Womens Health Business Case Report

2.3 Rationale for investment in Women’s Health

KEY MESSAGES

• Social determinants of health related to, and exacerbated by, socio-economic disadvantage are closely associated with poor mental and physical health in women • In NSW, women are hospitalised following domestic and family violence at more than 7 times the rate of men. • 51% of women in their late twenties, 34% of women in their early forties and 26% of women in their sixties to early seventies report experiencing at least one type of sexual violence • The adverse physical and mental health impacts of trauma associated with domestic and family violence, and sexual violence are serious, long- lasting and complex, and continue even after the violence has ceased.

• Women in NSW continue to experience physical and mental health vulnerabilities at significantly higher rates than men across a wide range of indicators. • Overall, women experience higher rates of psychological distress, poorer self-reported health status, higher rates of hospitalisation for self-harm, and are more likely to have multi-morbid chronic health conditions. • Women experience a range of gender-based vulnerabilities, many connected with social determinants of health, that impact on their access to health services and overall health outcomes. • Women are more likely to experience socio- economic disadvantage as a result of income inequality and their disproportionate role as caregivers. Women in NSW continue to experience physical and mental health vulnerabilities at significantly higher rates than men across a range of indicators (see FIG 1). In the 2020 NSW Population Health Survey 3 , 19.2% of women reported a ‘high or very high level of psychological distress’ on the K10 scale, compared with 14.2% of men. The rate is consistently higher for women in the lowest socio-economic quintile and has increased over the last decade. Overall, women are more likely to report their health status as ‘poor’ or ‘very poor and longitudinal research consistently demonstrates the complex links between women’s mental and physical health. For example: • domestic and family violence is closely linked to both physical and mental health issues resulting from trauma • type 2 diabetes is associated with increased risk of anxiety, depression and psychological distress 4 • comorbid depression and anxiety are associated with the onset of heart disease 5 • among middle aged women, depression has been found to be a predictor of urinary incontinence 6 , stroke 7 and the onset of arthritis 8 2.3.1 Women’s Physical and Mental Health Indicators

Overall, women are also more likely than men to experience multi-morbidities (2 or more chronic physical and mental health conditions) 9 , which have been shown to increase health care costs and the likelihood of hospitalisation 10 . Multi-morbidity rates are highest amongst socio- economically disadvantaged women and common in women who have experienced domestic and family violence, interpersonal violence or sexual assault.

Health Indicator

NSW Females

NSW Males

Self-Rated Health Status – ‘Poor’ or ‘Very Poor’ Persons with 3 or more long-term health conditions Persons Reporting High or Very High Levels of Psychological Distress (2018-20) Mental Health Related Emergency Presentations – rate per 100,000 population (2020-21) Intentional Self Harm Hospitalisations – rate per 100,000 population (2019/20)

5.9% 4.5%

3.3% 2.6%

19.40% 14.2%

1607.3

1379.0

109.8

66.5

Insufficient Physical Activity in Adults

42.3% 34.1%

Socio-economic Disadvantage – personal income below $800 per week

49.0% 35.7%

FIG 1: NSW Key Health Indicators by Gender (Sources: ABS Census 2021; NSWHealthStats)

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Women’s Health NSW – October 2022