Introduction by Croakey: A combination of “social prejudice, ingrained bias in medical practice and exclusion from research trials and other studies culminate in a medical catastrophe for women”, writes Assistant Minister for Health and Aged Care Ged Kearney in an article that marks International Women’s Day.
In the article, Kearney talks about why, amid many discussions on ‘medical misogyny’, the Federal Government has established a new National Women’s Health Advisory Council, which she chairs.
Kearney cautions she is “not saying there is some dark conspiracy where people in lab coats and scrubs are gathered in basements plotting to make sure women suffer disproportionately. Of course they aren’t. But there is an inherent structural problem that requires structural solutions.”
The need for structural equity reform that goes beyond technical understandings of ‘medical misogyny’ is the call in the article below, by researchers from Centres of Research Excellence that are part of the Collaboration for Enhanced Research Impact (CERI) and focused on women’s health.
They outline multiple and intersecting layers of inequity faced by women globally and in Australia, and say it is vital to understand and address the complexities involved at a systems level.
Martha Hickey, Rachel Huxley, Danielle Mazza, Helen Skouteris and Helena Teede write:
Women in Australia have seemingly made significant strides towards equality with men in recent decades despite the World Economic Forum reporting that we are making rather limited progress with Australia 43rd on the global gender gap index. While gender disparities still exist, women are working in leadership roles at all levels of government, education and business.
In health, more than half of medical graduates and almost all the nursing and allied health workforce are women. Public health research, policy and practice also has a predominantly female workforce.
Why, then, are there stark differences in health outcomes for women and girls, including delayed diagnosis, overprescribing and dismissal of pain or other symptoms, as recently highlighted by Assistant Minister for Health and Aged Care, the Hon Ged Kearney MP, who is chair of the new National Women’s Health Advisory Council.
Much of the commentary around the establishment of the Council could be perceived as putting the blame on ‘medical misogyny’ – which technically implies dislike of, contempt for, or ingrained prejudice against women by individual health professionals.
It may be that there are individual practitioners (of different genders) who are prejudiced against women; however our research, across several NHMRC-funded Centres of Research Excellence, indicates more complex factors are at play.
We propose it is vital to understand and address these complexities at a systems level and also note that an emphasis on the broader implications of misogyny, including dislike and contempt for women, may disengage the very healthcare providers we must engage to collectively understand and modify the knowledge, attitudes and behaviours of the healthcare workforce to improve women’s health.
Systemic inequities
Australia has rising inequity. According to the World Health Organization, wherever there is societal inequity, women are always disproportionately affected. In almost every aspect of their lives, women living with pervasive socio-economic disadvantage are more likely to be vulnerable and face discrimination.
This directly affects those seeking healthcare where disadvantaged women face more barriers to quality care, for example, people living in rural and remote areas, women from culturally and linguistically diverse (CALD) communities, Aboriginal and Torres Strait Islander women, and/or women who have or who continue to experience disadvantage.
The inequities are compounded by multiple stresses and responsibilities including paid and unpaid work. They may be looking after children or other family members, working and pursuing their careers, contributing to their communities, trying to cope with the rapidly rising costs of living, or dealing with the many layers of disadvantage caused by family violence and trauma.
There are also gross inequities in terms of access to healthy foods at a cost that people can afford, particularly in rural and regional areas. The options for being physically active or taking other measures to prevent disease are limited for many women of culturally diverse backgrounds and for First Nations women.
These issues affect entire communities, but women often bear the brunt. For example, research has shown that young women in rural and remote areas experience higher rates of unplanned pregnancy. Our research has highlighted gaps in service provision including availability of contraception and medical abortion, higher rates of chronic disease, and a much greater burden of mental distress.
Blame, bias and stigma
Add to that a rising tide of misinformation on social media and stigmatising practices and language across society in relation to laying blame on individuals for their poor health, and it’s little wonder that these women experience poorer health outcomes. Indeed, there is now evidence that shows stigma leads to less engagement in the health system and a reluctance by some women to advocate for their own care.
Our research, including one project co-authored by First Nations and non-Indigenous experts in Australian perinatal care, shows that older women, women who live with overweight and obesity, Aboriginal and Torres Strait Islander women, and women from LGBTQA+ and CALD communities, are less likely to access care because of perceived bias in the health system. One study showed, for example, that women living with overweight and obesity may attend their first mammogram, but are less likely than other women to return for a second.
Older women also face gendered ageism and stigma that drives many of the negative views about menopause and ageing in women.
There are also inequities in terms of research into health issues that are unique to women, meaning the evidence and algorithms used to inform prediction tools, guidelines and clinical practice are usually based on studies conducted on Caucasian males.
Our research into admissions with non-traumatic chest pain, for example, highlighted inequities at every stage of the healthcare journey. From the moment women present to the emergency department, they wait longer to be seen, are less likely to be assessed for heart disease, less likely to be admitted to coronary or intensive care, and experience higher 28-day mortality rates.
Another example is in the opportunities lost for prevention of health conditions arising from female conditions such as infertility, polycystic ovary syndrome (PCOS), and around the time of menopause and beyond.
Priorities for action
Addressing these issues requires an understanding of the complexity of the causes, and needs a multifaceted, systems approach across all key stakeholders.
Key priorities include to improve reporting and accountability on the ground. Data are urgently needed to provide a clearer picture of service gaps for women, especially in regional and remote areas, and inform our planning and delivery of targeted services, as well as workforce training. There is also great room to learn more about women’s priorities for research and service delivery to ensure the priorities of end users in this research are taken into consideration.
At the same time, we need to provide health information to women in ways that are engaging and easy to understand. This should include support to navigate our highly complex health system.
Education of the future health workforce will play a vital role in improving the perceptions across health professionals, the health system and the public around sex and gender bias. Primary care practitioners such as general practitioners, nurses and pharmacists should also be supported in the areas of women’s health service delivery especially in relation to meeting the needs of priority populations and achieving equity of access to services.
Policy levers can be very powerful. Governments and funding agencies can link equity provisions to healthcare and research funding, as has been done successfully in Canada. Policies can also influence inclusion and equity and can consider health in policymaking for other sectors such as housing, transport and town planning.
We applaud Minister Kearney and the National Women’s Health Advisory Council for bringing these issues into the public conversation. It will take engagement with clinicians – male as well as female – along with researchers, representatives of vulnerable communities and, of course, women with lived experience to achieve real change.
We will all benefit when health outcomes are improved for our more under-served communities. Ultimately, health equity is important for all in society and there is a growing cohort of women’s health experts and academics willing to assist.
Author details
Professor Martha Hickey, Centre of Research Excellence on Women and Non-communicable Diseases
Alfred Deakin Professor Rachel Huxley, Executive Dean, Faculty of Health, Deakin University
Professor Danielle Mazza, Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care
Professor Helen Skouteris, Centre of Research Excellence Health in Preconception and Pregnancy
Professor Helena Teede AO, Centre of Research Excellence in Women’s Health in Reproductive Life
The authors are all members of the Collaboration for Enhanced Research Impact (CERI).
See Croakey’s archive of articles on women’s health
