National Women's Health
Developing a Women's Health Policy for Australia - Setting the Scene
Outlines why the Government is developing a National Women's Health Policy, what the Government wants the policy to achieve, and gives an overview of health issues affecting women.
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- What is this paper about?
- Overview of Australian women's health
- Gender as a determinant of health
- Social Determinants of Health
- Aboriginal and Torres Strait Islander women
- Women from culturally and linguistically diverse backgrounds, including refugees
- Barriers to health care access
- Principles for the development of a National Women's Health Policy
- Want to know more and have your say?
Online ISBN: 1-74186-799-1
Publications Number: P3-477.
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The Australian Government has made a commitment to develop a National Women's Health Policy to ensure that the planning and delivery of health services better meet the needs of Australian women. This paper outlines why the Government is developing a National Women's Health Policy, what the Government wants the policy to achieve, and gives an overview of health issues affecting women.
What is this paper about?In 2007, the Australian Government made an election commitment to develop a National Women's Health Policy. The Policy will recognise gender as a basic determinant of health, which gives rise to different health outcomes and different needs for women and men.
In line with international developments and the Government's social inclusion agenda, the National Women's Health Policy will emphasise prevention, health inequalities in our society, and the social determinants of those health inequalities. The women's policy will address the needs of:
- Aboriginal and Torres Strait Islander women;
- women in rural and remote areas;
- women from culturally and linguistically diverse
- backgrounds, including refugees; and
- women from disadvantaged backgrounds.
Why do we need a new National Women's Health Policy?It has been almost 20 years since the last National Women's Health Policy was developed and it is time to revisit the issues and concerns of Australian women for today and the future.
Women are the majority of health consumers, the majority of health service providers and the majority of carers in the Australian community. Improving the health of all Australian women will improve the health of the whole community.
However, while the average life expectancy of Australian women continues to rise (83.3 years at birth1), significant health inequalities exist between different groups of Australian women. In addition, while Australian women have a higher life expectancy than men (78.5 years2), there are gender related differences in health outcomes.
Addressing these health inequalities will require new approaches to provide a basis for focussed and coordinated action. A detailed examination of mortality in Australia found that there is "considerable scope for reduction in inequalities, especially those between Aboriginal and Torres Strait Islander peoples and other Australians, between males and females, and between low and high socioeconomic groups".3
What does the Government want to see from the National Women's Health Policy?The Government wants to improve the health and wellbeing of all women in Australia, especially those with the highest risk of poor health. The Policy will adopt the World Health Organization's broad definition of health, "complete physical, mental and social wellbeing and not merely the absence of disease and infirmity".4
The Government also wants to encourage the health system to be more responsive to the needs of women and to actively promote participation of women in health decision making and management.
1 ABS 2006 Deaths, Australia, 2005. ABS cat. No. 3302.0. Canberra: ABS.
3 Ring, I.T. O'Brien, J.F. 2007. "Our hearts and minds—what would it take for Australia to become the healthiest country in the world?" Medical Journal of Australia 187(8):860-865.
4 WHO 1946. Constitution of the WHO, 45th ed. Supplement, October 2006.
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Overview of Australian women's healthLife expectancy for Australian women is increasing and now ranks equal second in the world.5 However, there are worrying levels of risk factors causing chronic illness, injury and premature death, including:
- overweight and obesity – nearly half of Australian women are overweight or obese, with younger women gaining weight at a much higher rate than previous generations; 6, 7
- physical inactivity – about one third of women do not exercise; 8
- poor diet – over consumption of high fat and sugar foods and inadequate intake of fruit
- (40% of women) and vegetables (80% of women); 9
- stress – compensation claims for workplace stress almost doubled between 1996 and 2004); 10 and
- smoking, alcohol consumption, unprotected sex, and self harm in young women. 11, 12, 13
The top five causes of death for Australian females are: 15
Ischaemic (coronary) heart disease – a form of cardiovascular disease;
Dementia and Alzheimer's disease;
Trachea and lung cancer;
Changes in the leading causes of death with increasing age reflect the ageing process and longer exposure to risk factors. For girls and young women, injury and poisoning are the major causes of death. Among women aged 25 to 64, cancer is the leading cause of death and for women aged 65 and over, cardiovascular disease is the leading cause.16.
In 2003, the leading contributors to the burden of disease (years of "healthy life" lost due to disease or injury17) for females were:18
Anxiety and depression (10 per cent);
Ischaemic (coronary) heart disease (8.9 per cent);
Stroke (5.1 per cent);
Type 2 diabetes (4.9 per cent);
Dementia (4.8 per cent).
Asthma is the leading contributor to burden of disease for the 0–14 age group, anxiety and depression in the 15–44 age group, breast cancer in the 45–64 group, and ischaemic heart disease in the 65 and over group.19
The higher levels of risk factors and the poorer health status of groups, such as Aboriginal and Torres Strait Islander women, are discussed below.
5 WHO 2007. WHO statistical information system. Life tables for WHO member states. Geneva: WHO
6 ABS 2006. National Health Survey: Summary of Results 2004-05 Cat. No. 4364. Canberra: ABS.
7 Adamson L. Brown W. Byles J. 2007. Women's weight: Findings from the ALSWH. Department of Health and Ageing.
8 ABS 2006. National Health Survey: Summary of Results 2004-05 op. cit.
10 Australian Safety and Compensation Council 2007, Compendium of Worders' Compensation Statistics Australia 2004-05.
11 Australian Institute of Health and Welfare (AIHW), 2008, Australia's Health 2008 Cat. no AUS 99 Canberra AIHW.
12 ALSWH 2008. Use and costs of medications and other health care resources. Department of Health and Ageing.
13 AIHW 2007 Young Australians: their health and wellbeing 2007 AIHW cat. no. PHE 87
14 AIHW 2006. Life expectancy and disability in Australia 1988 to 2003. Cat. No. DIS 47. Canberra: AIHW.
15 ABS 2008. Causes of Death Australia 2006. ABS Cat. No. 3303.0. Canberra: ABS.
16 Australian Institute of Health and Welfare. 2008. Australia's Health 2008. Cat. No. AUS 99 Canberra: AIHW.
17 Begg S. Vos T. Barker B. Stevenson C. Stanley L. Lopez A.D. 2007. The Burden of Disease and Injury in Australia 2003.
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Gender as a determinant of healthIn 2002 the World Health Organization (WHO) released the Madrid Statement, saying:
"to achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities."
Consistent with this, the Government's approach to developing the National Women's Health Policy will be based on a principle of gender equity. To achieve gender equity in health, both women and men need health policies that target their specific or unique needs.
Gender differences in the leading causes of death and burden of diseaseThe leading causes of death and burden of disease in Australia demonstrate that there are differences in the conditions experienced by women and men, for example:20, 21
- Anxiety and depression – the first or second leading causes of burden of disease for females in the age groups spanning 0–64 years, and females experience more than double the burden of males in each of these groups. The Australian Longitudinal Study on Women's Health has found that the most common claim on the Pharmaceutical Benefits Scheme for the youngest cohort, 30–35 years, is for antidepressants.22
- Breast cancer – a major cause of burden of disease in the 15–74 age groups, the leading cause in the 45–64 group, but is not a significant disease for males.23
- Cardiovascular disease including stroke – contributes to 60 per cent of all female deaths, and women are 10 per cent more likely to suffer from it than men.24
- Dementia and Alzheimer's disease – the third ranked cause of death in females (eighth for males) and the fifth ranked contributor to the burden of disease in females but does not appear in the top ten for males.25
- Migraine – the second highest contributor to the burden of disease in the 15–44 age group but does not appear in the top 10 for males26
Gender specific conditions – sexual and reproductive healthConditions relating to women's sexual and reproductive health include:
- Antenatal and postnatal depression – affects an estimated 15 per cent of Australian women during pregnancy and early parenthood.27
- Chlamydia – can lead to infertility. A study found that the number of reported female cases had nearly tripled between 2000–2006.28
- Endometriosis – affects an estimated one in ten females of reproductive age and up to 30 per cent of women with infertility. It has no known cure and on average takes 7 to 12 years to diagnose.29
- Gestational diabetes – diagnosed in 5–12 per cent of pregnant women, who then have a 50 per cent risk of developing Type 2 diabetes within five years, and is lifestyle related.30
- Menopause symptoms – changed periods, hot flushes, depression, sleeping difficulty and shifts in weight distribution to the abdomen (which is associated with the development of cardiovascular disease and Type 2 diabetes) can significantly impact on women's lives.31
- Polycystic Ovary Syndrome – up to 10 per cent of women and 30 per cent of obese women32 have this condition, which is associated with an increased risk of diabetes, cardiovascular disease33 and mental health issues.34
21 ABS 2008 op.cit.
22 ALSWH 2007 Use and costs of medications and other health care resources: Findings from the Australian Longitudinal Study on Women's Health Department of Health and Ageing
23 Begg et. al. 2007 op. cit.
24 AIHW 2008 Australia's Health 2008 op. cit.
25 Begg et. al. 2007 op. cit.
26 Begg et. al. 2007 op. cit.
28 Carnie J Dr Chlamydia Forum http://www.health.vic.gov.au/vwhp/downloads/forum/john_carnie.pdf
30 Di Cianni G. Volpe L. Lencioni C. Miccoli R. Cuccuru I. 2003. Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Research and Clinical Practice. 62:2
32 Norman R.J. Wu R. Stankiewicz M.T. 2004. MJA Practice Essentials - Endocrinology 4: Polycystic ovary syndrome. Medical Journal of Australia, 180, 132-137.
33 Meyer C. McGrath B.P. Teede H.J. 2005. The eff ects of medical therapy on insulin resistance and the cardiovascular system in polycystic ovary syndrome. J Endocrinology & Metabolism, 90(10) 5711-6.
34 Coff ey S. Mason H. 2003. The eff ect of polycystic ovary syndrome on health-related quality of life. Gynecology Endocrinology, 17, 379-386.
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Social Determinants of HealthHealth inequities, "the avoidable inequalities in health between groups of people within countries and between countries",35are shaped by the social and economic conditions of people's lives. The AIHW has identified some of these as the broad features of society,
eg culture, affluence, political and economic systems, and socioeconomic characteristics, eg education, employment and income.36
The World Health Organization (WHO) Commission on Social Determinants of Health report "Closing the Gap in a generation: health equity through action on the social determinants of health" found that in all countries at all levels of income, "health and illness follow a social gradient: the lower the socioeconomic position, the worse the health".37
Changes in the adverse conditions of people's lives are necessary to reduce avoidable health inequalities. It is the adverse social and economic circumstances of people's lives that lead to high levels of stress and unhealthy behaviours that then lead to high rates of disease and injury.38
Social Inclusion AgendaThe Australian Government is committed to reducing health inequalities by addressing the social exclusion of disadvantaged Australians – "the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas".39
The Australian Social Inclusion Board and the Social Inclusion Unit have been established to ensure that "all Australians… [are] able to play a full role in Australian life, in economic, social, psychological and political terms".40 Priority areas for action include disadvantaged communities and closing the gap in Indigenous life expectancy.
The new National Women's Health Policy will form part of the Government's social inclusion agenda by addressing the health inequalities which exist between different groups of Australian women. Social exclusion is associated with high levels of risk behaviours, such as obesity and tobacco smoking, and much worse health outcomes, but good health enables women to be socially included and fully participate in community life.41
Health inequalities between groups of Australian women Major inequalities in the health status of Australian women exist in relation to the groups of women outlined below. There is a degree of overlap between these groups as, for example, socioeconomic disadvantage plays a significant role in the health status of all of the groups.
35 World Health Organisation. 2008. Commission on the Social Determinant of Health, Key Concepts. Geneva: WHO.
36 AIHW 2008 Australia's Health 2008 op. cit.
37 CSDH 2008. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva:WHO.
38 Marmot M. 2005. Social determinants of health inequalities. Lancet; 365: 1099-1104
39 Levitas R. Pantazis C. Fahmy E. Gordon D. Lloyd E. Patsios D. (2007) The multi dimensional analysis of social exclusion Bristol
40 An Australian Social Inclusion Agenda 2007 ALP http://labor.com.au/download/now/071122_social_inclusion.pdf
41 Social Inclusion Unit, PM&C 2008 Social Inclusion – Origins, concepts and key themes
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Aboriginal and Torres Strait Islander womenAboriginal and Torres Strait Islander women experience poorer health across almost all health areas compared to non-Indigenous women and life expectancy is 17 years less than for non-Indigenous women.42 For example, Indigenous women have:
- higher rates of mental health conditions, and hospitalisation and mortality for those conditions;43, 44
- hospitalisation as the victims of assault at a rate 33 times higher;45
- a higher proportion of deaths due to disadvantage, particularly for circulatory diseases, diabetes and kidney diseases;46
- more than double the rate of cervical cancer in 2000–0447and more than four times the death rate for this cancer;48 and
- higher rates of chlamydia and hepatitis C in young Indigenous women.49
In addition, over half of Indigenous women reported their level of physical activity as "sedentary" compared to a third of non-Indigenous women.52 While Indigenous status is not collected for cervical screening, it is known that Aboriginal and Torres Strait Islander women access breast cancer screening (BreastScreen Australia) less than non-Indigenous women. 53
The Australian Government is committed to closing the gap between Indigenous and non-Indigenous Australians by tackling Indigenous disadvantage and improving the health of Aboriginal and Torres Strait Islander women. The National Women's Health Policy will form part of this eff ort.
Women living in rural, regional and remote areasWomen in rural and remote areas have poorer health than women living in urban areas, including higher rates of diabetes, arthritis, high blood pressure and asthma (in inner regional areas).54 Preventable cancers, such as melanoma, lung cancer and cervical cancer, have significantly higher incidence rates in women living in rural and remote areas than those in the cities.55, 56
Women in remote areas of Australia participate in cervical and bowel cancer screening at lower levels than in other areas, and in breast cancer screening at lower levels in very remote areas.57, 58
Women living in rural and remote areas have higher levels of risk factors such as being overweight or obese, smoking tobacco and lower consumption of fruit and low fat milk.59
Higher death rates than expected are also experienced by women living in regional and remote areas compared to women living in major cities, and the death rate rises with increasing remoteness.60
42 ABS 2007. Deaths Australia 2006. Cat. No. 3302.0 ABS: Canberra.
43 AIHW, 2008, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Population
44 Australian Health Ministers' Advisory Council 2006. Aboriginal and Torres Strait Islander Health Performance Framework Report 2006. Canberra:AHMAC.
45 ABS, AIHW 2008. The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples AIHW cat. no. IHW 21; ABS cat. no. 4704.0
46 Australian Health Ministers' Advisory Council 2006 op. cit.
47 Australia's Health 2008. op. cit.
48 AIHW 2008. Cervical screening in Australia 2005-2006. Cancer series no. 41 Cat. No. CAN 36. Canberra AIHW.
49 ABS, AIHW 2008. The Health and Welfare of Australia's Aboriginal and Torres Strait Islander People. op. cit.
50 Vos T. Barker B. Stanley L. Lopez AD. 2007. The Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples 2003, University of Queensland.
51 ABS, 2006, National Aboriginal and Torres Strait Islander Health Survey 2004–05, ABS Cat. No. 4715.0.
53 Australia's Health 2008. p476 op. cit.
54 AIHW 2008. Rural, regional and remote health: indicators of health status and determinants of health. Cat. no. PHE 97. p7, 119
55 AIHW 2008. Australia's Health 2008 op. cit. p83
56 AIHW 2008. Rural, regional and remote health: indicators of health status and determinants of health. op.cit. p23
57 AIHW 2008. Australia's Health 2008. op. cit. p476
58 AIHW 2008. National Bowel Cancer Screening Program 18 month monitoring report
59 AIHW 2008. Rural, regional and remote health: indicators of health status and determinants of health. op.cit. p 92, p111, p115, p125
60 ibid p61
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Women from culturally and linguistically diverse backgrounds, including refugeesWhile many migrant woman arrive in Australia with better health than other Australian women, due to selective immigration policies, some ethnic groups may be at higher risk due to genetic predispositions to developing certain diseases.61
The adoption of Western diets and lifestyles and changed environments can accelerate the development of diabetes and associated conditions in some groups. Particular cultural practices and beliefs can increase risk, for example, among Pacific Island populations, larger body sizes are traditionally associated with high status, power, authority and wealth.62
Many migrant women also experience a double disadvantage due to lower levels of English proficiency than male migrants,63 which impacts on the ability to access health related knowledge, health services, and more broadly, education, employment and income.
Additionally, refugees may face particular health challenges and often have little or no family support. Common health issues include: 64
- mental health issues, eg. anxiety, depression and post traumatic stress disorder;
- dental health;
- nutritional deficiencies;
- infectious and communicable disease; and
- chronic disease.
Women from disadvantaged backgroundsSocial and economic disadvantage, eg lower levels of income and education, unemployment, limited access to services and inadequate housing,65 is directly associated with reduced life expectancy, premature mortality, injury and disease incidence and prevalence, and biological and behavioural risk factors.66
A recent study showed a 31.7 per cent greater burden of disease for the most disadvantaged population compared with the least disadvantaged,67 due to higher rates of burden for most causes, particularly mental health disorders, suicide, self-harm and cardiovascular disease. In 2000–02, women living in the most disadvantaged areas had a 29 per cent higher death rate
from coronary heart disease than people living in the most advantaged areas.68
Women from disadvantaged backgrounds report a greater use of doctors and hospital outpatient services, but are less likely to use preventive health services.69 Participation in preventive health screening programs, eg breast, cervical and bowel screening, is lowest for the most disadvantaged women.70, 71
Socioeconomically disadvantaged women are more likely to have a higher rate of health risk factors, such as being overweight or obese, having fewer or no daily serves of fruit, smoking tobacco, and being exposed to violence.72, 73
61 AIHW 2008. Australia's Health 2008. op. cit. p91
62 Colagiuri R. Thomas M. Buckley A. 2007. Preventing Type 2 Diabetes in Culturally and Linguistically Diverse Communities in NSW. NSW Department of Health: Sydney.
63 ABS 2008. Perspectives on Migrants, 2007 Cat. No. 3416.0 Canberra: ABS.
64 Victorian Dept of Human Services 2005. Refugee Health Wellbeing Action Plan 2005–2008. Melbourne.
65 Furler J. Young D. 2005. Prevention and socioeconomic disadvantage. Australian Family Physician 34(10): 822-824.
66 AIHW 2008. Australia's Health 2008. op. cit. p65
67 Begg et. al. 2007. op. cit.
68 Australian Institute of Health and Welfare 2006. Australia's Health 2006. Canberra: AIHW.
69 Australian Institute of Health and Welfare 2004. Australia's Health 2004. Canberra: AIHW.
70 AIHW 2008. Australia's Health 2008. op. cit. p476
71 AIHW 2008. National Bowel Cancer Screening Program 18 month monitoring report
72 AIHW 2008. Australia's Health 2008. op. cit.
73 Mouzos J. Makkai T (2004) Women's experience of male violence Aust Institute of Criminology RPPS No. 56 p28
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Barriers to health care accessAustralian women accounted for 56 per cent of visits to GPs in 2006–07, but the groups of women outlined above face significant barriers in accessing health care services and information. These barriers are part of the social and economic conditions of women's lives which lead to health inequalities, and include:74, 75, 76
- a lack of affordable health care services;
- a lack of female doctors, including Indigenous
- service providers;
- distance to health care services and lack of affordable transport, particularly in rural and remote areas, but also an issue in the outskirts of cities;
- a lack of culturally appropriate services and information;
- a lack of services and information available in other languages;
- inaccessibility of buildings, services and information for people with disabilities; and
- health services being ill equipped to deal with the complexity of the health and social needs of women from these groups.
Culturally appropriate frameworksIn order to address the health issues and risk factors faced by women from different cultural and ethnic backgrounds, health services and preventive programs and strategies need to take account of the diversity of cultural and ethnic backgrounds and need to be culturally and linguistically appropriate.
The Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2004–2009,77 may be an appropriate tool to guide the development of culturally relevant, gender based policies and service delivery, and thus contribute to improved health outcomes for Aboriginal and Torres Strait Islander women. Other frameworks could be developed to assist in addressing the specific needs of women from culturally and linguistically diverse backgrounds.
Participation in health decision makingWomen's participation in decision making about their own health and health services is important and needs to be strengthened, to ensure that women's needs are adequately addressed. The National Women's Health Policy will examine ways in which women, as consumers and service providers, can increase their participation in decision making in their own health and at the community and government levels in relation to the development and delivery of health care services and programs.
74 Australian Institute of Health and Welfare 2007. Aboriginal and Torres Strait Islander Health Performance Framework, 2006 report: detailed analyses. AIHW cat. no. IHW 20. Canberra: AIHW.
75 Boustany J. 2000. Health access problems facing the Aboriginal community http://www.medicineau.net.au/clinical/abhealth/abhealt3504.html.
76 Ansari Z. A review of literature on access to primary care health care. Australian Journal of Primary Health Vol 13 No 2 August 2007
77 AHMAC (2004) The Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2004-2009 Dept of Health SA
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Principles for the development of a National Women's Health PolicyIt is proposed that the National Women's Health Policy be based on five principles:
1. Gender equityGender equity means that women and men are given equal opportunity to realise good health, and that gender is also a determinant of health.78 A gender equity approach recognises the different challenges that women and men face in managing their health, including their different health requirements and the different barriers they face in accessing services.
2. Health equity between womenThere is substantial evidence that some groups of Australian women have not benefited from the overall improvements in health experienced by most women. The needs of women who are at higher risk of a range of health problems will be addressed through the development of interventions which are culturally appropriate and designed to target areas of health inequity.
3. A focus on preventionThe prevention of illness requires the identification of its causes in order to modify, reduce or eliminate them.79Conversely, protective factors can be built and strengthened. The National Women's Health Policy will complement the work of the National Preventative Health Taskforce and the National Preventative Health Strategy, which is focussing on reducing obesity, tobacco smoking and alcohol consumption, as a means of addressing chronic illness in Australia.
4. Evidence baseAs the population ages, the growing burden of disease will impact increasingly on health resources. An evidence based approach will assist to maximise the effectiveness of policies and programs and facilitate the allocation of resources to cost-effective interventions. There is a need for comprehensive gender-relevant evidence, and further knowledge on how women and health professionals can best address women's health issues and behavioural risk factors.
5. A life course approachA life course approach explores the distinctive roles and experiences that an individual progresses through from birth to death.80 It recognises key developmental and transition points in women's lives, and the cumulative effects of experiences over time. This approach incorporates sexual and reproductive health.80
78 L Doyal, S Payne and A Cameron, (2003), Promoting gender equality in health, University of Bristol.
79 Australia's Health 2008 op. cit.
80 Hankivsky O. (2007), "More Than Age and Biology: Overhauling Lifespan Approaches to Women's Health" in Morrow M, Hankivsky O & Varcoe, C (Eds) (2007), Women's Health in Canada, Critical Perspectives on Theory and Policy, University Toronto Press, Toronto.
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Want to know more and have your say?Consultations for the development of the National Women's Health Policy will take place during 2009. Key women's stakeholder groups and peak bodies will be included in the consultations which will importantly consider lessons of the previous National Women's Health Policy so these can be built on in the new policy.
Specific consultations with Aboriginal and Torres Strait Islander women, women from rural and remote areas, women from culturally and linguistically diverse backgrounds, and other disadvantaged women will be a key part of the process.
An Advisory Group under the Australian Population Health Development Principal Committee (a subcommittee of the Australian Health Ministers' Advisory Council) will provide input to the process. The Advisory Group has representatives from state and territory governments.
The National Women's Health Policy is expected to be finalised in 2010. Information about the development of the policy is available on the Department of Health and Ageing's website
www.health.gov.au/womenshealthpolicy. This website will be updated with new information and papers as the consultation progresses. If you want to provide feedback or comments log onto the website for details about how to do this.
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