Address the social determinants of health for a gender equal world
05 March 2020
Life expectancy among women in the poorest parts of England has fallen since 2011. Healthy life expectancy is also down, and the more deprived the area, the shorter the life expectancy. Those are the shocking headline findings of the Marmot review.
Women are dying sooner and spending more time in ill health in our poorest communities. This slowdown in life expectancy is the worst in England in 120 years, and we're seeing a bigger decline in the UK than the rest of Europe. Something is very wrong.
Addressing the social determinants of health
It’s vital we pay more attention to the impact of social determinants to our health - the factors affecting our health and wellbeing - in how we plan our care. While there are developments in treatments and technology, these findings emphasise the importance of people having social support and access to the basic resources to help keep them well.
Some social determinants disproportionately impact women. By the time women are 46, half will have taken on a caring role. For the next decade, women are twice as likely to have reduced hours due to caring responsibilities. One in seven women lose their jobs while on maternity leave. More women are outside of the labour market, and while in work women face a gender pay gap of 17.3%. Loneliness is reported at higher levels by women than men. Low pay, being out of work, isolation and the stresses of caring all impact health. Importantly, these statistics look at women as one homogenous group, and frequently the data doesn’t take into account the combined experience of being a woman and also being from a BAME background, low paid, or LGBTQ+.
The problems I’ve raised are often unspoken. In our research, 57% of consumers made the startling admission that their doctor had never discussed social factors that could affect their health. Many of these challenges are a product of how our society is constructed; whether it’s how we choose to structure and fund our (often unpaid) care system or the degree to which we train care professionals - men and women - to confront their own unconscious bias. The challenge is playing out at the systemic level, with a cost borne by society as well as by individuals, and so requires a systemic solution.
The Marmot review makes the case for change. It highlights previous initiatives in the UK addressing healthcare inequality that have had success. But there needs to be a renewed focus and bold national strategy led by the government and the NHS.
In our report “Action required: The urgency of addressing social determinants of health” we set out five practical steps to address these challenges. Establishing there is a problem and building the collective will to address it is the first step. Good data is powerful here - and we’re moving towards a position where machine learning can begin to unpick where women are disproportionately impacted by inequalities (assuming that we don’t inadvertently teach the algorithms bias, and that we collect data specifically about women in the first place).
Women must be engaged in the solution - women from low income backgrounds who are working as unpaid carers; women who have had difficulty getting their voice heard within the health system; women who are trying to navigate a health and care system while in insecure, inflexible employment.
On International Women’s Day 2020 if the mantra is that “an equal world is an enabled world”, it is vital we address the issues creating inequalities in our health.