Sandra Coney: Skimp on our health care and all suffer

New Zealand women, as a group, live longer than men and this bald fact is being used to put women's health on the backburner. While determinants of health are the fashion of the day, no emphasis is put on the determinant of gender.

Women are seen as privileged, too, because they have breast and cervical screening programmes, a mixed blessing, some would say, after inquiries into both.

Internationally, New Zealand has nothing to skite about in the health of its women. Women live longer than men in all countries except for Nepal and Sri Lanka, where women have extremely low status. Internationally New Zealand women rank 17th for all-cause mortality, our men rank 13th.

Since the 1970s, all-cause mortality has reduced more dramatically in men than women. An Otago University study showed that if Australian rates of cancer were applied to New Zealand, 600 fewer women (and 200 fewer men) would die each year.

Despite women's longevity, women live more years of their lives dependently disabled and have more chronic ill-health than men. Sole mothers, some 8 per cent of all adult women, have particularly poor health.

Women, and young women in particular, are adopting behaviours that will come to haunt them. They are picking up smoking just as quickly as men are giving up, and adopting male patterns of heavy drinking.

Women face medicalisation of normal life events, which is potentially harmful and wasteful of health dollars. By the time the bad news broke about heart attacks, strokes, blood clots and breast cancer among users of HRT, up to 100,000 women were using it.

This is the third example of potential harm to women from pharmaceuticals - third-generation oral contraceptives and Diane-35 were the others - in the past few years. Caesarean sections have reached epidemic rates in many hospitals.

There is an irony in the fact that both the Minister and the Director-General of Health are women, for women's health has seriously lost ground over the past few years. A women's health focus has been relentlessly stripped out of the health sector. This is out of step with international trends to strengthen women's health at policy, governance, service and research levels.

The United States has a high-level Office on Women's Health, and most other developed countries have similar agencies.

Go back 15 years and in New Zealand there was a women's health manager and section in the then Department of Health. Many area health boards had women's health staff and service delivery groups. Even in the regional health authorities there was a women's health focus, and the Health Research Council had a women's health committee. All this, and much more, is gone.

Constant restructuring, the obsession with bottom lines, the vogue for managerialism and the influx of private-sector bosses with no health experience have created an amnesiac culture which easily abandons hard-won gains for women.

When Auckland District Health Board deputy-chair Margaret Horsburgh was asked why women were left out of the board's draft strategic plan, she replied: "Women's health isn't a Government priority. There are 13 health objectives and women aren't on that list."

A similar answer was received from the minister when she was asked about the failure of the Government to instruct health boards to address women's health. Yet Labour's health election policy before the 1999 election - Focus on Patients - identified eight population groups, of which women were one, and promised to advocate these at health board level.

The New Zealand health strategy emphasises population groups with poor health statistics, specifically Maori and Pacific people. Having been the sole consumer representative on the Health Sector Reference Group that advised the Government on the strategy, I can say that this emphasis was never intended to be at the expense of other groups.

The reality is that women's health services are being quietly and incrementally eroded without any fuss or outcry. Given the low priority given to women's health by the Government, it is not surprising that district health boards should see this as a fruitful area in which to make cuts.

Perhaps the fate of National Women's Hospital best illustrates what has happened to women's health. For the past six or more years, women's groups have been fighting the submergence of women's health when the hospital moves into the new general hospital being built in Grafton.

Wayne Brown, the Government-appointed chairman of the Auckland District Health Board, sees nothing different about women's health from any other service. Women's health has become just another service in the newly named Auckland City Hospital. The National Women's name has disappeared.

The position of general manager of the hospital has been rolled into a joint one with the manager of Starship children's hospital, dedicated theatres for women have been cut from four to three so that women will have to share general surgical space and general, as opposed to dedicated, women's health staff.

In the past, women's health activists have rejected the reduction of their needs to their reproductive roles, but even these are not receiving adequate attention. They have avoided arguments that emphasise the benefits to families and communities of supporting women's maternal and family roles. The neglect of women has the potential to put undue strain on women and this will inevitably spill over onto families.

Despite major changes in women's roles, they do have sex-specific needs for adequate maternity services and support for breastfeeding, and they do take more responsibility for reproductive control, care of dependent family members, and care of children, including health care. Failure to recognise and allow for these will have wide social repercussions.

Nurturing women's health is important not just for women. Much ground was gained in the implementation of the 1988 Cartwright Report, to the benefit of all healthcare consumers. Since women are high users of the health system, both when they are sick and as users of reproductive and maternity services, it is not surprising they make up the largest numbers of complainants.

Many of the high-profile scandals, misadventures, inquiries and court cases have centred on their mistreatment. Women have been at the cutting edge in advocating consumer representation at all levels of the health sector and a safer, more accountable health system for all. Consign women to the margins and the whole of society will be the loser.

* Sandra Coney is the executive director of the Women's Health Action Trust.

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