Chapter 3: Health

View the most recent version.

A key determinant of well-being

Throughout their lives – as children, adults and seniors – women face life conditions and health issues specific to their biology and social circumstances. Women’s health involves their emotional, social, physical and spiritual well-being and is determined by a complex combination of the various determinants of health: income and social status, education and literacy, employment and working conditions, social and physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, culture and gender. The distinction and interrelationship between “sex” including biology, physiology, genetics, and “gender” including social roles, relationships, relative power, and self-definitions, are important considerations when examining women’s health status in Canada.

It is also essential to recognize the diversity among the women of Canada when presenting a statistical profile of their health. Women’s health experiences differ within and between social groups. For example, immigrant women, Aboriginal women, women in remote and rural areas, women with disabilities, women living in low-income situations, and lesbian, bisexual, and transgendered women have differential access to health services and differing health care needs. As well, women make up a substantial majority of the very oldest Canadians, a population that is generally the most susceptible to serious health problems. Women are also the primary providers of health care in Canada, either as health professionals themselves, or as family members providing care and assistance to sick or elderly relatives, friends, or neighbours.

Women’s self-perceived health

The large majority of the female population living at home describe their general health in positive terms.¹ Indeed, in 2003, 88% of the female population aged 12 and over said their health was either excellent (22%), very good (36%) or good (30%). However, 12% reported their health was either fair or poor. (Table 3.1)

Table 3.1 Self-reported health status of females and males aged 12 and over, by age, 2003

Not surprisingly, the likelihood of women having fair or poor health rises with age. In 2003, 32% of women aged 75 and over² reported their health status as only fair or poor, while the figure was 23% among those aged 65 to 74, 19% among those aged 55 to 64 and 13% among 45 to 54-year-olds. In contrast, the share of younger women who said their health was only fair or poor that year was under 10%.

As well, women are slightly more likely than men to describe their health in negative terms. In 2003, 12% of the female population aged 12 and over, versus 10% of their male counterparts, described their health status as either fair or poor. Part of this difference simply reflects the fact that there are more senior women than men in Canada and that people aged 65 and over are the most likely to report poor health. Indeed, senior women are about as likely as their male counterparts to indicate that their health status is only fair or poor. In most other age ranges, though, women are somewhat more likely than men to report their health status in negative terms.

Women with chronic health conditions

While most women report that their overall health is relatively good, a substantial number have a chronic health condition as diagnosed by a health professional. In many cases, these chronic health problems can have a major effect on quality of life, including the limiting of activities, hospitalizations and even death. In 2003, 74% of the female population aged 15 and over living in a private household had at least one such chronic health condition, compared with 64% of their male counterparts. (Table 3.2)

Table 3.2 Percentage of the female and male population aged 15 and over diagnosed with selected chronic health conditions, 2003

The proportion of women who report chronic or degenerative health problems rises with age, although the majority of women in all age ranges indicate they have at least one chronic health condition. In 2003, 94% of women aged 75 and over, 91% of those aged 65 to 74 and 87% of those aged 55 to 64 reported they had at least one chronic health problem as diagnosed by a health professional. In younger age groups, the share of women reporting they suffered from a chronic condition ranged from 77% among those aged 45 to 54 to 60% of those aged 15 to 24. In addition, women in all age groups were more likely than their male contemporaries to report health problems.

Non-food allergies, arthritis and rheumatism, and back problems are the health problems most frequently reported by women. In 2003, 32% of the female population reported they suffered from non-food allergies, while 22% indicated they had arthritis or rheumatism and another 22% suffered from back problems. At the same time, 16% of women reported they suffered from high blood pressure and 15% had recurring migraines, while smaller percentages reported suffering from food allergies (10%), asthma (10%), diabetes (5%), or heart disease (5%).

Women are also more likely than men to report most of these chronic health conditions. For example, in 2003, women were two and a half times more likely than men to report suffering from recurring migraines. That year, 15% of females aged 15 and over, versus only 6% of males in this age range, had migraines. At the same time, 32% of women, versus 23% of men, reported they had non-food allergies, while 22% of females, compared with 13% of males, had arthritis or rheumatism.

Senior women are generally more likely to report suffering from chronic health conditions than their younger counterparts. Indeed, in 2003, over half of women aged 65 and over reported suffering from arthritis / rheumatism, while close to 50% had high blood pressure, whereas this was the case for much smaller percentages of females in age groups under age 65. On the other hand, the incidence of non-food allergies is higher among younger females than among those in older age ranges.

Women with disabilities

Women make up the majority of the Canadian population with disabilities.³ In 2001, 54% of those who had a disability were women, whereas females accounted for only 51% of the total population. That year, 13.3% of Canadian females had a disability, compared with 11.5% of the male population. (Table 3.3)

Table 3.3 Population with disabilities, by age, 2001

The likelihood of women having disabilities increases with age. In 2001, 42% of all women aged 65 and over had a disability. This was almost twice the figure among women aged 55 to 64, 22% of whom had a disability, and well above the figures for women in younger age groups. That year, for example, 12% of women between the ages of 35 and 54, 5% of those aged 15 to 34, and just 3% of those under the age of 15 were considered to have a disability.

The prevalence of disabilities also increases among women in older age groups in the senior population. Indeed, in 2001, 72% of all women aged 85 and over had disabilities, while the figures were 50% among women aged 75 to 84 and 32% for women aged 65 to 74.

As reported in the chapter on women with disabilities, the largest proportion of women with disabilities have a mild disability. Nevertheless, a substantial share - 14% in 2001 - of women aged 15 and over with disabilities had a severe disability. That year, just over 800,000 women, nearly 7% of all women aged 15 and over, had disabilities which were considered severe or very severe.

Senior women are more likely than their younger counterparts to have a severe disability. In 2001, 6% of all women aged 65 and over had a very severe disability, while 12% had a severe disability. These figures were about twice those for women aged 55 to 64 and well above those for females in younger age groups.

High life expectancy

Females in Canada have a longer life expectancy than males. Female children born in 2001, for example, could expect to live an average of 82 years, whereas the average life expectancy of male children born that year was just 77 years. (Table 3.4)

Table 3.4 Life expectancy of females and males at selected ages, 1921 to 2001

There has been a dramatic increase in the life expectancy of the female population in Canada since the early part of the last century. The life expectancy at birth for female children born in 2001 was 82 years, compared with 79 years for those born in 1981, 74 years for those born in 1961 and just 61 years for those born in 1921.

As well, long-term increases in the life expectancy of females over the course of the past century have been greater than those for males. Indeed, the life expectancy at birth of females born in 2001 was almost 22 years longer than that for a female born in 1921, whereas the life expectancy of males rose by only 18 years in the same period. As a result, in 2001, newborn female children could expect to live, on average, 5 years longer than their male counterparts, whereas in 1921 the gap was less than 2 years.

The long-term trend in the life expectancies of females and males, however, masks the fact that since 1981, gains in life expectancy among females have only been about half those experienced by males. Indeed, between 1981 and 2001, the life expectancy of newborn females increased by over three years, whereas the figure among males was up 5 years in the same period.

Compared with other industrialized nations, the life expectancy of females in Canada is somewhere in the middle. Female children born in Canada in 2001 could expect to live, on average, 82 years; this was almost three years less than their counterparts in Japan and a year less than those in Switzerland, Spain and France. On the other hand, the life expectancy of females in Canada is two years greater than that for females in both the United Kingdom and the United States. (Chart 3.1)

Chart 3.1 Life expectancy of females at birth in selected Organization for Economic Cooperation Development (OECD) countries, 2001

When measuring life expectancy, it is important to note that measures of life expectancy are not necessarily indicators of quality of life. As discussed in the chapter on seniors, women aged 65 and over are particularly likely to live alone and to have low incomes, or to have chronic or degenerative health problems.

Lower death rates

The long-term increase in the life expectancy of females is a reflection of declines in the female death rate in recent decades. Overall, in 2002, there were 110,000 deaths among the female population. This represented 486 deaths for every 100,000 females, down 10% from the figure in 1993, once the effect of changes in the age structure of the female population was factored in.⁴ The decline in the age-standardized death rate for women in this period, though, was somewhat smaller than that among men for whom the agestandardized death rate declined 17% between 1993 and 2002. (Chart 3.2)

Chart 3.2 Age-standardized death rates1 for females and males, 1993 to 2002

Age-standardized death rates among females, though, are still considerably lower than they are among males. In 2002, there were 486 deaths per 100,000 females, 54% lower than the figure of almost 750 deaths per 100,000 males.

Leading causes of death among women

Heart disease and cancer are the leading causes of death among women. Indeed, these two causes accounted for over half of all female deaths in 2002. That year, 28% of all female deaths were as a result of cancer, while 23% were from heart disease. At the same time, 8% of female deaths that year were attributed to cerebrovascular disease, while another 8% were the result of respiratory diseases. (Table 3.5)

There have, however, been considerable differences in the long-term trends for heart disease and cancer deaths among the female population in the past two decades. On the one hand, the age-standardized death rate due to heart disease among women was 61% lower in 2001 than in 1981, whereas there was no change in the cancer death rate among women in the same period. (Chart 3.3)

Chart 3.3 Cancer and heart disease death rates, 1981, 1997 and 2001

There have, in fact, been declines in deaths due to heart disease among both the female and male populations in the past two decades. Indeed, for the most part, these declines have mirrored each other. The death rate due to heart disease among women, though, is currently only about half that for men.

It should also be noted that there are differences in some of the major characteristics of heart disease in the female and male populations. Women tend to experience a wider range of symptoms; they are less likely than men to be investigated and treated for the disease with medication, surgery and other interventions; and they generally have poorer health outcomes. There are also gender differences in the risk factors for heart disease, including hypertension, cholesterol levels, cigarette smoking, diabetes, depression, lack of physical activity and obesity. Some of these, such as hypertension, diabetes and depression, pose greater risks for women than to men. As well, populations such as Aboriginal women and South Asian women tend to be more vulnerable to this health condition.

While the death rate from cancer among females has changed little in the past two decades, the rate among men has fallen, albeit slowly. Still, the cancer death rate among females is currently 50% lower than that of males.

There have also been different trends in mortality rates from various cancer types among women in the past two decades. For example, the death rate due to lung cancer for females in 2001 was more than twice the figure in 1979. In contrast, the agestandardized lung cancer death rate among men declined 10% in the same period. The lung cancer death rate among women, though, is still only about half that of men. (Chart 3.4)

Chart 3.4 Age-standardized lung and breast cancer death rates, 1979 to 2001

On the other hand, there has been a gradual decline in the age-standardized death rate from breast cancer among the female population in the past two decades. In 2001, the number of deaths from breast cancer for every 100,000 women was about 20% lower than the figure in 1979, once the impact of changes in the age structure has been eliminated.

Overall death rates among women also mask the fact that the leading causes of death vary greatly among women in different age groups. Women between the ages of 30 and 79, for example, are the most likely to die of cancer. In fact, in 2002, over half of all deaths of women in both the 50 to 59 and 60 to 69 age ranges, as well as almost half of those of women aged 40 to 49, were attributable to cancer. At the same time, cancer accounted for over a third of all deaths of women aged 70 to 79. On the other hand, heart disease was the leading cause of death among women aged 80 and over, while females under the age of 30 were the most likely to die in motor vehicle accidents. (Table 3.5)

Table 3.5 Deaths per 100,000 females, by age and selected causes, 2002

There are also differences in the leading causes of cancer deaths among women in different age groups. Breast cancer is the leading cause of cancer death among women between the ages of 30 and 49. In 2002, breast cancer accounted for 28% of all cancer deaths of women between the ages of 40 and 49 and 26% of those among women aged 30 to 39, whereas lung cancer was the leading cause of cancer deaths among women over the age of 50. Indeed, lung cancer accounted for over one in four of all cancer deaths among women in age groups between the ages of 50 and 79 in 2002 and 16% of those among women aged 80 and over. (Chart 3.5)

Chart 3.5 Percentage of cancer deaths of women from lung and breast cancer,1 by age, 2002

Incidence of cancer rising

Recent differences in the growth of the overall cancer death rate among women and men reflect, at least in part, the fact that there have also been gender differences in the number of new cancer cases in the past decade.⁵ The number of cases of cancer detected for every 100,000 females in 2004 was 3% higher than in 1994, once the impact of changes in the age structure of the population has been accounted for. In contrast, the incidence of new cases of cancer among men declined by 8% in the same period. (Chart 3.6)

Chart 3.6 Age-standardized incidence rates of all cancers for women and men, 1976 to 2004

The incidence of new cases of cancer, though, is still lower among women than men. In 2004, there were 351 new cases of cancer detected for every 100,000 females, 28% less than the figure among men, once the impact of differences in the age structures of the female and male populations was accounted for.

While lung cancer currently accounts for more deaths among women than breast cancer, breast cancer accounts for the largest share of new cases of cancer among women. There were 106 new cases of breast cancer diagnosed for every 100,000 women in 2004, more than twice the number of new cases of lung cancer (48) diagnosed for every 100,000 women. Indeed, newly diagnosed cases of breast cancer accounted for 30% of all new cancer cases diagnosed among women that year. (Chart 3.7)

Chart 3.7 Age-standardized incidence rates for selected cancers for women and men, 1976 to 2004

The number of new cases of lung cancer being diagnosed among women, though, is growing faster than other leading types of cancer. Indeed, the age-standardized incidence rate of new cases of lung cancer among women was 22% higher in 2004 than in 1994, compared with a growth rate of 7% for new cases of breast cancer, while the incidence of new cases of colorectal cancer declined slightly in the same period.

As well, the number of new cases of lung cancer continues to rise among women, while it has declined in the male population. Between 1994 and 2004 the age-standardized incidence of new cases of lung cancer was 22% higher among women, while the figure declined 17% among men. Still, there were 33% fewer cases of lung cancer per 100,000 population, 48 versus 72, diagnosed among women than men in 2004.

The current rate of growth in the number of new cases of lung cancer among women, though, is somewhat slower than in previous decades. Between 1994 and 2004, the age-standardized incidence rate of new cases of lung cancer among women rose 22%, whereas the figure had almost doubled in the decade beginning in 1976, while it rose 32% in the ten-year period starting in 1985.

Smoking rates down

It has been speculated that the increase in lung cancer deaths among women is a reflection of the fact that many women started smoking in the era after the Second World War and the effects of this trend are now showing up in mortality data. In 2003, 21% of all women aged 12 and over were current smokers, that is, they smoked on either a daily basis or on occasion. That year, 16% of the female population smoked daily, while another 5% smoked occasionally. At the same time, 36% of women were former smokers, while 43% had never smoked. (Table 3.6)

Table 3.6 Smoking status, by age, 2003

There has, however, been a sharp decline in the number of smokers in the Canadian population over the past three decades as the dangers of this practice have become more widely known. In 2003, 21% of all women aged 15 and over were current smokers, down from 30% in 1991 and 38% in 1970. The prevalence of smoking has decreased even more sharply among men, dropping from 55% in 1970 to 25% in 2003. Men, though, are still somewhat more likely than women to be current smokers. (Chart 3.8)

Chart 3.8 Percentage of women and men aged 15 and over who were current smokers, 1970 to 2003

Among women, young adults are the most likely to smoke cigarettes. In 2003, 31% of women aged 20 to 24 were either daily or occasional smokers, as were 24% of those between the ages of 25 and 34 and 22% of female teenagers aged 15 to 19. In contrast, 18% of women aged 55 to 64, along with only 13% of those aged 65 to 74 and just 7% of those aged 75 and over, smoked either daily or occasionally. (Table 3.6)

The overall smoking rate among women could decrease even further in the future as there has been a sharp decline in smoking rates among young adults. Among women aged 20 to 24 in 2003, for example, 31% were either daily or occasional smokers, down from 36% in 1999. (Chart 3.9)

Chart 3.9 Percentage of women aged 15 to 24 who smoke daily or occasionally, 1970 to 2003

There has been an even steeper decline in the incidence of smoking among teenaged females in recent years. In 2003, 22% of females aged 15 to 19 were current smokers, down from 32% in 1999. In fact, the current drop in smoking rates among women in this age range reversed a worrisome trend in the 1990s when the percentage of 15 to 19- year-old females who smoked had risen from just over 20% in 1990 to 32% in 1999.

Breast cancer screening

Mammography is an important preventive practice for the early detection of breast cancer. At present, guidelines from the Canadian Task Force on Preventive Health Care recommend that women aged 50 to 69 undergo a mammogram once every two years, as there is strong evidence that early detection of breast cancer among women in this age group reduces the risk of death from this disease. In fact, there has been a substantial increase among women in this age range having mammograms. In 2003, over 70% of women in both the 50 to 59 and 60 to 69 age groups had received a mammogram within the past two years. These figures were up from just 65% for women aged 50 to 59 and only 57% for those aged 60 to 69 as recently as 1996. (Chart 3.10)

Chart 3.10 Percentage of women aged 50 to 69 who had a mammogram within the past two years, 1996, 2000 and 2003

Cervical cancer screening

It is also currently recommended that sexually active women up to age 70 receive a Pap smear test once every three years to detect cervical cancer. In fact, most women in Canada had received this test within these guidelines. In 2003, almost three out of four women between the ages of 18 and 69 had had a Pap smear test within three years. In fact, just over half of women in this age range had been screened for cervical cancer within the last year, while another quarter had received their most recent Pap smear within the previous three years. Still, over one in 10 women reported that they had not received a Pap smear in the past three years and 14% had never been screened. (Table 3.7)

Table 3.7 Percentage of women aged 18 to 69 receiving a Pap smear test, by age and timing of the most recent test, 2003

Sexually transmitted infections

Sexually transmitted infections are another serious health problem which does not affect women and men in the same way, largely as a result of differences in the symptoms and course of these infections.⁶ In particular, women are far more likely than men to suffer long-term health consequences as a result of sexually transmitted infections. For example, sexually transmitted infections in women can lead to pelvic inflammatory disease, which can seriously affect reproductive health; these infections may also cause scarring of the fallopian tubes and an increased risk of ectopic pregnancy or tubal infertility. It is also important to note that the data on sexually transmitted infections probably understate the actual incidence of these conditions, since in many cases the infections are asymptomatic, especially in women. As such, infected persons may not seek treatment with the result that the condition is not diagnosed.

The issue of sexually transmitted infections is also of growing concern because young women are at a particularly high risk of contracting some types of sexually transmitted infections. This is because many young women reportedly engage in risky sexual behaviour, including having unprotected sexual relations with different partners. In fact, the incidence of sexually transmitted infections is generally higher among young women than their older counterparts. In 2002, there were almost 1,400 cases of chlamydia diagnosed for every 100,000 women in both the 15 to 19 and 20 to 24 age ranges, compared with rates of just over 500 cases per 100,000 women aged 25 to 29, 137 for women aged 30 to 39 and very small numbers in older age ranges. (Table 3.8)

Table 3.8 Rates for reported sexually transmitted infections, by age, 1991 and 2002

There was a similar pattern for gonorrhea, although females aged 15 to 19 were somewhat more likely to be diagnosed with this infection than their counterparts aged 20 to 24. On the other hand, women aged 25 to 29 were more likely than women in other age groups to be diagnosed with syphilis. Rates for syphilis, though, were very low in all age ranges.

Perhaps because of women’s more frequent contact with health professionals during their reproductive years, they are generally more likely than men to be diagnosed with sexually transmitted infections. For example, 15 to 19-year-old women were more than five times more likely than men in this age range to be diagnosed with chlamydia in 2002, while they were more than twice as likely to have been diagnosed with gonorrhea. Women aged 20 to 24 were also more than twice as likely as their male counterparts to contract a chlamydia infection. However, women in this age range were somewhat less likely than men to be diagnosed with gonorrhea. Indeed, men were considerably more likely than women to contract gonorrhea in age groups over the age of 25, whereas women between the ages of 25 and 39 were more likely than their male counterparts to get a chlamydia infection.

The incidence of chlamydia infections among women has risen somewhat over the last decade. In 2002, there were 244 cases of this type of infection for every 100,000 women aged 15 and over, up 28% from 1991. In contrast, the incidence of gonorrhea among women is currently less than half the rate in the early 1990s. In 2002, there were 17 gonococcal infections for every 100,000 women aged 15 and over, compared with a rate of 38 in 1991. At the same time, there has been little change in the incidence rate of syphilis among women in the past decade.

Acquired Immune Deficiency Syndrome and HIV infections

Each year a small number of females in Canada are diagnosed with AIDS. As of June 2004, over 1,600 women aged 15 and over had been diagnosed with AIDS, representing approximately 9% of all AIDS cases reported in Canada. (Table 3.9)

Table 3.9 Number of reported AIDS cases among women and men, by year of diagnosis, 1979 to 2004

The number of women diagnosed with AIDS, though, has fallen in the past decade. In the early part of the 2000s, 50 to 60 women aged 15 and over were being diagnosed with this disease each year, whereas the figure had been well over 100 in the late 1990s. There has been an even more dramatic decline in the number of men diagnosed with AIDS, although men continue to make up the large majority of those diagnosed with AIDS.

Because the time between infection with the human immunodeficiency virus (HIV) and the subsequent development of AIDS can be 10 years or more, AIDS case statistics do not provide a complete picture of the present-day problem, that is, the number of women with HIV who have the potential to develop AIDS. As of June 2004, 8,400 females had tested positive for HIV. Overall, females accounted for 16% of all those who have tested positive for HIV. (Table 3.10)

Table 3.10 Positive HIV test reports among women and men between 1985 and 2004, by age at the time of diagnosis

The large majority of women testing positive for HIV are between the ages of 20 and 39. As of June 2004, 35% of all females with HIV were aged 30 to 39 at the time of diagnosis, while 32% were aged 20 to 29. Another 14% were aged 40 to 49, while smaller percentages were aged either 50 or over or 20 and under.

Contact with health care professionals

Almost all women visit at least one health care professional over the course of a year. In 2003, 86% of females aged 12 and over had contacted a medical doctor, including a family doctor or general practitioner or specialist, at least once, while 66% had been to the dentist. (Table 3.11)

Table 3.11 Percentage of females and males who consulted with a medical doctor or dentist in the past 12 months, by type of professional, 2003

In fact, women are more likely than men to consult a health care provider. In 2003, 86% of females aged 12 and over, versus 74% of their male counterparts, consulted with a medical doctor, while 66% of females, compared with 61% of males, went to the dentist.

Women aged 65 and over are slightly more likely than younger women to contact a medical doctor, although close to 90% of women in all age groups over the age of 20 saw a doctor at least once a year in 2003. At the same time, 80% of 15-to-19-year-old females saw a doctor at least once that year, while the figure was just 69% for girls aged 12 to 14. In contrast, less than half of senior women saw a dentist at least once that year, whereas in younger age groups the proportion seeing a dentist ranged from 86% of 12 to 14-year-olds to 60% of those aged 55 to 64.

Hospitalizations

Hospitalization rates tend to be higher for the female population than for the male population⁶. In 2002-2003, there were over 10,000 hospital separations⁷ for every 100,000 women of all ages, compared with just under 7,500 for every 100,000 men. (Table 3.12)

Table 3.12 Separation rates for females and males for acute-care hospitals, by age, 2002-03

Most of the difference in hospital separation rates for women and men, though, is accounted for by the large number of female hospitalizations for reasons related to childbirth. Indeed, childbirth, complications of pregnancy, and puerperium⁸ are the leading causes of hospitalization among women. This difference is also reflected in the relatively large number of hospital visits made by women between the ages of 20 and 34. In 2002- 2003, the hospital separation rate for women aged 25 to 34 was five times that of their male counterparts, while women aged 20 to 24 were almost four times more likely to be hospitalized than men in this age range. Among the female population, seniors have the highest rates of hospitalization. In 2002-2003, there were almost 31,000 hospital separations for every 100,000 women aged 75 and over, and more than 16,000 for women aged 65 to 74. In contrast, the figure was less than 8,000 for women between the ages of 35 and 64.

Senior women, though, are less likely to be hospitalized than their male counterparts. Among those aged 75 and over, for example, there were 31,000 hospital separations for every 100,000 women in 2002-2003, compared with almost 39,000 for men. Similarly, among those aged 65 to 74, the hospital separation rates were 16,400 for women, versus 21,300 for men. Women aged 45 to 64 were also somewhat less likely than their male counterparts to be hospitalized, as were females under the age of 15, whereas the opposite was the case among those in age groups between the ages of 15 and 34.

While senior women are less likely than their male counterparts to be hospitalized, they tend to remain in hospital for somewhat longer periods. In 2002-2003, the average length of stay in hospital for females aged 75 and over, for example, was 13 days, versus 11 for men in this age range. On the other hand, women under the age of 65 tend to remain in hospital for shorter periods than men of the same age.

Hospitalization for reasons of mental health

Women are also more likely than men to be hospitalized because of mental disorders. In 2002-2003, there were 626 separations for mental disorders in psychiatric and general hospitals for every 100,000 women of all ages, compared with 583 for men. (Table 3.13)

Table 3.13 Hospital separations for mental health reasons, by age, 2002-03

Women in the very oldest age groups are more likely than their younger counterparts to be hospitalized for mental health reasons. In 2002-2003, there were just under 1,200 hospital separations for mental disorders for every 100,000 women aged 75 and over, a figure that was almost 50% higher than the next highest rate of just over 800 hospital separations for mental health reasons among women aged 35 to 44. The hospitalization rate for senior women for mental health reasons, though, was almost the same as that for their male counterparts.

As well, women tend to be hospitalized for different mental illnesses than men. In 2002-2003, women were much more likely than men to be hospitalized as a result of affective psychoses, such as bi-polar disorder, neurotic and personality disorders, and senile and pre-senile organic conditions. In contrast, women were considerably less likely than men to be hospitalized for schizophrenic psychoses or for alcohol psychoses. (Chart 3.11)

Chart 3.11 Number of hospital separations for mental health disorders, by cause, 2002 to 2003

Mental health

In fact, according to the Canadian Community Health Survey on Mental Health and Well-being conducted in 2002, women of all age groups, and particularly young women aged 15 to 24, are more likely than men to perceive their mental health as fair or poor. Women also suffer a higher incidence of panic disorder, agoraphobia, social anxiety disorder, and eating disorders. Research shows that higher rates of abuse, particularly sexual abuse, among girls and women are a contributing factor to many of these mental illnesses.

It should also be noted that specific populations of women in Canada may be particularly vulnerable to certain mental illnesses. For example, new immigrant and refugee women are likely to experience stress due to relocation, isolation and economic circumstances, all of which can increase the post-traumatic stress they may already be experiencing upon arrival. Aboriginal women and lone-parent mothers are likely also especially vulnerable to life stresses.

While most women cope with life’s challenges, a small, but substantial share of the female population experience mood disorders. In 2003, 7% of the female population aged 12 and over reported having a diagnosed mood disorder. This, in fact, was almost twice the rate for men, just 4% of whom had a mood disorder that year. (Chart 3.12)

Chart 3.12 Percentage of women and men with a diagnosed mood disorder, by age, 2003

Those between the ages of 35 and 64 are the most likely women to report experiencing a mood disorder. In 2003, 8% of women in this age range reported being diagnosed with a mood disorder, while the figure was 7% among those aged 20 to 34, and 6% for those aged 18 or 19. In contrast, the prevalence of mood disorders was 5% or less among senior women and younger female teenagers. As well, with the exception of seniors aged 75 and over, women were considerably more likely than their male counterparts to report experiencing a mood disorder in all age ranges.

While there are no national statistics in Canada linking the concepts, it is very likely that the relatively high rates of mood disorders experienced by women between the ages of 35 and 64 is related to the fact that women in this age range have many conflicting roles. As reported in the chapter on the work experiences of women, more and more women, and especially those with children, are participating in the paid work force. However, even when employed full-time, women are still largely responsible for the care of their children and families. At the same time, many women in this age range find themselves part of the “sandwich generation” in that they are not only looking after their own children and families, but are also responsible for the care of their elderly parents.

Suicide

While women generally are more likely than men to experience episodes of clinical depression and to be hospitalized for attempted suicide, they are far less likely than men to take their own lives. Indeed, in 2002, there were 5 suicides for every 100,000 women, compared with 18 per 100,000 men. (Chart 3.13)

Chart 3.13 Suicide rates of women and men, by age, 2002

Among the female population, those between the ages of 30 and 60 are the most likely to take their own lives. In 2002, there were 8 suicides for every 100,000 women aged 50 to 59 and 7 per 100,000 population aged 30 to 39 and 40 to 49. This compared with rates of 5 suicides per 100,000 females in both the 20 to 29 and 60 to 69 age groups, 3 per 100,000 population among seniors aged 70 and over, and just 2 among those under the age of 20. Again, though, women in all age groups are considerably less likely than their male counterparts to take their own lives. It is important to note, however, that the overall suicide rate among women masks the fact that the incidence of suicide among specific groups of women may be much higher than the national rate.

Alternative health care usage

A growing proportion of the female population use alternative health care services such as massage therapy, acupuncture or homeopaths or naturopaths. In 2003, 17% of women aged 15 and over had used some of alternative health care service. In fact, women are considerably more likely to use such services than their male counterparts; that year, just 9% of males aged 15 and over had consulted with an alternative health care service provider. It should be noted, though, that these data only address use of alternative practitioners and not the use of natural health products. (Table 3.14)

Table 3.14 Proportion of women and men using alternative health care, by age, 2003

Those between the ages of 25 and 54 are the most likely women to use an alternative health care service. In fact, in 2003, over 20% of women in age groups between the ages of 25 and 54 consulted with an alternative health care practitioner. In contrast, 10% or less of senior women, as well as those aged 15 to 19, used such health services. In all age ranges, though, women were considerably more likely than their male counterparts to use the services of an alternative health care practitioner.

Women’s unique physiology and transitions across the life span including their reproductive health and menopause, as well as the greater prevalence of chronic conditions among women than men, are among the factors contributing to greater use of alternative health care practitioners for prevention of illness and treatment of health conditions.

Induced abortions

The number of induced abortions performed in Canada has remained relatively stable over the past decade.⁹ In 2002, there were 105,000 abortions performed in either hospitals or clinics on Canadian women. This is up slightly from the early 1990s, but is down somewhat from the peak years in 1996 and 1997 when there were over 110,000 abortions were performed in Canada. (Table 3.15)

Table 3.15 Induced abortions, 1975 to 2002

Fewer abortions, though, are being performed in hospitals, while more are taking place in clinics. In 2003, 58,000 abortions were performed in Canadian hospitals, whereas there were over 70,000 hospital abortions performed annually each year between 1989 and 1997, with a peak figure of just under 75,000 recorded in 1996. In contrast, the number of abortions performed in clinics has risen from just over 30,000 in the early 1990s to 47,000 in 2003.

While this change has occurred, there has been little change in the overall abortion rate in Canada in the past decade. There were, for example, 15 abortions performed in either hospitals or clinics for every 1,000 women between the ages of 15 and 44, a figure which has been relatively consistent through the 1990s. Similarly, there has been no change in the number of abortions expressed as a percentage of all live births in Canada in recent years.

Women between the ages of 18 and 24 are more likely than women in other age groups to have induced abortions. In 2003, there were 30 abortions performed for every 1,000 women aged either 18 or 19 or 20 to 24, compared with 22 for women aged 25 to 29, 14 for those aged 30 to 34, and 10 or less among other age groups. (Table 3.16)

Table 3.16 Induced abortion rates, by age, 1974 to 2002

Alcohol consumption

The consumption of alcohol is another lifestyle activity that can have an impact on health. In 2003, 51% of all females aged 12 and over reported they were regular drinkers, that is, they consumed an alcoholic beverage at least once a month. At the same time, 22% of women were occasional drinkers, while 14% were former drinkers and 13% were lifetime abstainers. (Table 3.17)

Table 3.17 Percentage of women and men who consume alcohol, by age and type of drinker, 2003

Women, though, are less likely than men to be current drinkers. In 2003, 51% of females aged 12 and over reported they drank an alcoholic beverage at least once a month, compared with 69% of their male counterparts.

Young women are generally more likely to drink than seniors or women approaching their retirement years. In 2003, close to 60% of women in both the 35 to 44 and 45 to 54 age groups were regular drinkers, as were 57% of women aged 25 to 34 and 55% of those aged 15 to 24. In contrast, this was the case for just 42% of those aged 65 to 74 and only 33% of those aged 75 and over. At all ages, though, women were considerably less likely than men to be current drinkers.

Women are also less likely than men in all age ranges to be heavy drinkers. In 2003, 12% of females aged 12 and over who were current drinker, versus 29% of their male counterparts, reported they had had five or more drinks at one sitting at least once a month. As with males, those under age 35 were the most likely women to be considered to be heavy drinkers. In 2003, 20% of current drinkers among females in both the 12 to 19 and 20 to 34 age groups qualified as being heavy drinkers, compared with 11% of those aged 35 to 44, 7% of those aged 45 to 64 and just 2% of seniors. (Chart 3.14)

Chart 3.14 Percentage of women and men who are heavy drinkers, by age, 2003

Leisure-time physical activity

Less than half of the female population in Canada is physically active during their leisure time. In 2003, 23% of females aged 12 and over were considered physically active and 25% were moderately active, while 51% were physically inactive. As well, women tend to be less active than men. That year, 49% of females aged 12 and over reported they were either very or moderately active during their leisure time, compared with 55% of their male counterparts. (Table 3.18)

Table 3.18 Percentage of females and males participating in leisure-time physical activity, by age and level of activity, 2003

Women in younger age groups tend to be more physically active than older women. In 2003, for example, 29% of women aged 20 to 24 were very active during their leisure time, as were 20% or more of those between the ages of 25 and 64. In contrast, this was the case for just 17% of women aged 65 to 74 and only 10% of those aged 75 and over. The most active females, though, were those under the age of 20. That year, 46% of girls aged 12 to 14, and 37% of those aged 15 to 19, were very active in their leisure time. At all ages, though, women tend to be less active than men.

Females less likely to be overweight

A growing concern among health officials in Canada is the fact that a substantial proportion of the population is overweight.¹⁰ In fact, in 2003, 39% of all females aged 18 and over were considered to be either overweight or obese. That year, 26% were overweight, while 14% were considered to be obese. There has, however, been little change in the share of the female population considered to be either overweight or obese since 1994-1995. (Chart 3.15)

Chart 3.15 Percentage of women and men aged 18 and over overweight or obese, 1994-95 and 2003

As well, females are generally less likely than their male counterparts to be overweight. In 2003, 39% of the female population aged 18 and over were considered to be either overweight or obese, whereas this was the case for 57% of males. Most of this difference, though, is accounted for by those considered to be overweight rather than obese. Indeed, that year, similar percentages of females (14%) and males (16%) were considered to be obese.

---

Notes

1. Note that the data in this and subsequent sections refer only to those living at home and do not include those living in an institution. Given that those living in an institution generally have more health problems than those living at home, these data tend to underestimate the totality of health problems among the female population.
2. More information on the health status of senior women is included in Chapter 11 on Senior Women.
3. More information on the health status of women with disabilities is included in Chapter 12 on Women with Disabilities.
4. Refers to the number of deaths per 100,000 population that would have been observed if the actual age-specific rates for a particular year had prevailed in the 1991 population. The process of age-standardization permits comparisons between years, since it accounts for changes that have occurred over time in the age distribution of the population.
5. It is important to note when considering the diagnosis of new cases of cancer, that increases may reflect as much improved methods of detection as actual increases in the incidence of the disease.
6. Data on sexually transmitted infections are considered to underestimate the actual incidence of these infections since they are asymptomatic, especially in women. As a result, people may not seek treatment and the disease is not diagnosed.
7. Hospital separations refer to the discharge or death of an inpatient. These statistics, however, do not reflect the experience of individual patients, since repeat hospitalizations may occur.
8. Includes spontaneous abortion; legally induced abortion; other abortion; other pregnancy with abortive outcome; normal delivery; hemorrhage of pregnancy; other complications related to pregnancy; indication for care in pregnancy, labour and delivery; complications occurring in labour and delivery, and complication of the puerperium.
9. Between 1969 and 1988, Canadian law held that abortion was a criminal act, except when approved by the committee of an accredited or approved hospital which felt that the life or the health of the women was in danger. In 1988, the Supreme Court of Canada removed the existing abortion legislation from the Criminal Code. As a result, induced abortions are currently a health service governed by the Canada Health Act.
10. A person is considered to be overweight if their body mass index is between 25 and 30; they are considered to be obese when their body mass index is over 30. Body mass index is measured by dividing a person’s weight by their height squared.