Tackling gendered health inequalities in Scotland

Tuesday 6th August 2019

The Scottish Government and COSLA have come together to establish a new body tasked with delivering ‘the significant changes we need’ when it comes to public health.

The new national body – Public Health Scotland - is being created to ‘re-focus’ the approach taken to protecting and improving the nation’s health.

The formation of a new body such as this has not been without its challenges (and delays – previously set to start work in December 2019, Public Health Scotland will be now established in April 2020) but it undoubtedly presents myriad opportunities to address what the Scottish Government has described as a need for ‘better, more visible leadership’ from an organisation playing an important role in translating public health intelligence and evidence into policy.

Well known for its thriving life-sciences sector and pioneering research, Scotland is a frontrunner in a number of areas of research, for example in lung disease or with individual patient tracking from cradle to grave through the Community Health Index (CHI) number  – praised by Scottish Government Minister Ivan McKee as one of the nation’s ‘real assets’.

The medical research gender gap however, is an issue that been gaining traction in recent years. A consultation on the new public health body, Public Health Scotland, closed last month, and the research gap is a problem highlighted by Engender (a leading feminism campaign group) in their submission.

The physiology of men and women is significantly different even down to a cellular level, but there is growing recognition of the fact that a lack of female inclusion in clinical trials and prevailing biases and stereotypes manifest in myriad ways that negatively affect women’s health.

Gender differences in health and healthy behaviours are under-researched and under appreciated by public health campaigns and professionals’, says Engender.

Gender-sensitive data collection and disaggregation by sex is patchy, not just in Scotland but globally, making key trends and comparisons in women’s health difficult.’

Among the questions and information included in the consultation, a desire to create a ‘genuine ‘culture for health'’ in Scotland is set out.

Any prospect of achieving this will require the new agency to ‘understand and influence the root causes of gendered health differences,’ Engender states.

Among the examples their submission points to, is that although women’s life expectancy exceeds men’s in Scotland, women spend more of their lives in disability and ill health and more women than men in Scotland live with a long-term health condition.

One of the best examples of this and of the medical research gender gap in practice can be found in a study published in the Journal of American Heart Association that found women were up to three times more likely to die following a serious heart attack than men ‘as a result of receiving unequal care and treatment’.

That cardiovascular disease and heart attacks are often perceived as a men’s health issue (across Europe cardiovascular disease is perceived to be low risk in females despite being the main cause of mortality for women across the region) combined with a disproportionately low number of women involved in cardiovascular clinical trials, contributes to excess mortality among women who suffer a heart attack.

In June of this year the Scottish Government said it intended to establish a working group on sex and gender data, led by Scotland’s Chief Statistician, to consider what guidance should be offered to public bodies on the collection of data on sex and gender.

As Public Health Scotland is anticipated to take a leading role in public health data science and innovation, ‘it is vitally important that data collection and analysis by [Public Health Scotland] adopts a fully gendered approach,’ Engender states.

‘Using data to simply note differences in men and women’s health will not deliver positive outcomes without gender competence also being built into Public Health Scotland.’

Counting women is the beginning and not the end of gender-sensitive data collection and analysis.’

Their submission to the consultation points to the formation of the new body as not only an opportunity to make progress in tackling gendered health inequalities, but an issue Public Health Scotland will have a responsibility to address.