Women’s Health Outcomes

Baroness Bull Excerpts
Thursday 8th July 2021

(3 months, 2 weeks ago)

Lords Chamber

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Department of Health and Social Care
Baroness Chakrabarti Portrait Baroness Chakrabarti (Lab) [V]
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My Lords, I thank the noble Baroness, Lady Jenkin, for leading this debate, an initiative wholly consistent, if I may say so, with her long record of campaigning on behalf of women.

Even in these days of deliberately stoked and exaggerated culture wars, there can be few who do not agree that millennia of structural inequalities have undermined women’s health worldwide. Further, it is obvious that the current devastating pandemic has magnified every such inequality on the planet. This includes the shocking, yet predictable, rise in domestic violence during necessary lockdowns, reduced access to sexual and reproductive healthcare and other vital women’s health and social services internationally.

Women are more likely to be involved in childcare, social care and cleansing, whether in the home or outside it, placing millions of them on the front line of infection. While older men seem more likely to die of Covid-19, it seems that women who survive it may be more likely to suffer from the chronic symptoms associated with long Covid. That means that every current decision in the debate about how best to either combat or live with the virus is likely to have a gendered impact.

The extent to which casting off the mask has become associated with one’s love of freedom is unfortunate indeed. I worry about the way in which some in government have become so wedded to irreversible “business as usual” from a particular date that they are risking more than necessary and perhaps forgetting that, for many, business as usual, even before the pandemic, was far from free, fair, safe or healthy.

If the Government want to honour their promise to vaccinate the planet and an earlier pledge for a new era of global Britain, they must stop siding with Germany in blocking the TRIPS waiver at the WTO and join the United States, India, South Africa and most of the Commonwealth—celebrated here earlier this afternoon—in demanding that industry shares know- how around vaccines, tests and treatment manufacture so these can be decentralised and scaled up to meet global demand.

19 July is not “freedom day”, but it could yet be solidarity day in a global race against vaccine-resistant variants and even more deaths.

Baroness Bull Portrait Baroness Bull (CB)
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My Lords, I congratulate the noble Baroness, Lady Jenkin of Kennington, on securing this debate, which feels particularly timely as we mark the 73rd birthday of the NHS this week. Women were undoubtedly among its most immediate beneficiaries, as the expansion of maternity care put an end to many of the horror stories of obstetric disasters, post-delivery haemorrhage and infections needlessly killing mothers after childbirth, for want of sterile surroundings. We have come a long way since then, but there is still some way to go.

The Library’s helpful briefing makes clear a range of healthcare areas in which women experience worse outcomes than men, including mental health. The Mental Health Foundation reports a strong relationship between women’s physical and mental health, with 85% of its surveyed members reporting that menstruation, menopause, pregnancy, fertility pressures and contraception impacted negatively on their mental health.

I will focus on eating disorders—serious mental health disorders that can affect anyone, but which are much more prevalent in women than men. A recent Finnish study found that one in six female adolescents and young adults met the criteria for an eating disorder, compared with one in 40 males. The pandemic has seen eating disorders spike, with demand for services up 200% in some areas and waiting lists at record highs. Those with high-BMI eating disorders cannot access treatment, since clinical pathways for binge eating are currently closed, as the NHS struggles to cope with the increase in low-weight disorders.

This is nothing short of a public health crisis, yet it receives neither the attention nor the funding it warrants. The best-known eating disorder, anorexia nervosa, has the highest mortality rate of any psychiatric disorder in the UK, yet the last available dataset comparing all mental health related research grants from major UK funders revealed that eating disorders received just 1% of the near £500 million available over the four-year period surveyed.

It is hard not to conclude that eating disorders suffer a triple whammy of perception and misperception: first, they are seen as a niche problem largely affecting a middle-class elite, which is not true; secondly, they are mental health conditions and, despite claims to the contrary, we have yet to live up to our promise to give mental and physical health parity of esteem; and finally, above all, they are seen as women’s issues.

Earlier this year, in the other place, the Minister Nadine Dorries said,

“for generations women have lived with a healthcare system that is designed by men, for men.”—[Official Report, Commons, 8/3/21; col. 535.]

Women continue to suffer as a result. I look forward to the forthcoming women’s health strategy and hope that it has some effect in redressing this age-old imbalance.

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab) [V]
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My Lords, I very much welcome this debate and commend the noble Baroness, Lady Jenkin, on her opening speech. One of my main concerns is that, historically, women have been underrepresented in clinical research, as both researchers and the subject of research. The noble Baroness, Lady Jenkin, also referred to that. As a result, many diagnostic tests and treatments have been based on data gathered from men. Women are still not taking part in clinical trials to the same level as men. We need to understand the barriers that prevent women taking part in these trials, and encourage and enable them to take part.

This impacts across medical provision, but I will focus on heart attacks. Research into different treatments for men and women has shown that women are more likely to be treated less aggressively in their initial encounters with the healthcare system, until they have to prove that they are as sick as male patients. Once they are perceived to be as ill as similarly situated males, they are likely—but not always—to be treated similarly. This can be seen with heart attacks, where women having a heart attack delay seeking medical help longer than men because they do not recognise the symptoms and believe it is men who get heart attacks, not women. Some 50% are more likely than a man to receive the wrong initial diagnosis for a heart attack. Many are less likely than men to receive a number of potentially life-saving treatments in a timely way and, following a heart attack, are less likely to be prescribed medications to help prevent a second heart attack.

If there was any complacency about women’s health issues, the recent report from the Health Select Committee on the shocking state of many maternity services should be a great warning to us. This has been known for some time now. There has been an endless number of inquiries, yet we have been waiting for action for far too long.

It is not just about research and treatment of disease, as experienced by women. Ensuring women’s safety, privacy and dignity while they are in hospital is vital. Women often favour single-sex wards for very good reason: rates of sexual assault are far higher in mixed-sex wards. The Health Service Journal reported last year that at least 1,000 sexual assaults were reported by female and male patients on mixed-sex mental health wards between April 2017 and October 2019, yet there are indications that the NHS is moving away from giving enough provision to single-sex wards. Could the Minister look into this and see what can be done to ensure the NHS does what Ministers asked of it over the last years?