium 
EU 15 
Finland 
The  Netherlands 
Sweden 
Ireland 
United  Kingdom 
Denmark 

0% 

20% 

40% 

60% 

80% 

100% 

ranked by aver?ge of both age-groups 

Yes 

100 

Source: Eurobarometer  44.3/1996 

Table 65 
Percent Reporting a Cholesterol Test in Past year 

Women 15+ Years, EU 15 (1996) 

15-34 
years 

35-49 
years 

50-64 
years 

65+ 
years 

Total 

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 

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 

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 

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 

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 

Greece 
Austria 
Germany W 
Germany E 
Portugal 
Luxembourg 
Spain 
France 
Italy 
Belgium 
EU  15 
Finland 
The Netherlands 
Sweden 
Ireland 
United  Kingdom 
Denmark 

Source: Eurbarometer  44.3/1996 

Figure 6- 7 
Percent Reporting a Diabetes Test in Past Year 

Women 40 + Years, EU 15 (1996) 

• age 65+ 

age 40-64 

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 

Source: Eurobarometer  44.3/1996 

80% 

100% 

101 

Table 6.6 
Percent Reporting a Diabetes Test in Past Year 
Women 15+ Years, EU 15 (1996) 

age <40 
years 

age 40-64 
years 

age 65+ 
years 

Total 

Germany E 
Germany W 
Portugal 
Greece 
Luxembourg 
Austria 
Finland 
EU 15 
Italy 
France 
Spain 
Belgium 
Denmark 
United Kingdom 
Sweden 
The Netherlands 
Ireland 

Source: Eurobarometer 44.3/1996. 

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 

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 

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 

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 

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 

EU 
average 

0% 

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) 

50+ 
years 

50-64 
years 

65+ 
years 

Total 

Austria 
Germany W 
Germany E 
Greece 
Belgium 
France 
Italy 
EU  15 
Denmark 
Spain 
Luxembourg 
Portugal 
The Netherlands 
United Kingdom 
Sweden 
Ireland 
Finland 

Source : Eurobarometer  44.3/1996 

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 

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 

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 

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 

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 

k^^\^\v^^ 

k \ \ V \ \ \ \ \ \ \ \ \ ^ ^^ 

0% 

20% 

40% 

60% 

80% 

100% 

ranked by % agree 

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) 

disagree 
strongly 

disagree 
slightly 

agree 
uncertain 

agree 
slightly 

agree 
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 

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 

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 

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 

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 

Denmark 
Finland 
Ireland 
Germany W 
Italy 
Germany E 
United Kingdom 
Greece 
Austria 
EU 15 
Spain 
Portugal 
France 
Belgium 
The Netherlands 
Luxembourg 
Sweden 

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) 

5-34 
years 

35-64 
years 

65+ 
years 

Total 

Denmark 
Austria 
France 
Germany E 
Finland 
Germany W 
Luxembourg 
Belgium 
EU 15 
Greece 
Italy 
United  Kingdom 
Sweden 
The Netherlands 
Spain 
Portugal 
Ireland 

Source:  Eurobarometer  44.3/1996 

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 

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 

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 

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 

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) 

15-34 
years 

35-49 
years 

50-59 
years 

60+ 
years 

Total 

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 

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 

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 

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 

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 

Germany E 
Denmark 
Austria 
Luxembourg 
Germany W 
France 
Belgium 
EU 15 
Finland 
Sweden 
Spain 
Italy 
The Netherlands 
United  Kingdom 
Portugal 
Greece 
Ireland 

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 

age 15+ • 

age 50-59 

EU 
average 

0% 

20% 

40% 

60% 

80% 

100% 

ranked by age 15+ 

Source: Eurobarometer  44.3/1996 

106 

Table  Ul 
Percent Favouring Mammography Screening 
Women 15+ Years, EU 15 (1996) 

15-34 
years 

35-49 
years 

50-59 
years 

60+ 
years 

Total 

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 

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 

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 

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 

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 

Finland 
Sweden 
France 
The Netherlands 
United Kingdom 
Spain 
Italy 
Greece 
EU 15 
Ireland 
Luxembourg 
Denmark 
Germany E 
Portugal 
Belgium 
Austria 
Germany W 

Source: Eurobarometer 44.3/1996 

Figure 6J3 
Percent Reporting a Mammography in Past Year 
Women 50-69 Years, EU 15 (1996) 

• age 60-69 

age 50-59 

Sweden 
Denmark 
The  Netherlands 
Luxembourg 
Finland 
Austria 
United  Kingdom 
France 
EU 15 
Germany  W 
Portugal 
Spain 
Germany E 
Italy 
Belgium 
Greece 
Ireland 

0% 

20% 

40% 

60% 

80% 

100% 

ranked by average of both age-groups 

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 
Denmark 
The Netherlands 
Luxembourg 
Finland 
Austria 
United Kingdom 
France 
EU 15 
Germany W 
Portugal 
Spain 
Germany E 
Italy 
Belgium 
Greece 
Ireland 
Source : Eurobarometer 44.3/1996 

2.4 
11.0 
6.1 
13.9 
2.4 
19.1 
2.6 
6.0 
8.1 
14.8 
10.7 
12.6 
14.2 
3.4 
11.0 
3.2 
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 

108 

7. 

S P É C I AL  I S S U ES  IN  W O M E N 'S  H E A L TH 

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 
b 

In this study, 8.3% of the sample population were men. 
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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1  West,  R_ (1994), Eating  disorders:  anorexia  nervosa  and  bulimia  nervosa.  London:  Office  of  Health 

Economics. 
Ibid 

2 
3  Hoek,  H.W.  (1995),.  "Impact  of  Urbanization  on  Detection  of  Eating  Disorders,"  Psychiatry,  152:8, 

1272-1278. 

4  Thomas, C. (1996), British Report  on  Women s Health,  Lancaster:  Unpublished 
5  West, R  (1994), Eating  disorders:  anorexia  nervosa  and  bulimia  nervosa.  London:  Office  of  Health 

Economics. 

6  West, R  (1994), Eating  disorders:  anorexia  nervosa  and  bulimia  nervosa.  London:  Office  of  Health 

Economics. 

7  Weilandt, C. (1996), German Report  on  Women's Health,  Bonn:  Unpublished. 
8  Folkhâisoinstitutet  och  Socialstyrelsen  (1995),  Ett  liv  av  vikt.  Regeringens  uppdrag  av  anorexia-

bulemia.  Stockholm. 

9  West,  R  (1994),  Eating  disorders:  anorexia  nervosa  and  bulimia  nervosa.  London:  Office  of  Health 

Economics. 

10  Vervaet,  M.  et  al. (undated), Attitudes  of  schoolboys  and girls  toward  body-weight  and  eating  habits 
and eating-style  as a risk factor  for  eating  disorders:  a pilot  study  in young females  (unpublished). 

11  Vermeulen, M. (1996), Dutch Report  on  Women s  Health,  Amsterdam:  Unpublished. 
12  Azevedo,  M.H.P.,  Ferreira,  C.P.(1992),  "Anorexia  Nervosa  and  Bulimia:  A Prevalence  Study."  Acta 

Psychiatry  Scandinavica,  86: 432-436. 
Baptista,  F.,  et.  al.  (1996),  "The  Prevalence  of  Disturbances  of  Eating  Behaviour  in  a  Portuguese 
Female University Population," European  Eating  Disorders  Review,  4(0).  144.1-11. 

116 

13 West, R  (1994), Eating disorders:  anorexia nervosa and bulimia nervosa.  London: Office  of Health 

Economics. 

14 European  Centre  for  the  Epidemiological  Monitoring  of  AIDS,  HIV/AIDS  Surveillance  in  the 
European Community and COST countries Europe: Quarterly Report, No 36, 30 September 1996. 
15 McKeganey et al.  (1992), "Female streetworking prostitution  and HTV infection  in  Glasgow," BMJ, 

305:801-804. 

16 Piot et al. (1988), HIV infection in female prostitutes, Antwerp: Institute of Tropical Medicine. 
17 Alary, M. (1993), "HIV infection  in European female sex workers: epidemiological link with the use 

of petroleum based lubricants," AIDS, 7:401-408. 

18 Ditch, J.,  Bradshaw, J.,  and  Eardley,  T.  (1994), Developments in national family policies in 1994, 

York: University of York. 

19 Member State reports on women's health (1996), unpublished 
20  Sinkkonen, S. (19%), Finnish Report on Women's Health,  Kuopio: Unpublished 
21 Thomas, C. (1996), British Report on Women's Health, Lancaster: Unpublished 
22 Riper, H., Cowley, H. (1996), Irish Report on Women's Health, Limerick: Unpublished 
23 Weilandt, C. (1996), German Report on Women's Health, Bonn: Unpublished 
24 Member State reports on women's health. 
25  Coeytaux, F.M,  Leonard, A.H., Bloomer,  CM.  (1993), "Abortion,"  in: Koblinsky,  M.,  Timyan,  J., 

and Gay, J. (Eds.), The health of women: a global Perspective.  Colorado: Westview Press. 

26 Ditch, J.,  Bradshaw,  J.,  and Eardley,  T.  (1994), Developments  in national family policies in 1994. 

York: University of York. 

27  Saurel-Cubizolles, M.J., Blondel, B. (1996), La Santé des Femmes,  Flammarion Médecine-Sciences, 

Paris. 

28  Segal, S., LaGuardia, K.D. (1990), "Termination of pregnancy: a global view," Baillieres Clin Obstet 

Gynecol,  4:235-247. 

29 Haas,  S.,  Schiff,  I.  (1988), "Symptoms of oestrogen deficiency,"  in:  Studd, J. WW.  and Whitehead, 

M.I. (Eds), The Menopause. Oxford: Blackwell Scientific Publications, pp. 15-23. 

30 Kallinikos, G, Roumeliotou, A. (1996), Greek Report on Women's Health, Athens: Unpublished 
31 Kroger,  H.  (toim.)  (1995),  "Osteoporoosin  diagnoisointi ja  hotio  Kuopion  yliopistollisen  sairaalan 
alueella,"  Pohjois-Savon sairaanhoitopiirin  julkaisuja.  (Publication  Series  of  the  Pohjois-Savo 
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) 

Greece 
United  Kingdom 
France 
Finland 
The Netherlands 
Denmark 
EU  15 
Spain 
Sweden 
Germany W 
Luxembourg 
Belgium 
Portugal 
Italy 
Austria 
Germany E 
Ireland 
Source  : Eurobarometer  44.3/1996 
*  Respondents were asked  to rate the extent 
with my body weight." The table shows the 
statement 

15-24 
years 

25-34 
years 

35-64 
years 

65+ 
years 

Total 

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 

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) 

15-24 
years 

25+ 
years 

Total 

Greece 
Luxembourg 
United  Kingdom 
Denmark 
The Netherlands 
EU  15 
France 
Spain 
Belgium 
Italy 
Germany W 
Finland 
Sweden 
Austria 
Ireland 
Germany E 
Portugal 

Source:  Eurobarometer  44.3/1996 

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 

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 

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 

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% 

20% 

40% 

60% 

80% 

.100% 

ranked by severe overweight 

* See note to Figure 7.1. 

Source: Eurobarometer 44.3/1996 

Table 7.3 
Cumulative Number of AIDS Cases* 
by Transmission Group, EU 15 (1996) 

Females 

Males 

Transmission  Group 

Cumulative 
Total** 
N 

Cumulative 
Total** 
% 

Cumulative 
Total** 
N 

Cumulative 
Total** 
% 

Homo/bisexual  male 
Injecting drug user (IDU) 
Homo/bisexual  IDU 
Haemophiliac/Coagulation  disorder 
Transfusion  recipient  *** 
Heterosexual  contact 
Other  ****/Undetermined 

TOTAL 

14 049 

71 
1439 
10 199 
1597 

27 355 

51.4 

0.3 
5.3 
37.3 
5.8 

100 

59 260 
51535 
2 535 
2 806 
1635 
12 869 
6 344 

136 984 

* 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. 

43.3 
37.6 
1.9 
2.0 
1.2 
9.4 
4.6 

100 

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-

4 0-

30-

"J 

........./•">-^^"«'^> 

0  J""'?1*' 

i 

r -i a! 

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-

4 0-

20- 

S 

.*'* 

- * • "" 

, w i l i « H H f ,T 

r * * * * ¥ — i — i —T ~ - \— i — i — i —» 
86  87  88  89  90  91  92  93  94  95 

85 

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  -

8 0-

6 0-

4 0-
2 0- 

"t 

.  —  . - .. 

i 

\ 

rw r trA , g /f;'rTî l A'i*Sf—i 
89  90 

8 6 8 6 8 7 88 

9 1 9 2 9 3 9 4 95 

Year of Diagnosis - Armée de diagnostic 

Finland 

Number of cases** by year of diagnosis 

Women -  Femmes 

Cases-Cas 

30-j 

2 5-

20 

15-

1 0-

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 
85  86  87  8 8 : 89  90  91  92  93  94  95 
Year of rJegnosts - Année de Diagnostic 

1 

1 

1 

1 

1 

I 

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 

2 5-

2 0-

15 

10 

S-l 

••**V 

1  I  - " 'I  "  1"'—V 

"I1 
65  85  87  88  89  90  91  92  93  94  95 
Year of Diagnosis - Armée de Diagnostic 

I  '"  » 

1 

\ 

I 

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  1 11  y" 

illiÉI 

M l l » M » y I H IM 

| 

y«M»^M. 

85  86  87  88  89  90  91 

9 2 9 3 9 4 95 

Year of Diagnosis - Année de Diagnostic 

Luxembourg 

Number of cases** by year of diagnosis 

Women - Femmes 

Cases-Cas 

12 

1 0-

8-

6-

4-

2-

A 

•  •< 

K^ 

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 

' i f T w —i 

1—-T 
65  86  87  88  89  90  91  92  93  94  95 
Year of diagnosis - Année de Diagnostic 

r —i 

1 

1 

Portugal 

Number of cases** by year of diagnosis 

Women - Femmes 

Cases-Cas 

300-

250-

200-

150-

100-

Q  -  — * < I I ' II  «• 

| i m M < y* 

« 

i 

ii. 

»  ii  i 

•  m  • 

i 

8 5 8 6 8 7 8 8 8 9 90 

91  92 

9 3 9 4 95 

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 
90  91  92  93  94  95 

rr—r» 

1 

\ 

Year of diagnosis - Année de Diagnostic 

Sweden 

Number of cases** by year of diagnosis 

Women - Femmes 

Cases-Cas 

120-1 

100 -

8 0-

6 0-

4 0-

20 

T1 

JUttàS* 
r r—r 

1  1 
65  86  87  88  89  90  91  92  93  94  95 
Year of Diagnosis - Armée de Diagnostic 

T 

T 

• • » . •; 
r 

1DU-UDI 

Heterosex. 

*13 years or over 
**Adjusted for reporting delays (1993-1995) 

1 29 

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) 

C o u n t ry 

Austria 
Belgium 
Denmark 
Finland 
France 
Germany 
Greece 
Ireland 
Italy 
Luxembourg 
Netherlands 
Portugal 
Spain 
Sweden 
United  Kingdom 

T O T AL  EC 

I 

' 

Cumulative  Total* 
30.9.1996 

1 609 
2  203 
1 957 
248 
43  451 
15  308 
1422 
549 
35  949 
114 
4  199 
,  3  575 
41  598 
1445 
13 394 

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 

Country 

Women  using 
contraception  (%) 
1986-93 

Total fertility  rate 

1970 

1993 

% Live births to 
mothers under 
20 latest 
available year 

Fertility  rate per  1000 
women  15-19 years 
1990 
1970 

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 

Ratio of  abortions 
to  1000 live births 
all  ages 

Ratio of abortions to  1000 
live births  under  20 

n/a 
n/a 
14.3 
7.9 
13.0 
n/a 
n/a 
n/a 
8.6 
n/a 
6.0 
n/a 
5.38 
18.3 
12.18 

(1993) 
(1994) 
(1990) 

(1994) 

(1994) 

(1994) 
(1994) 
(1994)* 

n/a 
n/a 
278.00 
157.34 
254.00 
146.60 
108.25 
n/a 
287.30 
99.00 
98.70 
200.00 
92.70 
290.00 
227.48 

(1992) 
(1993) 
(1990) 
(1992) 
(1991) 

(1991) 
(1992) 
(1992) 
(1994) 
(1990) 
(1993) 
(1988) 

n/a 
n/a 
1856.07 
961.22 
1058.00 
n/a 

86.47 

n/a 
n/a 
n/a 
558.50 
n/a 
n/a 
1701.40 
663.52 

(1988) 
(1991) 
(1990) 

(1992) 

(1988) 

(1993) 
(1988) 

Source  : Human Development  Report  1995/HFA,  1996. 

132 

Figure 7.5 
Percent Not Well Informed about HRT 
Women 35+ Years, EU 15 (1996) 

age 50-64 • age 35-49 

Portugal 
Ireland 
Spain 
Greece 
Italy 
The Netherlands 
United Kingdom 
EU  15 
Germany E 
Germany W 
Austria 
Sweden 
France 
Denmark 
Belgium 
Finland 
Luxembourg 

0% 

20% 

40% 

60% 

% not informed 

80% 

100% 

ranked by age 50-64 years 

Source: Eurobarometer 44.3/1996 

Table 7J 

Percent Not Well Informed about HRT 
Women 15+ Years, EU 15 (1996) 

<35 
years 

35-49 
years 

50-64 
years 

65+ 
years 

Total 

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 

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 

133 

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 

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 

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 

Portugal 
Ireland 
Spain 
Greece 
Italy 
The Netherlands 
United  Kingdom 
EU 15 
Germany E 
Germany W 
Austria 
Sweden 
France 
Denmark 
Belgium 
Finland 
Luxembourg 
Source: Eurobarometer  44.3/1996 

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, 
informed  about  the  potential  advantages  and 
regardless  of  age  feel  insufficiently 
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: 
Figure 1.2: 
Figure 2.1 : 
Figure 2.2: 

Sufficient  Attention for Women's Health 1996, Women 15+ Years, EU 15 
Sufficient  Attention Given To Women's Health,  1996, Women 15+ Years 
Féminisation Ratio,  1996 (EU  15) 
Féminisation Ratio in the 0-19 Years and 60+ Years Age-Group,  1996 (EU 
15) 
Families Past and Present, EU 15 
Trends in Economic Indicator of Fertility over the Past 40 Years 

Figure 2.3: 
Figure 2.4: 
Figure 2.5:  Changes in Employment (EU) 
Present Demographic Structure and Structure of the Active Population 
Figure 2.6: 
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: 
Figure 3.4: 
Figure 3.5:  Maternal Mortality 
Figure 3.6: 
Figure 3.7: 
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: 

Self-Perceived Health Status,  1996, Women  15+ Years, EU (15) 
Self-Perceived Health Status, Elderly Women, EU 15 (1996) 

Life Expectancy at Birth (in Years), EU  15 (1995) 
Infant Mortality Rate 

Figure 4.2: 

Figure 4.3: 

Figure 4.4: 

Figure 4.5: 

Figure 4.6: 

Figure 4.7: 

Figure 4.8: 

Figure 4.9: 

Percent with Disability Due to Long-Standing  Illness, Women  15+ Years, 
EU 15 (1996) 
Percent  with  Disability  Due  to  Long-Standing  Illness  by  Age-Group  and 
Severity, EU  15 (1996) 
Percent with Disability Due to Long-Standing  Illness, Women 65+  Years, 
EU  15 (1996) 
Percent with Restricted  Activity  in Past 2 Weeks Due to  Illness or Injury, 
Women  16+ Years, EU  11 (1994) 
Percent with Restricted  Activity in Past 2 Weeks Due to Illness or Injury, 
Women 65+ Years, EU  11 (1994) 
Percent  with  Restricted  Activity  in  Past  2  Weeks  Due  to  Emotional  or 
Mental Health Problem, Women 16+ Years, EU  12 (1994) 
Percent  with  Restricted  Activity  in  Past  2  Weeks  Due  to  Emotional  or 
Mental Health Problem, Women 65+ Years, EU  12 (1994) 
Percent Women with Doctor Consultation(s) in Past 2 Weeks, Women 15+ 
Years, EU  15 (1996) 
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 

Cancer Mortality in Women (1992), All Women, EU 15 
Breast Cancer Mortality (1992), Women 0-64 Years, EU 15 
Breast Cancer Mortality (1992), All Women, EU 15 
Breast Cancer Mortality (1992), All Women  1970-1992, EU 15 

Figure 5.5:  Cancer Mortality ( 1992), All Women, EU 15 
Figure 5.6: 
Figure 5.7: 
Figure 5.8: 
Figure 5.9: 
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) 
Ischaemic Heart Disease Mortality (1992), Women 0-64 Years, EU 15 
Figure 5.19: 
Ischaemic Heart Disease Mortality ( 1992), All Women, EU 15 
Figure 5.20: 
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: 
Figure 6.2: 
Figure 6.3: 
Figure 6.4: 
Figure 6.5: 

Percentage of smokers ( 1991 ), Women 15+ Years, Selected EU Countries 
Smoking Attributable Mortality ( 1990), Women 35 + Years, EU 15 
Liver Disease Mortality (1992), All Women, EU 15 
Percent Over- and Underweight, Women  18+ Years, EU 15 (1996) 
Percent  with  Heart  Check-Up  in  Past  Year,  Women  15+  Years,  EU  15 
(1996) 
Percent Reporting a Cholesterol Test in Past Year, Women  15+ Years, EU 
15(1996) 
Percent Reporting a Diabetes Test in Past Year, Women 40+ Years, EU 15 
(1996) 
Percent Reporting an Osteoporosis Exarnination in Past Year, Women 50+ 
Years, EU  15 (1996) 
Percent Preferring Women Doctors, Women 15+ Years, EU  15 (1996) 

Figure 6.9: 
Figure 6.10:  Percent Reporting a Cervical Smear Test in Past Year, Women  15+ Years, 

Figure 6.6: 

Figure 6.7: 

Figure 6.8: 

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, 

Figure 7.1 : 
Figure 7.2: 
Figure 7.3: 

EU 15 (1996) 
Percent Dissatisfied  with Body Weight, Women  15+ Years, EU  15 ( 1996) 
Percent Dieting during the Past Year, Women 15+ Years, EU  15 (1996) 
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, 

Figure 7.5: 

1985-1995 
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 

Female and Male Population in the EU (15) 

Table 2.1:  Women in the Total Population of the European Union 1993 (EU 15) 
Table 2.2: 
Table 2.3:  Marriages and Divorces in the EU (15),  1960-1995 
Table 2.4: 
Table 2.5: 
Table 2.6: 
Table 2.7: 
Table 2.8: 
Table 2.9: 
Table 3.1: 
Table 3.2: 
Table 3.3: 
Table 3.4: 
Table 3.5: 
Table 3.6: 
Table 3.7: 
Table 3.8: 
Table 4.1: 

Births and Fertility in the EU (15),  1960-1995 
Contraception Usage and Fertility (EU 15) 
Employment EU  15, (1993) 
Part-Time Employment as % of Total Employment EU  15, (1993) 
Unemployment Rates EU  15, (1993) 
Gender Related Development Indices 
Life Expectancy at Birth (in Years) EU  15 ( 1995) 
Life Expectancy at 15 Years (in Years) EU  15 (1995) 
Life Expectancy at 45 Years (in Years) EU  15 (1995) 
Life Expectancy at 65 Years (in Years) EU  15 (1995) 
Self-Perceived Health Status,  1996, Women 15+ Years, EU 15 
Self-Perceived Health Status,  1996, Women 65-74 Years, EU 15 
Self-Perceived Health Status,  1996, Women 75+ Years, EU 15 
Average Height (in cm), Women 18 + Years by Age-Group, EU  15 (1996) 
Percent with Disability Due to Long-Standing  Illness, Women  15+ Years, 
EU 15 (1996) 
Percent  with Disability  Due  to  Long-Standing  Illness By  Age-Group,  EU 
15 (1996) 
Percent  with Disability Due  to  Long-Standing  Illness  Women  65+  Years, 
EU 15 (1996) 
Percent with Restricted  Activity  in Past  2 Weeks Due to  Illness  or Injury, 
Women 16+ Years, EU  11 (1994) 
Percent  with Restricted  Activity  in Past  2  Weeks Due to  Illness  or Injury 
Women 65+ Years, EU  11 (1994) 
Percent  with  Restricted  Activity  in  Past  2  Weeks  Due  to  Emotional  or 
Mental Health Problem Women  16+ Years, EU  12 (1994) 
Percent  with  Restricted  Activity  in  Past  2  Weeks  Due  to  Emotional  or 
Mental Health Problem, Women 65+ Years, EU  12 (1994) 
Percent Women with Doctor Consultation(s) in Past 2 Weeks, Women 15+ 
Years, EU 15 (1996) 
Percent  Women  with  Doctor  Consultation(s)  in Past  2  Weeks,  By  Age-
Group, EU  15 (1996) 

Table 4.2: 

Table 4.3: 

Table 4.4: 

Table 4.5: 

Table 4.6: 

Table 4.7: 

Table 4.8: 

Table 4.9: 

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+ 

Table 5.1: 

Table 5.2: 

Years, EU  15 (1996) 
Perceptions  of  which  Gender  Lung  Cancer  Affects  More,  Women  15+ 
Years, EU 15 (1996) 
Perceptions  of  which  Gender  is  More  Affected  by  Health  Disease,  All 
Women, EU  15 (1996) 

140 

Table 5.3: 
Table 6.1: 
Table 6.2: 
Table 6.3: 
Table 6.4: 

Table 6.5: 

Table 6.6: 

Table 6.7: 

Table 6.8: 
Table 6.9: 

Perceived Main Risk Factors for Heart Disease ( 1996), All Women, EU 15 
Percentage of Smokers ( 1991 ), Women 15+ Years, Selected EU Countries 
Smoking Attributable Mortality (1990), Women 35+ Years, EU 15 
Percent Over- and Underweight, Women 18+ Years, EU  15 (1996) 
Percent  with  Heart  Check-Up  in  Past  Year,  Women  15+  Years,  EU  15 
(1996) 
Percent Reporting a Cholesterol Test in Past Year, Women  15+ Years, EU 
15(1996) 
Percent Reporting a Diabetes Test in Past Year, Women  15+ Years, EU 15 
(1996) 
Percent Reporting  an Osteoporosis Test in Past Year, Women  50+ Years, 
EU  15 (1996) 
Percent Preferring Women Doctors, Women  15+ Years, EU  15 (1996) 
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, 

Table 7.1 : 
Table 7.2: 
Table 7.3: 
Table 7.4: 
Table 7.5: 
Table 7.6: 
Table 7.7: 

EU  15 (1996) 
Percent Dissatisfied with Body Weight, Women 15+ Years, EU  15 (1996) 
Percent Dieting during the Past Year, Women  15+ Years, EU  15 (1996) 
Cumulative Number of AIDS Cases by Transmission Group, EU  15 (1996) 
Cumulative Number of AIDS Cases for both Sexes, EU  15 ( 1996) 
Contraceptive Use and Fertility Rates among Women, EU 15 
Abortion, EU (15) 
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 

The  Member  State  Coordinators  prepared  unpublished  national  reports 
women's  health which were used as input in the preparation of this report. 

on 

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 

Office  for  Official  Publications of the European  Communities 

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