Women's health: How can we improve health equity?

Health equity is defined as ‘the absence of unfair and avoidable or remediable differences in health among population groups’. Whilst it is true that we have reached gender parity in many areas of the life, there are still unfair and avoidable differences women face accessing healthcare. And in the UK, this is particularly acute. The UK has the largest female health gap in the G20 and the 12th largest globally. The recent Darzi report, laying bare the current state of the NHS, highlighted maternity care, often the first considerable interaction a women will have with the NHS, as a ‘important area of concern’. 

How does the ‘health gap’ translate in everyday life? Firstly, it could mean waiting longer for care. Our work with the Royal College of Obstetricians and Gynaecologists found that over three quarters of a million women and people in the UK are currently waiting for hospital gynaecology services and since the pandemic these lists have grown the largest of any specialty. Secondly there is a potentially a greater risk of being misdiagnosed. Research by the British Heart Foundation found that whilst heart disease is the leading cause of death in women, 50% are more likely to be initially misdiagnosed after a heart attack. And unfortunately particular groups of women experience disproportionate barriers; the MBRACE UK study in found that black women are four times more likely to die during pregnancy or childbirth compared to white women. 

Women are not only experiencing worser health outcomes, but spillover effects in other areas of life too. In employment, a 2021 survey by Bupa found that 900,000 women and people in the UK had left their jobs due to menopausal symptoms. McKinsey research has shown that investing in women’s health could boost the global economy by at least $1 trillion annually.  

A burning platform for change 

Policymakers are looking to find solutions, with the UK’s first Women’s Health Strategy launched in the UK in 2021 and the roll-out of Women’s Health Hubs. To continue to shine a light on the issue, LCP Health Analytics were keen to collaborate with our Women’s Network and Multicultural Network, last month bringing together a pan-industry event to raise awareness. We were joined by three expert panellists: Dr Nina Wilson, Private GP and Menopause specialist, Pauline Hakutangwi, Novartis UK Launch Brand Lead and UK Diversity Equity and Inclusion Lead, and Catrin Treharne, Health Economics Lead at LCP Health Analytics. 

Finding meaningful solutions to the gender health gap 

Whilst important to provide context on the challenge, the panel quickly moved away from ‘paralysis by analysis’ to identifying tractable solutions. Women are still at a disadvantage when it comes to their healthcare, with fragmented services and lack of information, yet change is happening. There are excellent initiatives making progress on improving health equity, which need to be learned from and scaled.  

We need a cultural shift in how we view women’s health

Dr Nina Wilson highlighted how for many years women’s health has traditionally been viewed as largely gynaecological, rather than diseases impacting the whole body. Not only have certain diseases been seen as ‘stereotypical male diseases’ but health systems have neglected research into women’s health conditions and whole-body impacts.  

For example, a third of deaths from ruptured abdominal aortic aneurysm (AAA) occur in women yet, unlike men, who are offered screening when they turn 65, women are not. Traditionally it was not seen as cost-effective to screen women. However, research shows that pre-eclampsia is known to elevate risk for certain CVDs, like AAA. In addition, cholesterol significantly increases for many women post-menopause leading to complications. 

Raising awareness about health issues impacting women and treating women’s health proactively and holistically is key. This starts with increasing representation of women in public health campaigns. Perimenopause should also be used as an important moment for a preventative ‘mid-life’ MOT Health Check for women, investigating not just direct menopausal systems but all changes occurring in the body at that time.   

We need to disaggregate data for targeted intervention

Catrin Treharne made the case for how granular data can highlight inequalities faced by certain women. In a resource constrained NHS environment, this can help us target proportionally. Data is particularly important for understanding intersectionality. Our work with Pfizer exploring inequalities in breast cancer found a higher percentage of black women (22%) were diagnosed with late-stage cancer compared to white women (14%). Data should be used to target those most in need, ensuring access to services and prevent worsening inequalities. 

Partnerships and collaboration are key

The gender health gap is an issue which everyone in the healthcare ecosystem has a role to play. In life sciences this starts with improving research and development into diseases more typically impacting women, as well as increasing female representation in clinical trials.

Pauline Hakutangwi also shared practical examples of the life sciences industry collaborating with the NHS to improve access and experience to care. As part of the collaboration between Novartis UK and Our Healthier Southeast London ICS to expedite cardiovascular diagnosis and early intervention for high-risk underserved communities, a Health and Wellbeing Bus travelled the borough, providing heart health education, blood pressure and cholesterol monitoring, and general health counselling to hard-to-reach communities. 58% of the individuals who utilised the health and wellbeing bus were women. Efforts like this can make a significant impact on the lives of busy women who can’t necessarily spare two hours to drive to their GP but can spare 30 minutes to visit a travelling clinic on their street.  

Empowering patients to advocate for themselves

Panellists finished on how women should feel empowered to ask for the care we need. This is not always easy, given potential system biases. However, raising awareness is crucial for empowering women with information to better understand their health, and help them feel confident when voicing concerns to a healthcare practitioner. Importantly, all of us, regardless of gender can play a role. As Pauline concluded, everyone can make one small change this week, asking a woman in their life, ‘How are you feeling at the moment?’. Creating the space for conversations about our health is a small, but critical, first step in creating gender health equity.  

LCP Health Analytics are dedicated to supporting organisations across life sciences and healthcare sector in incorporating equity considerations across clinical development through to access to medicines. If you are interested in learning more about our work in this space, please reach out to me directly.