Tackling the gender health gap: England’s first women’s health strategy

While women on average live longer than men, they often spend a greater proportion of their lives in ill health and disability. Historically, not enough attention has been given to women-specific issues and women have been seriously under-represented in clinical trials. Consequently, not enough is known about conditions that affect only women or why women react differently to conditions affecting both sexes. This situation and concerns over widening disparities for girls and women across the life course was highlighted in 2014 in the UK Chief Medical Officers 2014 annual report, and in several recent high profile independent reports and inquiries since then, all of which stressed that women’s voices are not being listened to. In 2021, the government launched a 14 week call for evidence, receiving an overwhelming response, and in July 2022, published its first ever Women's Health Strategy for England aimed at tackling the gender health gap.¹ This week’s blog explores the priority areas and potential implications for the life sciences and healthcare sector as a whole.

The case for change

Fifty-one percent of the UK population are women, yet healthcare ‘has been designed for men by men’.²  This means women face numerous obstacles obtaining timely diagnoses and treatments. This 'male as default' approach has been embedded across many areas from research and development to education and training and in policies. There has been significant gaps in medical research especially for conditions that only affect women, such as menopause or endometriosis. This disparity is not only affecting physical health but also mental health with decline in mental wellbeing after the onset of the COVID-19 pandemic in the UK twice as large for women as for men.³

The first Women's Health Strategy for England is the next step on the journey to reset the dial on women's health. The call for evidence, generated over 110,000 responses, 97,307 from individuals across England and 436 written responses from organisations and experts in women’s health. These responses demonstrated unequivocally that our healthcare systems are failing women at every stage of their interaction with the system and that the NHS services are simply not designed to meet women's day to day needs.

The prevailing view that emerged was that care could be provided more readily and conveniently and at significantly lower cost if it were provided during a single visit to a women’s health hub or centre, a ‘one-stop-shop’ model. The strategy, which focuses on seven core areas includes bold ambitions to tackle the deep-rooted issues within the health and care system and ‘reset’ how the health and care system listens to and involves women in health.

Why is there a gap?

Understanding the root cause of a problem is essential in finding the right solutions. The situation in the UK is not unique, a report by our Deloitte US colleagues emphasises that ‘women have been underdiagnosed, undertreated, and underserved in health care’.⁴ Moreover, many argue that women have been considered less of a priority in healthcare as far back as Ancient Greece.⁵  For example,  while there have been attempts to redress the under-representation of women in clinical trials, there is still a long way to go. Women have traditionally been excluded from clinical drug trials partly due to apprehensions over hormone fluctuations and liability concerns of any side effects to pregnancy/fertility.^6,7 Consequently, as clinical trials and dosages are historically calculated for men, women are more likely to suffer from side effects or simply not respond to the treatments.⁸

Aims of the strategy: tackling the gender gap

The plan outlined in the 10-year strategy sets out a six-point plan.

1. Ensuring women’s voices are heard – removing stigmas while ensuring women are listened to by healthcare professionals.
2. Improving access to services – making sure women have equitable access to match their needs while prioritising services for women’s conditions such as endometriosis
3. Addressing disparities in outcomes amongst women – making sure that a woman’s age, ethnicity, sexuality, disability, or where she is from does not impact her ability to receive treatment.
4. Better information and education – enabling women and wider society to better equip themselves with pertinent information about women’s health. This includes educating healthcare professionals on how to treat patients more knowledgably and empathetically.
5. Greater understanding of how women’s health affects their experience in the workplace – normalising conversations on taboo topics such as periods and the menopause to ensure women can remain productive and be supported in the workplace.
6. Supporting more research, improving the evidence base and spearheading the drive for better data – addressing the lack of research into women’s health conditions, improving the representation of women of all demographics in research.

The strategy is informed by the life-course approach and identifies as priority areas: menstrual health and gynaecological condition; fertility, pregnancy, pregnancy loss and post-natal support; menopause; mental health and wellbeing; cancers; the health impacts of violence against women and girls and healthy ageing and long-term conditions. It also includes several explicit commitments, including appointing the first ever Women’s Health Ambassador for England.

What might the findings of the report mean for life sciences and healthcare?

Improving education and training for healthcare professionals

Over 84 per cent of respondents said that there had been instances in which they had not been listened to by healthcare professionals (HCPS); disappointingly, less than two per cent of respondents were HCPs. This points to an urgent need to improve HCP awareness, education, and training on women’s health conditions. A key intention is to consult with all HCP representative bodies to redesign the curricula and incorporate changes to ensure students and newly qualified HCPs are capable, informed and well equipped to provide effective care.

Improved awareness and understanding of menopause

Difficulties accessing appropriate menopause care was mentioned frequently, citing an inability to recognise symptoms and a lack of support structures, with women made to feel it was a taboo subject. This has a detrimental effect on workforce productivity and retention. Tackling the issue requires equitable access to timely, high quality, personalised care within primary care, and specialist care if needed; and for all menopausal women who are suitable for HRT to get it at a reduced cost.

Faster and more accurate screening and diagnoses to prevent cancer deaths

UK cancer survival rates have long fallen behind other similar countries. The strategy identifies the difficulties women face securing a cancer diagnosis with symptoms often dismissed or confused with other conditions such as irritable bowel syndrome (IBS) or poor mental health. It proposes educating women and girls from a young age on the risk factors for cancer and improving vaccination rates for both Human Papillomavirus (HPV) and other routine vaccinations. Cervical cancer is one of the most preventable cancers, yet most women diagnosed have missed cervical screening opportunities; innovations such as Australia’s self-test HPV, which is part of an organised national screening programme, need to be adopted more quickly and more widely.⁹

Conclusion 

The gender health gap has had profound and wide-ranging impacts for generations. Although there are a number of obstacles that remain, the publication of the seminal Women’s Health Strategy report in July represents a significant, if somewhat overdue, milestone; acknowledged as the first step in ‘changing the dial’. However, the priorities outlined in the report will need to be delivered concurrently alongside the other significant and immediate challenges facing the NHS and wider life sciences and healthcare ecosystem. To ensure effectiveness and delivery of the many commitments and targets, as for any strategy, requires regular reflection and equitable implementation across the country, alongside engagement and buy-in from the diverse range of stake holders highlighted above. This genie is well and truly out of the bottle and women’s voices will no longer be able to be ignored.