Women, Ageing and Health:
A Framework for Action
WOMEN, AGEING AND HEALTH: A FRAMEWORK FOR ACTION
Ageing and Life Course; Department of Gender,
Women and Health
United Nations Population Fund (UNFPA)
Population and Development Branch
Focus on Gender
PAGE 2
This report summarizes the evidence about women, ageing and health from a gender
perspective and provides a framework for developing action plans to improve the
health and well-being of ageing women. It serves as a complement to a longer publica-
tion entitled Women, Ageing and Health: A Review. Focus on Gender.
This publication was developed by WHO’s Ageing and Life Course Programme under
the direction of Dr. Alexandre Kalache and Irene Hoskins, with the support of the
Population and Development Branch of the United Nations Population Fund (UNFPA)
and in collaboration with the Department of Gender, Women and Health of the World
Health Organization (WHO). It was drafted by Peggy Edwards, a health promotion
consultant from Ottawa Canada.
Suggested Citation: WHO, Women, Ageing and Health: A Framework for Action. Focus
on Gender. Geneva, WHO, 2007, ISBN ….
© Copyright World Health Organization, 2007
This document is not a formal publication of the World Health Organization, and the
WHO reserves all rights. The paper may be freely reviewed, abstracted, reproduced
and translated, in part or in whole, but not for sale nor for use in conjunction with
commercial purposes.
Design: Langfeldesigns.com Marilyn Langfeld/Art Director, Adina Murch/Design,
© Ann Feild/Didyk Illustration
PAGE i
WOMEN, AGEING AND HEALTH: A FRAMEWORK FOR ACTION
Contents

9. Physical Environment 39
Key Points 39
Implications for Policy, Practice and Research 41
10. Moving Ahead 43
Taking Action 43
Pillar 1: Health and Health Care 43
Pillar 2: Participation 44
Pillar 3: Security 45
Building a Research Agenda 46
References 49
PAGE iI
Taking Action for Older Women and Men
As they age, women and men share the basic needs and concerns related to the
enjoyment of human rights such as shelter, food, access to health services, dig-
nity, independence and freedom from abuse. The evidence shows however, that
when judged in terms of the likelihood of being poor, vulnerable and lacking in
access to affordable health care, older women merit special attention. While this
publication focuses on the vulnerabilities and strengths of women at older ages,
it is often difficult and sometimes undesirable to formulate recommendations
that apply exclusively to women. Clearly many of the suggestions for action in this
report apply to older men as well.
PAGE 1
WOMEN, AGEING AND HEALTH: A FRAMEWORK FOR ACTION
1. Introduction
“Gender is a ‘lens’ through which to consider
the appropriateness of various policy options
and how they will affect the well being of
both women and men.”
… Active Ageing: A Policy Framework
1

1
is requires a comprehensive
approach that takes into account the gen-
dered nature of the life course.
is report endeavors to provide informa-
tion on ageing women in both developing
and developed countries; however, data is
often scant in many areas of the developing
world. Some implications and directions for
policy and practice based on the evidence
and known best practices are included in
this report. ese are intended to stimulate
discussion and lead to specific recommenda-
tions and action plans. e report provides
an overall framework for taking action that
is useful in all settings (Chapter 2). Specific
responses in policy, practice and research
is undoubtedly best left to policy-makers,
experts and older people in individual coun-
tries and regions, since they best understand
the political, economic and social context
within which decisions must be made.
is publication and the complementary
longer Review are designed to contribute
to the global review of progress since the
Fourth World Conference on Women
(Beijing, 1995),
2
the Madrid International
Plan of Action on Ageing (2002),


Older women refers to women age 50 and
older. Ageing women refers to the same
chronological group but emphasizes that
ageing is a process that occurs at very dif-
ferent rates among various individuals and
groups. Privileged women may remain free
of the health concerns that often accom-
pany ageing until well into their 70s and
80s. Others who endure a lifetime of pov-
erty, malnutrition and heavy labour may
be chronologically young but functionally
“old” at age 40. Decision-makers need to
consider the contextual differences in how
the process of ageing is experienced in their
specific environment, when designing gen-
der-responsive policies and programmes for
ageing women.
Ageing is also both a biological and social
construct. Physiological changes such as a
reduction in bone density and visual acuity
are a normal part of the ageing process. At
the same time, socioeconomic factors such
as living arrangements, income and access
to health care greatly affect how individuals
and populations experience ageing.
Ageing may also constitute a continuum
of independence, dependence and inter
-
dependence

).
PAGE 3
WOMEN, AGEING AND HEALTH: A FRAMEWORK FOR ACTION
A Global Profile of Ageing Women
For multiple reasons the feminization of
ageing has important policy implications
for all countries:
• Ageing women make up a significant
proportion of the world's population
and their numbers are growing. e
number of women age 60 and over will
increase from about 336 million in 2000
to just over 1 billion in 2050. Women
outnumber men in older age groups
and this imbalance increases with age.
Worldwide, there are some 123 women
for every 100 men aged 60 and over.
6
• While the highest proportions of older
women are in developed countries, the
majority live in developing countries,
where population ageing is occurring at
a rapid pace.
• e fastest growing group within ageing
women is the oldest-old (age 80-plus).
Worldwide, by age 80 and over, there
are 189 women for every 100 men. By
age 100 and over, the gap reaches 385
women for every 100 men.
6

on men and exclude women. Surveillance
data that include sex and age-disaggregated
data are also limited. For example, most in-
ternational studies on health issues – such
as violence and HIV/AIDS – fail to com-
pile statistics on people over the age of 50.
Lastly, there is a paucity of research on gen-
der differences in the social determinants
of health. A recent study mapping existing
research and knowledge gaps concerning
the situation of older women in Europe
found a lack of research related to women
aged 50 to 60 in particular.
7
While there
were numerous longitudinal studies on
ageing, these studies had little or no gender
analysis of the different impacts of health
conditions and the social determinants of
health on ageing women and men. In this
report, some key issues for dissemination of
research and information are described in
each chapter.
PAGE 4
2. A Framework for Action
is chapter describes a gender- and age-
responsive framework for action based on
the following components:
• A life-course approach
• A determinants of health approach

vantages and environmental threats that
directly affect the ageing process and often
predispose to disease in later life.
Growing evidence supports the concept of
critical periods of growth and development
in utero and during early infancy and child-
hood when environmental insults may have
lasting effects on disease risk in later life.
For example, evidence suggests that poor
growth in utero leads to a variety of chronic
disorders such as cardiovascular disease,
non-insulin dependent diabetes, and hy-
pertension.
9
Exposures in later life may still
influence disease risk in a simple additive
way but it is argued that fetal exposures
permanently alter anatomical structures
and a variety of metabolic systems.
10
is
means that girls who are born into societ-
ies that favour boys and deprive girls are
particularly likely to experience disease and
disability in later life.
PAGE 5
WOMEN, AGEING AND HEALTH: A FRAMEWORK FOR ACTION
Examples of life course events that increase women’s vulnerability to poor health
in older age
• Discrimination against the girl child leading to inequitable access to food and care

11
Even with multiple changes in policies
related to education and labour market
participation, gender-specified roles and
careers interrupted because of childbear-
ing and caregiving make it very difficult
for women to earn as much as men in their
respective lifetime. us, the prevention
and alleviation of poverty in older age calls
for a set of policies based on a new para-
digm that provides social safety nets at key
times in the female life course, and particu-
larly when women are unable to earn an
adequate wage in the open labour market.
is includes policies and practices that:
• support reproductive health and safe
motherhood programmes;
• support girls’ enrolment in school with
a special effort to enable their transition
from primary to secondary and to post-
secondary schooling;
PAGE 6
• enable equitable entry to the labour mar-
ket and to meaningful, protected work;
• provide incentives for “family friendly
policies” in the workplace which support
pregnancy, breast feeding, and caring for
children and older family members;
• support caregivers of family members
who are ill or frail, and ease the financial

encing health. e social, political, cultural,
and physical conditions under which people
live and grow older are equally important
influences.
12

Active ageing depends on a variety of
“determinants” that surround individuals,
families and nations. ese factors directly
or indirectly affect well-being, the onset
and progression of disease and how people
cope with illness and disability. e deter-
minants of active ageing are interconnected
in many ways and the interplay between
them is important. For example, women
who are poor (economic determinant) are
more likely to be exposed to inadequate
housing (physical determinant), societal
violence (social determinant) and to not eat
nutritious foods (behavioural determinant).
Figure 1 shows the major determinants of
active ageing. Gender and culture are cross-
cutting factors that affect all the others.
For example, gender- and culture-related
customs mean that men and women differ
significantly when it comes to risk-tak-
ing and health-care-seeking behaviours.
Culturally driven expectations affect how
women experience menopause in different
parts of the world. e gendered nature

(see Figure 2). e policy framework for ac-
tive ageing is guided by the United Nations
Principles for Older People: independence,
participation, care, self-fulfilment and dig-
nity. Actions are based on an understand-
ing of how the social, physical, personal and
economic determinants of active ageing in-
fluence the way that individuals and popu-
lations age. is framework aims to reduce
inequities in health by understanding the
gendered nature of the life course.
e priority areas for action described in
Chapter 10 of this report are grouped under
the three pillars.
Active Ageing is the process of optimizing
opportunities for health, participation and
security in order to enhance quality of life
as people age.
1
e Gender- and Age-Responsive
Lens
Under the Active Ageing Framework,
the overall goal is to improve the health
and quality of life of ageing women by
implementing gender-responsive policies,
programmes and practices that address
the rights, strengths and needs of ageing
women throughout the life course. ese
efforts need to take into account the special
situations of older women with disabilities,

understands ageing and cumulative
disadvantage as a process that spans the
entire lifespan and provides supportive
policies and activities at key transition
points in a woman’s life;
• encourage intergenerational solidarity
and respect between generations.
Gender analysis has become a common
policy tool in many settings. is report
proposes that policy-makers apply a dual
perspective to their decisions – one that
takes both gender and age into account
(Figure 3).
Figure 2. The three pillars of a policy framework for active ageing
Active Ageing
Participation Health Security
U
n
i
t
e
d
N
a
t
i
o
n
s
P

n
a
n
t
s
o
f
A
c
t
i
v
e
A
g
e
i
n
g
Source:
Active Ageing: A Policy Framework
, WHO, 2002
PAGE 9
WOMEN, AGEING AND HEALTH: A FRAMEWORK FOR ACTION
Some Questions to Ask
Taking gender, age and equity into
account
1. Does the policy/programme address
gender- and age-specific concerns?
2. Does the policy/programme take gen

women and men and encourage a “soci-
ety for all ages”?
Figure 3. Applying a gender- and age-responsive lens to decision-making
Participation Health Security
G
e
n
d
e
r
L
e
n
s
PAGE 10
Development and implementation
10. How have diverse groups of older wom
-
en and men contributed to the develop-
ment of the policy or programme?
11. How will the policy/programme be
implemented, monitored and evaluated
in an age- and gender-responsive way?
An example of how to combine the
gender-sensitive/age-friendly lens with
the Active Ageing pillars and determi-
nants is provided in the central pages of
this document. It is focused on Primary
Health Care services and can be used as
a tool to facilitate the identification of

women are immense — for example, a baby
girl born in France or Japan can expect to
live more than 40 years longer than a baby
girl born in sub-Saharan African coun-
tries. ere are also dramatic differences in
women’s life expectancy after age 60. For
example, a 60-year-old woman in Sierra
Leone can expect to live another 14 years
while a woman of the same age in Japan can
expect to live another 27 years. Mortality
patterns also differ within countries; for
example, in Australia, Canada and Mexico
women in indigenous communities have
poorer health and significantly lower
life expectancies than non-indigenous
women.
15, 16, 17
Life expectancy is closely
related to income and social status and
can vary among neighbourhoods. For
example, female life expectancy between
women living in London varies from 84.7
years in Kensington/Chelsea to 79 years
in Newham. e latter is situated in inner
London and is characterized by poor hous-
ing conditions, low levels of education and
employment, high crime rates and a higher
percentage of pensioners living in poverty.
18
Non-communicable diseases are the lead-

acknowledgement for their work, fewer op-
portunities in education and employment,
and greater risk of domestic violence.
21
e
risk of mental illness is also associated with
indicators of poverty, including low levels
of education, and in some studies with poor
housing and low-income.
22

While women do not experience more
mental illness than men, they are more
prone to certain types of disorders, including
depression and anxiety.
21
Women and men
are equally likely to develop Alzheimer’s
disease and other dementias in old age;
however, the prevalence is higher among
women because they live longer.
23
e
emotional, social and financial costs of
Alzheimer’s disease to families and societ-
ies are already massive and will continue to
increase.
23,24
Worldwide, older people have
a higher risk of completed suicide than any

malaria, tuberculosis and leprosy grows
increasingly severe with time and ageing.
For example, an individual who experi-
enced pulmonary tuberculosis early in life
may – even if successfully treated – sustain
residual ventilatory incapacity which can
be aggravated by the ageing process in later
years. In all countries, older people are at
high risk for contracting influenza and its
complications, including death.
PAGE 13
WOMEN, AGEING AND HEALTH: A FRAMEWORK FOR ACTION
Ageing women remain at risk for HIV/AIDS
and other sexually transmitted infections
(STIs). Like ageing men, women can remain
sexually active until the end of life, but they
may have fewer opportunities because most
outlive their partners. Many STIs are physi-
cally transmitted more efficiently at all ages
from males to females than from females
to males. e risk is increased by customs
such as older men engaging in extramarital
relationships, widow cleansing, polygamy
and wife inheritance, as well as by older
women’s roles as caregivers. Once infected,
women face a disproportionate burden of
sequelae from STIs, including AIDS result-
ing from HIV infection and cervical cancer
as a result of the transmission of the hu-
man papillomavirus (HPV).

(Hormone replacement therapy, which was widely used in high-income countries has
been shown not to prevent heart disease after menopause as was originally thought, but
rather is associated with an increased risk of stroke and heart disease among some ageing
women.
32,33
Women with heart disease tend to present with different symptoms than
men and are less likely to seek or to be provided with medical help and to be properly
diagnosed until late in the disease process. While improvements have been made, women
are less likely to have appropriate investigations and treatment, and are more likely to be
under-represented in research on heart disease.
34

The lifetime risk for breast cancer among women in most developed countries is about
one in ten. This risk increases with age – especially after age 50 – and only declines after
the age of 80. Lower fertility rates, increasing age of pregnancy and a decrease in the
number of years of breastfeeding all contribute to a predicted rise in breast cancer in
developing countries.
Cervical cancer, which kills an estimated 274,000 women every year, is the most com-
mon cancer in women and the leading cause of cancer deaths in developing countries.
Providing girls with a new vaccine to prevent infection from the human papillomavirus
(HPV), which causes cervical cancer, provides the possibility of eliminating the incidence
of cervical cancer in the future. Meanwhile, it is critical to provide existing cohorts of age-
ing women with pap smear screening or other low-cost prevention and screening technol-
ogies.
35
Use of these techniques can dramatically reduce mortality due to cervical cancer.
Osteoarthritis and osteoporosis are associated with chronic pain, limited quality of life
and disability. Between the ages of 60 and 90 years, the incidence of osteoarthritis rises
20-fold in women as compared to 10-fold in men.
36

mate goal is to prevent and manage chronic
diseases, thus postponing disability and
death and enabling ageing women and men
to maintain their positive contributions to
society. If this achievement is to be shared
equally by women and men, policies and
programmes must take both gender and
age into account.
Addressing inequities in diseases that affect
older women. Tackling inequities in coro-
nary heart disease requires the education
and training of health professionals about
sex and gender differences in the clinical
manifestations and progress of the disease,
the full inclusion of older women in cardiac
studies, earlier and more aggressive control
of risk factors, and appropriate access to
diagnosis and treatment.
34

In light of the high burden of breast
cancer, and predictions that the incidence
will increase world-wide, there remains
an urgent need for a better understanding
of its root causes, increased availability of
effective and affordable screening tools for
use with older women, the expansion of
effective treatment regimes and support for
breast cancer survivors.
Use of the new vaccine to prevent HPV

proving mental well-being among women
of all ages. Developing gender-sensitive
national policies, with budgets dedicated to
mental health and mental illness, needs to
become a priority in all countries. Evidence
suggests that practices and programmes
encouraging socialization and physical ac-
tivity can help ease depression,
37,38
and that
most mental health problems in later life
can be dealt with in age-friendly primary
health care services, and through commu-
nity services and interventions that support
families and caregivers.
39,40

Communicable diseases. Older women will
be major beneficiaries of efforts to control
and eliminate infectious diseases in set-
tings where communicable diseases are
common. WHO urges all Member States
to implement a national influenza vaccina-
tion policy and to implement strategies to
increase vaccination coverage of all people
at high risk, with the goal of attaining vac-
cination coverage of the older population of
at least 50% by 2006 and 75% by 2010.
41


Similarly, gen-
der-specific research into the causes and
management of dementia becomes increas-
ingly critical as life expectancies increase.
Because of the stigma attached to suicide in
many cultures, it is likely that the number
of suicides among older men and women
are undercounted. Many questions about
suicide in later life remain unanswered.
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