Health inequalities faced by women and girls in Scotland are deeply entrenched within the systems that are meant to care for us. 

When it comes to healthcare, women consistently describe experiences of not being listened to or taken seriously. Women wait longer to be diagnosed or prescribed pain medication than men and are more likely to have physical symptoms ascribed to mental health issues.

We are more likely to have heart disease misdiagnosed or to become disabled after a stroke. Women are also more likely to suffer illnesses historically ignored, minimised or denied by the medical profession, including Pre-Menstrual Dysphoric Disorder (PMDD), endometriosis, symptoms associated with menopause and others. 

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Health issues that disproportionately affect women, or affect women differently to men, have historically lacked funding and professional focus, meaning that women’s health needs are not equally prioritised and understood across health services. For example, although women’s life expectancy exceeds that of men, women spend longer living with disability and ill health, and more women than men in Scotland live with a long-term health condition.

Women and men experience mental health differently; more women report experiencing anxiety disorders, and women are twice as likely to be affected by depression than men. Autoimmune diseases have a greater prevalence amongst women, as do certain post-viral conditions, dementia and other health issues.

This week, the Scottish Government has released the three-year review of the Women’s Health plan, marking a key moment in Scotland's efforts to tackle women's health inequality.

The review outlines progress toward improving women’s health and well-being in Scotland. However, the report on the 2021-24 plan ultimately identifies that women continue to experience ingrained health inequalities in Scotland, today.

It states, “Women are consistently experiencing a greater burden of mental health issues than men... rates of maternal obesity, diabetes and preterm birth rates have been increasing since 2010/11... Deprivation is a key mediating factor across several aspects of women’s health... Women are more likely to be living with chronic pain compared with men.”

The significant gender health gap women experience in Scotland is a result of generations of biased and exclusionary medical research and ungendered health approaches, which will require time to address. We urgently need cross-party, long-term commitment to addressing women’s health. This is critical to ensure the current plan has a lasting impact that extends beyond individual parliamentary terms.

Intersecting equality issues, including race, disability and class have a major bearing on health outcomes for women in Scotland.

For example, highly unequal health outcomes exist within certain minority ethnic communities. Scottish South Asian women experience an 80% higher rate of heart attacks than the general population; the physical and mental health of transgender women is put at risk by lack of knowledge amongst healthcare professionals; disabled women are significantly more likely to have unmet healthcare needs than both non-disabled people and disabled men; and women in the most deprived areas of Scotland experience good health for 25 years less than women in the most affluent parts of the country.

These groups of women have been frequently failed by discrimination in health systems, poor collection of data and lack of focus on their specific experiences in research. We urgently need to improve the collection and use of intersectional data and research in the design and delivery of healthcare.

This is vital to ensure minoritised women’s experiences are understood, their needs are effectively met and that their health outcomes meaningfully improve.

The Women’s Health Plan has been delivered in the extremely challenging context of the Covid-19 pandemic. We know the pandemic has had lasting impacts on women's health and has changed the baseline of women’s health inequalities that the 2021-24 Plan was based on.

For example, women’s mental health was twice as likely as men’s to have deteriorated during the first lockdown, and young and disabled women were especially exposed to negative impacts on their mental health because of the crisis.

The Scottish Government should reflect on how the pandemic has impacted the roll out and impact of the plan, and particularly the funding available for its delivery. These reflections are critical to understanding the work that needs to come next.

The creation of high-level strategies such as the Women’s Health Plan are essential in raising the profile of women’s health inequalities and ensuring leadership and action to tackle them. However, these strategies require significant investment to create systemic change.

They are also most effective when they are linked to accountability measures including effective monitoring and evaluation of progress. We need more detail on the funding for the Women’s Health Plan so far, and what accountability measures are in place.

The 2021-24 Women’s Health Plan committed to establishing a Scottish Institute for Women’s Health. However, this has not been delivered. Engender has called for all political parties in Scotland to commit to this initiative.

We believe there is a need for a permanent body that can help drive the necessary systemic changes to policy, research medical training and use of data that is needed in the long term to improve women’s health experiences and outcomes.

Catherine Murphy is the Executive Director of Engender.