Social inclusion is a determinant of mental health and wellbeing. In today’s analysis, Autumn Pierce (@otonoenespanol) of Women’s Health East (@WHEast) shares highlights from their important new report The Unheard Story: The Impact of Gender on Social Inclusion for Older Women, which explores how inequalities accumulate across the lifespan to increase the risk and impacts of social exclusion for older women.

Within the last few years elder abuse has come into focus in Victoria after being recognised within a family violence context as part of the 2016 Royal Commission into Family Violence findings. Women’s Health East’s primary prevention approach means that within this space, rather than addressing risk factors such as dependency and social isolation, we ask – What are the norms, practices and structures that enable abuse against older people to occur? And how does gender influence the risk and impacts of elder abuse?

The absence of a gender lens in the presentation of leading elder abuse data and the conversations within the sector at the time made it clear we had an important advocacy role to play in the prevention of elder abuse against older women. The manifestations and implications for women and gender inequality in Australia – the wage gap, lower superannuation balances and greater risk of sexual and physical violence and workplace harassment, to name a few – aren’t exchanged for Seniors Cards. If anything, where these experiences of discrimination intersect with ageism, their effects are further compounded.

This is a key point missing in the approach to most issues affecting older women, and nothing gets us more fired up than a story only half told. Recognising the interconnectedness of issues disproportionately affecting women, we started investigating opportunities to influence not only the narrative around elder abuse, but around older women’s experiences more broadly.

Understanding social inclusion

We honed in on social inclusion, leveraging the expertise of a partner organisation working in the social inclusion and healthy ageing sectors. For older populations, social inclusion is recognised as an enabling contributor to healthy ageing. However, when we started investigating, we found limited attention in guiding literature given to the intrinsic link between gender, social inclusion and healthy ageing. This is despite social inclusion being an indicator of healthy ageing, and gender being an established determinant of overall health.

Maintaining vital social connections in older age is made difficult for women following a lifetime of accumulated disadvantage. Photo credit: Matthew Henry for Burst.

The Unheard Story: The Impact of Gender on Social Inclusion for Older Women is the culmination of our investigative work to understand the current context and tell the ‘whole’ story of ageing. The Unheard Story explores women’s access to resources, capabilities and opportunities to learn, work engage and have a voice, in line with the Australian Social Inclusion Board’s definition of social inclusion. This gendered distinction not currently reflected in key international, national and local documents that guide contemporary practice in social inclusion and healthy ageing.

The Unheard Story highlights how current narratives continue to disadvantage women by failing to recognise the lifelong impacts of inequality that are further compounded in later years, and discusses the implications of this oversight on healthy ageing. The paper also captures insights from two focus groups held with practitioners working in both social inclusion and healthy ageing within the Eastern Metropolitan Region of Melbourne. These focus groups were designed to gauge practitioners’ understanding of the impact of gender on social inclusion for older women and to determine how to best support practitioners and organisations in this space.

ASIB’s defining elements of social inclusion are learn, work, engage and have a voice. The Unheard Story uses the following social inclusion indicators adopted by the ASIB to explore the different pathways to social exclusion for women and men:

Income
Access to the job market
Social supports and networks
Effect of the local neighbourhood
Access to services
Health

The paper also looks at another predictor of social exclusion specific to older people – elder abuse.

The data: Gendered disadvantage accrues across a lifetime

A gender analysis of the key social inclusion indicators reveals the specific, but largely ignored, barriers older women face to experiencing social inclusion, the consequences of which can be compounded over a lifetime. For example, older women are more likely than older men to live in poverty and are more likely to experience entrenched poverty. The reason for this disparity is multifaceted and accumulated over time. During their working life, women are likely to have earned less, due to the persisting gender wage gap, and are likely to have taken time out from the paid workforce to have children and take on full-time caring roles. This lower wage and gaps in employment mean that on average, women in Australia retire with about half the superannuation of men.

When considering access to the job market in later years, older women are more likely than older men to be perceived as having outdated skills, being too slow to learn new things, or likely to deliver an unsatisfactory job. But seldom acknowledged is the link between these perceptions of women in their older years and the gaps in their employment history during their younger years.

Financial insecurity caused by unequitable access to the job market is a significant contributor to poor physical and mental health. It is likely we are seeing the impact of the chronic stress of insecure income reflected in the higher rates of anxiety and depression, and more years of chronic illness experienced by older women.

Perceptions of safety and sense of trust in others also impacts on people’s physical and mental health, enabling or hindering their physical movements within their neighbourhood and social engagement with their community. It is significant that older men are more likely than older women to agree most people can be trusted, and feel considerably safer walking down their street alone after dark.

Access to services is significantly affected by the loss of a driver’s licence, which women experience sooner than men. Rates of a driver’s licence possession begin to decrease for women from the age of 65, but not until 70 for men. The proportion of women holding a driver’s licence between the ages of 65-69 is 85.1%, which significantly drops to 42.7% at 85 years. In contrast, 89% of men aged 70-74 hold a driver’s licence and this sees a much smaller drop during the older years, with 73.8% of men 85 years and older still possessing a driver’s licence. Loss of independence, social participation and ability to access services all have health and wellbeing consequences.

Much of the literature looking at social inclusion puts a strong focus on social isolation, a risk factor for social exclusion, and how to improve participation for those who are socially isolated. A breakdown of data by sex is most commonly provided in social inclusion literature when emphasizing the risk of social isolation amongst older men. Discussing gender only to suggest older men are more likely to be socially isolated fails to paint the whole picture and account for the complexities of the issue. Older women are in fact more likely to be socially excluded than older men, yet women are not identified as a priority population in any key social inclusion or health ageing documents reviewed for this paper. Women are overrepresented in many of the specific groups of people at risk of social exclusion. For example, women have a greater life expectancy than men, and make up the majority of the oldest population. Women also make up the majority of carers across most age groups, and are overrepresented in residential care.

All older people are at increased risk of experiencing social exclusion, but their needs are not homogenous. A failure to recognise the gendered drivers of social exclusion disadvantages everyone, including men.

Practitioner insights

To gain better insights into practitioners’ knowledge of the impact that gender has on shaping older women’s social inclusion and how these unique needs are addressed at a service delivery level, Women’s Health East undertook two focus groups with practitioners working in Melbourne’s East. The focus groups were designed to answer the question: Do social inclusion and healthy ageing practitioners recognise gender as an impacting factor on older people’s capacity for social inclusion? In other words, we wanted to know if practitioners were make the connections the literature was not.

The answer - yes and no. The focus group discussions indicated there is great variation among practitioners’ understanding of how gender can impact on older women’s experiences of social inclusion, but certain themes did emerge. Participants spoke about barriers to optimal mental health, including grief and trauma, feelings of invisibility/not mattering, and the mental toll of caring. Participants also spoke extensively about the gender inequality women experience across their lifespan and how this can accumulate and become more pronounced in older age. These areas include education, jobs, caring, income, elder abuse, driving and literacy. The effects of declining physical health on an individual’s confidence and self-perception were discussed, as well as the different experiences of ageing for women and men, particularly relating to chronic illness. Failure to meet clients’ needs and the barriers that prevent certain groups of people from accessing services was another emerging theme, with participants identifying people with disabilities and LGBTIQ people with disabilities are at particular risk for exclusion.

Interestingly, the practitioners used their own experiences to reinforce the points they made relating to their clients, demonstrating the pervasiveness of the issues.

‘It’s taken me three years to get a job; I came second all the time. I’ve coloured my hair now. Ageing is really tricky, you know. Society dismisses you a lot.’

‘In my family my mother had six brothers and four sisters, only the boys went to school past primary school.’

‘I feel at a loss because I don’t have the knowledge and understanding of dementia, how to work with it organisationally. You shouldn’t not come to a [community] class because you have dementia. We should be making things easier to be included while you’re going through that.’

The focus group discussions also explored how practitioners can be supported to build their capacity to improve social inclusion for older women. The main themes emerging from this facilitated discussion included a need for:

Action to address societal attitudes that support gender stereotypes and do not recognise the social capital older women contribute
Advocacy to elevate the voices of women and ensure sufficient funding for neighbourhood houses
Localised data disaggregated by sex, age and other demographic characteristics to improve services
Meaningful commitment from funding agencies to apply what is known about the impact of gender on women’s social inclusion, and adequate training to build services’ capacity around healthy ageing, dementia, inequality and mental health to meet the intersecting needs of their clients.

The necessity of a multi-pronged approach

Practitioners identified that services need more support, training and funding to meet the needs of women in the community, but they also reinforced the need to address the structural barriers to social inclusion outlined in the report. Cleary, a multi-pronged approach is one that recognises the interconnectedness and compounded nature of the issues. For example, if our aim is increase older women’s financial independence we must fund programs designed to improve financial literacy while also funding initiatives that address housing insecurity, personal safety and the impact of caring responsibilities. And this must be informed by women.

In addition to challenging gender inequality, we also need to challenge ageism, which the World Health Organisation calls the most ‘normalised’ of any prejudice in that it is not widely countered like sexism or racism. All older people are exposed to ageism, but when we regard all older people’s experiences as homogenous, it benefits no one, least of all women.

‘Respect the strength of women. Respect and honour who women are, what they’ve been through, and what they have to offer.’

This post is part of the Women's Policy Action Tank initiative to analyse government policy using a gendered lens. View our other policy analysis pieces here.

The gender divide in social inclusion: The unheard story of older women