18.7.2018   

EN

Official Journal of the European Union

C 252/99

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having regard to the Treaty on the Functioning of the European Union, and in particular its Article 19 and its Article 168, which lists ensuring ‘a high level of human health protection’ among the objectives of all EU policies,

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having regard to the Charter of Fundamental Rights of the European Union, and in particular Articles 21, 23 and 35 thereof,

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having regard to Regulation (EU) No 536/2014 of the European Parliament and of the Council of 16 April 2014 on clinical trials on medicinal products for human use and repealing Directive 2001/20/EC,

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having regard to Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001 on the approximation of the laws, regulations and administrative provisions of the Member States relating to the implementation of good clinical practice in the conduct of clinical trials on medicinal products for human use (‘the Clinical Trial Directive’),

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having regard to the Commission communication of 3 March 2010 entitled ‘Europe 2020: A strategy for smart, sustainable and inclusive growth’ (COM(2010)2020),

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having regard to the Commission Green Paper entitled ‘Improving the mental health of the population — Towards a strategy on mental health for the European Union’ (COM(2005)0484),

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having regard to the EU-Compass for Action on Mental Health and Well-being,

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having regard to the Comprehensive Mental Health Action Plan 2013-2020 of the World Health Organisation (WHO),

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having regard to the WHO’s Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030,

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having regard to the Mental Health Declaration for Europe of 2005, signed by the WHO, the Commission and the Council of Europe,

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having regard to the WHO’s European Mental Health Action Plan 2013-2020,

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having regard to the European Pact for Mental Health and Well-Being of 2008,

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having regard to the Commission’s Joint Action on Mental Health and Well-Being (2013-2016),

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having regard to General Comment No 14 of the UN Committee on Economic, Social and Cultural Rights on ‘The right to the highest attainable standard of health’ (UN Doc. E/C.12/2000/4) and to General Comment No 20 on ‘Non-discrimination in economic, social and cultural rights’ (UN Doc. E/C.12/GC/2009),

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having regard to Recommendation CM/Rec(2010)5 of the Committee of Ministers of the Council of Europe to member states on measures to combat discrimination on grounds of sexual orientation or gender identity,

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having regard to Rule 52 of its Rules of Procedure,

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having regard to the report of the Committee on Women’s Rights and Gender Equality and the opinion of the Committee on Development (A8-0380/2016),

A.

whereas the right to the highest attainable standard of physical and mental health is a fundamental human right and includes an obligation of non-discrimination; whereas everyone should have access to healthcare; whereas access to mental healthcare is an issue of crucial importance with a view to improving the quality of life of European citizens, fostering social inclusion and ensuring economic and cultural development in the Union;

B.

whereas in a global context marked by an ongoing economic crisis and a sharp rise in unemployment, in particular among young people and women, the incidence of mental health problems such as depression, bipolar disorders, schizophrenia, anxiety and dementia is steadily increasing;

C.

whereas the WHO defines mental health as physical, mental, and social wellbeing, and not just the absence of disease or infirmity; whereas according to the WHO, ‘mental disorders’ denotes a range of mental and behavioural disorders, such as depression, bipolar affective disorder, schizophrenia, anxiety disorders, dementia and autism; whereas the WHO defines mental health as a state of emotional and psychological wellbeing in which an individual is able to use his or her cognitive and emotional capabilities, function in society, meet the ordinary demands of everyday life, establish satisfactory and mature relationships with others, make a constructive contribution to social change and adapt to external conditions and internal conflicts;

D.

whereas mental health must be seen and addressed holistically, by taking account of social, economic, and environmental factors, requiring a psychosocial all-of-society approach to attaining the highest possible level of mental well-being for all citizens;

E.

whereas a holistic strategy on mental health and wellbeing must include a life-cycle perspective, taking into account different factors that affect individuals of different ages; whereas the specific vulnerabilities of teenage girls and older women must be taken into account;

F.

whereas physical and mental health are interlinked, and are both central to general wellbeing; whereas it is recognised that poor mental health can lead to chronic physical conditions and that those with chronic physical conditions are more likely to develop mental health conditions; whereas despite the known links between the two, research on physical health is often prioritised over that on mental health;

G.

whereas women’s and girls’ mental health is adversely affected by a variety of factors, including prevalent gender stereotypes and discrimination, objectification, gender-based violence and harassment, workplace environment, work-life balance, socio-economic conditions, absence or poor quality of mental health education, and limited access to mental healthcare;

H.

whereas almost 9 out of 10 people suffering from mental health problems say they have been affected by stigma and discrimination, and more than 7 out of 10 report that stigma and discrimination reduce their quality of life;

I.

whereas attention must be paid to geographic factors of mental health and wellbeing and to differences between urban and rural environments, inter alia in terms of demographics, access to care and service provision;

J.

whereas the hormonal changes during perimenopause, and the time after menopause, may affect a woman’s emotional health and lead to mental health problems, including depression and anxiety; whereas hypersensitivity to symptoms may hinder timely detection and appropriate treatment;

K.

whereas determinant factors of mental health and wellbeing vary between men and women and age groups; whereas factors including gender inequality, income disparities, women’s greater exposure to poverty and overwork, socio-economic discrimination, gender-based violence, malnutrition and hunger expose women further to mental health problems; whereas according to the WHO, there is no significant gender difference in the case of severe mental disorders but women have higher rates of depression, anxiety, stress, somatisation and eating disorders, while men have higher rates of substance abuse and antisocial disorders; whereas depression is the most common neuropsychiatric disorder and is more likely to affect women than men; whereas it is also the most common illness among women in the 15 to 44 age group;

L.

whereas mental health conditions and mental wellbeing are often overlooked, ignored, or suppressed, due to stigma, prejudice or lack of awareness or resources; whereas this leads many of those with mental health conditions not to seek care, and for doctors to fail to diagnose patients, or at times diagnose wrongly; whereas the diagnosis of mental health conditions is heavily gendered, with women more likely to be diagnosed with certain conditions than men;

M.

whereas in particular lesbian and bisexual women, as well as transgender and intersex persons, face specific mental health issues arising from minority stress, defined as the high levels of anxiety and stress caused by prejudice, stigmatisation and experience of discrimination, as well as medicalisation and pathologisation; whereas LGBTI people may face specific mental health and wellbeing challenges which must be taken into account in any mental health strategy;

N.

whereas the forms of somatisation occurring most frequently in women and more likely to be diagnosed in women than in men include fibromyalgia and chronic fatigue, the main symptoms being pain and exhaustion, although women have many other symptoms that are common to other diseases;

O.

whereas transgender identities are not pathological, but are deplorably still considered mental health disorders, and most Member States request such diagnoses for access to legal gender recognition or transgender-related healthcare, even though research has shown that the ‘gender identity disorder’ diagnosis is a source of significant distress for transgender persons;

P.

whereas depressive disorders account for 41,9 % of all cases of disability resulting from neuropsychiatric disorders among women, as compared to 29,3 % among men;

Q.

whereas the WHO has estimated that depression affects 350 million people; whereas by 2020 this illness will be the second leading cause of inability to work;

R.

whereas gender-variant prepubescent children are still subjected to unnecessary and harmful diagnostic practices, while every child should be able to safely explore their gender identity and expression;

S.

whereas, because of a variety of factors, primarily concerning different gender roles and gender inequalities and discrimination, depression is approximately twice as prevalent among women as it is among men, and transgender people show significantly elevated levels of suicide ideation and attempts; whereas studies show that imposed traditional gender roles negatively affect women’s mental health and wellbeing;

T.

whereas not enough attention is paid to mental health and wellbeing in education systems across Member States, or in the workplace, given that mental health is often highly stigmatised or a taboo subject; whereas education on mental health fights the stigma surrounding the subject, and it should address gender-specific vulnerabilities, gender stereotypes and discrimination facing women and girls;

U.

whereas men and boys experience gendered mental health conditions; whereas in Europe, men are almost 5 times more likely to commit suicide than women and suicide is the biggest cause of death for men under the age of 35; whereas men are 3 times more likely than women to become alcohol-dependent and are more likely to use (and die from) illegal drugs; whereas men are less likely to access psychological therapies than women; whereas men and boys face gender stereotypes surrounding masculinity which may encourage repression of emotions or resort to anger, and these have an impact on men’s mental health, as well as on the phenomenon of gender-based violence;

V.

whereas there are about 58 000 suicide cases a year in the EU and a quarter of those who commit suicide are women, and whereas suicide continues to be a major cause of death;

W.

whereas the psychosocial all-of-society approach to mental health requires policy coherence for wellbeing, coordinating healthcare, education, employment, economic and social policies in order to attain higher overall levels of mental wellbeing;

X.

whereas eating disorders such as anorexia and bulimia are increasing among adolescent and post-adolescent girls;

Y.

whereas the long-term physical and mental health effects of eating disorders such as anorexia and bulimia have been well documented, as has the gender dimension of their causes;

Z.

whereas at work women are more exposed to psychological and/or sexual harassment, which causes psycho-physical problems among those subjected to it;

AA.

whereas social care models that address mental illness through sport, arts, or social activities should be taken into account in public health programmes in respect of prevention, treatment, and rehabilitation;

AB.

whereas people with disabilities risk suffering exacerbated mental health conditions;

AC.

whereas sex and relationship education is key for overcoming gender stereotypes, tackling gender-based violence, and improving mental health and wellbeing for both girls and boys and women and men;

AD.

whereas mental health conditions and illnesses are one of the main causes of incapacity, adversely affecting health, education, the economy, the labour market and the EU’s welfare systems, causing large-scale economic costs and a significant adverse impact on the EU economy, giving further impetus to the need to tackle mental healthcare in a holistic, comprehensive, and gender-sensitive manner; whereas, according to a study conducted by the European Depression Association (EDA), one in 10 workers in the EU has taken time off work for depression, costing society an estimated EUR 92 billion, mainly as a result of lost productivity;

AE.

whereas above and beyond biological characteristics, women’s mental health depends on factors such as the education that they have received, the extent to which they have internalised social and cultural values, norms, and stereotypes, the way in which they have lived through and assimilated their experiences, the attitudes that they have towards themselves and others, the roles that they play, and the obstacles and pressures facing them;

AF.

whereas taking account of women’s diversity and their physiological distinctness from men, and incorporating these factors into both preventive and treatment-oriented health policies addressed to women, with specific measures targeting vulnerable and marginalised groups, would strengthen the effectiveness of those policies;

AG.

whereas for various reasons female subjects have been excluded from toxicology, biomedical research and clinical trials, and whereas large gender gaps in research limit how much we know about the difference between women’s health and men’s; whereas, as a result, biomedical research has tended to reflect predominantly a male perspective, mistakenly assuming women and men to be identical in areas where physiological differences exist; whereas there is a lack of research on the specific needs of intersex women;

AH.

whereas the exclusion and under-representation of women as subjects and of gender and sex as factors in biomedical research and clinical trials put women’s lives and health at risk;

AI.

whereas Regulation (EU) No 536/2014 on clinical trials of medicinal products for human use introduced requirements for taking account of gender in trials, but the implementation of this regulation needs to be evaluated; whereas the regulation does not specify any considerations regarding women other than for pregnant and breastfeeding women;

AJ.

whereas specific strategies to implement guidelines for the study and evaluation of gender differences in the clinical evaluation of drugs have not been developed by the European Medicines Agency (EMEA), despite the fact it has acknowledged that ‘some of the factors that influence the effect of a medicine in the population may be important when considering potential differences in response between men and women’ and that ‘gender-specific influences can also play a significant role in drug effect’ (1);

AK.

whereas the impacts of such drugs or medication as contraceptive devices, antidepressants and tranquilisers have on women’s physical and mental health are still poorly understood, and require further research with a view to eliminating harmful side-effects and improving care delivery;

AL.

whereas the sex and gender dimensions of health imply that women face a number of specific health risks over their lifetimes;

AM.

whereas there is a lack of comparable data on available, accessible and quality transgender-specific healthcare, and products used in hormone replacement therapy are not properly tested and licensed;

AN.

whereas maternal mortality is regarded as a major marker of health system efficiency, quality and performance;

AO.

whereas lack of access to of sexual and reproductive rights, including safe and legal abortion services, endangers the life and health of women and girls and of all persons with reproductive capacity, increases maternal mortality and morbidity, and leads to the denial of life-saving care and to an increased number of clandestine abortions;

AP.

whereas in all countries with available data, significant differences in health exist between socio-economic groups and between women and men, in the sense that people with lower levels of education, occupation and/or income tend to have systematically higher morbidity and mortality rates; whereas these health inequalities are one of the main challenges for public health policies today; whereas adverse socio-economic conditions, poverty and social exclusion have a significant negative impact on mental health and wellbeing;

AQ.

whereas comprehensive, age-appropriate, evidence-based, scientifically accurate and non-judgmental sexuality education, quality family planning services and access to contraception help to prevent unintended and unwanted pregnancies, reduce the need for abortion, and contribute to the prevention of HIV and STIs; whereas teaching young people to take responsibility for their own sexual and reproductive health has long-term positive effects, lasting throughout their lifetime and having positive impact on society;

AR.

whereas one in four births in the EU is now by caesarean section and, statistically, attendant health problems for mothers and children are increasing;

AS.

whereas there are already dangerous gaps in provision in some Member States as a result of closures of maternity hospitals and the considerable reduction in the number of midwives and obstetricians;

AT.

whereas restrictions and budget cuts imposed by national governments in the area of public health and education also make access to health and mental health services more difficult and this impacts disproportionately on women, especially single mothers, and on large families;

AU.

whereas female migrants, refugees and asylum seekers may additionally suffer from sometimes very serious medical conditions as a result of a lack of proper treatment or face specific problems related to reproductive health, such as complications with pregnancy and childbirth and potential additional psychological trauma such as antenatal and postnatal depression, as well as a risk of traumatic exposure to, or consequences of, (sexual) violence and abuse, and specific risks to their mental health and well-being; whereas there are several specific challenges to providing mental health care to these categories, the extent of which varies depending on a range of factors, including where the persons have come from and the amount of time they have spent in the host country;

AV.

whereas women suffer from certain forms of cancer such as breast, uterus and cervical cancers that exist predominantly among or are exclusive to women;

AW.

whereas women suffering from cancer who have been subjected to surgery and invasive treatments such as radiotherapy and chemotherapy are in general more prone to depression;

AX.

whereas 10 EU Member States have set the target of screening 100 % of the female population for breast cancer, and whereas eight have such a target for cervical cancer screening;

AY.

whereas illnesses such as osteoporosis, musculoskeletal problems and central nervous system illnesses such as Alzheimer’s and/or dementia are linked to hormonal changes that women experience at the time of menopause, or earlier because of hormonal treatments; whereas, although it is known that women are affected by these illnesses with a higher frequency than men, the gender dimension of research on such topics has been weak;

AZ.

whereas endometriosis is an incurable disease affecting about 1 in 10 women and girls (i.e. roughly 180 million women worldwide and 15 million within the EU); whereas this illness frequently leads to infertility and often causes high levels of pain and mental health problems, thus making it highly incapacitating for various aspects of work and of personal and social life;

BA.

whereas physical and psychological gender-based violence and violence against women and their impact on victim’s health constitute a fundamental barrier to the achievement of gender equality and women’s full enjoyment of the freedoms guaranteed by fundamental human rights;

BB.

whereas women and girls who are subjected to female genital mutilation are exposed to serious short- and long-term effects on their physical, psychological, sexual and reproductive health;

BC.

whereas intersex persons subject to genital mutilation also experience effects on their physical, psychological and sexual and reproductive health;

BD.

whereas transgender people are still exposed to forced sterilisation in gender recognition procedures in 13 Member States;

BE.

whereas systematic and adequate data collection on violence against women is crucial in order to ensure effective policymaking in the field, both at central and at regional and local levels, and monitor the implementation of legislation;

BF.

whereas women who have been subjected to gender-based violence suffer after-effects, often for life, in their physical and mental health; whereas according to the WHO’s World Report on Violence and Health (2), the repercussions which gender-based violence has on women can take a variety of forms: physical effects (bruising, fractures, chronic pain syndromes, disability, fibromyalgia, digestive problems, etc.); psychological and behavioural effects (alcohol and drug abuse, depression and anxiety, eating and sleep disorders, feelings of shame and guilt, phobias and panic attacks, low self-esteem, post-traumatic stress disorder, psychosomatic disorders, suicidal and self-harming behaviour, insecurity in later relationships, etc.); sexual and reproductive effects: gynaecological disorders, infertility, complications during pregnancy, miscarriages, sexual dysfunction, sexually transmitted diseases, unwanted pregnancy, etc.); and fatal effects (murder, suicide, death from a sexually transmitted disease, etc.);

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