The Health of Women and Girls: Health and Social Care Policy - Beyond the Women's Health Plan

Tackling Health Inequalities in Women and Girls

"Women do tolerate a lot of things more than men and I think we’re seen as a stronger person when it comes to health problems and quite resilient to it." - BHF Focus Groups, Participant 2.

A range of biological factors impact women’s health. Throughout their lives, women and girls experience unique health needs and face risks that differ from those of men.

The evidence is clear that tackling the health inequalities experienced by women and girls cannot be achieved through a single policy, but requires a whole government approach. To make long term and sustained change, the specific needs and circumstances of women and girls should be embedded in all policy areas and across sectors.

It is important to consider and understand the conditions in which women live, as this significantly impacts overall health and women’s ability to access healthcare services.

The competing demands of unpaid labour and economic insecurity may compel women to prioritize immediate family or financial obligations over their own healthcare needs, leading to a cycle of untreated or undertreated conditions that could have long-term consequences for their health and well-being^[1].

Women remain less likely to be in contractually secure jobs, more likely to be segregated into low-paid sectors culturally stereotyped as ‘female,’ less likely to be in senior positions and earn less than their male counterparts including when they have comparable educational qualifications.

These issues are further compounded for women with intersecting protected characteristics, low socioeconomic backgrounds and for women from rural and island areas^[2].

That is why work to support the early years, to tackle the gender pay gap, to address child poverty, are all key to improving the health of women and girls in Scotland.

All women and girls will have different experiences, and these experiences will impact their health in different ways. They face multiple, and often overlapping, disadvantages and barriers to their health and to accessing good healthcare. For ethnic minority women, for example, these inequalities are further exacerbated by experiences of racism and discrimination. A whole government approach is necessary to tackle the health inequalities experienced by women and girls experiencing multiple and compounding marginalisation or disadvantage.

The Cabinet Secretary for Health and Social Care has identified racism as key driver of health inequalities, and a significant public health challenge, setting the expectation that anti-racism will be embedded across the health and care system. All health boards, territorial and national, are working to develop and deliver on anti-racism plans, covering workforce and service delivery.

To support Boards, the Scottish Government has published anti-racism planning guidance, which includes a framework for action on anti-racism. The guidance was developed in collaboration with stakeholders including the NHS Ethnic Minority Forum (EMF).

The Framework sets out initial priorities for tackling racialised healthcare inequalities:

• Leadership, governance and accountability — to drive real change, with clear accountability for progress;
• Improving data and evidence – to identify and address inequalities;
• Workforce culture and wellbeing – creating inclusive environments for staff and patients;
• Embedding a focus on equity and anti-racism in services – starting in areas where inequalities are most pronounced: perinatal care (the time from pregnancy up to a year after birth), type 2 diabetes and cardiovascular disease prevention, and mental health.

These priorities build on, and go beyond, the recommendations of the Expert Reference Group on Covid-19 and Ethnicity.

Health Boards are already taking action. For example, NHS Greater Glasgow and Clyde have done targeted work to improve maternity care for ethnic minority women. Key steps taken to drive change included: examining baseline UK, national and local data and evidence; working with and listening to women and local third sector organisations, such as Amma Birth Companions, to better understand women’s experiences behind the data; applying an anti-racism and equity lens to understanding outcomes; and finally carrying out focused work to improving access, experiences and outcomes, taking a quality improvement and multi-disciplinary approach.

To accelerate progress and enable wider sharing of effective approaches to reducing racialised healthcare inequalities, a national anti-racism support offer is being provided by Public Health Scotland, NHS Education for Scotland, Healthcare Improvement Scotland and the Scottish Government.