IncomeThere is a strong link between income and health. In all countries, at all levels of income, health and illness follow a social gradient—the lower the socioeconomic position, the worse the health.367
The Australian Institute of Health and Welfare has found:
Areas of highest socioeconomic status have the lowest rates of avoidable mortality and areas of lowest socioeconomic status have the highest rates. For example, in both the capital cities and of state/territory areas, there is an almost continuous socioeconomic gradient in the rates of avoidable death. In the capital cities and major urban centres, the overall avoidable mortality rate for the ‘worst-off’ fifth was 60 per cent higher than for the ‘best-off’ fifth.368
This has a particular bearing on women, as many are less economically secure. Some groups of women are disproportionately represented among the least well off—including Aboriginal and Torres Strait Islander women, immigrant and refugee women, women with a disability and women living in rural and remote areas. 369 Young lesbians (22–27 years) have lower personal incomes, greater difficulty in finding a job, and report more stress about economic aspects of their lives than other young women.370
Sole parent families, most of which are headed by women, are the most likely of any household to be living in poverty.371 Elderly couples and elderly people living alone comprise the three households who have the least income.372 The numbers of older people will grow substantially over the next three decades, and this is likely to increase the concentration of women in the ranks of those on the lowest incomes.
International and national research has found women with lower economic status report poorer self-assessed health status, higher rates of long-term health conditions, higher rates of tobacco consumption, lower rates of physical exercise and worse dietary habits.373 374 375 376
Women living in the most disadvantaged areas report higher numbers of visits to GPs and hospital outpatient services, but less use of preventative health services, including dental services, compared to the rest of the population.377 378.379 Women who are economically insecure are also at higher risk of poor mental health, homelessness and marginalisation. Women from lower socioeconomic backgrounds may find it more difficult to access preventive health services and avoid lifestyle risk factors that lead to poor health.
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Paid workOver the past 20 years, Australian women have increased their involvement in paid work. However, they still have lower and more interrupted workforce participation rates than men and do more part-time and casual work. One of the most common challenges for women to stay in paid work is because of their caring responsibilities. Women are far more likely to be working part-time than men, with almost 45 per cent of women working part-time compared with 15 per cent of men.
While women have improved their earnings relative to men over the past 20 years, a sizeable gap remains. The disparity between ordinary full-time earnings for men and women is close to 17 per cent.380 381 When part-time and casual earnings are considered, women earn around two-thirds of the amount earned by men.382 As a group, women have lower incomes even when employed full-time. They also have less superannuation.383 384 385 386
Paid employment improves health. The Australian Longitudinal Study on Women’s Health shows that there is a clear association between employment and women’s health. Women who were always in paid work had both higher mental and physical health than women who were not employed or whose labour market participation was intermittent.387 Women who did not participate in paid work had poorer mental health and a higher risk of premature mortality.388
Unpaid work—caringWomen make up 71 per cent of primary carers.389 Gender stereotypes can press women into care-giving roles, sometimes at the expense of their own health and economic security. Primary carers have lower workforce participation than non-carers (39 per cent compared to 68 per cent of non-carers).390 Over one-third (37 per cent) of primary carers report
providing more than 40 hours of care each week.
Caring roles vary greatly. They can include a lifetime of caring for a child with a disability, caring for a spouse with a chronic or terminal health condition, and caring for a frail elderly person or spouse or parent with dementia. Women can move in and out of caring roles at different stages of their lives.
Carers often report poorer physical, mental and emotional health and wellbeing because of their caring responsibilities. This can be associated with disturbed sleep, being physically injured while providing care, and the constant pressure of caring. Time spent caring, and coping strategies, are factors in shaping carer stress.391
Within the caring population, female carers in particular experienced much lower levels of mental health compared to both male carers and the general population. This included increased levels of clinical depression, with over 50 per cent of female carers reporting being depressed for six months or more since they started caring.392
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EducationCollectively, women have made major advances in education. Australia is ranked first in the world for women’s education attainment.393 Over 80 per cent of girls now continue to year 12, and women’s participation in higher education has steadily increased.394 Women students now outnumber men in higher education: they make up 55 per cent of enrolments.395
These advances do not show that educational choices remain highly segregated on the basis of gender. Women continue to be over-represented in areas of study linked to lower-earning industries. For example, women outnumber men 3:1 in health and education courses and men outnumber women 5:1 in engineering courses.396
Also education differs greatly between groups of women. For example, while the national year 12 completion rate for Australian girls is almost 81 per cent, the completion rate is only:
- 66 per cent for socioeconomically disadvantaged girls (in the bottom 25 per cent of post codes) in 2006 397;
- 61 per cent for girls in remote areas (23 per cent in the Northern Territory) in 2006 398;
- 44 per cent for Aboriginal and Torres Strait Islander girls in 2005.399
Social inclusion and supportSocial inclusion incorporates the degree to which women feel valued, connected, empowered and able to participate within their community. Interactions of factors such as poor physical or mental health, inadequate housing or homelessness, exposure to violence and economic insecurity will limit women’s ability to integrate with their community and fulfil their potential as valued citizens.
Recent research shows the impact of social networks on health outcomes. Support systems—both formal and informal—play an important role in women’s health and wellbeing. Belonging to a family, a community and a society makes people feel good. It also contributes to healthier communities.
Social support can also improve health through a variety of mechanisms including emotional assistance, care giving, support for access to treatment, and financial or physical help.
Maintaining social networks is critical to healthy ageing, and involves a mix of informal, personal networks and participation in organised community activities.402 Women’s longer lifespans contribute to social isolation later in life when women, who have often been carers themselves, may have few people to care for them. The cohort of older women in the Australian Longitudinal Study of Women’s Health has emphasised the importance of their homes, social support and their active participation in their community as fundamental to their wellbeing.403
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Women’s social connectedness can be interrupted by various factors, such as violence, safety perceptions and geographical isolation. Social isolation has been associated with poor mental health and wellbeing in older Australians.
Safety and securityWomen’s access to a safe and secure environment has a significant impact on their health. Women’s safety and security can be undermined in range of settings, including their family, neighbourhood, workplace and community through experiences of verbal, physical and sexual harassment and violence.
One in three Australian women experiences physical violence and almost one in five women experiences sexual violence in their lifetime, with most violence against women taking place in the home. In most cases the assailant is a current or previous partner, male family member or male friend.404
Violence is perpetrated against women of all socioeconomic backgrounds but some groups of women are more vulnerable to violence. These include communities affected by social and economic disadvantage—these may include some Aboriginal and Torres Strait Islander communities, refugee and new arrival communities together with established culturally and linguistically diverse communities, women with disabilities, young women405, and some older women, particularly those in carer roles. It is important to note that not all women within these groups are marginalised. The vulnerability to violence of these groups of women is often associated with the higher rates of unemployment and socioeconomic disadvantage in these communities.406
Violence against women has significant impact on women’s health and wellbeing, as well as on their families and communities. Intimate partner violence alone is the leading contributor to death, disability and illness in Victorian women aged 15 to 44, being responsible for more of the disease burden than many well-known risk factors such as high blood pressure, smoking and obesity.407
Key health outcomes of intimate partner violence, which make up the substantial disease burden, include physical illness, mental health problems including depression and anxiety, reproductive and sexual issues, and tobacco and alcohol use.408 409 Women who have been exposed to violence report poorer physical health overall, are more likely to engage in practices that are harmful to their health, and experience difficulties in accessing health services.410