Gender inequality within healthcare exposed by the COVID-19 pandemic

Via Peters
© iStock/visualspace

Blandine Mollard of the EIGE discusses the findings from the Gender Equality Index 2021 and explores how gender inequality needs to be addressed within health and social care.

The Gender Equality Index has had a focus on health for 2021, looking at how gender affects the health of men and women, and access to health services. It is clear that the COVID-19 pandemic has exposed the links between health and gender inequality. Women are overrepresented in the healthcare sector and therefore face a greater risk of contracting the virus. Men, however, have a higher risk of being hospitalised with COVID-19 due to pre-existing conditions, such as cardiovascular disease, being more common.

To address these issues, the European Institute for Gender Equality (EIGE) has argued that policies which affect gender equality must be implemented within the health and social care sectors. Here, Blandine Mollard, research officer at EIGE and co-author of the Gender Equality Index 2021, discusses the findings from the Index in greater detail and explores the actions needed to be taken to address gender inequality in health and social care in the EU.

What did the recent Index findings reveal about the ways in which the COVID-19 pandemic has impacted both men and women? Were any of these findings particularly surprising?

The full impact of the pandemic on the EU population will take time to emerge, as numbers of registered cases and deaths are believed to be underestimated. On average, the EIGE estimates that the excess mortality rate between 2020 and 2021 was 17% higher for men than in previous years, and 14% higher for women.1 Beyond the effects of biological differences, pre-existing gender inequalities in society have shaped the pandemic’s impact on the health and lives of all women and men.

With non-communicable diseases (NCDs) linked to an increased risk of severe COVID-19, the pandemic has underlined the importance of tackling causes of illness, such as unhealthy lifestyles or highly gendered risky behaviours. The need for immediate and long-term mental health care which acknowledges gender differences has become clearly evident.

The pandemic has taken a high toll on men. While women are more likely to be tested, overall infection rates are rather similar for women and men. As of late Sept 2021, women accounted for 51% of all COVID cases and men for 49%.2

Men are more likely to be hospitalised and to be admitted to an intensive care unit, and are also more likely to die from the virus. In Autumn 2021, men accounted for 54% of deaths from COVID-19 in the EU.3 Older men, men with NCDs, and those in essential and precarious jobs have been particularly affected. The pandemic has also been devastating for nursing home residents.

Working-age women in the EU have been greatly exposed to infection, partly because of their over-representation in frontline professions. Vulnerable workers, such as migrant women or women in precarious jobs, have been most at risk. Evidence is emerging that women are more affected by ‘long COVID’, pointing to potentially long-term consequences for large segments of the female population.

Apart from the direct health consequences of the virus, there are also secondary impacts on physical and mental health. These are likely to be gender specific and long-lasting. In particular, there is great concern over the global surge in intimate partner violence, causing a ‘shadow pandemic’ that is likely to peak only when restrictions are lifted.

The true extent of the pandemic’s mental health consequences will take time to unfurl, with experts warning that the peak may come long after the pandemic is controlled.

In spring 2021, mental wellbeing among the general population was the lowest since the outbreak, with large segments of the population at risk of depression. Women have had lower levels of mental wellbeing than men in each of the three pandemic waves, with the lowest levels noted among working-age women during the third wave. This not only reflects the pervasive impact of social isolation, but also the increased and sustained burden of unpaid work triggered by school closures and movement restrictions during lockdowns.

More specifically, frontline healthcare professionals are at particular risk of severe mental distress. This is especially due to the stress of poor pandemic preparedness of health systems, trauma from having to prioritise care and seeing patients suffer or die, insufficient rest and overwork, and the fear of infection or infecting others.

Finally, the COVID-19 pandemic has further exacerbated barriers to access healthcare services, including Sexual and Reproductive Health Services (SRH) services in the EU, either as a result of deferment and de-prioritisation of certain medical procedures, or due to fear of infection. In particular, the European Foundation for the Improvement of Living and Working Conditions COVID-19 e-survey found that 21% of respondents had missed a medical examination or treatment during the pandemic. This proportion was highest in Hungary, Portugal, and Latvia. In spring 2021, 18% of respondents were experiencing a health issue for which they could not get treatment.4

What are the key risks posed by gender inequality within healthcare, both in terms of patients and healthcare providers? Would greater representation of women, both in government and in STEM fields, be useful in forming healthcare policy which protects and empowers women?

First of all, it is interesting to see that political representation and access to decision-making are now more frequently understood as social determinants of health (SDH). A 2020 WHO report found that the gap in life expectancy is correlated with the degree of political equity, and the benefit is greater for men.5 In addition, it was found that a high degree of macro-level gender equality, especially with more women in political decision-making, is associated with lower levels of depression in both women and men.6

To give only one example, the glaring absence of women in COVID-19 emergency decision-making has raised concerns on the lack of gender-sensitive response measures. Ensuring gender balance in decision-making on disease prevention and response in all countries can strengthen governments’ responses and improve the safety of frontline workers.

According to the International Council of Nurses (ICN), the pandemic exacerbates both the global shortage of nursing staff and attrition of nursing staff. Female nurses report occupational hazards, such as ill-fitting personal protective equipment (PPE), more often than men. According to EU-OSHA, ‘almost half of carers did not have adequate PPE in April 2020 and one in five care workers considered quitting over the lack of PPE’.7

Women make up the majority of medical staff in low-level positions, such as nurses, and occupational segregation is a key reason why female nurses leave the profession. With significant exposure to infected patients, fewer social support systems and different coping mechanisms, women are at greater risk than men of developing PTSD as a result of the pandemic.8 The International Council of Nurses argues that the pandemic-induced health crisis is worsening the gender inequalities, gender-based violence, and social stigmatisation that nurses experience generally.

More broadly, it is important to acknowledge how gender norms and power impact access to health services. WHO’s work has shown that gender norms and power relations influence women’s access to health services and timely diagnosis, while harmful notions of masculinity increase men’s risk-taking, and reduce their willingness to use health services. In particular, age, wealth, marital status, ethnicity, religion, caste, disability, education level, homelessness, and migration status can lead to stigma and discrimination, which influence access to and use of health services.

Several population groups, such as lone parents, older people, migrants, people with disabilities, and in particular, women, stand out as being highly vulnerable to unmet healthcare needs. Overall, about 7% of women and 6% of men with disabilities report unmet needs for medical services in the EU, but the levels are much higher in Estonia (29% of women and 23% of men), Romania (25% of women and 23% of men) and Greece (25% of women and 22% of men).9

© iStock/Morsa

A survey by the Fundamental Rights Agency (FRA) found that 16% of respondents felt discriminated against by healthcare or social services staff because of being LGBTI in the preceding 12 months.10 Trans and intersex people were the most affected, with 34% of respondents reporting feeling discriminated against in a health context, followed by lesbian women (16%), bisexual women (14%), gay men (11%) and bisexual men (10%). Members of the LGBTI community are still, at times, refused healthcare services or experience discrimination, and many feel unable to be open with healthcare professionals about their sexual and/or gender identity, or about being intersex.11

How do you hope the findings from the Gender Equality Index 2021 will encourage policymakers to better address the different needs of women and men in the post-pandemic recovery?

The full impact of the pandemic on the EU population will take time to emerge. What seems clear is that the pandemic has profoundly unequal social and economic consequences. While many were able to insulate themselves from the virus, essential and precarious workers were placed at much higher risk.

Long-term health consequences are likely for individuals having gone through hospitalisation and for those suffering with ‘long covid’. Classifying COVID-19 as an occupational disease would help ensure workers have adequate social protection while dealing with long-term effects of the infection.

Given the EU’s ageing population, access to affordable and quality long-term care is more critical than ever. A renewed commitment to the implementation of the European Pillar of Social Rights has taken on a greater urgency in light of the COVID-19 pandemic – particularly on long-term care needs.

The pandemic has also highlighted poor working conditions and staff shortages in the health and social care sector. These will need urgent redress if health system resilience is to be strengthened. More than ever, we need ambitious, long-term investment in care systems. The upcoming EU Care Strategy, while its content is not yet known, would be a step in the right direction.

The secondary impacts on physical and mental health will be gender-specific and long-lasting. Sustained and renewed efforts to promote quality, accessible mental health services are key.

The EU has adopted ambitious objectives and strategies when it comes to health – the EU health programme and WHO’s strategy to improve health and reduce health inequalities, to name just two. For these commitments to become a lived reality, a clear gender approach to mitigating the impact of COVID-19 is vitally needed.

References

  1. EIGE’s calculations, based on Eurostat, Deaths by week and sex (https://ec.europa.eu/eurostat/web/products-datasets/-/demo_r_mwk_ts), extracted on 27 April 2021 (2021, provisional data)
  2. EIGE’s calculations from Global Health 50/50 for 25 EU MS for which sex-dissagregated data is available (except PL and HU). Dataset | Global Health 50/50 (globalhealth5050.org) data updated on Sept 28th 2021 and extracted on Oct 13th 2021
  3. EIGE’s calculations from Global Health 50/50 for 25 EU MS for which sex-dissagregated data is available (except PL and HU). Dataset | Global Health 50/50 (globalhealth5050.org) data updated on Sept 28th 2021 and extracted on Oct 13th 2021
  4. https://www.eurofound.europa.eu/sites/default/files/ef_publication/field_ef_document/ef21064en.pdf
  5. WHO Regional Office for Europe. (2020c). The WHO European health equity status report initiative: understanding the drivers of health equity: the power of political participation. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/337952/WHO-EURO-2020-1697-41448-56504-eng.pdf
  6. Van de Velde, S., Huijts, T., Bracke, P., andBambra, C. (2013). Macro‐level gender equality and depression in men and women in Europe. Sociology of health & illness, 35(5), 682-698
  7. European Commission. (2021h). Mental health and the pandemic: living, caring, acting! Conference Report
  8. Carmassi, C., Foghi, C., Dell’Oste, V., Cordone, A., Bertelloni, C. A., Bui, E., andDell’Osso, L. (2020). PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Research, 292, 113312. Retrieved from https://doi.org/10.1016/j.psychres.2020.113312
  9. EIGE’s calculation with microdata, EU-SILC, 2019 (IE, IT, 2018).
  10. EIGE’s calculations for EU-27 based on FRA, EU-LGBTI II 2019 in the 12 months before the survey. Respondents were asked the question ‘In the past 12 months have you ever felt discriminated against due to being LGBTI by healthcare or social services personnel (e.g. a receptionist, nurse or doctor, a social worker)?’
  11. FRA. (2020). EU-LGBTI II. A long way to go for LGBTI equality. Retrieved from https://fra.europa.eu/sites/default/files/fra_uploads/fra-2020-lgbti-equality_en.pdf

Blandine Mollard
Researcher
EIGE
https://eige.europa.eu/
https://www.linkedin.com/in/blandine-mollard-63b89053/?originalSubdomain=lt

This article is from issue 20 of Health Europa Quarterly. Click here to get your free subscription today.




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