Many EU Member States are introducing reforms of the health and social sector designed to improve the relevance, sustainability, efficiency and cost-effectiveness of the current ‘silo system’, which is not sensitive enough towards gender. Policy-makers and politicians have here a policy window opportunity to ensure that the reform process, including the non-disruptive digitalisation, addresses long-standing inequality between women and men, both as providers and as recipients of care.
The Lisbon Reform Treaty considers gender equality among its key values and objectives, but to date, health and social care ecosystems have been largely blind to the gender equality impact! Furthermore, women are, still nowadays, overrepresented in lower paid and informal care-giving roles, and have been disproportionately affected by human resources’ policies that fail to consider their professional needs in employment contracts, incentives and career advancement opportunities. Though, building gender equality in health and social care ecosystems improves their functioning and responsiveness with the goal of improving health outcomes.
At EU level, nursing is predominantly a female profession, with 92% of women. As the largest healthcare profession, nurses and nursing are a powerhouse for change, and voting (!), for non-disruptive innovation and leading new ways of working, including blockchain to make Electronic Health Records (EHR) connected. Increasing numbers of countries are now introducing nurse prescribing, which is a significant enabler of change when co-designing EHR at EU level (cf. Smart4Health & InteropEHRate, two EU projects in which the EFN is a partner to strengthen the end-user requirements). Equally nursing roles in public health and prevention that reach deep into communities and frequently work alongside organisations supporting the wider social determinants of health such as housing and education should be supported within the EHR. That leads to “Health in all Policies!”
Furthermore, if the goal of developing gender-sensitive policies is to be achieved, this needs to be built explicitly in the design of services that can be used for evaluation purposes feeding into the European Semester. As the challenges in different sectors, particularly those related to health and social care, are tackled by the European Commission by analysing the state of play and making recommendations to improve performance, all Member States need to make a series of political and policy priorities that reshuffle investments towards building a human health and social Ecosystem. Gender mainstreaming is therefore key for the design of new ecosystems driving change towards integrated and continuity of care, starting with an EHR fit-for-purpose, build in the end-user requirements!
Also, and in the context of Horizon 2020 and Horizon Europe, which pay particular attention to gender, it is necessary that science includes more evidence from women than is currently the case. Research outcomes and opportunities can be biased towards women, which can be countered by including the nurses when designing calls and submitting proposal. End-user codesign is key for deployment and impact. Whilst we continue to build systematic understanding of lifestyle and patient outcomes, we miss gender sensitive and responsive research in healthcare.
And last but not least, and still a reality in 2019, even if the trend is slightly starting to change, caring responsibilities, both for children and older relatives, still fall mainly on women in European households whether they are working or not. This dual caring role is growing with more women of working age having children later on in life or getting involved in childcare for their grandchildren or caring for older relatives. Addressing this issue and finding ways to help nurses work more flexibly would help to retain existing nurses and could even attract people into nursing. The attrition of a nurse professional is a major issue which has not been adequately addressed up to now. The emphasis of any strategy should therefore be on retention: Recruitment without Retention is Resource wasted.
It is, therefore, key to make sure that gender parity becomes finally achieved.