This policy focuses equally on issues common to a broad range of women as well as on the needs of specific groups of women. Women are not a homogenous group. They differ by factors such as ethnicity, geographic location, (dis)ability and sexuality. Issues such as unemployment, financial insecurity, lack of adequate housing, violence and social disconnectedness can all affect women’s health and their access to health care in particular ways.
These issues can contribute to women’s exposure to risk, their experience of illness and their attitudes towards health. They can make a difference to their access to and understanding of health information, their use of services and their perceptions of care.
While progress has been made in identifying and responding to the needs of particular groups of women, more can be done. The government is committed to continuing to reduce inequalities—this policy is one of a number of approaches to improving the health and wellbeing of all women in Australia, especially those at highest risk of poor health—and to promoting health equity between women.
Generating equity in health for women means eliminating unfair differences in opportunities for health among different groups of women based on social, economic, cultural or geographical context. To promote health equity among women we need to focus on Aboriginal and Torres Strait Islander women, culturally and linguistically diverse women, rural and remote women, women with disabilities, lesbian and bisexual women.
Aboriginal and Torres Strait Islander womenFactors that affect the health of Aboriginal and Torres Strait Islander women include: lower levels of education 411, lower incomes than other Australians, higher rates of unemployment and lower rates of home ownership 412 , and housing insecurity. An estimated 14 per cent of Aboriginal and Torres Strait Islander households are overcrowded.413 Dispossession, racism, marginalisation, and forced removals from family and exposure to violence can also have a significant impact on Aboriginal and Torres Strait Islander women’s health. Women from Aboriginal and Torres Strait Islander backgrounds face a significantly higher risk of exposure to violence, suffering more severe forms of abuse and face particular barriers to
addressing violence once it has started.414 415
Aboriginal and Torres Strait Islander women have poorer physical and mental health in almost every dimension than non-Aboriginal and Torres Strait Islander women. They are estimated to have a life expectancy 9.7 years less than that of their non-Aboriginal and Torres Strait Islander counterparts.416 Aboriginal and Torres Strait Islander status can also impact on women’s use of health services. Reduced access to primary care may contribute to fact that Indigenous Australians are twice as likely to present at hospital and outpatient services as non-Indigenous Australians. 417
Women in rural and remote areasApproximately one-third of the Australian population lives outside metropolitan areas. Many people including women living in rural and remote areas face multiple disadvantages. In 2006 over half of all very remote areas were in the bottom quarter of Australian socioeconomic areas. In contrast, only one in 50 were in Australia’s top quartile. Education levels are lower in rural and remote areas than in major cities, with very remote areas having the lowest levels of school completion.418 Almost a quarter of people in remote areas are Aboriginal or Torres Strait Islanders, compared to 2.5 per cent in the general population. Some rural communities have recently experienced both rapid economic and demographic change, and drought, resulting in widespread unemployment and increased poverty, which are known determinants of violence against women.
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A more remote area of residence is often associated with poorer access to and lower satisfaction with general practitioner services.419 After-hours care, family planning services and counselling services are all significant problems for women in small rural centres and remote areas. 420
Many women prefer to have access to a female primary health worker. In rural and remote areas, access to female general practitioners is lower.421
Rural women are more likely than urban women to encounter particular barriers to seeking help including social and physical isolation and lack of support services. Many rural women feel unable to seek help because of confidentiality issues and conflicting relationships within smaller communities.422
The Australian Longitudinal Study on Women’s Health found that, even after adjusting for self-rated health status, morbidity, age, smoking, Body Mass Index (BMI) and physical activity, older rural women (born between 1921 and 1926) have a 14 per cent greater risk of dying than urban women. 423
Women from culturally and linguistically diverse backgroundsThe health needs and expectations of culturally and linguistically diverse women are based on a wide range of factors, including their cultural background, language skills, education levels, reasons for leaving their home of origin, pre-arrival experiences, experiences of trauma and displacement, post-arrival experiences, length of time in Australia, support networks, existing health, work and social opportunities. For women who have arrived in Australia on humanitarian grounds, the whereabouts and circumstances of family and friends can also affect their physical and mental health.
The health status of migrant women is generally high on arrival, relative to that of the population.424 However, this diminishes over time and converges with the health status of the local-born population.425 In contrast to migrants, refugees often arrive in Australia in poorer health. After living in Australia for five years, the health of many immigrant and refugee women deteriorates. Compared to their Australian-born and English-speaking counterparts, immigrant and refugee women often experience higher rates of illness and health disadvantages.
Socioeconomic status has consistently been shown to play a major role in health outcomes. This is especially so for women from non-English speaking countries and refugee women. A number of studies have shown high levels of unemployment or underemployment among refugee populations.426 427 428
Research suggests that women from minority ethno-cultural and language backgrounds in Australia experience unequal burdens of disease, confront cultural and language barriers in accessing appropriate health care and receive a lower level and quality of care when they do access health care services compared to the average population. 429 430 431 432 433 434
Women with a disabilityOne in five Australian women lives with a disability 435 and most will face many everyday challenges. Some women live with disability throughout their lives and many more face disability as they age. Disability steadily rises with age, reaching more than 90 per cent for those aged 90 years and over.
People with all types of disabilities are more likely to have lower incomes, greater financial stress, and more difficulties with transport and accessing services. They are less likely to have paid work, and will spend a greater proportion of their income on medical care and health-related expenses.436 Women with a disability are more likely to experience marriage breakdown and divorce, less likely to have children, and more likely to be single parents. They also have less daily contact with friends or family.437 Women with disabilities are 40 per cent more likely to be the victims of intimate partner violence than women without disabilities.438
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The multiple disadvantages women with a disability face impacts on their mental and physical health.439 Women with disabilities are less likely to use primary preventative health care services, yet are as likely as the general population to engage in health risk behaviours. For example, forty-one per cent of women with core activity restriction disabilities in Australia aged 70–75 years have never had a mammogram and 30 per cent have never had a Pap test. Thirty-nine per cent of women who had had a Pap test had not had regular tests.440
Lesbians and bisexual womenThis policy recognises sexuality, sex and gender identity as social determinants of health. While lesbian and bisexual women are a diverse group, the discrimination, violence and marginalisation associated with homophobia and heteronormativity impacts on their health and wellbeing, albeit in different ways. These health impacts include violence,
isolation, high rates of depression and high rates (and health consequences) of risky behaviour.
A 2007 report by the Human Rights and Equal Opportunities Commission highlights a lack of understanding in the community about gender diversity and describes the discrimination faced by lesbian and bisexual women in health, aged care and workplace settings.441
Women who identify themselves as lesbian are more likely to experience violence. A recent Victorian study found that 85 per cent of lesbian, gay, bisexual and transgender Victorians had been subject to heterosexist harassment and violence in their lifetimes, and 70 per cent of the respondents in the past two years. Nearly half the people in the survey reported hiding their fear of violence and harassment.442
For same sex attracted women, the fear or experience of insensitive treatment, or of blatant discrimination, can be a major barrier to accessing appropriate and acceptable health care.