Austerity and Women’s Health

In this month’s extended Research Reflections blog, Research Officer Lorna Orriss-Dib and Research Ambassador Maria Karpouzou explore the impact of austerity on women’s health, drawing on their respective experiences living and working in the UK and Greece. 

Definitions of ‘women’s health’ have typically focused on health issues concerning reproductive and maternal health. Whilst this is a critical part of women’s health (services providing maternity and reproductive healthcare, for example, must be safe, accessible, and high-quality), the way we define ‘women’s health’ needs to expand to encompass all aspects of a woman’s health and wellbeing. The World Health Organisation (WHO) has remarked that there has previously been strong emphasis on the reproductive element of women’s health. Broader definitions that incorporate the wider determinants of health are needed (WHO, 2023).

A woman’s experience of disease can be different to that typically experienced by a man and those working in the health care system do not adequately recognise men and women’s contrasting experiences. This can negatively impact on the timeliness of referrals, women’s health-seeking behaviours, and quality of life. For example, in addition to the sudden onset of pain described by both men and women when having a heart attack, women may also experience symptoms of dizziness, shortness of breath, back pain and fatigue (Joseph et al., 2021). Health care practitioners’ failure to recognise these symptoms can lead to women’s delayed diagnosis and treatment when compared to men (Aggarwal et al., 2018).  Women are also more likely to be diagnosed with multiple long-term conditions, particularly in middle-age (Head et al., 2021; Violan et al., 2014).

Furthermore, women encounter barriers when accessing and using health services. One study found that women who attended emergency departments with abdominal pain, on average had to wait longer than men for pain relief (Hayes et al., 2023). Male health care professionals are also more likely to perceive women’s pain as less severe than a male patient’s (Bernardes and Lima, 2011). It is unclear why such disparities in pain assessment occur, but stereotypical images of the stoic male and emotional female have been highlighted as factors by researchers.

Societal, biological (e.g. hormonal) and economic factors also impact upon women’s health. In our interconnected world, the collapse of the US based Lehman Brothers bank in 2008 led to a global financial crisis (Bank of England, 2023). As governments sought to reduce their spending, programmes of austerity were introduced in countries around the world, resulting in significant cuts to spending on public services.  The effects of the financial crisis and subsequent austerity measures continue to be felt today, as austerity policies have not been reversed. Women use public services more than men, are more likely to have a public-sector job, and typically provide the bulk of unpaid care for children, and disabled or elderly relatives (Reis, 2018). Consequently, austerity and the lack of public sector investment has had a disproportionately negative impact on women. This was reiterated by the UN Special Rapporteur for Extreme Poverty during their visit to the UK in 2018, when they reported the disproportionate effect of austerity on women, those with disabilities, ethnic minorities, children and single parent families.

Austerity has had a clear impact on women’s health. In the UK, austerity measures were introduced in 2010, and spending on disability benefits, early years programmes and unemployment benefits was reduced from 2009-2011 (Reeves et al., 2013). Austerity directly widens health inequalities via cuts to public health programmes. It also has an indirect impact due to increased unemployment and a reduced social security net. The UK officially entered recession in early 2009 (Wearden, 2009). Before 2011, life expectancy was increasing for all. However, life expectancy has since stalled or declined among the poorest women in the UK (Bennet et al., 2018). Poor mental health rates during the recession were similar to pre-recession levels among women. However, these rates increased among women with the onset of austerity programmes in the UK (Thomson et al., 2018).  Whilst men were more likely to report poor mental health during the recession, women’s declining mental health aligned with the implementation of austerity (Thomson et al., 2018). As previously mentioned, women are more likely to either use public services or work in the work sector. Cuts to these services are therefore guaranteed to have an increasingly negative impact on their health and wellbeing. Increasing pressures on the NHS, for example, disproportionately affect women as they make up 55% of all adult hospital admissions (NHS Digital, 2022). The Marmot Review (2020) reported that since 2010 there has been a larger increase in the years lived in poor health among women compared to men.

Greece experienced a severe financial crisis and required substantial loans in 2011. This resulted in austerity measures and an increase in poverty. The implementation of austerity and a rise in poverty levels affected the quality of the Greek health system and the accessibility of health care. The Greek primary care system underwent austerity-driven reforms following the financial crisis. Health care coverage in Greece is a mix of public funding, social insurance and private financing. Health insurance coverage also depends upon an individual’s employment status. In 2016, the unemployment rate in Greece was 24.4% (Kraatz et al., 2016). With healthcare entitlements linked to a citizen’s employment and insurance contributions, out of pocket payments significantly increased during the economic crisis. Out of pocket payments are medical costs not covered by the insurer or reimbursed by the employer. Greece has the highest rate of out-of-pocket healthcare costs in the EU (European Observatory on Health Systems and Policies, 2019) and costs were cited as the main barrier to accessing health services (Saridi et al., 2017).

As in the UK, austerity measures in Greece disproportionately affected women through job loss, salary cuts and increased poverty. The Greek government capped their public health spending and from 2009-2012 spending on outpatient services was reduced by 35% (Crookes et al., 2020). In one study, 77% of women stated that their health insurance did not cover preventative screening such as cervical smear/pap testing and over half of women indicated that they attended their mammography screening more regularly prior to the financial crisis (Saridi et al., 2017). Following the crisis and subsequent austerity measures, attitudes towards screening changed, with women feeling more indifferent towards their own health. The daily needs of the family, anxiety around household budget and unemployment concerns were described as more important than health.

At one hospital site in Greece, there was a 57% increase in the number of women hospitalised with a heart attack, compared to pre-crisis levels (Makaris et al., 2014). Job insecurity and rates of unemployment are higher among women compared to men, and financial stress has previously been linked to cardiovascular morbidity.

Policy makers should be aware of the gendered impacts of austerity measures when reviewing public sector services. Women have fewer savings and lower wages compared to men and are disproportionately taking on unpaid care work when there is a shortfall in public service provision. This makes women more vulnerable to rises in the cost of living (Reis, 2018). These socioeconomic factors have implications for women’s health. Good quality secondary health services (such as hospitals) are crucial, but the main drivers of health lie outside of the acute sector. There must be greater recognition that policies relating to housing, early years, employment and economic security affect women’s health and wellbeing.

Lorna and Maria will continue to work together on our upcoming project on women’s health and wellbeing across the life course.

Lorna Orriss-Dib is a Research Officer at Healthwatch Essex, where she has led and supported a wide range of projects including her recent work on pregnancy and inflammatory bowel disease [IBD]. Prior to joining Healthwatch Essex she studied MSc Public Health and previously worked as a nurse for 10 years in various clinical specialties. Having come from a quantitative background as a cardiovascular research nurse, she is enjoying the opportunity to gain further qualitative skills and showcase the importance of lived experience.  Lorna is passionate about public health, the social determinants of health and women’s experiences of long-term health conditions. In her spare time, Lorna enjoys spending time with her daughter and husband, is an avid reader and collector of books, and enjoys being out in nature.

Maria Anastasia Karpouzou lives in Greece and is currently an undergraduate student studying applied and clinical psychology at Anglia Ruskin University. Maria has always had a passion for research and the Healthwatch Essex Research Ambassador scheme has given her the opportunity to learn how to conduct research using qualitative methodologies. Maria is interested in pursuing an MSc in Neuroscience. In her free time, Maria likes to read books, go for walks with her dog and dance traditional Greek dances.


Photo by pratik prasad on Unsplash