Rebel Bodies: A guide to the gender health gap revolution, by Sarah Graham

Have you ever been to a doctor and felt like you were being fobbed off or ignored? In an inclusive and empowering manifesto for change in women's healthcare, Sarah Graham explores the systemic and deep rooted sexism within medicine, and offers actionable ways for women to advocate for themselves and others and get the diagnosis and treatment they need.
Rebel Bodies: A guide to the gender health gap revolution, by Sarah Graham
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The gender health gap is a global problem, with women and people of other marginalised genders experiencing worse treatment and health outcomes, on average, than men. In recent years a growing body of research, and a groundswell of patient advocacy, have both helped to draw attention to this disparity, as well as highlighting other, often intersecting, health inequalities. In my debut book, Rebel Bodies: A guide to the gender health gap revolution, I examine both the issues and the activism surrounding the gender health gap in the UK.

From a purely financial perspective, endometriosis alone is estimated to cost the UK economy £8.2 billion a year, while 14 million working days per year are lost to the menopause. Yet these health issues, and many more, remain marginalised, under-researched and dismissed as ‘normal’ or unimportant by the medical profession. That attitude doesn’t just hurt affected individuals and their families: the literal cost to society is huge. In the following extract, taken from Rebel Bodies’ final chapter, I explore how we can go about bridging the gender health gap, in the context of the UK’s struggling National Health Service.


At the most fundamental level, we need a properly functioning health service. That requires funding for necessary equipment and infrastructure, but above all it requires people – well- trained, compassionate, skilled people and plenty of them. Adequate staffing levels are essential for patient safety and we urgently need investment, not just in recruiting more doctors, nurses, midwives and support staff, but also ensuring they’re well enough paid and supported to do their jobs to the best of their abilities, and to keep them in those roles long-term.                      

We need these staff to be diverse, inclusive and trained in recognising and challenging their own biases and those of their colleagues. This type of awareness and self-reflection must become ingrained in medical school curricula and other healthcare training courses, but it should also be an ongoing part of continuing professional development and lifelong learning.

We need to rethink the medical model that still too often views textbook knowledge as fixed, infallible and in conflict with patients’ own intimate knowledge of themselves; to drop the idea that ‘doctor knows best’ and instead begin to treat medicine as a collaborative partnership between patients and healthcare professionals, each with complementary forms of expertise. The patient-centred ‘ICE’ model for medical consultations is a great starting point, and already widely used. Introduced by Pendelton et al in 1984, it’s based on exploring patients’ ideas, concerns and expectations, with the aim of achieving a shared understanding.

We need to rethink the medical model that still too often views textbook knowledge as fixed, infallible and in conflict with patients’ own intimate knowledge of themselves

We need those in management to be truly representative of all the staff and patients the NHS serves, and to consider the healthcare needs of all patient groups when making decisions about policy and service planning. That includes working with marginalised patients to develop strategies that take real, tangible steps towards tackling health inequalities, rather than simply paying lip service to ‘equality and diversity’ or dismissing these groups as ‘hard to reach’.

We need research to bridge the many gaps in medical knowledge, and to inform more effective treatments and diagnostic tools. [T]here are dozens of female-dominant health issues, across all sorts of medical specialities, all desperately vying for a sliver of research funding and attention. It’s difficult to know where to even begin with filling in these gaps, but, if you’re a budding researcher, a quick flick back through [my book] should offer plenty of potential starting points.

Growing numbers of women in medicine and research will no doubt help, but the major problem, as always, is money. We need a concerted funding effort to support research in fields like menstrual and reproductive health, menopause, autoimmunity and chronic pain. We also need medical researchers across all fields to properly consider the implications of sex and gender in their work, as well as overlapping factors like race, socioeconomic background and trans status, even when it comes to seemingly gender-neutral issues.

Finally, we need the results of that newfound medical knowledge to trickle down, not only to those healthcare professionals currently in training, but to anyone whose patients could benefit. Medical science must continue to change, grow and evolve in this way, and we need healthcare professionals to adapt their existing practice when presented with new evidence, rather than stubbornly persisting with the way they’ve always done things.

Also on the Forum Network: Women at the Frontline: Towards a Gender-equitable post-COVID Recovery, by Willemien Bax Head, OECD Forum, OECD
If we are to achieve a truly equitable post-COVID recovery, we must make sure that women across the socioeconomic spectrum have seats at the decision-making table. This means not only ensuring that women are present in leadership forums and boardrooms, but also fighting gender segregation across all sectors and industries. 

Throughout [my book we see] how powerful and important patient advocacy can be. Even during these most challenging of times for the NHS, sustained pressure from campaigners has thrust issues like menopause and the Black maternal mortality rate onto the political and public agenda. Similarly, Long Covid activism has shone a light on the experiences of those with other long-neglected chronic illnesses, and conversations about conditions like endometriosis have continued to gain media attention. There is a real momentum here and, regardless of how bleak healthcare in the UK feels right now, I also can’t help but feel a little bit hopeful for the future.

The gender health gap is a stubborn, patriarchal beast and there is an awful lot of hard work to be done at institutional levels to tackle it.

Part of that hopefulness comes from my passionate and long-held belief in the power of sisterhood, solidarity and women coming together to make change happen. These women have been the central voices in my work, not only because their stories deserve to be heard, but because they really can and do help to make a difference. I also feel hopeful about the number of healthcare professionals still fighting for change in the face of such enormous pressure and uncertainty. The very best of these are informed not just by their own compassion and professional expertise, but by listening to their patients.                                       

Of course, none of the changes I’ve outlined here can happen overnight or without significant investment and reform. The gender health gap is a stubborn, patriarchal beast and there is an awful lot of hard work to be done at institutional levels to tackle it. In truth, it’s this systemic stuff I’m least hopeful about – the changes that will require our government to invest vast sums of money and commit to radical policy transformations rather than decades more of tinkering around the edges. I’m certainly not naive enough to believe that, even collectively, individual patients and clinicians can fix a centuries-old problem like medical misogyny. But what we can do is continue to shift attitudes in the right direction and chip away at the most egregious examples.

Find out more about Rebel Bodies: A guide to the gender health gap revolution, by Sarah Graham (2023, Bloomsbury Publishing)
And to learn more, check out also the OECD Gender Data Portal, which includes selected indicators shedding light on gender inequalities in education, employment, entrepreneurship, health, development and Governance, showing how far we are from achieving gender equality and where actions is most needed.

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