Thoughts on the Protection of the Right to Health of Elderly Women from the Perspective of Human Rights
Lu Yi *
Abstract: The right to health is an important right in the human rights system. The full realization of the right to health is particularly important for ensuring the dignity and senior years of older women. in the process of China’s economic and social development, the protection of the right to health of older women faces certain dilemma. China has the duty and responsibility to respect, protect and realize the right to health of older women. The country should actively fulfill its obligations and make continuous efforts to improve the protection of the right to health of older women through various practical channels and effective methods.
Keywords: old women · right to health · human rights · State responsibility
Women’s right to health is an important part of women’s human rights. Protecting the right to health is of particular importance to older women. From the perspective of the right to health as a basic human right, this paper briefly analyzes and discusses the right to health of older women.
I. The Connotations of the Right to Health for Elderly Women
The right to health is a fundamental human right recognized by international human rights instruments. The preamble to the Constitution of the World Health Organization in 1946 defined health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. Article 25, Paragraph 1, of the universal Declaration of Human Rights adopted in 1948 states that “everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services. Article 12 of the international Covenant on Economic, Social and Cultural Rights (1966) clearly puts forward that, “everyone has the right to the enjoyment of the highest attainable standard of physical and mental health”, 1 which has become the most influential clause on the right to health in the international human rights law.” In 2000, the Committee on Economic, Social and Cultural Rights issued its General Comment No. 14 on Article 12, which stated that the right to health, as a fundamental human right, is essential for the enjoyment of all other human rights and that everyone has the right to the highest attainable standard of health conducive to a decent life. It also made clear that the right to health is not only the right to access health care, but also access to the determinants of health, namely, “to enjoy facilities, goods, services and conditions essential to achieving the highest attainable standard of health.” In addition, the right to health is recognized as a fundamental human right in many regional human rights conventions. For example, as stipulated in Article 16 of the African Charter on Human and peoples’ Rights (1981), everyone is entitled to the highest level of attainable physical and mental health. Article 10 of the Additional protocol to the American Convention on Human Rights in the areas of Economic, Social and Cultural Rights, known as the “Protocol of San Salvador” (1988), proposed that everyone has the right to health, which is explained as enjoying the highest level of physical and mental health and social well-being. Article 11 of the European Social Charter (Revised) (1995) states that States parties should put forward efforts to ensure that their people effectively exercise their right to health protection.
The right to health is an important part of women’s human rights. Karl Marx once pointed out, “Great social changes are impossible without feminine upheaval. Social progress can be measured exactly by the social position of the fair sex, the ugly ones included.” 2 As society develops, achieving gender equality and safeguarding women’s rights have become the core value and code of conduct for international human rights protection. Women’s human rights are the rights that every woman should enjoy based on her inherent human dignity, including political rights, personal rights, property rights, marriage and family rights, rights to health, education rights, work rights, and social security rights. Women’s right to health refers to “everyone has the right to the enjoyment of the highest attainable standard of physical and mental health”. 3 The Convention on the Elimination of All Forms of Discrimination against Women, adopted in 1979, is known as the “Charter for Women’s Human Rights”. Articles 11 and 12 of the Convention require States parties to take all appropriate measures to ensure women are on equal terms with men and there is no discrimination in health care. The social rights, such as the right to health, and provisions related to the right to health of rural women are specifically put forward in Article 14. In addition, women’s right to health is also addressed by international instruments that specifically guarantee women’s rights such as the Declaration on the Elimination of Discrimination against Women (1967) and the Declaration on the Elimination of Violence against Women (1993). In 1995, the programme of Action adopted by the Fourth World Conference on Women clearly stated that “women are entitled to the highest attainable standards of physical and mental health” and that “women must be “guaranteed the right on an equal terms with men to enjoy the highest attainable standard of health throughout their life cycle”.
The right to health is an important part of women’s human rights. Karl Marx once pointed out, “Great social changes are impossible without feminine upheaval. Social progress can be measured exactly by the social position of the fair sex, the ugly ones included.” 2 As society develops, achieving gender equality and safeguarding women’s rights have become the core value and code of conduct for international human rights protection. Women’s human rights are the rights that every woman should enjoy based on her inherent human dignity, including political rights, personal rights, property rights, marriage and family rights, rights to health, education rights, work rights, and social security rights. Women’s right to health refers to “everyone has the right to the enjoyment of the highest attainable standard of physical and mental health”. 3 The Convention on the Elimination of All Forms of Discrimination against Women, adopted in 1979, is known as the “Charter for Women’s Human Rights”. Articles 11 and 12 of the Convention require States parties to take all appropriate measures to ensure women are on equal terms with men and there is no discrimination in health care. The social rights, such as the right to health, and provisions related to the right to health of rural women are specifically put forward in Article 14. In addition, women’s right to health is also addressed by international instruments that specifically guarantee women’s rights such as the Declaration on the Elimination of Discrimination against Women (1967) and the Declaration on the Elimination of Violence against Women (1993). In 1995, the programme of Action adopted by the Fourth World Conference on Women clearly stated that “women are entitled to the highest attainable standards of physical and mental health” and that “women must be “guaranteed the right on an equal terms with men to enjoy the highest attainable standard of health throughout their life cycle”.
The right to health of elderly women mainly refers to the protection of the right to health of this particular group of women. Women’s right to health runs through the entire life cycle of women; therefore, from the perspective of the subjects of rights, women of all ages and at all physiological stages, whether girls, unmarried young women, pregnant women, and elderly women, should enjoy the right to health. Elderly women, according to the general views of the international society and the provisions of the Law of the people’s Republic of China on the protection of the Rights and interests of the Elderly, refers to women aged 60 and over. The physical condition of elderly women, who are already stepping into the twilight of their lives, are often not as good as before and they are less vigorous than before. Their concern for health and the desire for the protection of the right to health are naturally stronger than in previous stages of life. Therefore, elderly women should be the focus of women’s health rights protection. The right to health of elderly women has rich connotations. From the perspective of principal characteristics, since the subjects of the right are elderly woman, the right includes not only the right to health equal to men as recognized by international human rights law, such as the right to access and use basic health care resources, but also the right to women’s health based on gender equality and special protection for women, such as women’s right to live free of domestic violence. At the same time, compared with women of other age groups, it also reflects the right of the elderly at this particular stage, such as maternal reproductive right and the right of career women to a healthy workplace environment, which are no longer generally applicable to the seniors. But the right to prevent, control and treat women’s diseases related to age is undoubtedly of great concern to elderly women. According to the General Comment No. 14 of the Committee on Economic, Social and Cultural Rights, this right includes not only the most important and appropriate health care received in a timely manner, but also the basic factors that determine health, such as the use of safe and clean drinking water, access to adequate sanitation, adequate safe food, nutrition and housing supply, good hygienic conditions, access to health education
and information, and participation in health decision-making. From the perspective of rights, this right includes negative human rights that are exempt from State and social intervention, such as the right of female elderly to control their own bodies and health decisions, and the right to be free of such as forcible treatment and trial without their consent. It also includes active human rights that require the State to take active measures to promote realization, such as the right of elderly women to participate in the health protection system and the right to obtain the necessary medical resources. From the perspective of health, this right includes both the right to physiological health to achieve normal functioning of their bodies, and the psychological health right that achieves balanced and coordinated development of their mental state.
With respect to international human rights instruments and research results of relevant scholars, such as the international Covenant on Economic, Social and Cultural Rights and General Comment No. 14 on the right to health, the Convention on the Elimination of All Forms of Discrimination against Women, the Vienna Declaration and programme of Action, the Beijing Declaration and programme of Action, the right to health of old women should at least include the following aspects.
(1) The right to access to sanitation services. This refers to old women are entitled to access to equal and timely medical and health care services, including the right to the essential medicines, treatment and care, rehabilitation, and regular health checkups, health-related popularization and information, and a medical insurance system.
(2) The right to prevent and control diseases. This refers to aged women are entitled to access to prevention and control programs for infectious diseases, including sexually diseases, and other illnesses, and to receive equal treatment and humanitarian assistance in cases of accidents, epidemics and similar health risks.
(3) The right to access to a health environment. This refers to elderly women are entitled to have equal access to a healthy living environment, free from the threat of harmful health substances, as well as access to basic sanitation, necessary housing, clean drinking water, safe food and adequate nutrition.
(4) The right to reproductive health. This refers to old women have rights to enjoy health care and services that promote reproductive health, meet the needs of reproductive health and enhance the well-being of individuals.
(5) The right to participate in health decision-making. This means that elderly women have the right to know and participate in decision-making on health and the protection of the right to health at the national and community levels and to express their opinions freely.
II. The Problems Faced by the Elderly Women Related to Their Right to Health
As the social economy develops quickly, China is now rapidly entering an aging society. Since the average life expectancy of women exceeds that of men, there is a trend of the feminization of the elderly population. As former United Nations Secretary-General Kofi Annan pointed out during the 1999 International Year of Older Persons: “In the process of aging, we should also pay special attention to gender differences. In almost all the places, women’s life expectancy exceeds that of men, but old women, who tend to be poorer generally, have a higher rates of chronic diseases and disability due to illness, and are more susceptible to discrimination and neglect. 4 According to gender theory, the orientation and differences between men and women are not determined by natural physiological factors, but shaped and constructed by economic and social systems, culture, and concepts. Specifically, their relatively weak state “is characterized by the accumulation of relative weaknesses in all stages of the life cycle, as well as a superposition of multiple social inequities such as gender inequality, intergenerational inequality, and class inequality.” 5 This inequality and disparity are also evident in the right to health of elderly women.
A. The health status of aging women is not optimistic
According to the main data report of the third Survey on China Women’s Status, in the first decade of the 21 st century, the health status of women in China has been significantly improved. Most women think themselves in a good health condition, for example, “among women aged 18 to 64, 64.2% percent rated themselves as being well and 80.9 percent reported not suffering from chronic diseases, 80.7 percent of the respondents had no gynecological diseases, and 60 percent reported that they had basically no mental health issues;” however, when it comes to the group of women aged 65 and above, only 28.6 percent rated themselves as ‘good’ in health, and only 38.9 percent of those had had a physical examination in the past three years.” 6 Although the health status of older urban females is generally better than that of rural areas, “their health status is not as good as that of elderly men in the same area.” 7 It is visible that the health status of elderly women, especially those aged 65 and above, is not satisfactory or even optimistic. As women enter old age, many often suffer from gynecological diseases and various cardiovascular diseases and chronic diseases such as hypertension, heart disease, diabetes and osteoporosis. On the other hand, although the vast majority of retired female seniors still continue to run their social function such as doing housework and caring for the family. According to statistics, “Elderly women spend an average of 154 minutes a day doing housework, 1.7 times as much as elderly men.” 8 In addition, elderly women tend to spend more on their spouse care, children and grandchildren’s care than older men, which in turn has an adverse effect on their health. Studies have shown, for example, that grown children rely on their parents who can assist in housework and childcare, so that health, social participation and economic benefits of “the older generation (especially women) is to a certain extent undermined.” 9 Aging women have their own care needs, due to the gradual decline of their self-care ability, and may even be incapacitated. Among the elderly women with care needs, 82 percent of urban elderly women and 70.2 percent of rural elderly women are taken care of, while among elderly men with care needs, 85.6 percent of urban elderly men and 70.3 percent of rural elderly men are cared for. 10 It can be seen that there is still a gap between the proportion of elderly women and elderly men being cared for.
B. Elderly women are more prone to having psychological problems Elderly women are more likely to suffer from mental health issues, mainly because of the following reasons.
One is the impact of physical illness. Physical health is the physiological basis of mental health, as the two are closely related. Take a study in Fujian Province for example. It found that the physical health and the degree of psychological pleasure among elderly women in the developed coastal areas were significantly lower than that of their male counterparts. The proportion of elderly women who are psychologically affected due to physical illness was 42.99 percent, 7.5 percentage points higher than the 35.45 percent of elderly men. Physical illness is the leading cause of unhappiness among elderly women. 11
Second, there is a lack of sufficient affective interaction. Emotional support is an important factor affecting the subjective well-being and life satisfaction of the elderly. Studies have shown that the mental health problems of elderly women are largely the results of inadequate emotional exchanges. The emotional exchanges of older women are more dependent on their family and children than those of men. Once this communication is absent, it is easy to feel loneliness, depression and desolation. This is especially true for aging widows. Because women live longer on average than men, many widows are actually living alone. This can also be confirmed from the second report on the status of women in China. “Among the women aged 65 and over, 49.5 percent are widowed, 29.1 percentage points higher than widowers of the same age.” 12 The loss of a spouse not only makes elderly women lose the family income support of their spouse, but also the life partner who accompanies them all day and night. As a result, they suffer serious mental blows, and are prone to negative emotions such as loneliness and sadness, and even depression. In addition, if aging women who live together with their children cannot be timely provided with necessary spiritual comfort and emotional support due to the busy work or pressure in their children’s own lives, it will also have negative psychological emotions, which is not conducive to physical and mental health of older women.
The third is the mentality changes due to at different age stages. On entering the twilight stage of life, with the decline of physiological functions, elderly women tend to have a sense of loss that aging makes them useless; and their shirking interpersonal social circles will inevitably make older women feel lonely and empty; if there is no positive attitude toward the meaning of life, it will make them feel sad, depressed and anxious because life is about to come to an end. These all will have an effect on their healthy and a quality of life.
C. Elderly women have a lower level of health protection
The right to health, a comprehensive human right, is closely related to other human rights, especially the right to social security, to work, and to an adequate standard of living. Women in the early stage of the life tend to accumulate less social capital, such as level of education, position in the labor market due to their greater engagement with household chores, making them at economically, socially and domestically disadvantaged compared to men and they are more likely to become vulnerable and marginalized people, which directly affect the protection and realization of their right to health. According to statistics, “the primary source of income for 54.1 percent of urban elderly women is their pension or endowment insurance, compare with 79.3 percent of urban elderly men; the proportion of rural female seniors whose primary source of income comes from support of other family members was 59.1 percent, while families members are the main source of income for 38.8 percent of rural elderly men. The average annual income of urban elderly women is 49.6 percent that of elderly men in the same region and that of rural elderly women is 51.8 percent that of elderly men in the same region. 13 In terms of sources of income, female senior citizens receive less pension or endowment insurance than male senior citizens, and rely more on the support of spouses and other family members; in terms of economic income, the average annual income of elderly women only accounts for about half that of elderly men in the same region. Because the old-age security for women is “more a type of relatively low level of social security, such as the basic endowment insurance for urban residents and the basic endowment insurance for rural residents”, 14 once widowed, a woman can easily fall into economic difficulties after she loses the support of her spouses income.
The economic security dilemma faced by elderly women directly affects the realization of their right to health. For a long time, “the medical security system has been directly linked to the ability of individuals to obtain formal and urban employment opportunities.” 15 However, the disadvantages in the labor market in the early stage of life directly affect the opportunities and capabilities of many women to obtain health maintenance and medical service resources in their golden years. Therefore, although there are many different kinds of medical insurance, in general, elderly women are covered by urban residents’ medical insurance and new rural cooperative medical insurance, rather than the medical insurance for urban employed, which has a higher level of financing and a higher benefit rate of health services. In terms of medical treatment and medication, “the total cost of medical expenses for older women in the previous year only accounts for about 86 percent of the total medical expenses of older men, but the proportion of medical expenses paid by older women (74.6 percent) is 7.1 percentage points higher than that of their male counterparts. 16 Because of the economic pressure, older women living in poverty are often not helped in time and they are more vulnerable to disease. When a minor disease develops into a serious condition, they are forced to receive a treatment, and the huge medical expenses further aggravate their poverty, thus forming a vicious circle between disease and poverty.
D. Right to health of rural elderly women is frail.
Research shows that “the urban-rural dual structure that has existed in Chinese society for a long time means the living conditions for elderly women living in urban and rural areas significantly different. Empirical data shows that in many fields, the difference between urban and rural age groups greatly surpasses the difference between genders.” 17 Because of the urban-rural division and the gender gaps, elderly women in rural areas are in a more vulnerable position when it comes to protecting their right to health due to the dual disadvantages of their region (rural) and gender (female).
Elderly women in rural areas do not enjoy the same economic and social security as their urban counterparts, and there are gaps and shortcomings in the rural social security systems such as pensions and medical care. In terms of old age social security, China’s social endowment security system in rural areas is still not sound enough. Rural women do not have a retirement system. The current level of rural basic endowment insurance is relatively low, and it does not meet the needs of aging women. Due to a lack of relatively independent and stable incomes and other sources of income, rural elderly women rely more on support from family members than their urban counterparts. Some rural women still have to do what they can to earn a living in their twilight years. According to the third survey of Chinese women’s social status, “23.1 percent of older women in rural areas are still engaged in agricultural work”. 18 In terms of medical security, the full coverage of rural medical insurance and critical illness insurance have not yet been fully popularized in rural areas. Some rural areas are short of medical care and getting medical treatment is not convenient. Because of their fragile economic situations and the lack of comprehensive medical security, many old women in rural areas rarely receive regular physical examinations; therefore, it is very common for them to suffer ill health, and there is a high prevalence of chronic diseases among the rural elderly female population. Data show that, 29.2 percent of the rural elderly women have not seen a doctor when they got sick in the in past three years, which was 4.9 percent higher than the number of elderly men in rural areas who had not seen a doctor when sick in the past three years, and 9.2 percent and 14.6 percent higher than urban elderly women and men respectively. 19 The mental health of rural elderly women is also noteworthy. Many rural women have to stay in their village doing farm work and housework as best as they can, as well as taking care of their grandchildren, because their children work in cities. The self-evaluation of their health by elderly women in rural areas is generally more pessimistic due to a lack of necessary and adequate spiritual support from family members. In addition, the suicide problem among old women in rural areas requires urgent attention as well. According to a survey, the suicide rate has been on the rise in the past decade and is likely to last 10 to 20 years. 20 Survival difficulties caused by the lack of material support and long-term daily care are the main reasons for elderly rural women committing suicide. In addition, the pain caused by physical illness, physical disability and mental suffering, as well as being unwilling to tie their children down, are also important inducements. According to statistics, “among women aged 60 and above who have committed suicide, those with various diseases account for more than four-fifths, among which, the elderly women with disability and semi-disability account for nearly half”. 21
III. State Responsibility for Safeguarding the Right to Health of Elderly Women
In a traditional society, individuals are responsible for their own health. Only when their health is threatened or damaged by others, will the law intervene to help them. The right to health is therefore limited to the private sphere. “The State has only passively providing the final remedies for the private sector within the limits of the minimum moral standards.” 22 In modern times, with the process of large-scale socialized production and industrialization, European countries such as the United Kingdom began to offer medical services to the poor in the form of government relief to maintain social stability and ease social contradictions. The State thus undertakes limited moral responsibility and legal responsibility to maintain public and individual health, and the right to health has also become a social right beyond the individual. After World War II, with the rise of human rights and people’s attention to public hygiene and health issues, the right to health has been established as an essential human right by the international human rights instruments such as the universal Declaration of Human Rights and the international Covenant on Economic, Social and Cultural Rights, which are in line with civil rights and political rights.
The right to health has the basic characteristics of human rights. For example, it is universal and equal. Everyone has the right to the benefits of the right to health, free from unfair treatment, in order to achieve human dignity and value; in addition to not hindering or intervening in the exercise of the right to health, a State and/or a government should actively create conditions for the exercise and protection of the right to health; with particular emphasis on the concern of socially disadvantaged groups such as women, children, and the disabled, because they are more vulnerable to deprivation and discrimination of the right to health. Emphasis should be placed on the interdependence and correlation between the right to health and other social rights such as the right to social security, the right to work, the right to an appropriate standard of living, and the right to life, as human rights that are rich in content are yet closely related and inseparable. Among them, the standard of human rights is particularly important for the adjustment of State-to-individual relations. Since “the most important impact of the human rights approach is to hold the government accountable”, 23 a State has an unshirkable obligation and responsibility for the protection of the right to health. In other words, although the right to health does not mean that the State should ensure that everyone can be healthy, after all, genetic factors, physical condition, and lifestyle and so on, are likely to have an important impact on personal health, but the State has the obligation and responsibility to make the most of available resources and do its utmost to achieve the highest possible health standards for individuals .In accordance with the General Comment No. 14 of the Committee on Economic, Social and Cultural Rights on the right to health, the right to health, like all human rights, requires States parties to assume three types of obligations, namely, respect, protection and realization. In combination with the protection of the right to health of elderly women, the State’s obligations are embodied in the following aspects.
Obligation to respect. This requires the State not to directly or indirectly interfere with the right to health of elderly women. These include the State’s non-discriminatory approach to the health status and needs, not depriving or restricting elderly women equal access to preventive, curative and pain-relieving health services; elderly women should not be restricted in their access to healthy life and health care, including sexual health; they should not be prevented from participating in health matters, deprived of decision-making opportunities and resources in the health sector; they should not be given false health information.
The obligation to protect. This requires the State to take measures and actions to prevent any individual or organization from violating the right to health of elderly women. These include the responsibility of the State to adopt a law or other measures to ensure that they have equal access to health care services, to supervise and ensure quality health care services are available to the female senior citizens, to prevent and punish violations of the right to health and to provide health care services and assistance to elderly women in particularly difficult circumstances.
Obligation to fulfill. This requires the State to adopt appropriate legal, administrative, budgetary, judicial, promotional and other measures to fully realize the right to health of elderly women. These include a State’s full recognition of the right to health of elderly women when making national policies and legal systems, and the development of detailed plans to achieve the right to health to ensure that elderly women have equal access to basic health elements such as nutritious safe food and clean drinking water, standard sanitation and adequate housing and living conditions.Public health institutions, medical facilities and affordable health insurance which help to protect these rights should also be provided. Relevant research into elderly women’s health and raising awareness of the right of elderly women to health is also necessary.
IV. Suggestions for Promoting the Protection of the Right to Health of Elderly Women
It is believed that China can make efforts in solving the aforementioned problems from the following aspects.
A. Improving laws and regulations to protect the right to health of elderly women
In terms of guaranteeing citizens’ right to health and women’s rights and interests, China has introduced a series of laws and regulations. As stated in Articles 21, 45 and 48 of the Constitution, the State develops medical and health undertakings to protect people’s health; citizens have the right to obtain material assistance from the State and society in the context of senility, suffering a disease or incapacity to work. The State develops the social insurance, social relief and medical and health services to ensure citizens enjoy the right; and women enjoy equal rights with men in all aspects of politics, economy, culture and family life. For example, Article 98 of the General principles of the Civil Law stipulates that citizens have the right to life and health; Article 110 of the General principles of the Civil Law stipulates that natural persons have the right to life, body and health; Article 2 of the Tort Liability Law provides that infringement of the right to health shall bear the tort liability. In addition, the Labor Law, the Criminal Law, the Consumer protection Law, the Maternal and infant Health Care Act, and many other laws also have relevant content. In particular, the Law on the protection of Women’s Rights and interests, which is specifically designed to protect women’s rights and interests, has clear provisions on the protection of women’s health rights. As mentioned in Articles 28 and 38, the State guarantees women’s rights and interests in social insurance, social assistance, social welfare and health care. Women’s right to life and health should not be violated, and maltreatment and abandonment of sick, disabled and senile women shall be prohibited. However, these provisions are still too general for the elderly women as a special group, and need to be detailed in practical operation and specific application. Another example is the Law on the protection of the Rights and interests of the Elderly, which is specifically targeted at the elderly. Although it has provisions on family support, social security, and social services related to the right to health, it does not fully reflect the special needs of elderly men that differ from those of elderly men. Therefore, the adoption of specific legal means to effectively protect the right to health of elderly women and to reflect and meet the gender differences in the protection of the right to health of older women should be the direction for further improvement of relevant legislation in the future.
B. Developing gender equality in the health care for the elderly
In order to promote the construction of healthy China, China issued the Outline of the Healthy China 2030 plan in October 2016, proposing that strategic theme of building a healthy China, “Building and sharing together and healthy for all”. Since the fundamental purpose of building a healthy China is to achieve universal health, it is necessary to establish a focus on the whole population and the whole life cycle to provide fair and accessible and systematic and continuous health services for all people. Among them, a special emphasis is placed on the need to address the health problems of key populations such as women, children, the elderly, the disabled and low income groups. For elderly women, as their health rights disadvantages are largely the result of gender differences and inequalities in the previous life course, therefore, based on the principle of equality and non-discrimination of human rights, it is necessary to increase the gender perspective in the development of the elderly health undertakings and implement the principle of gender equality so that the male and female seniors can enjoy the right to health on an equal basis. This should not only reflect the factors that should consider gender differences when formulating relevant laws, but also represent the social perspective when formulating social policies on the development of health care for the elderly, so as to provide a good social environment for the protection of the health rights of old women. For example, when formulating policies, plans and programs for the health of the elderly, gender equality in resource allocation should always be considered, and the collection, analysis and publication of relevant indicator data should be institutionalized and normalized. In the process of implementation and evaluation, the special health needs of the elderly women should also be addressed, and discrimination and prejudice against older women in social culture should be resisted and eliminated. The European Union’s approach in this regard is worth learning. In view of the increasing protection of women’s right to health, some scholars even believe that “some health decisions made by EU member States are now more applicable to women”, and “many problems of men’s and women’s health are completely different” and, “most of the introductions to health information come from women, or for women, far more than men’s health information.” 24
C. Improving the health care level of elderly women
The Vienna Declaration and programme of Action, adopted in 1993, emphasizes the importance of women’s physical and mental health to the highest standards throughout their lives and reaffirms women’s right to adequate and accessible health care. 25 Subsequently, General Comment No. 14 of the United Nations Committee on Economic, Social and Cultural Rights, in 2000, clearly stated that convenience, access to conditions, acceptance of conditions and quality should be essential for the State’s protection of the right to health (it is summarized as sufficiency, accessibility, acceptability and quality by some scholars). 26 The right to health of old women should also reflect the above requirements: that both urban and rural areas should provide adequate and parallel health care facilities, goods and services for older women; based on the principle of non-discrimination, these health care facilities, commodities and services should be safe, practical, and economically affordable for elderly women; in addition to adhering to medical ethics and cultural practices, these health care facilities, goods and services should also consider the unique needs of gender and the female life cycle and should be accepted by elderly women; the sanitation facilities, goods and services provided to them must be reasonably appropriate and of good quality, including highly skilled medical personnel, scientifically certified qualified medicines and hospital equipment, and appropriate sanitation conditions, etc. Considering that the relatively low medical security level of rural elderly women and the large gap between urban and rural areas, they are more likely to suffer from chronic diseases, it is necessary to adopt a sloping and targeted support policy, such as increasing relevant capital investment into the public health service system to better serve rural women. All elderly women should have access regular physical examinations, and health education and research should be conducted on the common diseases and chronic diseases suffered by elderly women, paying attention to the special needs of elderly women for medical and health resources, helping to solve the lack of money for medical treatment, so that they can obtain high-quality and affordable health care services in disease prevention, treatment and physical and mental rehabilitation.
D. Enhancing social security for elderly women
As mentioned above, the right to health is a comprehensive human right. To better protect the right to health of elderly women, perfect and effective social security is indispensable. In terms of medical security, it is necessary for the State to further expand the coverage of social health insurance for the elderly women and the scope of health services, and provide practical medical assistance to impoverished elderly women. For example, experts have proposed that the free examination to detect cervical cancer and breast cancer should not only be offered women of right age from low-income families in urban areas, but also rural women, especially poor rural women. Exploring the inclusion of “Two Cancer Examinations for Women” in the scope of medical insurance reimbursement for urban and rural residents in areas where conditions permit, and gradually forming the institutionalization, standardization of the “two cancers” examinations. It is also necessary to explore the inclusion of women’s two cancer screenings into urban and rural residents’ medical insurance reimbursement scope where conditions permit” 27 , and gradually form the institutionalization, standardization and long-term effects of the examinations for the two cancers.
In terms of pension security, the following measures can be implemented: first, the implementation of the same retirement ages for two genders, the pensions for women can be increased to narrow the income gap with elderly men. The second is to effectively implement the system of guarantees for women after their husband has died. At present, in the countries like the United States, Canada, Japan, and India, a social security survivors benefits guarantee system has been generally established, 28 which plays an important role in ensuring the basic life of old women. In China, although Article 73 of the Labor Law clearly stipulates that after the death of a laborer, his surviving family enjoys the survivor’s allowance according to law, but the amount of funeral expenses and pension paid by the spouse’s work unit is often small and they lack long-term economic support, 29 which can easily lead to widowed elderly women in a difficult situation. Therefore, the survivor’s guarantee system should be incor- porated into a stable social security system to effectively protect the basic needs of widowed elderly women. The third is to provide special subsidies and assistance. In a prosperous economic development area, special support policies can be considered to help solve the real life difficulties by granting special subsidies.
In terms of social welfare, it is necessary to increase investment in the welfare of elderly women and meet their welfare needs, for example, through the establishment of institutions such as community health centers, and medical service centers, to provide old women with the necessary medical treatment and medical care services to help them develop a healthy and good lifestyle. Through the establishment of public facilities, such as canteens and entertainment centers for the elderly, universities and other facilities in a community for seniors, elderly women can be provided with the necessary social places and activities and enabled to participate in social interactions, which will enrich spiritual and cultural life, and help them to maintain a positive attitude towards life and health mental State. For a qualified community, a special socialized aged care institution can be established on the basis of the home-based medical care model to provide professional care for elderly women, especially those who enter the disability disorder and are seriously ill in bed. In addition, it is necessary to guarantee the right to family reunions and to provide facilities and conditions for family reunions, which is also necessary for maintaining the good physical and mental health of elderly women in rural areas.
V. Conclusion
The right to health as a basic human right is of particular importance to elderly women. The State should assume the most important responsibility for human rights protection to ensure and promote the full realization of their right to health. This is not only an inevitable requirement for China to implement the Healthy China 2030 plan, the development of the cause of health for the elderly, but also a concrete manifestation of China’s implementation of the international commitment to safeguard human rights and put forward the human rights of women.
(Translated by Yu Nan)
* LU Yi ( 陆艺 ), Associate Professor of Marxism College, Nanjing University of Traditional Chinese Medicine, Jurum Doctor. This paper is a phased achievement of “Study on the Protection of Women’s Health Rights under the Perspective of Human Rights”, Provincial Philosophy and Social Science Fund Project of the Jiangsu Provincial Department of Education in 2017 (Project No. 2017SJB0321)
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