Islamset - Older women's health

The continuing aging of the population will be one of the most significant changes in the social landscape for the remainder of this century and the early decades of the next. The impact of this phenomenon on health services, community services and families is receiving increasing attention. As Dr Darnton-Hill points out, elderly people's quality of life deserves more emphasis. Surveys repeatedly indicate that this is understood largely in terms of economic, psychosocial and physical well-being. There are important differences between women and men in these three dimensions of life, but discussions about "the elderly" often neglect them, and make the special concerns of women invisible. There are at least four good reasons for counteracting this tendency and bringing the status of older women to the forefront in policy considerations.

Women's lifelong disadvantage

The health disadvantages and problems faced by aging women stem from economic, social, cultural and political factors as much as biological ones. Women are discriminated against on the basis of age earlier than men, and are routinely perceived as weak, dependent, vulnerable and lacking in femininity and sexuality. Such negative images contribute to making them invisible, and disregard their wide diversity and resourcefulness.

Women's experience of aging and its effects on their health is profoundly influenced by the cultural setting within which it occurs. Conventional attitudes towards older women and towards menopause too often negatively influence expectations in later years, and it is a well known fact that self-esteem is of central importance for health. The mental and physical well-being that results from positive attitudes also allows personal development and involvement in society to continue.

Growing numbers of women

Though aging is a common political concern in industrialized countries, in many developing ones it is not yet seen as an issue. Nevertheless, already more than half the world's women aged 60 and over live in developing regions: 148 million, compared with 121 million in industrialized regions. Women of 70 or over are still more numerous in industrialized regions, but only just: the figures are 60 million and 58 million respectively. The future distribution of elderly women can be seen in the numbers of those now between 45 and 59 years of age: altogether there are 311 million women in this age group, and over two thirds (213 million) of them live in developing countries.

Differences in life expectancy

In industrialized countries women live on average about six years longer than men (1). Women in industrialized countries live about 15 years longer than those in middle-income developing countries, and about 30 years longer than those in the poorest countries, where life expectancy is 50 years (2). The difference between women's life expectancy in rich and poor countries has only slightly decreased during the last 20 years, and represents an inequity that needs urgent attention. Inequities in mortality rates are also seen within countries, and are associated largely with class differences.

Women in industrialized countries live about 15 years longer than those in middle-income developing countries, and about 30 years longer than those in the poorest countries.

A large part of the gap between men's and women's life expectancy is due to differences in alcohol and tobacco consumption, as well as accidents, suicide and chronic diseases. The impact of increased numbers of women who smoke is now being seen in rising mortality rates for mature women.

The need for information

The significant differences in women's health in different population groups and countries show that aggregate data on the aged population as a whole are inadequate for monitoring trends in health status. The relevant data should be presented by sex and economic status as well as age. Improvements in demographic data are very much needed both for monitoring the health status of aging women and for providing further indicators, such as healthy life expectancy. There are a number of technical problems in preparing such indicators, and also the need to take into account social and cultural variations in the meaning of disability and other key terms.

The quality of life of older women should be judged in terms of their capacity to maintain physical, social and mental well-being despite varying levels of illness and disability. This is as important as the length of life and the number of disability-free years lived, but measuring it is harder, as it depends to a large extent on the opinions of those concerned regarding what is acceptable. Emerging indicators such as "disability-adjusted life years" (DALY) and "quality-adjusted life years" (QALY) do not take this into account (3,4). In fact there is a danger that this way of measuring the burden of illness will give an unduly negative account of the health of aging women, unless it is counterbalanced by more adequate indicators.

In terms of the future, the basic goal for the health of aging women globally should be to reduce the inequities between those in industrialized and developing countries. These inequities must be measured not simply in years of life but in the underlying determinants of health and the quality of life.

A simple goal is to increase the number of disability-free years women live. This would have obvious economic advantages for the women concerned, their families and the societies in which they live. At the same time it would expand the roles women can play, and promote a more positive image of aging women as active citizens. As yet there is no clear evidence that women's greater life expectancy represents an advantage in terms of disability-free years.

If longer lives are to be healthier lives, policies must focus on ensuring the quality of life of women as they age. For this, the functional status and well-being of aging women need to be monitored. WHO has a key role to play in gathering these data and widening the range of indicators available.

United Nations Development Programme. Human development report 1994. New York, Oxford University Press, 1994.
Kinsella K, Taeuber CM. An aging world II. In: International population reports, Washington DC, United States Government Printing Office, 1992.
Murray CJL Quantifying the burden of disease. the technical basis for disability-adjusted life years. Bulletin of the World Health Organization,1994,72: 429-445.
Nord E. Methods for quality adjustment of life years. Social science and medicine, 1992, 34: 559-569.