Health of adult people

The following section deals with the health potential of adult people, from when they set out to enter the labour market up to the time when they usually leave it again. This stage of life entails some forty years

and includes life events such as taking up employment; parenting; citizenship; caring for parents;

witnessing children leave the house; and leaving employment.

Over the years, the nature of such life events has undergone considerable change. For many adults in Europe, economic and social conditions are unsatisfactory. An increasing number of people spend some part of their lives either under- or unemployed, due to trends such as the globalization of trade and

technological development. For those who are employed, declining stable employment and the emergence of new types of work mean that large categories of workers are vulnerable to job insecurity: these include foreign workers, immigrants, ethnic minorities, older workers and women with young children. Family structures tend to be less sustainable, and many new forms of living together are being seen.

Working environment: At present too much emphasis is placed on short-term economic considerations, rather than on the longer-term human investment which creates socially productive roles for people of working age. A high level of job insecurity may create short-term economic benefits but worsens the health status of working people – and those they care for – in the long term, thus increasing the pressure on the health system.

Women’s health and wellbeing: A major barrier to the achievement of health for all is inequality, both between men and women, among women in different parts of the European Region, and among social classes and ethnic groups. Women and men are affected by many of the same conditions, but they experience them differently. Poverty and economic dependence, violence, negative attitudes and other forms of discrimination, limited power over sexual and reproductive life, and lack of influence in decision-making, are all factors which impact adversely on women’s health.

Women sometimes have different and unequal access to and use of basic health services and opportunities to protect, promote and maintain their health. Health policies and programmes often perpetuate a gender stereotype and may not fully take account of women’s lack of autonomy regarding their health.

Complications related to pregnancy and childbirth are among the leading causes of mortality and

morbidity of women of reproductive age in some countries with economies in transition. Unsafe abortions threaten the lives of a large number of women – in the more eastern part of the Region in particular – representing a grave public health problem; it is primarily the poorest and youngest who take the highest risk.

A larger proportion of the workforce than previously is now female, and the increase in working mothers and dual-worker households has implications for caring for children and older people. Traditionally women have fulfilled this role, and in many countries they continue to do so as well as working outside the home.

Poor housing and community environments (see Chapter 5) prevent many adults from adopting health-promoting behaviour. For low-income women, smoking may be a way of coping with the stress of poverty or monotonous work conditions. In poor districts, many factors make healthy lifestyles more difficult:

• there are fewer recreation areas;

• a heightened sense of crime inhibits people from going outdoors, socializing, engaging in a physical activity;

• access to public transport is poorer;

• the types of food recommended in health-promoting strategies are not available or affordable;

• primary health care services are less available than in more advantaged areas.

Proposed strategies

Policies for health need to help people cope with the diseases they may encounter during adult life.

Preventing disease and premature death by addressing the underlying causes and risk factors should,

however, be an important focus of every health strategy. A number of risk factors are common to cardiovascular diseases, cancer and diabetes (and, to some extent, chronic respiratory disease): these are smoking, alcohol use, unhealthy diet, lack of physical exercise and, increasingly, stress. Therefore, rather than concentrating preventive efforts on individual factors only, an integrated approach should be adopted to tackle all the major risk factors, within the framework of a broader health promotion and disease prevention strategy as outlined in Chapter 5.

Ensuring job security maintains and improves the health of working people. The resulting increase in individual productivity and decrease in health care costs also lead to long-term economic benefits. As outlined in Chapter 5, the health of working people can also be improved if labour market policies, while ensuring job security, promote flexible and family-friendly employment practices, giving workers the opportunity to participate in the labour market and meet personal and family responsibilities. Providing opportunities for parental leave, part-time work and job-sharing can promote the health of workers and families.

Health and wellbeing of women: By supporting and acting on the commitments in various international agreements (such as the Programme of Action of the International Conference on Population and Development, the Copenhagen Declaration on Social Development, and the Convention on the

Elimination of All Forms of Discrimination against Women), governments, in collaboration with NGOs and employers’ and workers’ organizations, and with the support of international institutions, can promote and protect the health of women.

Women’s health can be improved through the provision of more accessible, available and affordable PHC services of high quality, including those for sexual and reproductive health (e.g. family planning information and services), with particular attention being paid to maternal and emergency obstetric care. Recognizing and dealing with the health impact of unsafe abortion, as agreed in the Programme of Action of the

International Conference on Population and Development, is a major public health issue for some countries and requires, as mentioned earlier, a well planned family planning programme.

Redesigning health information services and training programmes for health workers so that they are gender-sensitive, reflect the user’s perspectives with regard to interpersonal and communications skills and take into account the user’s right to privacy and confidentiality, are approaches which can ensure that a greater number of women have access to good health services and are treated in a way appropriate to their needs.

To promote equality between men and women, among women in different parts of the European Region, and among woman in different social classes and ethnic groups, all policies in the health sector and other fields should incorporate a gender perspective. Particular attention should be paid to developing policies and programmes that support men and woman in their various roles and responsibilities – as individuals, parents, workers and carers, among others – and that remove gender-related barriers to health and human development.

A GENDER PERSPECTIVE – RECOGNIZING THE NEEDS OF WOMEN AND MEN A gender perspective is essential to health policy because it:

• recognizes the need for the full participation of women and men in decision-making;

• gives equal weight to the knowledge, values and experiences of women and men;

• ensures that both women and men identify their health needs and priorities, and acknowledges that certain health problems are unique to, or have more serious implications, for men or women;

• leads to a better understanding of the causes of ill health;

• results in more effective interventions to improve health;

• contributes to the attainment of greater equity in health and health care.

Ensuring a safe home and community: Adequate housing is a prerequisite for health, but people’s housing needs usually change over the course of their lives and housing should be adapted to meet these changing needs, including the increase in work from home. Recreation areas, safe streets, and access to public transport and basic amenities and services are essential resources for a healthy and safe community and strong social networks, and they should be maintained and improved. Health can be improved if PHC services increase the percentage of immunization coverage and focus on the early detection of

cardiovascular diseases and cancer and the rehabilitation of people with chronic diseases. Services should reach out to those most in need (see Chapter 6).

Healthy lifestyles: Adults are often responsible for the care of others. The choices they make and are enabled to make can therefore influence the health of a number of people. Ensuring access to safe and affordable food, disseminating information, labelling food (in particular genetically modified foods) in an appropriate way, and providing education and training in the safe preparation of food can promote and protect the health of individuals and families. Moderate physical activity is one of the cornerstones of good health for adult people. The health benefits of physical activity are reviewed in Chapter 5. The design of daily living facilities should enhance moderate physical activity.