Women’s Health Outcomes

Baroness Walmsley Excerpts
Thursday 8th July 2021

(3 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care
Baroness Massey of Darwen Portrait Baroness Massey of Darwen (Lab) [V]
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My Lords, I thank the noble Baroness, Lady Jenkin, for introducing this important debate. I know that many important issues relating to inequalities in health will be addressed. I am delighted that the noble Baroness spoke eloquently about young women’s health; I shall raise concerns about young women’s mental health in particular.

The Association for Young People’s Health, of which I am a patron, has welcomed the proposal to develop a women’s health strategy for England, stating that this must take account of the diversity of young women’s health issues, and that young women and girls must participate in the development and implementation of the strategy. Young women’s experiences of healthcare are affected by general factors, such as deprivation, ethnicity and geography, and by specific issues, such as sexual and certain kinds of reproductive health issues, mental health, and gender-based violence. In general, young women’s health outcomes are less favourable than those of young men.

As the Mental Health Foundation states,

“There is no health without mental health”.

Mental health affects physical health and the data on mental health and well-being, self-harm, suicide and eating disorders show that the link between body image and life satisfaction is twice as strong for girls as for boys. Young women’s mental health gives specific rise to concerns: 43% of young women aged between 16 and 29 experience some depressive symptoms, compared with only 26% of men of the same age. Girls between the ages of 11 and 17 have had more emotional difficulties than boys during periods of school closures. As we know, Covid has had an unequal impact on different groups and individuals. Young people generally have been less likely to become infected with the virus, but have faced enormous upheavals in education, employment and social interaction during what is often a difficult period in their lives.

Given the different mental health needs of boys and girls, the Royal College of Psychiatrists has suggested that, to deal with these needs, different interventions and methods for supporting different young people are required. It recommends that an extra £500 million of investment is needed to address the mental health needs of children and young people. These needs, including treatment, have intensified to an alarming degree during Covid-19.

Can the Minister say whether the strategy for women’s health will take account of the importance of maintaining and improving research and data collection on young women’s health? Will the views of women and girls be taken into account as the strategy develops? Both these issues are important in ensuring access to services and appropriate, high-quality preventive measures and treatment. I look forward to the Minister’s reply.

Baroness Walmsley Portrait Baroness Walmsley (LD) [V]
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My Lords, I am delighted to take part in this debate on women’s health issues, so ably introduced by the noble Baroness, Lady Jenkin.

A common issue coming out of all the briefings, and particularly from the report by the noble Baroness, Lady Cumberlege, First Do No Harm, published last year, is the need to listen to women when they talk about their health. We all heard the noble Baroness talking movingly in this House, when we first debated her report, about how upsetting it was when she really listened to the women who had been damaged, or whose babies had been damaged, by valproate, Primodos or vaginal mesh and how relieved the women were to be listened to at last. Can the Minister say when the Government will implement all her recommendations?

Information is vital because, without it, women cannot exercise proper choice. In the case of the anti-epilepsy drug valproate, we heard from women with epilepsy when we debated the report last year that women were still not being fully informed of the risks in case they become pregnant. Let us remember: about half the pregnancies occurring in the UK are unplanned.

So information is key, but so is listening. I am horrified when I hear that women who eventually get a diagnosis of endometriosis have usually been to their GP 10 times before they finally get a proper investigation, diagnosis and treatment—just one example of where women’s pain is not taken seriously. I recognise that the non-specific symptoms are of course difficult to diagnose, but I would like to know what training trainee doctors get in actively listening to women.

As we just heard, women are also underrepresented in clinical trials, even for drugs specifically aimed at women. This is completely unscientific when you understand the differences between women’s and men’s biology. Can the Minister say why the regulator allows this?

I am, like the noble Baroness, Lady Massey, very concerned about women’s mental health services, particularly since the pandemic has isolated so many women in their homes with sole responsibility for caring for their children and sometimes elderly relatives. A listening ear has been more important than ever during the pandemic and many kind members of the community have stepped up, but they are no substitute for clinical services. Asking questions and listening to the answers is particularly important in antenatal clinics, where mental health issues and domestic violence can often be detected early. I ask the Minister: will women’s mental health be specifically included in the new Secretary of State’s plan for mental health?

Another factor of women’s health which has worsened over the past year is nutrition and obesity. We have seen an increase in poverty, which is linked to obesity, and an increase in eating disorders. When will we get Henry Dimbleby’s long-awaited national food strategy? This is really important for women themselves and for those they feed and care for.

Lord Rooker Portrait Lord Rooker (Lab) [V]
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My Lords, as the first male Member of your Lordships’ House to speak in the debate, I welcome very much what the noble Baroness, Lady Jenkin, had to say. Her opening speech was, frankly, awesome—that is how I would describe it.

I do not apologise for returning to the Marmot review, which the Minister has heard me speak about before. Inequalities in life expectancy have increased since 2010, especially for women. Female life expectancy declined in the most deprived 10% of neighbourhoods between 2010-12 and 2016-18. Female life expectancy decreased in every region save for London, the West Midlands and the north-west. Life expectancy in England has stalled since 2010, which has not happened since 1900. When health has stopped improving, it is a sign that society has stopped improving. That is all from the Marmot Review 10 Years On, published in February 2020.

Of course, health is linked to all the other conditions in which people are born, grow, live and work, together with inequalities in power, money and resources. Frankly, the Government have not prioritised health inequalities, despite the concerning trends, and there has been no national health inequality strategy since 2010. This is a national UK issue and cannot be shoved off as a devolved matter.

I have not mentioned Northern Ireland. It has suffered the same as the other three nations but one figure, set out on page 12 of Build Back Fairer: The COVID-19 Marmot Review, is unique in respect of female health. The table is titled: “Relative cumulative age-standardised all cause mortality rates by sex, selected European countries, week ending 3 January to week ending 12 June 2020”. Of the eight countries where the situation got worse—as opposed to the 11 where it got better—the UK’s four nations were in the eight, and in only one of all the countries where it got worse, it got worse for females compared to males. That was Northern Ireland. There is quite clearly something badly wrong in health inequalities between men and women in Northern Ireland for it to stick out like that among all those countries. The recommendations for change are all well known. They are listed in both the Marmot reports I have used.

I note the BMA has highlighted more targeted issues, such as those relating to domestic abuse, pregnancy and maternity services, which male Secretaries of State keep ignoring. However, the first move has to be an acceptance that things have gone really badly since 2010, when the coalition Government imposed swingeing cuts to public expenditure without any analysis of the consequences. One consequence is the stalling of life expectancy, where women have been affected worse than men.