The women missing from Britain's health policy
4 min read
If ministers want to reform the NHS, whose ill health are we missing?
Our Health Equity North report, Woman of the North: Closing the health gap for minority ethnic women, shows how easily women’s experiences disappear into national averages. That’s not just a problem with the data. It’s a problem with the decisions that follow.
Ethnicity alone doesn’t explain these experiences. Gender, age, deprivation and where women live all matter, with those in the North facing disadvantages. Yet the evidence is patchy or missing. Broad ethnic labels can hide differences between communities. There’s no single experience shared by all minority ethnic women.
Take the North East and Yorkshire, where babies born to Black women experience neonatal mortality rates almost twice those of babies born to white women. Minority ethnic women in England are up to six times more likely to be diagnosed with psychosis; nearly one in five in the North has a long-term limiting illness. They’re more likely to receive a cancer diagnosis at a later stage.
Violence against women and girls is also a worrying issue in the North, 7.1% of women of mixed ethnicity experience it, the highest rate of any ethnic group and above that among white women. The question is what these figures tell us about women’s circumstances and the help available, not ethnicity itself.
Work matters - in Yorkshire, over 14 per cent of Asian women are unemployed, compared with 2.5 per cent of white women. We can’t separate health policy from economic policy.
Policymakers need evidence that brings ethnicity, gender, age, deprivation and place together. But women shouldn’t have to wait for a perfect dataset for change. Tackling poverty, racism and barriers to work and services must happen alongside better measurement. Otherwise, evidence-gathering becomes a way to delay action.
The government should start with sustained investment that reflects local need, including in deprived northern communities, with services that understand women’s cultural contexts and work with organisations they trust. Women’s knowledge should shape the decisions, with reliable funding behind that partnership. Expecting communities and the third sector to plug gaps in public services isn’t a sustainable plan.
To tackle these inequalities, women need a leading role in shaping and evaluating policy. In a North East maternity care study, women described travel costs, communication barriers and feeling rushed and unheard. Help with travel, accessible information and time to listen could make an appointment feel like care, not box-ticking.
For women experiencing domestic abuse, getting help can be harder. A North East study found language barriers, inadequate interpretation and fears linked to immigration status could stop women reporting abuse or supporting police investigations. Services need to understand what makes seeking help difficult, not expect women to come forward.
In a Sheffield study, health professionals met women in community settings, while organisations helped them get to appointments. In a study across Liverpool, Greater Manchester, and Middlesbrough, community-led organisations liaised with health professionals by arranging community health screenings and navigating healthcare and housing services through interpretation and advocacy; women reported feeling more connected and better able to access support.
That work builds trust, confidence and leadership. But how can organisations continue when funding is unstable and grant processes shut smaller groups out? Ministers who want community partnership need to give it secure foundations.
And who gets to decide? Asking women for their views after decisions are made isn’t sharing power. Ministers, regional leaders and the NHS need clear responsibilities and measurable goals, with public reporting showing whether gaps are closing for different groups. Better averages alone won’t tell us that.
Prevention is about changing the conditions that make people ill, not just asking them to manage their risk. Minority ethnic women need more than to be heard. They need institutions that listen, invest and act. Alongside sustained research funding, the government must meet this test. We have the evidence to support immediate change.
Oluwaseun Esan, University of Liverpool and Health Equity North
