At last, the government has acknowledged the gender inequality at play in health by appointing a women’s ambassador, Maria Caulfield the minister responsible for women’s health. This follows a consultation on the topic earlier this year, which saw more than 100,000 responses revealing how endemic the issue is. The responses fell into two broad categories: first, the distinct health issues faced by women, and secondly their experience of the healthcare system if they seek support for these problems.
Maria Caulfield said she was “shocked” and that these issues must be addressed. Sadly, most women reading the responses won’t be as shocked as the minister, many of the problems raised will already resonate all too well with them. For example, the taboos and stigma associated with women’s health prevent them from seeking help and, just as damaging, it reinforces the idea that women’s debilitating symptoms are “normal” – in other words, what are you complaining about?
This wasn’t an isolated experience as almost one in three women said they felt unsupported with a health problem, and more than three-quarters felt they had not been listened to by those working in healthcare. This will be familiar to any woman experiencing endometriosis or the menopause, for example. Diagnosis can take time if diagnosed at all but the problem doesn’t end there, securing effective treatment and advice about management can be a real battle. This is an unnecessary struggle as we have effective ways to assess and diagnose conditions like endometriosis, and established evidence-based ways of treating it. It isn’t evidence that we lack, it’s entrenched beliefs and attitudes that stand in the way of alleviating what can be a crippling condition.
It’s been evident for some time that women’s health and treatment has been inferior to men’s. So serious is this gender inequity in research that a statement was drawn up and agreed by the leading scientific journals to encourage researchers to report outcomes for men and women. Known as the Consort agreement, it recognised that all too often when women participated in health trials their outcomes weren’t reported. This omission means that emerging evidence from research couldn’t be used to inform assessment and treatment of women; essentially, the science was orientated towards men. Depressingly, despite this agreement, trials still don’t disaggregate male and female data – it’s such a waste, and a missed opportunity to gain vital intelligence about women’s health.
Most of the medicines we rely on today for a range of health problems were developed without being tested on women, particularly childbearing women. Pharmaceutical companies view women of childbearing age as too risky to include in the development of novel medicines. It might be that it makes no difference if medicine has only been tested on men, but it is surely wrong to wait until a drug is approved and brought to market before establishing how well tolerated it will be by women. In essence, it is luck rather than scientific rigour if women don’t develop a serious adverse reaction to medicine.
To understand why gender inequality in health persists in 2021 you need to look at how the world of research is organised. Research teams are dominated by male professors, even though their research teams are made up of more junior females than males. Equally, men dominate the editorial positions of leading scientific journals. This creates a male gaze on female health, no matter how much these men think they are not biased, they can miss the nuance of women’s experience as they have no first-hand experience.
While its welcome to see women’s health be acknowledged as sub-standard by the government, it will take far more than appointing an ambassador to make meaningful change to this issue. We need female leaders in research and science if we are to move beyond acknowledging a problem and provide some tangible solutions – that can’t happen fast enough.
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