Introduction

Last year, the UK government published the Women’s Health Strategy detailing policy actions intended to address inequalities in health outcomes between men and women.

The strategy (Department of Health & Social Care 2022) is underpinned by a 6-point plan for transformational change that involves:

• Ensuring women are listened to and increasing representation of women at all levels of the health and care system.
• Ensuring women can access services that meet their reproductive health needs, prioritising services for women’s conditions and ensuring conditions that affect both men and women consider women’s needs by default.
• Ensuring that a woman’s age, ethnicity, sexuality, disability or where she is from does not impact upon her ability to access services, or the treatment she receives.
• Enabling women and wider society to easily equip themselves with accurate information about women’s health, and healthcare professionals to have the initial and ongoing training they need to treat their patients knowledgably and empathetically.
• Normalising conversations on taboo topics, such as periods and the menopause.
• Addressing the lack of research into women’s health conditions.

Action that has already taken place at a national level includes:

• Introducing a Maternity Disparities Taskforce and a UK Menopause Taskforce.
• Banning virginity testing and hymenoplasty.
• Appointing the first women’s health ambassador for England - Professor Dame Lesley Regan.
• Expanding women’s heath hubs and one stop model health hubs.
• Abolishing the tampon tax.
• Introducing the medical license assessment which includes topics related to women’s health.
• Commissioning a new policy research unit through the National Institute for Health and Care Research, to focus on reproductive health, menstrual health, gynaecological conditions and menopause.

Action is also starting to be put in place at a local level. For example, in Liverpool, women-specific health hubs have been set up in GP surgeries (LGA 2022). This allows women to access services such as cervical screening, long-acting reversible contraception, and treatment for menopause. The hubs have been devised so there is particular ease of access in the most deprived areas of the city.

In Newcastle, to enhance accessibility of the national cervical screening campaign for harder-to-reach communities, a social media campaign was devised targeting ethnic minorities, trans- and non-binary people. The campaign focused on messages of inclusivity and directly targeted those communities through specific social media activity. Around 1,500 people were reached successfully (LGA 2022).

Also of note is an initiative in Lancashire where workshops, peer support groups and online chat channels have been devised to help create a menopause-friendly work environment at the council. The workshops are considered to be successful, with over 30 people attending them each month, covering topics including the symptoms of menopause, its effects and where to go to for support. Various levels of staff have attended, representing an important step in normalising the topic of menopause in workplaces. Equally, the chat channel has seen a regular engagement of roughly 200 people. With the council employing over 13,000 people in the local area, such initiatives have significant impact, and it is hoped it can also be rolled out to other workplaces in the region (LGA 2022).

How has the strategy been received?

There have been acknowledgements that the strategy was a significant step in the right direction and offered up some important suggestions (Wickens and Jefferies 2022, Epilepsy Research UK 2022, Lindsay 2022). The most highly praised initiative was the introduction of women’s health hubs as a one-stop-shop model (Scott 2022, Lindsay 2022, Devlin 2022, Bagenal et al 2022). The removal of barriers to IVF for lesbian, bisexual women and transgender people was repeatedly noted as an important development in ensuring those from minority groups are treated more fairly (Scott 2022, Onyx Health 2022). Commitments within the strategy were also welcomed, particularly regarding an increased focus on menopause, gynaecology and increasing women’s health issues as subjects of research (Jo’s Cervical Cancer Trust 2022).

There were, however, concerns and/or skepticism over whether funding streams would be available, both immediately and in the longer term, to ensure the commitments are turned into tangible action (Devlin 2022, St Mungo’s 2022, Association of Directors of Public Health 2022, Lindsay 2022).

Some organisations also felt that the strategy did not offer much in the way of a unified approach, rather it brought together disparate initiatives that, in some cases, were already in place. The strategy was described as a patchwork quilt of downstream health services and treatment interventions rather than a more fundamental attempt to change systemic and structural practices (Devlin 2022, Onyx Health2022 and Banegal et al. 2022). In terms of women’s mental health, the strategy was dismissed as simply restating an existent government pledge to invest £2.3 billion in mental health services by 2023-24 (Devlin 2022 and Onyx Health 2022). This failure to adopt a holistic perspective has meant a lack of focus on intersectional inequalities, for example, with women with learning disabilities receiving minimal attention in the national framework (McAteer 2022).

Directly related, there was a feeling that the strategy failed to recognise how cultural and institutional factors play an integral part in health inequalities. For example, whilst undergraduates and incoming health professionals will now be taught about women-specific issues, there was no mention of training existing staff, meaning a lack of attention to changing current workplace cultures (Onyx Health 2022, Wickens and Jefferies 2022, Bagenal et al 2022). Equally, consultation for the strategy had minimal engagement with health care professionals, thereby failing to explain why women may not be listened to or how, from the perspective of those working in healthcare, the sector could improve accessibility and outcomes for women (Wickens and Jefferies 2022, Bagenal et al 2022). Additionally, women’s health issues were not considered within social determinants of health framework, rather, in relation to women’s reproductive role in society. For example, issues such as diabetes were only considered in relation to reproductive health conditions rather than social factors (Bagenal et al 2022). This contrasts to India, Australia and the WHO European region where social, political, environmental and commercial determinants of women’s health are considered in their women’s health approaches (Bagenal et al 2022).

Reflections

The scale and nature of the critique that the strategy has received suggests that policy action needs to go a great deal further to comprehensively address the issue of health inequalities between men and women.

Two key priorities that have emerged:

1. More efforts are needed to address structural inequalities. Whilst biological differences do have some part to play in varying health outcomes between men and women, it is important that social and structural determinants of health are also considered in policy development.
2. All relevant stakeholders should be consulted about their experiences and proposed solutions. Of the approximately 100,000 consulted in the call for evidence, the demographic profile was 99% cisgender, 80% 25-29 and 91% White (Bagenal et al 2022). Further, those from the South of England were overrepresented. All this would suggest that the voices of harder-to-reach communities remain unheard and poorly considered in the strategy.

References

Department of Health & Social Care (2022) Women’s Health Strategy for England, London: Department of Health & Social Care, available online at https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england, accessed 10/02/2023.

Local Government Association (2022) ‘Women’s Health: How councils are making a difference’, available online at https://www.local.gov.uk/publications/womens-health-how-councils-are-making-difference, accessed 15/02/2023.

Wickens, C., and Jefferies, D. (2022) ‘Has the Women’s Health Strategy listened to what women really need?’, available online at https://www.kingsfund.org.uk/blog/2022/08/has-womens-health-strategy-listened-what-women-really-need?utm_source=The%20King%27s%20Fund%20newsletters%20%28main%20account%29&utm_medium=email&utm_campaign=13423495_NEWSL_HWB_2022-09-05&dm_i=21A8,7ZPMV,7LWGDE,WOIJQ,1, accessed 14/02/2023.

Epilepsy Research UK (2022) ‘Women’s Health Strategy: What it means for women with epilepsy’, available online at https://epilepsyresearch.org.uk/womens-health-strategy-what-it-means-for-women-with-epilepsy/, accessed 16/02/2023.

Lindsay, J. (2022) ‘Launch of first Women’s Health Strategy in England’, available online at https://www.wellbeingofwomen.org.uk/news/launch-of-first-womens-health-strategy-in-england/, accessed 13/02/2023.

Devlin, H. (2022) ‘Are there enough concrete commitments in the women’s health strategy to truly ‘reset the dial’?’, The Guardian, 20 July, available online at https://www.theguardian.com/society/2022/jul/20/are-there-enough-concrete-commitments-in-the-womens-health-strategy-to-truly-reset-the-dial, accessed 15/02/2023.

Bagenal, J., Khanna, R., and Hawkes, S. (2022) ‘Not misogynistic but myopic: the new women’s health strategy in England’, The Lancet, 400(10,363): 1,568-1,570.

Scott, L. (2022) ‘New Women’s Health Strategy must join up with those for HIV and sexual/reproductive health’, available online at https://www.tht.org.uk/news/new-womens-health-strategy-must-join-those-hiv-and-sexual-reproductive-health, accessed 12/02/2023.

Onyx Health (2022) ‘The Politics of Women’s Health: Is Anyone Listening to ‘Women’s Voices’ in Healthcare?’, available online at https://onyxhealth.com/womens-healthcare-voice/, accessed 11/02/2023.

Jo’s Cervical Cancer Trust (2022) ‘Our response to the Women’s Health Strategy’, available online at https://www.jostrust.org.uk/press-release/response-womens-health-strategy, accessed 15/02/2023.

St Mungo’s (2022) ‘St Mungo’s welcomes the new Women’s Health Strategy’, available online at https://www.mungos.org/news/st-mungos-welcomes-the-new-womens-health-strategy/, accessed 16/02/203.

Association of Directors of Public Health (2022) ‘Comment on new Women’s Health Strategy for England’, available online at https://www.adph.org.uk/2022/07/comment-on-new-womens-health-strategy-for-england/, accessed 12/02/2023.

McAteer, M. (2022) ‘Women’s Health Strategy: what about learning disabilities?’, available online at https://rcni.com/learning-disability-practice/opinion/comment/womens-health-strategy-what-about-learning-disabilities-189376, accessed 13/02/2023.