The dust has settled on an excellent Women’s Health Week and we were so heartened to see people posting online about their commitment to women’s health. As they should – we are more than half of the world’s population!
However, it did give me pause for thought. How far have we come and where are we now?
In 2013, former COO of Facebook, Sheryl Sandberg, published Lean In – her part memoir, part leadership guide calling for women in the workplace to pursue their ambition, take risks and claim leadership opportunities.
Backed by the preceding decade of corporate feminism and girl boss leadership, it struck the perfect tone and was lapped up by international leaders and businesses desperate to find answers to low rates of women’s leadership and workforce participation.
But it didn’t take long for critics to call out Lean In for its focus on individual fixes to structural problems. The discussion moved to the fact that no amount of hard work, extra skills and moxie would change systemic discrimination.
In women’s leadership, economic participation and other aspects of life, the narrative has finally shifted: the system needs to change, not the women.
As women’s health has its much-deserved moment in the spotlight, we’re seeing the same shift to structural reform.
Until now, women’s health has been narrowly understood as ‘within bikini lines’ – shorthand for focusing exclusively on women’s reproductive health, often funded by specific programs and initiatives.
However, frustrated and traumatised by a health system designed predominately by and for male bodies, patients and advocates demand lasting reform. By sharing experiences of gender bias in cancer care, heart disease and mental health they have exposed how sex and gender differences affect prevalence, diagnosis and treatment.
This is also the case for trans and gender diverse people who continue to face poorer health due to discrimination in a health system designed without considering their specific needs.
It’s a moment we can’t miss. We must capitalise on public interest to embed system reform to make sure everyone receives the same quality of, and access to, care that men enjoy.
The only way to address structural inequity is with structural reform. How do we do that?
First, medical research must include sex and gender considerations. Women and gender diverse people have been underrepresented in clinical studies for decades, leading to blind spots about how healthcare impacts half the population and encourages incorrect diagnoses and treatments. Currently, the inclusion of women in clinical trials is only a recommendation.
Second, medical education must change. Health professionals are still trained in male-centric models of care that ignore how symptoms vary by sex, gender, culture and identity. Gender-responsive, culturally safe care must be built into education and clinical practice – supporting clinicians to address system bias and improve outcomes for all.
Third, we need to change the way healthcare is funded. Australia’s excellent Medicare system aims to provide universal access, but in practice it can perpetuate inequity. Women are more likely to present with chronic, complex conditions needing longer consults. Yet short GP consults attract higher rebates. This disincentivises GPs from providing effective care, particularly outside metro areas where rebates are even lower.
Lastly, and perhaps most importantly, we must believe women. Lived experience is powerful evidence and must be centred in reform. The 13,000 people who responded to the Victorian Government’s Inquiry into Women’s Pain rightly expect a more equitable system.
Every woman in my immediate family has a history of undiagnosed or improperly treated endometriosis. For my mum, this has led to decades of pain, countless abdominal surgeries, infertility and debilitating bowel obstructions caused by adhesions. When my mum had a hysterectomy at 48, a leading gynaecological specialist told her he almost stitched her up after 20 minutes of looking for her uterus through a web of adhesions. When Mum asked him after the surgery what her future looked like, he kindly told her, ‘discomfort.’
She’s just one story. There’s thousands like her.
Thirty years on this is still the case and it remains unacceptable.
The Victorian Government’s Inquiry into Women’s Pain and forthcoming response present a landmark opportunity.
This moment marks a shift from individual fixes to genuine system reform. The demand for equity is loud and clear, and it’s not going anywhere.
As a society, we must all ‘lean in’ and redesign it, for good.