Women live longer than men, but they experience more years of discomfort and (mental) health issues, including in Belgium. This stems from a long history of neglecting girls' and women's health, a new study by the Sciensano National Health Institute shows.
The report, called 'How is the female population in Belgium doing?' was published this week. To answer that question, Sciensano researchers examined numerous available studies and research on the topic and came to some shocking results.
"Historically, the health of women and girls has often been neglected due to discrimination. This means that women and girls cannot reach their full health potential," said Sciensano in a press release. "Women's health should be high on the public health agenda."
Data on women's health is still often non-existent or difficult to access, making it difficult to analyse or reuse, the institute stressed. This leads to gaps in well-being, prevention and healthcare, a newly published health report shows.
More than just hormones
"Gender and sex have a significant impact on health, as a result of both biological and socially shaped differences and inequalities," the researchers said. "Today, there is still a clear underrepresentation of women in clinical studies and inadequate attention to sex and gender differences in research."
The inequalities start during puberty. When it comes to physical and psychological health, the gap between boys and girls starts to grow from the age of 13. "This has to do with more than just menstrual problems and hormone fluctuations," said Sciensano.
Several school surveys show that the mental health of adolescent girls is worse than that of boys in adolescence. Girls report more psychosomatic and depressive symptoms and think about suicide more often than boys of the same age.
Although girls show better results in terms of preventive health behaviour (such as eating more fruit and vegetables) and taking better care of themselves (such as brushing their teeth more often), they also appear to be generally less physically active than boys.
KU Leuven Brussels Campus students class
Having better support for sexual and reproductive health could go a long way to improve women's well-being, Sciensano argued. Although Belgian citizens have good access to contraception, better reimbursement could further improve access to it.
Additionally, information is lacking about the number of people who have fertility issues as well as about their experiences with it. While the number of pregnancies resulting from IVF treatment is increasing (especially in Flanders and Brussels), other information such as access to fertility care and the mental and physical health burden associated with fertility treatments is lacking.
On top of that, there is currently no information available on the epidemiology of endometriosis or polycystic ovary syndrome (PCOS) in Belgium. These conditions are not only often misdiagnosed, undertreated or unrecognised, but are also risk factors for infertility and other conditions.
In general, the path to a diagnosis is longer for women for other health complaints; they are less often referred for additional examination if they have the same symptoms as men, while pain complaints are often attributed to psychological problems. "Doctors downplay pain in women more often than in men."
Under-treated and misdiagnosed
"Overall, maternal and perinatal health in Belgium is good, but inequalities do exist," Sciensano said. "Women of Moroccan, Sub-Saharan African and Turkish nationality score lower on average in terms of maternal and perinatal health than women of Belgian nationality. There is also very little data available on postpartum depression (PPD)."
These health inequalities between men and women also persist into adulthood. The study showed that women are more likely to access health services for mental health problems, but they have poorer outcomes across a range of mental health indicators.
The death rate from suicide is lower among women than men in Belgium, but it is still one of the highest in Europe.
A European study on occupational health has also shown that women in Belgium have poorer mental health, more musculoskeletal problems (such as neck and shoulder pain) and experience more workplace violence than men. "Women are also more likely to be under-treated and misdiagnosed in clinical settings compared to men, even though women have more contact with healthcare professionals."
Credit: Belga / Dirk Waem
Additionally, pre-menopausal symptoms (such as insomnia and mood swings) are undertreated in Belgium and can have a negative impact on quality of life and risk of disease. Hormone replacement therapy and symptom management can improve the quality of life in premenopausal women, but the lack of awareness, fear of side effects and taboos can deter women from seeking treatment.
Women are also at high risk for cardiovascular disease (partly due to hormonal changes during menopause) whose symptoms may go unrecognised by the women themselves and, worryingly, their healthcare providers. Women with cardiovascular disease often show fewer symptoms than men, for example.
The number of screenings for breast cancer, cervical cancer and colorectal cancer is higher in Flanders than in Wallonia and the Brussels-Capital Region. Despite the fact that HPV vaccination is free for young people up to the age of 18, the vaccination rate is still too low.
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In general, women live longer despite spending more of those years in poor health. Older women are particularly affected by some chronic diseases such as musculoskeletal disorders, urinary incontinence and dementia and are at greater risk of having multiple diseases at the same time.
They are also at greater risk than men of developing Alzheimer's disease, for which there is no suitable treatment.
Older women are especially at risk of falls and osteoporosis leading to fractures that affect their quality of life. In 2018, the prevalence of osteoporosis was almost ten times higher in women aged 55 and older (13%) than in men (1.8%). However, that difference can be partly attributed to the underdiagnosis of osteoporosis in men.
