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Yes, women’s healthcare is poor – but gender bias is not to blame for that | Zoe Williams

The health secretary, Steve Barclay, this morning unveiled his plan to tackle gender health inequality. A “landmark moment”, he called it, “in improving the health and wellbeing of women across the country”.

The proposition was unarguable. That the healthcare system was historically designed for men, by men, is evidenced everywhere, from the comparatively lower life expectancy among women in poor areas to the fact that women, while they live longer, spend a quarter of their lives in poor health, compared with a fifth for men. The report was the result of a 100,000-strong consultation, in which 84% of respondents said they had felt “ignored or not listened to” when seeking help from the NHS.

Every suggestion in the report, however, was infinitely debatable – not least the laughable idea of a 10-year strategy on anything from a government whose typical horizon is the fortnight it takes for one crisis to segue into the next.

Ideas include an expanded women’s health section on the NHS website; a certificate for parents who experience pregnancy loss before 24 weeks; mandatory teaching and assessment on women’s health for all medical students and doctors, with sections on menopause, obstetrics and gynaecology; 25 new mobile breast-screening units; better access to contraception, IVF, maternity support and mental health services; and a national fitness programme to help older women build muscle strength.

I’d never dispute patient testimony, or argue against additional training for GPs and specialists; but if women are finding their problems minimised, misunderstood or undiagnosed when they first seek help, I doubt that’s because their GP is more comfortable treating male patients. Female GPs have outnumbered male ones for nearly a decade; it’s simply not plausible that they find gynaecology or fertility problems exotic.

Even before the pandemic, in 2018, nearly half of GPs reported stress levels so high they felt unable to cope at least once a week. Sixty per cent were working more hours than they were contracted, and 45% were sure that the experience was going to deteriorate, which it duly did during Covid.

The same problems persist of an overstretched, underfunded service, with the additional burden of mountainous backlogs, pay stagnation and a perversely hostile media. I’m just running the odds here; if there’s a suboptimal interaction between a GP and a patient, is that because the GP is endemically sexist and needs equality training? Or is it because both are under a phenomenal amount of chronic pressure?

Drilling into specific areas, such as IVF and sexual health, the same story is written in more detail: funding constraints have simply made the services worse – slower, more parsimonious and more unjust between one postcode and another. No one in mental health would say that the rolling crisis was down to a failure to take women seriously; nor would they say that men were being treated with more gravity or getting any kind of priority.

At a more fundamental level, if health outcomes are worsening and deteriorating faster in poorer areas – and they are – we have known for more than a decade why this is. When you cannot meet your material needs, the epidemiologist Michael Marmot has repeatedly shown, that amounts to a “psycho-social assault” with a large number of physical and mental impacts. To say “women are more likely to live in poverty; women are suffering more ill health; therefore health services are gender-biased” is the most basic syllogism. But like so much government by press release, it’s strategic.

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