Our response to the Women’s Health Strategy- bridge the woman-doctor divide by putting lived experience at the heart.
We welcome and applaud the explicit acknowledgement of the reality that the UK’s health and care system has been designed “by men, for men”. We also celebrate the important step forward that having a dedicated strategy for Women’s Health in England represents.
We particularly welcome the commitments to invest more in research and evidence and to focus public funding onto research that takes account of sex differences. These are actions we advocated for strongly in our submission and we are delighted to see them featured prominently.
However, the strategy appears to lack a clear theory of change or equivalent model of the social determinants and drivers of women’s health outcomes that could help focus limited investment and effort onto key windows of opportunity for significant impact. Although the document acknowledges disparities and biases, the lack of a coherent theory or model for how this disparity has been created and is being maintained risks a strategy that attempts to do everything at once. We fear that this will lead to downstream, expensive and fragmented intervention when targeted, carefully co-ordinated, upstream intervention could achieve significantly more for less. We submitted our own systematic review and model of women’s menstrual experiences, created as part of our work with UK government’s Period Poverty Taskforce (accessible here: https://pubmed.ncbi.nlm.nih.gov/34288971/), and believe that an equivalent or similar model for women’s broader health outcomes needs to sit at the heart of this strategy for investment to have maximum impact.
We know from the evidence that already exists and the experiences of our community that harmful gender and social norms play a critical role in the historic neglect of women’s health and the current challenges women experience accessing care, and yet the word gender is only mentioned 7 times in the 129 page document, never clearly defined and never mentioned in reference to social norms. Gender, currently defined by the World Health Organisation as “the characteristics of women, men, girls and boys that are socially constructed….[including] norms, behaviours and roles associated with being a woman, man, girl or boy, as well as relationships with each other,” is a recognised social determinant of health and acknowledged driver of unequal health outcomes for women. We do not believe a strategy to improve Women’s Health can succeed without explicitly naming and tackling the social drivers that have led to its systematic neglect.
This leads us to our biggest and most pressing concern with the current strategy and associated processes. The document recognises that women feel unheard and that listening must be at the heart of change but even at this early stage in the process this is not being given sufficient thought. For example, information about sexual orientation was not collected in the public survey, limiting in the conclusions that can be drawn about the experiences of lesbian, gay and bisexual women from that analysis- a group that we know often face additional and unique barriers accessing care.
We must be cognisant of the reality that current approaches and methods to solving these challenges within the healthcare system are subject to the same biases and limitations that this strategy needs to dismantle, as are the people involved in its implementation. We urge the adoption of co-production principles and approaches within this process so that technical experts can work in partnership with lived experience experts to identify blind spots and genuinely transform healthcare for women and girls. We advocate for the appointment of champions with lived experiences of the issues this strategy aims to address to work alongside the Ambassadors, who bring extensive experience of working within the healthcare system. We also recommend the creation of a Working Group or Task Force combining technical and lived experience to support the ongoing development of this strategy and its implementation.
It is only through genuine partnership across the woman- doctor divide that we will deliver the government’s ambitious vision and close the gender health gap.