Compared to men, women experience a greater variety of acute physical and mental changes during different life stages. For this reason, many countries have created comprehensive frameworks to support women’s health and active social participation, and health policies anchored in an awareness of gender differences that make the case for the promotion of women’s health and gender equality. Below, we compared the situation in Japan to precedents from the United States and Europe.
The fact that the promotion of women’s health contributes to the economy has now been scientifically established. It is hence necessary to formulate health policies that aim for a society where women enjoy good health irrespective of their life stage.3 “Women’s health” was a pillar of the New Health Frontier Strategy announced by the Government of Japan in April 2007. In March 2008, the Ministry of Health, Labour and Welfare (MHLW) designated the first week of March as “Women’s Health Week,” to be observed yearly. During this week, regional municipalities are encouraged to undertake various projects to support women’s health, centering on awareness-raising efforts. The decision by MHLW to create this week was part of a comprehensive set of initiatives aimed at supporting women to achieve good health, become self-reliant, and enjoy bright and fulfilling lives.4 In 2009, 3.5 billion yen was allocated to commission projects that benefit women’s health, such as projects for preventing osteoporosis and uterine cancer. Prefectural and city governments were entrusted with the implementation of these projects, and were urged to research effective project development and verification methods. Such activities are assumed to have promoted disease-based health policymaking.5
On the other hand, since the psychological and physical conditions of women change greatly depending on their life stage, there has also been active discussion on the shortcomings of disease-based measures and the importance of providing comprehensive support to women’s health throughout their lifetime. Based on these discussions, the “Bill on Comprehensive Support for Women’s Health” was submitted to the Diet in 2014. As of August 2017, the bill has not yet been passed.6,7 The passage of this bill is expected to help spread awareness of issues related to gender differences, ageing, and life stages. The law is also expected to stimulate research and countermeasures related to female-specific diseases, the large of number of women suffering dementia and osteoporosis, and the difficulties that many women face from their employers when they marry or become pregnant.
“Bill on Comprehensive Support to Women’s Health” (Liberal Democratic Party’s Website) http://www.shugiin.go.jp/internet/itdb_gian.nsf/html/gian/honbun/houan/g18602027.htm
In the U.S, comprehensive support initiatives for women’s health started a long time ago. In 1991, the Office on Women’s Health was established as a government agency with the mission of promoting comprehensive support for women’s health. Among other activities, the Office keeps statistics on increases in women’s life expectancy, improvements in breast cancer screening rates, and female participation in clinical studies.8 The Office’s activities center on research, prevention, the provision of healthcare, training of health personnel, and supporting the careers of women in the health and science fields. Based on these activities, the Office provides support to policies and campaigns dealing with different life-stages, trauma care, HIV/AIDS, violence, and health disparities.8
In 2010, the Obama Administration passed the Patient Protection and Affordable Care Act (ACA). This Act greatly improved women’s access to healthcare, and reduced out-of-pocket expenditures by extending health insurance coverage. For example, insurance coverage requirements widened to cover preventative measures against diseases generally affecting women, particularly complete psychological and physical care for issues affecting pregnancy such as the prevention of all types of STDs, medical examinations for anemia, smoking and domestic violence related issues, and counseling for contraception.9
The effects of the ACA and state legislature were alluded to in a planning report titled “Improving Women’s Health: Health Challenges, Access, and Prevention.” This led to further awareness-raising about issues of health and to policy and policy changes. For example, based on the line of thinking that “Promoting good health among women not only contributes to the wellbeing of women, but also to the wellbeing of their families, and eventually , to the wellbeing of state and national finances,” many states have launched health programs targeting women, including initiatives on early case detection and diagnoses of dementia, the administration of HPV vaccines to adolescent girls, and awareness-raising campaigns on the prevention of non-communicable diseases.10
“Respect for basic and human rights” is one of the fundamental principles upon which the European Union (EU) was established. This principle was behind the creation of the Lisbon Treaty, which came into effect in 2009. This treaty granted legally binding powers to the EU Charter of Fundamental Rights and set out requirements for the prevention of gender discrimination and for gender equality in all sectors.11 That said, since the EU has not developed region-wide policies on health and education systems, variations exist in these sectors among member states at the present time. The EU, however, has previously stated that health differentials between men and women must be considered when creating policies. What’s more, EU-related organizations are active in research on women’s health, and the health disparities that exist between men and women. A report of the European Institute for Gender Equality (EIGE) entitled “Data and Information on Women’s Health in the European Union” laid out the main social and biological determinants of health disparities between men and women.12,13
In response to this report, in 2006 the Council of the European Union declared that it is imperative to reduce gender-related health disparities. In 2010, the Council called for the creation of policies and action plans on the optimization and collation of data and knowledge related to the reduction of health inequities. The Council also called for further efforts to secure healthcare access for all – including children, youth, and pregnant women – and to implement preventative measures that gave due consideration to the social determinants of health.14 In 2011, the European Parliament approved a bill that emphasized the extent to which gender inequities and economic reasons contribute to disparities in access to healthcare.
The Council of the European Union report entitled “The Report on Sexual and Reproductive Health and Rights” highlighted existing best practices in member states and pressed for further awareness-raising activities. For example, under “The Equality Act 2006,” all public institutions in the United Kingdom are to introduce the “Gender Equality Duty.” The Duty urges medical institutions to provide services fairly regardless of the recipient’s identity or nation and region, and to ensure that health outcomes do not differ between men and women15.