Women with activity limitations

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by Susan Crompton

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Introduction
Women are more likely than men to have an activity limitation
The population with activity limitations is substantially older
Pain is the most common cause of poor functional health among women with activity limitations
Women perceive that their activity limitations stem largely from disease or illness
Half of women with activity limitations have arthritis and/or back problems
Over one-quarter of women with a chronic physical health problem also have a psychological condition
One-quarter of women with activity limitations live alone
Women with activity limitations have less postsecondary education
Over half of women with activity limitations say activities at home are restricted by their condition
Half of women with activity limitations need help with everyday tasks
Women of prime working age participate less in the workforce if they have activity limitations
Accommodations in the workplace
Women with activity limitations report 25% lower personal income than other women
Household income gap even wider
No income gap when main source of income is the same
The majority of women with activity limitations report non-employment income as their main source of income
Women with activity limitations score below normal on well-being measures
Women with activity limitations visit the doctor more and exercise less

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Introduction

A long-term health problem or chronic condition can prevent someone from participating in necessary activities—doing housework, making meals—or in leisure activities—going places, doing things with family and friends. The social environment may also prevent a person with such a condition from taking part in events; for example, when an event lacks ramps to facilitate physical access or does not provide technical aids such as hearing devices.¹

In this chapter, a person is defined as having an activity limitation if they report that they have a long-term physical or psychological health problem, or a chronic condition, that is severe enough to "often" affect their normal functioning at home, at work, at school, or in another domain such as transportation or leisure activities.²

This chapter will use data from the 2009 Canadian Community Health Survey. It will examine the age structure of the population with activity limitations, the different types of limitations, as well as the education and income of women with and without activity limitations.

Women are more likely than men to have an activity limitation

In 2009, 12% of women aged 15 and over reported that they had an activity limitation. That is, about 1.7 million Canadian women had a long-term health condition or problem that often made it difficult for them to function normally in everyday life. (A long-term condition is a condition that is expected to last, or has already lasted, six months or more.) Somewhat fewer men aged 15 and over reported having an activity limitation, at 11% or just under 1.5 million.

Everyday tasks generally become more difficult as the human body ages: the joints get stiff, the muscles weaken and chronic illnesses take their toll. So it is not surprising that the proportion of women reporting an activity limitation increases steadily with age. Only 5% of women in their teens or 20s reported having an activity limitation. For women in their 40s, this proportion doubled to 10%, and it almost doubled again to 18% for those in their 60s. By the time women reached their 80s, more than one in three (35%) had a long-term health condition or problem that often restricted their daily activities in some way (Chart 1).

Chart 1 Prevalence of activity limitations among women and men aged 15 and over, by age group, Canada, 2009

The prevalence of activity limitations is the same for women and men until they reach their 60s and 70s. In these two age groups, women had a significantly higher likelihood of reporting an activity limitation: among those in their 60s, 18% of women versus 16% of men, and among those in their 70s, 24% versus 21%.

The population with activity limitations is substantially older

The population with activity limitations is considerably older than the population without them. Over 2 in 5 women with activity limitations (45%) are aged 60 and over; this is more than twice the proportion of women without activity limitations (21%). The same pattern is true of the male population with activity limitations (Chart 2).

Many demographic and socio-economic characteristics of the population with activity limitations reflect this older age composition. For instance, women with activity limitations have a higher rate of widowhood and lower levels of income and labour force participation compared with the rest of the population. These issues will be discussed later in this chapter.

Chart 2 Distribution of population with and without activity limitations, by age group, Canada, 2009

Pain is the most common cause of poor functional health among women with activity limitations

The Health Utility Index (HUI) developed by McMaster University is used to assess a person's "functional health". It measures how well a person is able to see, to hear, to walk, to talk, to handle objects and to remember and think; it also assesses a person's emotional well-being and the amount of pain they experience. When all these components are rolled up into the HUI, the overall average functional health score of women with activity limitations is 0.57 out of 1. This score is considered to be an indicator of "moderate to poor" functional health. In contrast, the HUI score for women without activity limitations averaged 0.91, indicating that they have "good to full" functional health.³

Of the eight components of the HUI, pain was by far the major contributor to poorer functional health among women with activity limitations. Over 1 in 5 women with activity limitations (21%) reported that they did not participate in most activities because it was too painful for them. Another 2 in 5 (38%) said that pain prevented them from performing some activities (Table 1).

Table 1 Women and men aged 15 and over, by degree of difficulty with functional health components and activity limitations status, Canada, 2009

Just over 1 in 10 women with activity limitations (12%) indicated they had poor emotional well-being, saying that they were somewhat to very unhappy. Almost as many reported they had serious mobility problems: about 1 in 10 women with activity limitations (11%) needed a wheelchair or help from other people, or were unable to walk at all.

Over 7% of women with activity limitations reported impaired functioning for cognitive tasks, saying they found it very difficult to remember and to think. This finding probably reflects the much higher concentration of senior women in the population with activity limitations. In other key areas of functional health (vision, speech and dexterity), only 2% of women with activity limitations had severe difficulties.

Pain may be correlated with poor functional health in several key areas of everyday life. For example, 41% of women with activity limitations who had severe ambulatory problems reported that pain prevented them from performing most activities. Similarly, 31% of those who were somewhat to very unhappy had levels of pain that excluded them from performing most activities (data not shown).

Women perceive that their activity limitations stem largely from disease or illness

In 2009, about 41% of women with activity limitations attributed them to disease or illness, and another 16% to what they described simply as ageing. Men were less likely to identify these causes than women, at 29% and 12%, respectively (Table 2).

Table 2 Women and men with activity limitations aged 15 and over, by main cause of activity limitation, Canada, 2009

On the other hand, men had almost a 1.5 times greater probability of identifying an accident (especially a work accident) as the origin of their activity limitation, at 29% compared with 20% of women. The likelihood that a man's working conditions were the source of his activity limitation was also much higher than a woman's (13% versus 5%).

Half of women with activity limitations have arthritis and/or back problems

Among people with activity limitations, 9 in 10 women (91%) had been diagnosed with at least one chronic health problem or condition, as had 86% of men. However, it is very common for people with activity limitations to have more than one health problem: 34% of women in this population had three to four chronic conditions, and 20% had five or more; the corresponding figures for men were 28% and 12%, respectively (data not shown).

The most common chronic conditions among women with activity limitations were arthritis (50%) and back problems (47%). High blood pressure affected close to 2 in 5 women (37%). Other commonly diagnosed chronic conditions were migraines (22%) and mood disorders (22%), such as depression, manic depression, bipolar disorder and dysthymia (Table 3).

Table 3 Prevalence of selected chronic conditions, women and men with activity limitations aged 15 and over, Canada, 2009

In general, most chronic health problems were more prevalent among women than men who had activity limitations. The exceptions were heart disease and diabetes, which were slightly more common among men with activity limitations. The likelihood of having COPD (chronic obstructive pulmonary disease), ulcers, cancer, Alzheimer's or the effects of a stroke did not differ between the sexes.

Over one-quarter of women with a chronic physical health problem also have a psychological condition

Women with chronic physical health conditions also often experience psychological problems such as depression or anxiety. Twenty-five percent (25%) of women and 16% of men with activity limitations had a psychological condition in addition to a chronic physical health problem (data not shown).

Some chronic diseases were more often accompanied by a psychological condition than others. For example, more than one in three women with bowel disorders, migraines, asthma, COPD and ulcers also had mood or anxiety disorders. In contrast, only about one in five women diagnosed with high blood pressure, cancer or the effects of a stroke had also been diagnosed with a psychological condition.

One-quarter of women with activity limitations live alone

As discussed earlier, living with activity limitations becomes increasingly common as people age. In fact, two-thirds of women with activity limitations are aged 50 or over; their living arrangements reflect those of an older population, that is, a higher concentration of one- and two-person households. Women with activity limitations were almost twice as likely as other women to live alone (26% versus 14%), and were only about half as likely to live with a spouse and children (15% versus 28%). Within the activity-limited population, men were less likely to live alone than women and more likely to live with their spouse in a couple only or with children (Table 4).

Table 4 Women and men aged 15 and over, by living arrangement and activity limitations status, Canada, 2009

The marital characteristics of women with activity limitations also reflect the fact that they are generally much older than women without activity limitations. Women with activity limitations were three times more likely to be widowed (17% versus 6% of other women) and almost twice as likely to be divorced or separated
(14% versus 8%) (data not shown).

Women with activity limitations have less postsecondary education

Women with activity limitations are not as well-educated as other women: 42% have no more than high school compared with 33% of women without activity limitations. This disparity partly reflects the older age structure of the population with activity limitations, since seniors generally have lower levels of educational attainment. However, even when the population is restricted to women of prime working age (25- to 54-year-olds), those with activity limitations still have fewer educational credentials. They were twice as likely as women without activity limitations to have less than high school (13% versus 7.4%), and only two-thirds as likely to have a university degree (22% versus 32%). On the other hand, the likelihood that they had a community college diploma was about the same as that for women without activity limitations (Table 5).

Table 5 Women and men aged 15 and over, by educational attainment, age group and activity limitations status, Canada, 2009

Over half of women with activity limitations say activities at home are restricted by their condition

It is important to distinguish the domain in which a person's activity limitation manifests itself: having trouble functioning normally may have quite different implications depending on whether one is taking part in leisure events or discharging responsibilities at home or at work. Over half of women with activity limitations (55%) reported that their activities at home were often reduced by their long-term health problem or condition. A slightly larger percentage (57%) said their condition often curtailed their participation in leisure activities or created transportation problems. Similar proportions of men with activity limitations experienced restricted freedom of activity in each of these domains (Chart 3).

Chart 3 Domains in which a long-term health condition or problem limits activities among persons with activity limitations, Canada, 2009

Among women with activity limitations who were working at a job in 2009, 45% reported that their activities at work were often restricted by their condition. Substantially fewer women attending school said their condition often affected their academic activities (34%).

Half of women with activity limitations need help with everyday tasks

Just over half (52%) of women with activity limitations needed some help with at least one major activity of daily living. In contrast, only one-third (33%) of men with activity limitations said they needed help.

This disparity between the sexes is due to the fact that men required much less assistance with household tasks and transportation. Women with activity limitations were much more likely to need help with housework (42% versus 25% of men), and with getting to appointments or running errands (37% versus 22% of men). Women also had a somewhat higher probability of needing help to prepare meals, at 19% compared with 15% of men with activity limitations (Chart 4).

On the other hand, men with activity limitations were just as likely as women to need help with personal finances, personal care and moving about inside their home.

Chart 4 Type of activities of daily living with which help is needed among persons with activity limitations aged 15 and over, Canada, 2009

Women of prime working age participate less in the workforce if they have activity limitations

In the week preceding the 2009 Canadian Community Health Survey, about 60% of women aged 25 to 54 with activity limitations had paid work or were self-employed. This is a significantly lower rate of employment than that for other women of prime working age, 81% of whom were working.

However, among prime-working-age women who were employed, those with activity limitations were no different than other women in terms of the amount of hours they worked and the kinds of jobs they held. More than half (54%) of employed women aged 25 to 54 with activity limitations usually worked between 30 and 40 hours a week; just under one-quarter (24%) worked more hours. The same is true of women without activity limitations (Table 6).

Table 6 Women and men aged 25 to 54, by selected employment characteristics and activity limitations status, Canada, 2009

The majority of working women aged 25 to 54 with activity limitations were employed either in sales and service jobs (25%) or jobs in business, finance and administration (25%). Only 6% were employed in management occupations. A significant proportion (20%) worked in occupations related to social sciences, education, government, culture and similar jobs; another 13% worked in health occupations. This distribution is very similar to that of women the same age without activity limitations.

Sixty-seven percent (67%) of men aged 25 to 54 with activity limitations had a job, a higher employment rate than that of women with activity limitations (60%). In contrast, men were twice as likely to work over 40 hours a week, at 48%, compared with 24% of women (Chart 5).

Chart 5 Women and men aged 25 to 54 with activity limitations, by selected employment characteristics, Canada, 2009

Men with activity limitations were also twice as likely as women to work in management occupations, which are generally higher-paying white-collar jobs that are less physically demanding. On the other hand, the most common occupations held by men were trades and blue-collar jobs (38%) (Table 6), which may explain the higher proportion of men who attribute the cause of their activity limitation to their working conditions and job-related accidents (Table 2).

Accommodations in the workplace

In 2006, 545,000 women with activity limitations were employed in the workforce. According to the Participation and Activity Limitation Survey, over 4 in 10 of these women (44%) reported that they needed at least one kind of accommodation from their employer in order to be able to work (Table 7).

The most common requirement, identified by almost one-quarter (23%) of working women with activity limitations, was a modified work day or reduced work hours. Somewhat fewer women (20%) needed a special chair or back support. About 14% needed to change or modify the duties of their job, and/or to have their workstation modified or replaced by an ergonomic workstation. Access to facilities—parking, washrooms and elevators—was needed by about 5% of women with activity limitations in order for them to do their work. Other, more specialized types of accommodation, including technical aids and human assistants, were required by fewer than 3% of employed women with activity limitations.

When women were asked if the accommodations they needed had been made available to them, the majority answered that they had. At least 8 in 10 women needing accessible washrooms, modified working hours, and help with physical access like handrails or ramps had obtained them from their employer. So had at least 7 in 10 women who needed an accessible elevator, parking, transportation, or modified workstation. At least 60% of women requiring a special chair or back support, job redesign, or other type of equipment, help or work arrangement said their employer had made the necessary help available. An accommodation had been received by half (50%) of the women who needed the support of a human assistant, such as a person to read for them, provide sign language interpretation, or be a job coach or personal assistant.

Table 7 Type of accommodation required to be able to work, employed persons with activity limitations, Canada, 2006

Women with activity limitations report 25% lower personal income than other women

Women with activity limitations have a considerably lower average income than other women. According to the 2009 Canadian Community Health Survey, their average personal income was about three-quarters that of women without activity limitations, at $24,000 compared with $32,100 (Table 8).

These averages did vary considerably by age group, however. Among women aged 25 to 44, women with activity limitations reported an average personal income about 79% of that of other women, at $28,600 compared with $36,300; among women aged 45 to 64, the income gap between those with and without activity limitations was only 65%. Among seniors though, the gap narrowed again: women with activity limitations reported an average personal income that was 91% of that of other women ($21,400 versus $23,400).

Table 8 Average income of women and men aged 15 and over, by age group and activity limitations status, Canada, 2009

Average personal income also varied considerably depending on a woman's province of residence. In Atlantic Canada, the ratio of women with activity limitations to women without them was 81%, and it was 64% in Alberta (Table 9).

Table 9 Average income of women and men aged 15 and over, by region and activity limitations status, Canada, 2009

Men with activity limitations had lower personal income than other men, but they did much better than women. Their average personal income was $41,200, which was 72% higher than the average for women with activity limitations. The size of this disparity varied across the country; it was about 66% in Atlantic Canada and British Columbia and 47% in Alberta (Chart 6).

Chart 6 Average personal income of women and men with activity limitations, by region, Canada, 2009

Household income gap even wider

At the household level, the income gap between women with and without activity limitations was even wider than for personal income. Average household income was $54,500 for women with activity limitations and $78,100 for those without, a difference of about 30%. As shown earlier, a significantly higher proportion of women with activity limitations live alone, which would account in part for this phenomenon. Also, as discussed earlier with regard to personal income, average household income varies substantially depending on age group (Table 8).

However, when comparing women and men with activity limitations, the gap between the sexes was smaller for household income (17%) than for personal income (42%). In fact, in Atlantic Canada and British Columbia, household income was roughly equivalent for both women and men with activity limitations (Chart 7).

Chart 7 Average household income of women and men with activity limitations, by region, Canada, 2009

No income gap when main source of income is the same

The overall income average masks a somewhat more complicated story. The income gap between women with and without activity limitations largely disappears when their main source of income is the same. For example, women with activity limitations whose primary source of income is employment (paid work and self-employment) reported personal income of $37,300, statistically the same as that for women without activity limitations ($39,400). The same is true for most other personal income sources. The exception is income received mainly from pensions and investment—in this case, women with activity limitations averaged about $4,000 less, at $22,600 compared with $26,700 (Table 10).

The pattern is somewhat different for household income. Women with activity limitations live in lower-income households than those without activity limitations. When looking at specific income sources, women with activity limitations had less household income if its main source was from paid work or self–employment or from pensions and investments.

Table 10 Income of women and men aged 15 and over with activity limitations, by main source of income, Canada, 2009

The majority of women with activity limitations report non-employment income as their main source of income

If women's personal income does not differ much when it comes from the same main source, why is the overall average income so much lower for women with activity limitations? One reason is that the majority of them rely on non-employment income. Compared with other women, they were half as likely to report paid work or self-employment as their principal source of personal income, (35% versus 68%); on the other hand, they were twice as likely to report pensions and investments (28% versus 12%) and three times as likely to rely on government transfers—that is, Old Age Security, Guaranteed Income Supplement and Social Assistance (21% versus 7%). Similar findings generally apply also to their main source of household income (Table 11).

Table 11 Women and men aged 15 and over, by main source of income and activity limitations status, Canada, 2009

When comparing women and men with activity limitations, men have a substantially higher probability of reporting employment as their main source of income, and a lower probability of relying on government transfers (Chart 8).

Chart 8 Distribution of women and men with activity limitations aged 15 and over, by main source of income, Canada, 2009

Women with activity limitations score below normal on well-being measures

Across a range of subjective measures of well-being, women with activity limitations scored lower than other women. On the Health Utility Index that measures overall ability to function normally in everyday life, 70% had moderate to poor functional health, compared with 13% of women without activity limitations. They were also four times as likely to report that their mental health was poor to fair (17% compared with 4%) (Table 12).

Table 12 Distribution of women and men aged 15 and over, by selected measures of well-being and activity limitations status, Canada, 2009

Women with activity limitations rated their general life satisfaction much lower and their level of stress much higher than other women. While 26% of women with activity limitations reported being very satisfied with their lives, 41% of other women did so. Similarly, over one-third of women with activity limitations described their daily lives as high-stress, compared with fewer than one-quarter of women without activity limitations. Among women who were employed, a high level of stress was even more common, at 45% and 32%, respectively.

Much of the dissatisfaction that women with activity limitations express about their lives stems from the state of their health.⁴ Even when women with activity limitations were asked to think about their health in more holistic terms—that is, not just as the presence (or absence) of any disease or illness, but also as their physical, mental and social well-being—over 4 in 10 (44%) described their general health as poor to fair. Furthermore, one-third (35%) said that their health had deteriorated since the previous year (Table 12).

In general, men with activity limitations do not score much differently than women on these measures of well being. They were somewhat more likely than women to fall into the good to full functional health category as measured by the Health Utility Index, and as such were a little more likely to describe their general health as excellent, at 8% compared with 4% for women with activity limitations.

Women with activity limitations visit the doctor more and exercise less

Not surprisingly, almost all women with activity limitations had visited a health professional in the 12 months preceding the survey. They were more than twice as likely to have gone to their family doctor or medical specialist five or more times in the previous year (60% versus 25% of other women). On average, they reported about 9 visits to a medical practitioner, compared with almost 4 for other women (Table 13).

Women with activity limitations were only half as likely as other women to be physically active on a daily basis. Over two-thirds were classified as inactive, based on the number of calories they burned doing physical activities each day. Comparing women and men with activity limitations, women were less likely to be active, at 13% versus 19%.

Reflecting their relative lack of physical activity, women with activity limitations were considerably more likely than other women to be overweight (31%) or obese (28%). On the other hand, they were less likely to be overweight than men with activity limitations.

Table 13 Distribution of persons aged 15 and over by health behaviours and activity limitations status, Canada, 2009

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Notes

1. For a more detailed discussion of the concept of social-functional activity limitation, and how the ICF (International Classification of Functioning, Disability and Health) has been operationalized in Statistics Canada's health surveys, see: MacKenzie, A., M. Hurst and S. Crompton. 2009. "Living with disabilities series: Defining disability in the Participation and Activity Limitation Survey". Canadian Social Trendsno. 88. Statistics Canada Catalogue no. 11-008 (accessed November 7, 2011).
2. Having an activity limitation can also be a temporary condition; for example, someone who has had a knee or hip replacement may face difficulties performing daily activities during months of recovery, but later regain their full functional mobility.
3. An overall HUI score of 0.8 to 1.0 is considered to indicate 'good to full' functional health; scores below 0.8 are considered to indicate 'moderate to poor' functional health. See: Statistics Canada. "Functional Health 2009." Health Fact Sheetsno. 2. Catalogue 82-625.
4. Crompton, S. 2010. "Living with disabilities series: Life satisfaction of women with disabilities." Canadian Social Trendsno. 89. Statistics Canada Catalogue no.11-008.