A turn for the worse

It is no secret that women in the UK experience poorer health outcomes than men. This bucks the trend across 156 other countries where gaps in outcomes generally leave men at greater risk of poorer physical and mental health than women, according to a 2020 study by men’s healthcare start-up Manual. But to meaningfully address health inequalities we must see the full picture.

The disparity in outcomes between women and men in the UK – the largest gap in the G20 – makes for sobering reading. Take dementia as an example: a 2016 study by researchers at UCL found that women with dementia made fewer visits to a GP, received less health monitoring and took more potentially harmful medication than men. When looking at mental health, the Department of Health and Care found that eating disorders and the risk of self-harm are both greater among women and girls than men and boys.

There has been much study on the contributing factors towards the ‘gender health gap’ in the UK – from women being routinely underrepresented in clinical trials and receiving less medical research funding than men, to bias in the treatment of pain resulting in women being less likely to be prescribed relevant medication or admitted to hospital.

We have, however, made great strides in understanding the systemic biases at play here. And this year, the government made clear that the Women’s Health Strategy would “make women’s voices heard and put them at the centre of their own care”.

But there are stark inequalities between different groups of women in relation to their health.

A particularly bleak statistic is that Black women in the UK are more than four times more likely to die in pregnancy and childbirth than their white counterparts.

There are now concerns that Covid-19 has worsened these gaps in care, as an inquiry from the all-party parliamentary group on sexual and reproductive health into access to contraception suggests: Data indicates that only 31 per cent of healthcare professionals were confident that  women from marginalised groups could access contraception and other sexual reproductive healthcare during lockdown.

So how do we address the different challenges in women’s healthcare?

It is first important to acknowledge the role of wider social factors. The Health Foundation champions the need to view health as inextricably linked to the conditions in which people are born, grow, live, and work; their age; and inequities in power, money and resources – the social determinants of health.

It is in this vein that many healthcare leaders are calling for a cross-government strategy to reduce health inequalities, accompanied by the necessary funding.

But where does this leave women facing worse outcomes across different aspects of healthcare? How can we ensure our strategy is able to eradicate inequalities in pregnancy and birth outcomes, or improve health outcomes for transgender women, for instance?

Any overarching strategy to reduce health inequalities for women must be underpinned by equity policies across the life course. In practice, these are policies that can address inequalities in physical and mental health from preconception and early years up to adolescence, working age, and older age. This is how we significantly address the inequalities not only between women and men, but also between women.

And we can only make meaningful progress by taking an intersectional approach to tackling inequalities. This means that our policies must reflect the inextricable way that factors such as race, class, gender, disability, and sexuality intersect to shape each other.

Researchers are looking at how this can be done in practice, including a group in the United States who reviewed the challenges around adoption of the HIV-preventative treatment PrEP among young adult Black women. Alongside their sexual and reproductive healthcare needs, researchers explored multiple other factors including awareness, interest, and the utilisation of PrEP within these groups of women.

Essentially, we cannot take one social category at a time. Instead, we need to adopt a cross-sector policy framework that recognises the way in which different inequities are intertwined – with the aim of making tangible health improvements for different groups of women.

‘Levelling up’ is said to be a key agenda for the government – although it is widely criticised for being more of a slogan than anything else. And it is yet to translate into progress by way of developing a cross-sector strategy. We are also still awaiting the publication of the Women’s Health Strategy, further to the call for evidence closing in mid-June.

The Labour party has long held itself up as ‘the party of equality’, with pledges including the introduction of a new Race Equality Act to tackle complex structural racism in the UK. Putting this commitment meaningfully into practice in women’s health is an important task, albeit not an easy one. But with a general election potentially around the corner, now is the time to show how it will rise to the challenge.