Women's health plan

Introduction by the Chair of the Women's Health Group

It has been a great privilege to lead on the development of the Women's Health Plan – as a woman, as a doctor, and as Interim Deputy Chief Medical Officer for Scotland. Contributing not just to ensuring we support the best possible health outcomes for women, but also to ensuring all girls and women of Scotland are able to reach their full potential is very close to my heart.

'Women's health' can be traditionally thought of solely in terms of reproductive health, despite the fact that slightly more than half of the population accessing healthcare are actually women. There are excellent examples of first-class care and innovative approaches to improving the health of women. But undertaking the work to produce this Plan has brought into sharp focus the way that women and their health needs are not necessarily considered as different to men within our health services, and how our services can be failing to fully meet the needs of women. The lack of inclusion of women in medical research, which then impacts on the availability and efficacy of treatments for women, is a very tangible example and illustration of how we have not done enough to date to ensure services equally recognise and meet the needs of women.

Whilst this Plan focusses on how changes in healthcare can improve the health of women, it is, of course, far from the full story. As a public health doctor, the importance of the social and economic determinants of health, and the way they can disproportionately impact on women is very much on my mind. The factors which impact on a woman's health stretch far beyond healthcare services and include educational opportunities, employment options, housing, caring responsibilities and income.

Whilst outside the scope of this Plan, the very significant impact of social and economic determinants of health on women in particular must be fully recognised.

The themes of Realistic Medicine resonate throughout this Women's Health Plan. One of the themes that emerged strongly from our lived experience work was that women wish to take an active role in decisions around their health. Shared decision-making means ensuring women have access to accurate and relevant information as well as being proactive in including women in discussions about their health and healthcare. Women also want a personalised approach to their care, recognising that one model will not work for all women. For example, women experience the menopause in a variety of ways. For most women, their GP and the primary care team will be able to support them where required through their menopausal years. However, some women will require more specialised support and will need onward referral. Healthcare professionals must work with women to understand their individual circumstances, health needs and preferences in order that personalised and tailored care is provided. Finally, Realistic Medicine calls on us all to be 'improvers and innovators'. In order to improve care for women we must work across sectors and organisations and look at innovative ways in which healthcare can be provided. Covid-19 has introduced and accelerated many of these innovations, for example in the provision of virtual abortion care, but there is far more work to be done.

I would like to extend my very sincere thanks to all the people involved in the development and creation of this Plan. Firstly, to Dr Catherine Calderwood, former CMO, who had the vision to set this work in motion. Secondly to the members of the Women's Health Group, particularly Vice Chair Corinne Love, and the sub-group chairs Alison Scott, Heather Currie, Maggie Simpson, Irene Oldfather and the late Emma Ritch. I also want to pay tribute here to Emma Ritch who represented the First Minister's National Advisory Council on Women and Girls on our Women's Health Group, and chaired the Gender and Health sub-group. Emma was a tireless campaigner for women's equality and in her contribution to the development of this Plan she challenged us all to think differently. Her recent death leaves a huge void in the women's equality movement, but where she led we must now follow. And finally, thank you to the women of Scotland who engaged with our lived experience work. It is so crucial that the work to improve the health of women in Scotland is driven by the needs and wishes of women themselves.

This Plan represents only the beginning of the work to address the inequalities that impact on women's health. It illustrates that we have some way to go in adequately shifting our focus to women's health, and that will need commitment, leadership and effort from all those who provide services to women. My ask of my fellow health and social care professionals is to think about how you specifically consider women in the design and delivery of your services, to ensure that the different ways diseases can manifest in women, and the different treatments that might be appropriate for them are fully considered, to appreciate and understand the systemic barriers women may face when seeking healthcare and to play your role in breaking these barriers down. There is much work to be done but I am more than confident that we have the skills and the will to do this. Working together, we can and will improve women's health in Scotland.

Professor Marion Bain

Interim Deputy Chief Medical Officer for Scotland