S1: EP 011: Bridging the Gender Gap - embracing a culture of change in healthcare policies
Download MP3Hi, What the HealthTech listeners? I'm your host this week, Justine Abson. This is the podcast where we tackle some of the trending topics, ideas, and best practice in health and social care. This week, we're talking to Lottie Moore from Public Policy Projects. Lottie has worked in public policy for several years and is particularly interested in social justice and health.
Justine Abson:She joined Public Policy Projects in January 2021 and has launched several reports on health equalities since then. She also works with professor sir Michael Marmot at USCL leading a network of businesses engaged in public health. Outside of work, Lottie enjoys reading, socialising, and running occasionally. Hi, Lottie. Welcome to What The Health Tech.
Lottie Moore:Oh, hi. Thank you. Nice to be here.
Justine Abson:Great to have you. And thank you for traveling up for London today to, to come and be with us. It's great to great to have you here. So we're gonna talk a little bit today about, women's health and the series of papers that that you're working on. So can you tell us a little bit more about why the series of work focused on women's health in particular was started?
Lottie Moore:Yeah. So, I mean, when I joined PPP in January 2021, we sort of we're halfway through the pandemic at that point, and it's very clear that health inequalities have been, you know, exacerbated. Particularly, that burden was falling on women. So, you know, in the pandemic, it was it's it's women have suffered the most in terms of health outcomes, but also in terms of when everyone's stuck at home, you know, the amount of unpaid labor that women are doing as opposed to men. And particularly, it just it felt like it was the right time to do something.
Lottie Moore:And so that's kind of why we sort of kicked it off. Yeah. Back at well,
Justine Abson:yeah, a
Lottie Moore:year year and a half ago now, really.
Justine Abson:That's flown by. Yeah. I think with that, obviously, the the First International Women's Report, which is titled Women's Health Agenda Readdressing the Balance, was published in March this year, coinciding nicely with International Women's Day. Yeah. So what does this report cover?
Lottie Moore:So, I mean, women's health is actually can be quite a saturated space. So we wanted to do something that was not just another women's health report, and I don't it was sort of stereotype of women talking to other women moaning about women's issues. Do you know what I mean? That that's quite overdone. And so what we wanted to do, you know, there was nothing in what we were doing, which was reinventing the wheel.
Lottie Moore:We were, you know, we were we were not trying to come up with anything fancy or innovative. We were just looking at the current health policies that were in place for women and, I suppose, critically analyzing them and going, you know, why is it that a woman, you know, has to get a prescription every time she wants a contraceptive pill when it's been around for 60 years. You know, why is it that, you know, a man can get a vasectomy, a woman wants an abortion, she has to get, you know, 2 medical signatures on a on a on a form. So it was kind of just going over, what was out there and how we could, you know, produce good policy to kind of change that and change the dial slightly.
Justine Abson:Yeah. And I think that that brings us really nicely into the fact that, you know, the there's an area of focus about the fact that there is a lot of stigma still involved Yeah. In health care issues for women. You know, you mentioned about the pill there, the, you know, abortion. So what do these involve and and how can we do more to remove that stigma?
Lottie Moore:Yeah. I mean, I think part of the problem is that women themselves are not educated on their own health. So, you know, when it comes to periods, we don't know you know, very few people know what's normal and what's not. I mean, you know, all I knew about a period when I when I was taught about them was not to get toxic sock syndrome. And I've never met a woman that's ever had it, but I didn't know what was normal.
Lottie Moore:You know? And so I think it's it's it's that women themselves are not taught about their own bodies. You know? We're not educated on on what we should be looking out for, what's normal, and what's not. And I think so first is talking about it, is a way to remove that stigma.
Lottie Moore:But I think as well, it's about getting the men on-site too. You know? And that it's very easy for women to talk to their friends and sit in the pub and talk about, you know, their periods or, you know, whatever it is. But you need to talk to men about it as well because, ultimately, you know, the system we live in, lots of men are in power. So you need to get them on side as well.
Lottie Moore:I think that's probably a key, you know, key thing.
Justine Abson:Yeah. And I think that, that bit about talking about it is massive, really. Even, you know, you kinda mentioned that it's easier to talk to your friends about it in the pub or anything. But, you know, I still think a lot of friends don't talk about that sort of stuff either. And it's it's almost like there's a stigma even between friendship groups of mentioning that, well, actually, there's something wrong and is that right and Yeah.
Justine Abson:And that kind of thing. I
Lottie Moore:think as well we've seen that with Davina McCall and this menopause, you know, she's a celebrity figure that said talking about menopause for the first time, and suddenly now everyone's talking about the menopause. But it's it's not new. It's not like it's a new health condition. Do you know what I mean? It's been around since the beginning of time, and it's only now that people are it's in the public consciousness that this is a condition that women go through.
Lottie Moore:Everyone will go through it, you know, and and and people should be aware of it. So, you know, I think, you know, the kind of waves of sort of women's health progress is being made, but it's not consistent. You know?
Justine Abson:Yeah. Definitely. And I think it it does. It takes us back to an episode we filmed or recorded a a few weeks ago, which was all about mental health, awareness. And it's the same kind of thing, I guess.
Justine Abson:It's that talking about things that actually make people more aware of it and make it they normalise it. Everything that we talk about is normal. So normalizing it is Yeah. Such a big thing. Yeah.
Justine Abson:So one of the key themes is involved in the paper is is about sister's conception, and the postcode lottery that's involved with the process of things like IVF. How can reports like this help to look at readdressing these issues?
Lottie Moore:Yeah. So it's quite interesting because we IVF was actually kind of the odd one out in terms of what we were you know, the the chapters that we covered. We did, you know, women's cancers, and we did the kind of reproductive cycle. But, actually, IVF is part of the reproductive cycle, you know you know, conception, abortion, menstruation, menopause. You know?
Lottie Moore:And, actually, it this was an international report, so we weren't just looking at the UK. And in certain communities, in particularly in in in, middle and low income countries, you are not gonna get through the door to talk to women about stopping having children if you're not also gonna tell them to have children. Because in sub Saharan Africa, particularly, women are seen as just babymakers. They are literally just reproductive vehicles. And so, you know, in those communities where the men are really in charge, you know, if you're gonna go and try and talk to talk to, you know, someone's wife about how to stop having babies, you have to tell them how they can have them as well, and that was a really kind of tactical thing that we thought, well, you know, we can't just go into these, you know, recommend that these women all suddenly start taking contraception, which would would be would be more appropriate in the UK context because the the the the scale of the problem is so different, you know, internationally, you know, compared to what we're we're facing here.
Lottie Moore:But particularly with the IVF and then in in the UK as well, it's become a really commercialized industry. So, you know, actually, I think it was last year, IVF was more you know, the the more money was generated from IVF than cosmetic surgery, which is crazy considering you're meant to have 3 cycles on the NHS. That's that doesn't happen, but people are so desperate that they pay for it, and they're paying for services that are actually with no proven necessary you know, no no proven kind of scientific evidence that it will help them to have a child. But we wanted to really tackle this thing of, you know, why is IVF seen as this sort of privilege or this sort of medical extra when, you know, the World Health Organization, it it is die it is a disease. Infertility is considered a disease.
Lottie Moore:So why do we treat it as if it's like, you know, having a lip filler? Do you see what I mean? So Yeah. That was that was sort of part of why we we chose IVF, and and the solutions are, again, you know, more simple than that was always the point of this project was that actually none of the recommendations that we came up with were particularly complex or difficult or, you know, we weren't saying, you know, they were actually, you know, also reasonably cheap. It was just about reallocating resources and getting people to realize where there were barriers that didn't need to be in place.
Lottie Moore:And particularly, that was true with the IVF, situation. But, again, that was one chapter where it was really obvious the differences between global women's health problems and then, you know, I guess, Western women's health problems.
Justine Abson:Yeah. And I guess that is a you know, like you said, it's an international report. Mhmm. And there are definitely gonna be certain things that come up that are so obvious in one place that are, you know, not even thought about in in somewhere else. So Yeah.
Justine Abson:I think that probably is one of the interesting factors when you're looking at things on an international basis as well.
Lottie Moore:Yeah. So something that was mentioned or has been mentioned is why often straight forward and simple changes to women's health have not been addressed. What recommendations have been made on around that? Yeah. I mean, so, well, particularly around menstruation and menopause, you know, 20,000,000 girls each year miss school because they don't have access to period products.
Lottie Moore:So they they cannot afford a tampon, so they don't go to school. You know? And then I think the other stat was that, 40% of women, feel that their productivity is hampered in the workplace by their period, and that is costing the economy 6,000,000
Justine Abson:sick days
Lottie Moore:a year, which is, I think, £530,000,000. I don't know whether that's right.
Justine Abson:That's math.
Lottie Moore:Yeah. But, that that, you know, that was a stat that we really shocked me. So, you know, part of it was in Scotland. They've introduced free period products in every public space. And so you can go to the library, you can go to swimming pool, you know, that that's very, very achievable for us in England, and that would make a huge difference.
Lottie Moore:And, actually, you have to look at the kind of cost benefit. If you can, you know, understand, you know, that I don't know, you know, 5 days every month, a woman is probably not gonna be feeling as great. As an employer, rather than if that woman feels that she's being understood, she probably won't take a sick day, which is then gonna cost you less in the long run. So it it you know, if you can invest more in getting people to understand what a period is, well, men, because I think women don't know what a period is, but, it actually will cost you less in the long run. And the other thing that we did was around abortion, and this this recommendation actually got taken up very soon after we published the report, which was during the pandemic, having a taking a pill at home.
Lottie Moore:So for for early medical abortion, which means that you you need to abort before 12 weeks, you take 2 pills, and you used to have to go to the doctors. So the doctor would watch you take a pill. You'd go home. You'd probably miscarry on the bus, and then you'd have to go back 2 days later and take the other pill and then do the same thing again. In the abortion, because they didn't want women to be basically on public transport and spreading coronavirus, they legalized this at home.
Lottie Moore:So women would still have, you know, a face to face consultation, but it would be virtual. And then they could have they could pick up their prescription or they could have it posted to them. And the in terms of the safety, it was it it became something like over 99% more safe. You know, women were were less and less women were having complications, and it's just a really simple thing. Do you know what I mean?
Lottie Moore:And so we said the government was then considering repealing that legislation despite this all of this evidence, and we said that is mad. And not because it was any agenda, because it was that was what our our experts told us, and that's what we do here, you know, PPP. We don't just it's not just on a whim. You know, we had the best doctors in the world here saying, you can't you can't get rid of that. And so we recommended you know, we told you just she said, this is what we think you should do, and this is the medical evidence as to why.
Lottie Moore:And, you know, brilliant, you know, gain for women that that then, you know, the government said, actually, yeah, we you know, there's gonna be a riot if we try and take this away. So that's now been made permanent.
Justine Abson:Oh, I mean, that's amazing and that's credit to the the kind of work that that you guys Yeah.
Lottie Moore:And it's not it's not just us as well. There's lots of charities that we've also worked with that were really, really, you know, hot on this too. But, you know, it it is that kind of thing where you go, something that is actually really, really simple. We weren't saying it was any sort of amazing technology that needed to be invested in. Just a really simple trick that would add, you know, actually revolutionize, you know, women's health.
Lottie Moore:They weren't gonna have to go and face anti abortion activists in a in, you know, outside a clinic. You know, it was safer. You know, it makes sense. It's a lot less traumatic
Justine Abson:as well. Yeah. It's, you know, no one ever knows why why a woman's gonna go and get an abortion. Yeah. So it's to to kind of be able to do it at home in the comfort of your home Yeah.
Justine Abson:And know that, you know, like you said, like, when it happens, you're not on a bus. You're not Yeah. You know, in the car park or whatever that might be is Yeah. Definitely feels like it will be a lot less traumatic for Yeah. The the woman involved as well.
Lottie Moore:Yeah. And I think the other thing is that, you know, we've seen particularly in America which is, you know, supposedly a liberal democracy, abortion is being legal illegal legalized? It's being made illegal in certain states. Yeah. Of course.
Lottie Moore:So you can't ever take for granted women's health. The gains that we've made, we can't take them for granted because if somewhere like the US can then make abortion illegal, you know, no one's safe from it. And, you know, the thing is is what what what I always say is if you stop if you if you make abortion illegal, you're not gonna stop women having abortions. Women are gonna have abortions anyway, but they're they're gonna do it in an unsafe way, and they're gonna die, potentially. So, you know, you don't you don't if you make something more difficult, you don't stop it happening.
Lottie Moore:And I think there's a lot of things like that in women's health. You know?
Justine Abson:Yeah. Definitely. It doesn't just go away just because it's illegal, basically. And I think it's that like you said, you know, you you kinda don't wanna go 1 step back 1 step forwards, 2 step backwards. Yeah.
Justine Abson:You know, that decision's been made. So Yeah. You know, why kind of then turn around and take that decision back? So, yeah. Absolutely.
Justine Abson:I think it's and it's fantastic that that that has now become, obviously, legal in in the UK, which is great. One thing the report does highlight is the importance of embracing a culture of change, in the design and delivery of women's health to achieve national systems and local services that fit to meet the expectations of the 21st century woman, basically. Where are the biggest concerns around around this?
Lottie Moore:So I think with with it's just sort of 21st century women, you know. So, you know, in the UK, we've embraced a society which, it, you know, allows women to be educated to have careers. So, you know, my mother who was having her kids at 21, you know, I'm not I'm 25 now. I've got no plans to have kids anytime soon, because the opportunities that I've had, she didn't have. But at the same time, we're expecting women, to be in a, you know, financial position, to be in a stable relationship, which often doesn't come till later in life.
Lottie Moore:So you are gonna have a longer period of time where women are gonna need contraception, and you're gonna have a longer period of time where women might not be able to conceive naturally. So, again, going back to IVF and assisted conception, more and more women are gonna need to have that because in terms of the way that we're going societally, women are having children later and later and later. And so, you know, that needs to be a serious kind of consideration for the government, particularly in public policy, is that this problem's only gonna get more, you know, more exacerbated. And then linked to that is that more women are living longer. So, again, you know, more people in the menopause for longer.
Lottie Moore:And I think, particularly with the menopause, you know, women in their fifties sixties are often at the most productive and most skilled time of their lives in terms of, you know, they've had their kids, they've grown up, they've they've been in the workplace for 30 years or however long, so they've got the most skills they're ever gonna have, and they're leaving because of the menopause. They're retiring early because of the menopause, and that is actually a particular problem in the NHS. So, you know, we need to retain that workforce, And so I think that's a that's a big challenge, particularly is is basically the aging population of women and the actual natural cycles that they're going through. How do you make society how do you adapt society to those changes?
Justine Abson:Yeah. And I think, going back to obviously, you mentioned about the menopause and obviously at the beginning about actually talking and how important that is. And I think that is a huge thing. You know, I remember, you know, my my mom going through it when I was younger, and it it wasn't talked about. No.
Justine Abson:Instead, it was just like, oh, what's almost what's wrong now sort of thing and
Lottie Moore:Or she's gone mad, you know? Oh, god. You know? Yeah. There's a lot of stereotypes
Justine Abson:around it. To now be talking about that Yeah. Amazing this awareness, I think, is is so important, which brings me really nicely actually into, into my next question, which is about how we can all help to raise awareness. So, you know, from our listeners' point of view and and that kind of thing, how can we help raise awareness of these issues and help to shape the future of women for, I guess, not just the UK but but across
Lottie Moore:the world? I think, again, you know, education is a really key thing and particularly, you know, when you're talking to children or, like, young girls that are teenagers, like, being honest about what, you know, what the experience is like to have a period or, you know, to have a baby or, you know, to to struggle to have a baby. You know, those things that that are taboo, you you only dispel the taboo by talking about them. But also so I think it's an education piece particularly for younger girls, but also it's about recognizing the wider context in which we have it really lucky here, relatively. So, you know, when we're looking at, you know, low and middle income countries, what can what can we do here to help those places?
Lottie Moore:And, also, what can we learn from them? So a particular example was that, you know, Rwanda is is is actually, on track to beat cervical cancer before the UK does. Wow. So they have an elimination strategy that will that is going to eliminate cervical cancer the fastest in the world. If Rwanda can do it, why on earth have we not got policy in place to to eliminate cervical cancer?
Lottie Moore:And, actually, that that is going to be the next pandemic, for women is that, you know, maternal mortal maternal mortality has decreased. But more and more women, because they're kind of adapting to more Western lifestyles, they're having sex earlier, Cervical cancer is is is is gonna be killing women in 1,000,000 in, you know, 10, 15 years' time. So what are we gonna do now to prevent that? How are we gonna invest in those countries to make sure that those girls are protected? So I think it's about education, but it's also about context as well, you know.
Lottie Moore:There's loads of there's so you know, and, like, the thing is is that women are very good at sharing. So women, you know, they don't keep things to themselves. If you have a not you know, they're 50 what you know, 50% of the world, like, you can't you can't you can't stop them. Yeah. You know, you can't ignore 50% of the world.
Lottie Moore:Right? So you you know, I think it is just about, like, you know, riding on the wave of sort of feminism that we're in now. That does impact women's health. So I think recognizing that.
Justine Abson:Yeah. And I think it's, you know, it it is such an important important point. And there's so many things to talk about as well involved in women's health in general that, you know, just talking about little bits and pieces with your friends is is really key. Yeah. So what about the future?
Justine Abson:You know, what's next in the in the series of work for for women in healthcare?
Lottie Moore:Well, but I've got lot I've had lots of plans. I think I think we, you know, we'd really like to do something on, you know, minority ethnic women. So, you know, there's really bad statistics about, you know, black women are 4 times more likely to die in childbirth in this country than than white women. So there's a lot of, work, policy to be done on on on on, you know, how can we improve health care and access for for minority ethnic women. I think as well there's a lot on you know, we we have a a a big life sciences pillar within our within our, policy at PPP and particularly the intersection of health and life sciences then, you know, women participating in clinical trials so that, you know, the drugs that they're, they're receiving are properly tested on them.
Lottie Moore:You know? COVID 19 pregnant women were excluded from clinical trials, So pregnant women didn't know whether it was safe for them to take a vaccine. And now, really, really sadly, the women in ICUs now who are dying of COVID are pregnant, unvaccinated women. So women were not introduced into clinical trials until 9 months in. I mean, that's not that's not okay.
Lottie Moore:And that's often the case. So I think there's a lot of work to be done there.
Justine Abson:Yeah. And I think that's, you know, that is the the sort of the thing that probably does need looked at more Mhmm. And thought about. Mhmm. And, you know, there has to be a way to kind of get that involvement, I guess.
Justine Abson:Yeah. So, to tie up this episode, at the end of everyone, we ask everyone about what their health tech moment is. So the question is, bit of fun. You know, everyone's got weird and wonderful stories from from health care. So is there anything you've got that's impacted you or anything that you'd like to share with our listeners as your what the health tech moment?
Lottie Moore:I mean, well, yeah. No. Because, you know, obviously, working in kind of policy, I don't you know, we don't explicitly work in health tech. But in terms of my personal experience of health and tech, you know, I'm I'm a big doctor Google person, so I think I've probably diagnosed myself with about 4,000 terminal illnesses
Justine Abson:I think I think everybody has done the same.
Lottie Moore:When I'm actually perfectly healthy. So, yeah, I'm definitely, you know, a a a kind of Internet, doctor Google person. I could do much I could I would do much, better without without the Internet in terms of my health, I think.
Justine Abson:Yeah. I genuinely think most people have, in fact, I think everybody has definitely Googled that, that symptom thing at at least once. But, yeah, it can be a bit scary to do that, can't it? Yeah. Oh, brilliant.
Justine Abson:Lottie, thank you so much for joining us today. It's been great to have you and, obviously, to talk about such important topics that people don't feel comfortable talking about as well. And I think this series of papers is just gonna help raise that awareness and, you know, I, for 1, will kinda take away talking to my friends more about about some of these issues. So, yeah, I really appreciate you you joining us today. Next week, we're speaking to Craig Rainford, project manager at Radar Healthcare.
Justine Abson:Craig recently joined us after spending 20 years with 4 Seasons Healthcare Group. So we're really looking forward to chatting to him about about moving over to Radar Healthcare. Don't forget to rate and subscribe wherever you get your podcasts. And if you have any questions for our guests or us, please email what the health tech at radarhealthcare.com. Thanks.
