Women’s health in England: The need to embrace equity
This week, on 8th March, we celebrated International Women’s Day (IWD) with the theme ‘#EmbraceEquity’. 1 The campaign acknowledges that providing equal opportunities is not enough: considered actions to drive equity are crucial to advance outcomes and inclusion, including in health. Recognising that health disparities in the UK have a substantial impact on women’s health outcomes, in July 2022 the first Women's Health Strategy for England was published aimed at tackling the gender health gap.2 In this blog, we reflect on the difference between equity and equality and the potential of this strategy, still in its infancy, to embrace equity.
Equity versus equality
The terms equity and equality are often used interchangeably, but they have different meanings. Consequently, their adoption in the design of healthcare strategies results in very different policies. Health equality means that everyone gets the same opportunities for care and service access, without considering the different backgrounds, circumstances, or risk factors. Health equity, on the other hand, recognises that not everyone has the same start in life and representation, hence resources should be distributed according to individual needs. The different factors involved are reflected in the World Health Organisation (WHO) definition of equity: “the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g., sex, gender, ethnicity, disability, or sexual orientation).”3
These health determinants can result in significant differences in health outcomes, including substantial impacts on life expectancy. In England, for example, data from 2018 and 2019 showed that women with learning disabilities have a life expectancy 17 years shorter than the average female population.4 A 2022 report from the NHS Race and Health Observatory showed that British-born ethnic minority women and migrant women often face discrimination and mistrust when accessing health services.5 Furthermore, there are stark differences in their health outcomes compared to white women. For example, the rate of Black women dying during or one year after pregnancy is four times that of white women.6 Therefore a cultural and systemic change in health systems, adapted to care and communicate differently according to populational needs, is urgently needed to achieve health equity.
As the health equity definition suggests, it is more than just about health systems. There are many factors that can affect health outcomes and for which profound disparities exist, including housing, food and nutrition, education, safe environments, mobility, and economy.7 For example, in England, there has been a recognised relationship between life expectancy and deprivation. The Marmot Review 10 Years On published in 2020 showed that, between 2016 and 2018, the difference in life expectancy at birth between the least and most deprived deciles was 7.7 years for women.8 Therefore, health is not an isolated pillar: the only way to achieve health equity is to address these social determinants.
Women's Health Strategy for England: an important first step
Acknowledging how disparities affect women’s health, the publication of the Women's Health Strategy for England represented a significant first step, and importantly a political commitment, in changing the dial and raising awareness for the need to improve health systems to meet women’s needs. We highlighted the aims, priority areas and potential implications in our blog Tackling the gender health gap: England’s first women’s health strategy. Despite an overall focus on closing the gender gap, the strategy recognised that not all women have equitable access to care, particularly those who are disabled, homeless, refugees, asylum seekers, or are in prison, in addition to access disparities in terms of race and socioeconomic and geographical factors, and thus equitable action was also needed.
What initial progress has been made in the priority areas?
This week, on International Women’s Day, the government announced £25 million funding allocation to create new women’s health hubs to reduce pressure of secondary care, waiting lists and tackle health inequalities.9 These hubs will deliver women tailored healthcare and support across menstrual problems, contraception, pelvic pain, menopause care and more with an initial aim to see at least one hub in every integrated care system (ICS). The hub model aims to deliver services in the community to better fit around women’s lives and streamline access, reducing the impact of inequities. Digital models are also being used to tackle inequities in access to care and ensure services are delivered efficiently.
Alongside the strategy launch, the first ever Women's Health Ambassador was appointed to support the strategy implementation and understand challenges in accessing care services across several communities.10 Since the appointment, the role has been used to champion more regular breast cancer screenings, improve education and awareness of menstrual cycles and aims to break the taboo around menopause. The nomination of health ambassadors, recently extended to Scotland with the appointment of the first Women’s Health Champion earlier this year, is a welcome driver for implementation of the strategy, by listening to women, advocating for women’s rights, collating data and engaging with other stakeholders. This week, the government has also appointed a Menopause Employment Champion to encourage employers to develop workplace policies, including management training which has long been advocated for.
In January 2023, the UK government announced a £10 million investment for 29 new breast cancer screening units and almost 70 life-saving service upgrades, mainly in remote areas and regions with low uptake to improve screening access equality and save lives.11 Improving early cancer detection is one of the best ways to improve chances of survival and given that women in the most deprived groups are generally less likely to participate in breast screening, this investment is a welcome step in the right direction.12
Conclusion
IWD has been a powerful campaign to promote equality for women. This year, the ‘#EmbraceEquity’ campaign goes beyond equality recognising that ‘true inclusion and belonging require equitable action’.13 We hope the Women’s Health Strategy, like IWD, goes beyond equality and embeds equity in the DNA of its project and policies. The progress made so far is welcome, but as these strategies are developed, it is important not to lose sight that there are substantial differences between groups of women in the UK and consequently equity should be incorporated as a crucial value in policy. The implementation framework for the strategy is still awaited, but in the meantime, the acknowledgment of the topic in the political agenda, represents an important step forward to embrace health equity in the UK.
