Engender blog

Invisible in Scotland’s Health System

The recently published Voluntary Health Scotland (IN)VISIBLE research report explores the complex relationship between sex, gender, and health. In this guest blog, report author Sarah Latto reflects on the findings and how we can work together to bring about systemic change.  

 

A research participant describing her experience of navigating Scotland’s health system as ‘institutional gaslighting’ really cemented the importance of our (IN)VISIBLE project. I also have personal experience of my symptoms and pain being minimised in Scotland’s health system, and this is happening to too many of us, too often.   

Led by evidence and insights from over 50 representatives from Scotland’s third sector, the (IN)VISIBLE research looks at how sex and gender affect the health of all Scotland’s people, not just women. However, the report surfaces clear evidence of misogyny in Scotland’s health system that will be familiar to many Engender members.  

In writing the report, I was keen to ensure that the themes were navigated sensitively and inclusively. As well as engaging with a wide range of health-specific VHS member organisations, I approached third sector organisations that have expertise in gender issues, like Engender, for their insight. I also worked closely with LGBT Health and Wellbeing and Scottish Trans to ensure that an intersectional approach was adopted throughout.  

Physiological Differences 

For women assigned female at birth, physiology – or biology – plays an important role in determining their health. ‘Women’s health’ is often defined by the female reproductive organs and hormones, focusing on conditions like endometriosis, adenomyosis, or menopause. However, assigned females are also more likely to develop certain neurological conditions such as ME or Functional Neurological Disorder, and experience many other health conditions differently to assigned males.  

In fact, assigned females routinely have their symptoms dismissed, are misdiagnosed, or experience treatment delays because these physiological differences are not well understood by health professionals. As one participant stated, ‘women are seen as “little men”’ with treatment ‘based on the “typical” 70kg man’. This creates considerable health inequalities and can have life-threatening consequences for women.  

For trans women, physiological differences lead to more complex inequalities due to the binary nature of our health system. Gender identity healthcare often creates new biological realities that aren’t well understood, and don’t align with dated NHS systems for patient data. For example, a trans woman might be eligible for breast screening as a result of hormone therapy but they may also still require prostate screening. Unfortunately, screening invitations are largely based on binary gender categories, meaning that many trans people have to proactively request screening that is appropriate to them.  

Societal and Systemic Barriers 

Societal gender norms have a significant impact on health outcomes, along with systemic barriers in Scotland’s health infrastructure and workforce. For example, women are more likely to provide, or be expected to provide, primary unpaid caregiving roles. Several sources in the research spoke about the burden on women in heterosexual relationships to provide their partner with a ‘good death’, with some of that pressure appearing to come from health and care workers. This places significant economic pressure on many women, often leading to poorer health outcomes. It also limits their capacity to prioritise their own health, with many unpaid carers ending up ‘missing’ from the health system. 

 

 

Intersectional Inequalities 

The impact of gender on health is often compounded when it intersects with other protected characteristics. VHS members shared evidence of ageism, ableism, racism and queer-phobia, often having devastating impacts on the health of women in Scotland. Women with learning disabilities are often infantilised, with some reportedly experiencing pressure to terminate pregnancies. Similarly, migrant women regularly experience discrimination in maternity services, with reports of informed consent not being adequately obtained for procedures including the provision of long-term contraception.  

Bisexual women have a disproportionately high likelihood of reporting poor health outcomes, including depression, self-harm, disordered eating, and abusive relationships. Frustratingly, there is not enough evidence to understand why this is the case – a common theme when it comes to understanding intersectional health inequalities. One research participant stated that:  

‘Not only do we have data gaps, but where we have data, particularly when you’re talking about disaggregated data, it is not statistically significant enough for us to base anything on it.’ 

So, how do we solve this? 

There are six recommendations detailed in the report, all aimed at improving health experiences and outcomes by bringing about systemic change. Health policy and research need to reflect the impact of sex and gender on health, particularly where they intersect with other characteristics.  

The health workforce needs to be better informed on the specific impacts, and we need to invest in dedicated systems and spaces that address common barriers. We need to empower women through public awareness campaigns – only by understanding the ways that sex and gender impact on health will we be able advocate for ourselves.  

Finally, it is clear through this report that third sector organisations like VHS and Engender have a vital role to play in understanding and responding to inequalities. I urge women, and organisations that support and empower women, to read this report, share its core messages, and help us to make the invisible visible.  

Sarah Latto (she/her) has been the Policy and Public Affairs at Voluntary Health Scotland since May 2025. She is passionate about social justice and a proud member of Engender. Voluntary Health Scotland are a movement for health creation, working collaboratively with their 300+ members to reduce health inequalities. 

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