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Social Focus on Women and Men 2002

chapter four: Health and Care

Health and care is perhaps the single most relevant topic to all our lives. Whether we are a young child, a developing teenager, an expectant mother, a newly retired woman or an elderly man, our susceptibility to illness, our chances of successful treatment and our ability to make suitable lifestyle choices has significant influence on every aspect of our lives.

The area of health and care is vast; the latest figures for financial year 2001-02 show that the resource budget for the National Health Service in Scotland was £5.9bn, and this is only part of the picture. There are large numbers of targets and performance indicators that are set by central and local government as well as the National Health Service in Scotland, indicating the need to monitor progress and measure performance across the whole topic area.

On average the population of Scotland is now living longer than ever before, with life expectency in 2000 for both men and women being approximately 30 per cent longer at birth, compared with 1930. This is indicative of the considerable improvements that have been made in many important social and economic areas and in health care provision. However, it is also apparent that instances of disease, recovery rates, and lifestyle factors vary considerably across the socio-economic spectrum and between men and women.

The improvement in life expectancy at birth is strongly related to the decrease in infant mortality (death of infants aged one or less per thousand live births). Infant mortality is generally higher among boys than girls. In 1990, 8.8 boys and 6.6 girls per thousand live births died aged one or less. In 2000 the equivalent figures were 6.4 boys and 5.1 girls. This chapter looks at some of the other similarities and differences that occur between the genders.

Self Assessed Health

There is a large range of general indicators of health. In this section the overall health of the population is taken from part of the Scottish Health Survey which asks adults in Scotland to rate their state of health.

Chart 4.1 shows the percentage of adults aged 16 to 74 that stated their health as very good or good. The evidence from the survey suggests that people's health (as assessed by themselves) varies considerably with age and only marginally with gender. On average three out of four adults rated their health as good or very good, but there is a marked decline in self-assessed health around the age of retirement.

Chart 4.1: Self assessed health (very good or good), by gender and age, 1998
Percentages

Consultation with a General Practitioner

Whilst there is little difference between males and females in self-assessed health, the level of General Practitioner (GP) consultations differs significantly. Information over the period 1996 to 2000 shows that, except for the very young (under 4 years of age), women are more likely to visit their GP than men. Women aged between 15 and 44 are twice as likely as men of a similar age to visit their GP (a significant factor for women in this age group is family planning and maternity services provision), whilst women aged 45 to 64 are 50 per cent more likely than men of a similar age to visit their GP.

Chart 4.2 shows the different GP consultation rates per thousand practice population of all ages, in 2000 between men and women. This is a selection of the most common reasons for visiting a GP, and clearly shows that women are more likely to consult a GP about a range of illnesses including depression, upper respiratory tract infection (URTI), anxiety and hypertension. Men are more likely than women to consult a GP about ischaemic heart disease and drug abuse.

Chart 4.2: General Practitioner consultation rates, 2000
Rates per 1,000 population

For a common complaint such as URTI in 2000, there were 223 consultations per thousand women compared to 156 consultations per thousand men. In some cases only women will suffer from a particular condition, for example, post natal depression, but in other cases it appears that women are more likely to consult their GP for the same condition than men.

Figures on GP consultations for depression in 2000, show that there were 223 consultations per thousand women compared to 91 per thousand men. However, over the last five years, there has been an increase of 34 per cent in consultations by men for depression and 26 per cent for women. The rate of consultations for anxiety has by contrast remained constant over the last five years. On average, just over 50 men per thousand and 120 women per thousand consulted their GP for this condition.

Chart 4.3 shows the results of part of the Scottish Health Survey which measured the psychosocial health of people aged 16-74, across Scotland. The questionnaire used a series of 12 questions to assess general levels of happiness, anxiety, depression, sleep disturbance and stress over the previous few weeks. As one might expect, given the differences in GP consultations, women were more likely than men to record a high GHQ12 score. Overall, 18 per cent of women and 13 per cent of men answered the questions in such a way as to be identified as having a potential psychiatric disorder. It was also the case (except for people aged 55 to 64) that women were more likely to have a high GHQ12 score than men of a similar age.

Chart 4.3: Psychosocial health (GHQ12 score of four or more): Scotland, 1998
Percentage

Cancer

In Scotland the most common causes of death are cancers and heart disease. Death rates are falling, with mortality rates for coronary heart disease among the under 75 year olds having halved since 1986 and those for cancer falling 12 per cent over the same period. However, there are clear differences between the mortality rates from cancer for men and women.

Chart 4.4 shows the pattern in mortality due to cancer over the last nine years for all ages. There has clearly been a decrease in the rates for both men and women. The rates for men in 2000 are 272 deaths per 100,000 men of all ages, which is 10 per cent lower than in 1992. For women the rate of reduction over the same period was half that of the men, with the 2000 figure of 191 deaths per 100,000 women showing a 5 per cent decrease on the 1992 figure.

Chart 4.4: Mortality rate per 100,000 due to Cancer, 1992 to 2000
Rate per 100,000

Table 4.5 shows that there is a clear link between mortality rates from cancer and deprivation (as measured by the Carstairs and Morris index), with those men and women living in the least deprived category being less likely to die from cancer in comparison to those people living in the most deprived category.

Table 4.5: Death rate per 100,000 from cancer by deprivation category, 2000
Rate per 100,000

Source: General Register Office for Scotland
Note: The death rates are crude rates per 100,000 people aged under 75.

Whilst women are less likely to die from cancer than men, the relationship between deprivation and mortality from cancer is similar for men and women.

In 1998, there were just over 25,000 incidences of cancer (excluding non-melanoma skin cancer) diagnosed. The split between men and women was quite even; just under 52 per cent of these cases were female patients with around 90 per cent of all registered cancers occurring in people aged 50 years or more.

Chart 4.6 shows the ten most frequently diagnosed cancers by gender in 1997. For women, the three cancers that are most commonly diagnosed are breast, lung and large bowel, and for men they are lung, prostate and large bowel. The mortality and incidence rates for cancer differ between men and women. Considering those people diagnosed with cancer between 1991 and 1995, 45 per cent of the women were alive 5 years later, whereas only 34 per cent of the men were alive. A key reason for this is that breast cancer is the highest diagnosed cancer among women, and it has a survival rate of 75 per cent. In comparison the survival rate for trachea, bronchus and lung (the most common cancers for men) cancer is 7 per cent for men.

Chart 4.6: Ten most common Cancers, Scotland , 1997
Percentage of all cancers diagnosed

The incidence rates for cancers also show a relationship with deprivation category (Carstairs and Morris Index). Information on trachea, bronchus and lung cancer show a clear link for both men and women between incidence (first admission) and deprivation category, with the incidence rate for those people in the most deprived areas being between 2 and 3 times higher than for those people in the least deprived areas.

For some cancers, the incidence rate is inversely related to deprivation category. The incidence of breast cancer is higher for those women in the least deprived areas by around one and a half times, than for women in the most deprived areas. This is due to a number of factors, one of which may be patterns of childbearing. More affluent women tend to have their first child at an older age. The same relationship is also found with incidences of prostate cancer and deprivation category. There are two possible reasons for this. One is that there is a genuinely higher risk among the least deprived, the reasons for which are not known. The other is that there is a higher detection rate among men living in more affluent areas.

Survival rates are highly dependent on the type of cancer and the access to early diagnosis and treatment. There are effective and well-established national breast and cervical cancer screening programmes in place. In the year ending 31 March 2000, 87 per cent of eligible women had accepted an invitation in the previous 5.5 years for a cervical smear and 73 per cent of eligible women had accepted an invitation for breast screening. Considering those people diagnosed between 1991 and 1995, 58 per cent of the women with cervical cancer were alive 5 years later, and 73 per cent of the women with breast cancer were alive 5 years later.

However, there are some differences identifiable by gender. For those people diagnosed between 1991 and 1995, whilst there was a 44 per cent survival rate for men diagnosed with oral cavity cancer, for women the survival rate was 53 per cent. For malignant melanoma of the skin, the survival rate for men was 80 per cent and for women 87 per cent.

Heart Disease

The rate of mortality from heart disease has fallen for both men and women over the last few years. Chart 4.7 shows that since 1992, the mortality rate for men has fallen by almost 28 per cent to 283 deaths per 100,000 men. Over the same period, the mortality rate for women has fallen 25 per cent to 158 deaths per 100,000 women (figures standardised to European Standard Population). However, it is clear that men are significantly more likely to die from heart disease than women.

There is a clear relationship between deprivation category (Carstairs and Morris Index) and death rates from heart disease. In 2000, men were around twice as likely as women who lived in areas classed at the same deprivation level to die of heart disease. Men who lived in the least deprived areas were half as likely to die of heart disease as men who lived in the most deprived area, whereas women who lived in the least deprived areas were a quarter as likely to die of heart disease as women who lived in the most deprived areas.

Chart 4.7: Mortality rate per 100,000 for Heart disease, 1992 to 2000
Rate per 100,000

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