Health Situation of Women in Germany 1 Summary and conclusion The report on the ‘Health Situation of Women more often employed in systemically relevant pro- in Germany’ provides information about many fessions such as in nursing or as sales assistants in important aspects of women’s health, describes food retail. Depending on the type of activity, this the current situation based on concrete figures may also go along with an increased risk of infec- and highlights important developments. This con- tion [3–5]. Initial results of studies on the impact clusion focuses on four major topics under which of the pandemic on the labour market (i.e. unem- numerous results within the report can be sum- ployment) for women and men are now available marised. The first of these topics is demographic [6, 7]. A final assessment of gender-related effects change where the observed rise in life expectancy on the labour market will probably only be possible is accompanied by an increase in chronic disease. retrospectively. As women perform a large part of The second part of the conclusion proceeds to look the care work in families, they face particular pres- at ‘differences between’: the focus is on selected sures in times of closed care facilities and home diseases, aspects of health behaviour and health schooling. Initial survey results show that fathers care needs where differences can be observed have taken on a greater share of family work during between women and men. Here, differences in sex the corona crisis [8], but also that the additional care (referring to the biological aspects of an individ- work the pandemic has made necessary has often ual) and gender (referring to social constructions) been apportioned to women [9]. This aspect, too, are considered. The third part addresses women’s requires further analyses. Single parents have per- different life situations. The impact of social situa- ceived the situation as particularly stressful [8, 9]; tion, family situation, employment and migration and around 88% of all single parents in Germany history on health is well documented. This sec- are women. tion is therefore devoted to ‘differences within’ i.e. Also, there is concern that economic worries, social differences and different health opportuni- quarantine and restrictions on freedom of move- ties within the group of women. Many sections in ment could lead to a spike in domestic violence the report highlight potential for improving wom- against women [10]. Research projects on gender- en’s health. Research and data collection are areas related effects of the COVID-19 pandemic in Ger- which can contribute to further progress in wom- many started in spring 2020; they could only be en’s health. The final section of the conclusion included in this report selectively. explores data gaps and research topics needing to be put on the agenda and the potential for the topic of gender and health within health reporting. Demographic change and its conse- During the final stages of the report, the novel quences coronavirus SARS-CoV-2 was spreading at enor- mous speed throughout the world. The COVID-19 Baby girls born in Germany have never before had pandemic has been posing immense challenges the chance of living an average of around 83 years. for the health of the population and society as a According to estimates by the Federal Statistical whole since the beginning of 2020 also in Germany. Office, around one fifth of the girls born today will International findings point to sex and gender as live to the age of 100. On average, women aged 65 possible differentiating factors for corona infections today can expect to live another 21 years. The years and COVID-19 mortality, the extent and causes of women have gained through the increase in life which will need to be investigated in more detail. In expectancy can often be spent in good health, or at those countries where disaggregated data are avail- least not completely in disease. Life expectancy in able for women and men, men more often die from Germany corresponds to the EU average. From a COVID-19 and develop more severe symptoms [1]. global perspective, the privileged health situation As regards the psychological and social implica- of women in Western Europe is clear – life expec- tions of the pandemic, initial study results indicate tancy for new-born girls is 74 years on average that women are particularly affected [2]. They are worldwide [11]. 2 Health Situation of Women in Germany In Germany and many other countries, the cancers, living with cancer has increasingly become decline in infant and child mortality and the a focus as has treatment of late effects and long- successes in combating infectious diseases, e.g. term consequences. An important field in this tuberculosis, provided the basis for the continu- regard is psycho-oncological care. In Germany’s ous increase in women’s life expectancy. A further National Cancer Plan, psycho-oncological care is significant factor was the decline in maternal mor- found in the section ‘Improving the quality of care tality, which began during the first half of the 20th for people suffering from cancer’ [12]. century. In recent decades, the increase has been While the years of life gained due to increasing mainly due to a decrease in mortality from chronic life expectancy are mostly spent in good health, diseases. This also means that many people now the growing number of older people also creates a live with chronic diseases for a long time. For exam- higher number of people requiring long-term care. ple, one in two women aged 65 years and older is As women’s life expectancy is higher, they face a affected by osteoarthritis, and about one in six has greater risk of needing long-term care in old age. diabetes mellitus. The extent to which chronic dis- Around 2.3 million women and girls in Germany eases impact quality of life also depends on medical currently are in need of care and receive benefits care and, not least, on personal resources. When from long-term care insurance. That is two thirds asked to assess their own health, almost half of all of the people with recognised need for care. The women aged 65 years and older assess their own majority of those who provide care are also women. health as being good or very good. And over time, This applies both to caring for relatives and to pro- there is a trend towards better subjective health. fessional care. Around 9% of women in Germany Cardiovascular diseases, still the number one provide care for a person close to them. The propor- cause of death for women in Germany, have been tion of women in professional care – in the health declining over recent decades. This applies as much and nursing professions and in geriatric care – is to incidence as to mortality rates. The decrease is around 85%. When women themselves become linked to several factors, primarily to changes in in need of long-term care in old age, they are less health behaviour, the increasingly guideline-based likely than men to receive it in the home environ- treatment of hypertension and lipid metabolic dis- ment. A significant reason for this is that women orders, and advances in health care. The women’s are more likely to live the last years of their lives health movement that formed in Germany in the without a partner, as three-quarters of all women 1970s very successfully drew attention to the fact are younger than their partners and men’s life that ‘women’s hearts beat differently’. By empha- expectancy is lower. sising this fact, the activists opened the door to gen- der-equitable health care and contributed to a signif- icant reduction in the number of women receiving Sex and gender differences in health delayed care following a heart attack. Women and men do not show the same symptoms when they In addition to cardiovascular diseases and cancer, have a heart attack. The lack of awareness of this mental disorders are widespread in our society. fact was a key reason why women often did not They rarely shorten a person’s lifespan, but they receive adequate care. impact quality of life and can lead to short-term or Breast cancer is usually perceived as being a long-term inability to work. Many mental disorders very threatening disease for women. Nearly 69,000 such as depression, anxiety disorders and eating women were diagnosed with breast cancer in 2016, disorders affect women more frequently than men. and in particular due to medical and technical pro- Biological, psychological and social factors all play gress the probability of surviving after being diag- a role in the development of mental disorders and nosed with the condition has increased considerably are discussed as reasons for sex and gender dif- in recent years: the relative ten-year survival rate of ferences. However, there are also differences in women with breast cancer is now 82%. Screening approach to medical diagnosis, i.e. when present- examinations which are nationwide available have ing the same symptoms, women are more likely probably also contributed to this positive develop- to be diagnosed with a mental disorder and men ment. With the increase in survival rates for many with a physical disorder. Increases in sick leave and Health Situation of Women in Germany 3 early retirement figures indicate a growing aware- between 14 and 17 years are non-smokers. Smoking ness and changed perception of mental disorders is a key risk factor for numerous chronic non-com- – an awareness which would also be desirable with municable diseases such as cardiovascular diseases, regard to gender aspects.