Chapter 05

Equal access? Far from it.

Women face financial, geographic, cultural, and institutional barriers to healthcare that men simply don't. For vulnerable groups, these barriers become insurmountable walls.

The most significant barriers

41%

Financial Barriers

of women say they can hardly afford unexpected dental care (vs. 35% of men). 39% find mental health services unaffordable (vs. 33% of men). These gaps are catastrophic for low-income households and single-parent families.

2 yrs

Diagnostic Delays

Women are diagnosed on average 2 years later than men across 770 diseases. Delays in cancer diagnosis average 2.5 years; metabolic diseases 4.5 years. Each year of delay worsens prognosis.

Institutional Bias

Women presenting with the same condition as men may not receive the same evidence-based care. Healthcare providers are less likely to refer women to specialists or recommend further investigation.

Regional Disparities Across Europe

Gender health disparities vary dramatically by country. Women in Southern and Eastern European countries report significantly worse self-rated health and more activity limitations. Northern Europe shows narrower gender gaps. A Lithuanian woman is 13× more likely to die from heart disease than a French woman.

75.4%

Years Lived in Good Health

Women spend only 75.4% of their lives in good health vs. 79.8% for men — despite living longer. The additional years of life expectancy are lived with activity restrictions and chronic conditions.

Cultural & Mobility Barriers

Lower literacy levels, restricted mobility, caregiving responsibilities, and cultural norms hinder women's ability to access timely healthcare — particularly in sexual, reproductive, and mental health services.

Transportation & Time

Women more often cite transportation problems as a reason for declining clinical trial participation. Social and time constraints — childcare, elderly care, housework — make accessing care structurally harder for women.

Gender-Based Violence & Health

Gender-based violence is a pervasive and underrecognised threat to women's health across the EU. Fear, stigma, and institutional distrust discourage survivors from seeking medical help — further entrenching health inequalities.

Violence against women is linked with chronic stress, depression, cardiovascular risk, and behavioural changes including smoking and alcohol use. Maltreatment in childhood is positively correlated with a 9-fold higher risk of coronary heart disease for women.

1 in 3
EU women have experienced physical or sexual violence

EU Agency for Fundamental Rights, Violence Against Women Survey, 2024

Women vs. men: accessing the system

Measure Women Men What this means
Dental care affordability 41% cannot afford 35% cannot afford Women face higher financial barriers to routine dental care
Mental health affordability 39% find it unaffordable 33% find it unaffordable Women, who have higher mental health needs, face greater financial obstacles
Life expectancy at birth (EU 2023) 84.0 years 78.7 years Women live longer but the extra years are often spent in poor health
Healthy life years at birth (EU 2023) 63.3 years (75.4% of life) 62.8 years (79.8% of life) Men spend a greater proportion of their shorter lives in good health
Preventive/outpatient care engagement Higher engagement Lower engagement Women are more active in outpatient and preventive care — yet still receive worse outcomes
Heart attack: same-condition care quality Consistently worse Standard care Women with the same heart condition as men receive fewer referrals, less medication, and delayed treatment
Psychotropic medication prescription rate 2× more likely Baseline Gender bias in diagnosis leads to over-prescription of antidepressants and anxiolytics for women

Particularly vulnerable groups

Multiple, overlapping forms of discrimination create dramatically worse health outcomes for specific groups of women. The EU study emphasises an intersectional approach is essential.

Refugee & Migrant Women

  • Face language barriers, restricted legal access to care, and limited knowledge of available services
  • Higher risk for communicable diseases including hepatitis, tuberculosis, and HIV
  • Disproportionately affected by sexually transmitted infections and neglected tropical diseases
  • EU recommendation: targeted screening and improved access to maternal healthcare services

Women from Ethnic Minorities

  • Roma women face compounding stigma and discrimination in healthcare settings
  • Black women with lupus experience more severe disease, higher hospitalisation, and delayed diagnosis
  • Uterine fibroids are significantly more prevalent in Black women, with inadequate clinical attention
  • Pain from women of colour is consistently underestimated compared to white patients

Women Living in Poverty / Homelessness

  • Financial barriers prevent access to dental, mental, and preventive care
  • Single mothers and low-income working mothers face highest depression risk
  • Structural barriers including lack of transportation, childcare, and flexible appointments
  • Higher exposure to environmental pollutants linked to autoimmune and chronic conditions

Older Women

  • Over 40% of people aged 65+ report at least two chronic diseases — women more severely affected
  • Older women more likely to live alone and experience anxiety, depression, and polypharmacy risks
  • Cardiovascular risk increases substantially after menopause — often inadequately managed
  • More likely to struggle with daily activities (dressing, walking, bathing) and require long-term care

Women with Disabilities

  • Face physical, attitudinal, and systemic barriers in accessing care
  • Medical equipment and facilities are often designed without their needs in mind
  • Intersecting discrimination with gender makes healthcare particularly inaccessible

LGBTQI+ Women & Transgender Individuals

  • Transgender people are almost entirely absent from clinical trials — massive knowledge gap
  • Structural stigma in healthcare is documented across Europe — discourages care-seeking
  • Transgender-specific health needs are rarely included in medical education curricula
  • Hormonal profiles during transition and responses to treatment remain under-researched