AUSTRALIA ranks first in the world for women’s education but 70th for women’s economic security and opportunity. While there have always been physical and mental health burdens unique to women, the rising financial inequity and the COVID-19 pandemic have exacerbated these inequalities.

Our National Women’s Health and Wellbeing Scorecard launched on Monday 5 December 2022 has highlighted the declining reported health and wellbeing over the past decade for Australian women. This report confirms that progress is either not being made or is too slow, with over a century needed to close gender gaps.

This scorecard, based on the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) Survey and the National Health Survey collected by the Australian Bureau of Statistics, highlights key health and wellbeing indicators where women have poorer outcomes than men.

Australian women are poorer than men

This extends from a shocking gap in full-time employment (nearly 50% of men are employed full-time compared with only 30% of women), to under- and unemployment, and being out of the labour force due to child caring responsibilities. Women disproportionately have lower income, less superannuation and higher likelihood of income poverty than men, even in a high income country like Australia.

Australian women have poorer health than men

Women’s health has declined over the past 20 years on self-reported indicators of health covering physical and mental health. Women also report poorer health in almost all domains than men. There have been population level shifts in psychological distress rates, with older women aged in their 50s and 60s going from being the least likely to report psychological distress to the second most likely, in only two decades.

This sets up a wicked cycle of entrenched poverty and poor health, disproportionately affecting Australian women. Low income and unemployment are two of the primary determinants of poor health. Poor physical and mental health in turn reduces ability to participate in the labour force, lowers income and reduces wealth, limiting access to health care through affordability issues (here and here).

Equality is an urgent priority for Australia

Equitable health and wellbeing of the community is a social justice issue and is also essential for social and economic growth. Having good health, meaningful employment and a decent level of income and wealth allows individuals to fully participate in and contribute to society. Our economy is built upon healthy and skilled people participating in the labour force and in our society. Poor health, low income and absence from the labour force comes at enormous cost, presenting a key barrier to future prosperity.

But this should not be the status quo.

Removing the structural barriers that prevent equality is critical. Addressing the simultaneous inequalities in health, employment and economic resources is a complex undertaking and cannot be done in siloes. Women’s health and wellbeing needs a gendered and preventative public health lens. This should encompass and extend beyond sexual and reproductive health, and be addressed through a women-centred, evidence-based, systems-level approach – focused on achieving real change for women, through implementation of evidence, monitoring and accountability.

Action is needed now

For too long there has been a failure in Australia to focus on structural gender inequity and recognise the health impacts this brings. Emerging government policies are encouraging in terms their focus on women’s economic security, including around childcare, addressing the gender pay gap and in workplace gender equity.

However, never before has it been more important to ensure Australia focuses on financial and health equity.

The Monash Centre for Health Research and Implementation, Monash University and Monash Health have been working with partners towards the establishment of a dedicated Women’s Public Health, Wellbeing and Equity Institute, led by women, working with women, delivering for women across their lifespan, generating and implementing evidence-based strategies to improve health outcomes, linked to broader social determinants of health.

The aims of the proposed Women’s Public Health, Wellbeing and Equity Institute are to better serve Australian communities through greater partnership, especially with our community, through codesigned research. It also calls for greater implementation of evidence for impact with a strong focus on prevention and health care improvement and education of health professionals and empowerment of women as consumers and funders of health care. This is particularly important in regional and remote Australia and among underserved communities where issues of mental health, obesity, sexual and reproductive health, chronic disease, preventive health, and ageing are often neglected when it comes to the specific needs of women and children.

It will be important that strategies bring a life course approach, consider socioeconomic determinants alongside health and transcend research, health care and policy silos and settings. A learning system approach is needed to ensure evidence from stakeholders including women, evidence from research, evidence from policy and practice, and evidence from effective implementation are integrated (here and here). These integrated approaches arekey to delivering sustainable, scalable solutions and impact, ensuring women and underserved populations are at the forefront of evidence-based improvements in policy, public health and healthcare.

The Monash Women’s Health and Wellbeing Scorecard will be produced annually to evaluate changes in women’s health and wellbeing.

Associate Professor Emily Callander is a health economist and value-based care researcher specialising in maternal and women’s health. She is affiliated with Health Systems Services and Policy at the Monash Data Futures Institute.

Dr Joanne Enticott is a Senior Research Fellow and leads the Big Data Research and Learning Health System, and the Mental Health Epidemiology Research at ​Monash Centre for Health Research and Implementation.

Professor Helena Teede is the Director of Monash Centre for Health Research Implementation, Professor of Women’s Health Monash University, an endocrinologist at Monash Health, and Executive Director of Monash Partners Academic Health Sciences Centre.



The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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