Women have been let down too often when it comes to the health system

It is a costly waste of talent to carry on as we are, writes Ian Hamilton

We need an overhaul of health research (PA)

The government recently announced a call for evidence as it wants to develop a women’s health strategy. At long last, the health secretary, Matt Hancock, acknowledges in the ministerial foreword that our current healthcare system was designed by and for men.

This acknowledges not only the male bias in treatment delivery but also the structural bias in favour of men, who hold the majority of influential roles in health. It is remarkable to think that in 2021, women are often ignored when research is conducted and reported. Adding insult to injury even when data is disaggregated by gender, there is a collective failure to report and publish this basic demographic factor.

Without such data, we can’t see what, if anything, differs for women in health. So serious and problematic is this that the major health-related academic journals publishing such research have signed up to the Sex and Gender Equity in Research agreement (Sager). This is nothing more complicated or ambitious than a commitment to collect and report research data on women. Welcome as it is, it’s a depressing reminder of how this is currently an ambition rather than the norm.

Despite women being more likely to access primary healthcare, the system fails them. Endometriosis is thought to affect one in 10 women of reproductive age in the UK, so it's far from a rare problem; yet it takes eight years on average to diagnose. All too often, women are sent down different diagnostic paths, or are told that they are imagining symptoms. I am certain if it were men’s experience, they wouldn’t face the same issues.

Of course, health is just one part of a wider gender bias in society. As Caroline Criado-Perez highlights in her book Invisible Women, everything from phone design to pills are developed by men, for men. For example, cars are designed around men, meaning everything from comfort to safety is built around their needs as a standard.

This may seem trivial until you realise that despite being significantly less likely to be involved in car crashes, they are 17 per cent more likely to die. This is a direct consequence of using male-physique dimensions for crash test dummies and all the safety innovations that follow as a result.

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Not only are women failed by this male bias, we all are. Senior research, policy and treatment roles are dominated by men. Investigation and innovation of health is held back when we exclude the brains and insights of women. Bear in mind that the health and social care workforce is populated by women at a ratio of eight to one.

Women need to be involved in – or more importantly, running – projects, making clear the structural as well as treatment-delivery dysfunction and distortion by male views and interests.

While a call for evidence is welcome, acknowledging the failure of the health system to meet women’s needs, there needs to be a parallel way of making sure that this crystallises into a meaningful difference to women’s experience of healthcare.

We have sufficient information and evidence to know where the problems are, but without a strategy to implement change, all we do is leave everyone better informed but with no material gain.

This could be achieved with minimal cost – just as well given how unwilling this government is to spend money rewarding mainly female nurses. It is a costly waste of talent to carry on as we are. It is time for action, not just words.

Ian Hamilton lectures in mental health at the Department of Health Sciences, University of York