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Time to improve healthcare outcomes

We live in an era of robust and thorough evidence and there is no place for historical biases and that requires everyone involved to look beyond women’s reproductive cycle and take a more holistic approach to the health of half the world’s population.

When Dame Lesley Regan was appointed as England’s first ever women’s health ambassador with the aim of closing the gender health gap it was a not so tacit acknowledgement that women’s health outcomes are worse than men’s.

From Davina McCall’s Sex, Myths and the Menopause documentary to the latest research pointing to asthma treatments failing female suffers, a momentum has started to better highlight the male skew in healthcare.

This impacts all aspects of our healthcare; so much of medicine is based on male physiology, there is a shortfall in female clinical trial participants, doses of medicines are based on men’s pathology and too much of women’s healthcare is purely focused on their reproductive cycle such as fertility, childbearing and the menopause.

So, while women on average live longer than men, women spend a greater proportion of their lives in ill health and disability when compared with men. We all know the NHS is under ever greater strain, and the risk is that this will only exacerbate the already underserving of women by the system.

This all points to the need for significant behaviour change – and that requires, among other things, improved communications from all involved. High profile appointments and celebrities supporting a cause have an important role to play – just look at the improved awareness of bowel cancer symptoms thanks to the work of the late Dame Deborah James aka Bowelbabe.

While her awareness-raising work was aimed at women and men, an important aspect of improving women’s health outcomes is better understanding that their symptoms might differ to men’s. For instance, women are disproportionately impacted by cardiovascular disease – even though a common misconception is that it affects men more. Women are more likely to die from a cardiovascular event because it often appears as indigestion – and so is overlooked – with people more familiar with the male manifestation of a pain in their arm.

The female focus needs to be a positive experience. There comes a point where highlighting the issue isn’t enough and doesn’t help – it just adds fuel to the fire of underrepresentation. Instead, what’s needed is behaviour change and therefore action: awareness, inform, educate. Communications needs a hard reset – it needs to be disruptive.

This is a universal requirement. For long term improvement, the medical school curriculum must change so a future generation of doctors is educated with less bias; and the pharmaceutical industry needs to improve its recruitment of women to clinical trials to ensure that future drug treatments have been fully researched and tested equally among the sexes.

For more immediate change, we need an in-post emphasis – so that healthcare professionals (HCPs) currently practicing are trained. For example, NHS England has created a dialogue tool to train HCPs how to have better conversations with patients about obesity and diabetes. The focus is on greater empathy – to use their imagination to think about how they would feel if they were in the patients’ position – and to avoid saying anything derogatory or accusatory. Similarly practitioners needs to learn to read between the lines of what women say so we can ensure earlier intervention which results in better outcomes and experiences.

We live in an era of robust and thorough evidence and there is no place for historical biases and that requires everyone involved to look beyond women’s reproductive cycle and take a more holistic approach to the health of half the world’s population.

18th July 2022

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