In July 2023, the Ministry of Health launched six new health strategies, the Pae Ora | Healthy Futures Strategies, as mandated by new legislation (the Pae Ora Act) that underpinned the restructuring of the health system.
All of these strategies are important and set the direction for health services for the next decade. Three strategies were completely new – the Pacific/Te Mana Ola, Rural and Women’s Health Strategies.
Migraine Foundation Aotearoa New Zealand was involved in consultation for the Women’s Health Strategy, as migraine disease is 2-3 times more common in women than men and is sometimes stigmatised as a ‘woman’s disease’ which is harmful for both men and women.¹ Chronic underfunding of headache and migraine research is strongly linked to the fact that migraine affects more women than men.² ³
The Women’s Health Strategy ⁴ names this issue upfront, acknowledging that:
“Gender bias can result in gaps in research on women’s health, lack of information and a lack of services for health conditions that … are more common in women. It can also result in delays in diagnosis, and access barriers to health services.” (p 6)
It’s good to have this recorded, in black and white, in a Government document. This has been the experience of too many women with migraine in Aotearoa. And this is augmented for women who are also subject to racism and other discrimination within the health system. In summary, “many women do not feel heard, validated or taken seriously by health care workers regarding their symptoms, including pain.” (p13)
This is likely the first time that a Ministry of Health Strategy has explicitly mentioned headache disorders. In Figure 6, on page 17, headache disorders are listed in the top five burdens of disease for women aged 15-49 years old; and later, listed as one of several health conditions that are more likely to affect women than men (p19). Finally, the impact of migraine on women is recognised at a Government level.
The Strategy sets out the goals that all women and their whānau will feel welcomed and valued, not experience bias, be empowered to have ownership over their health, receive high quality, evidence-based care and have more options.
How might this happen? The Strategy lists a range of actions. Including the voices of a diversity of women at all the levels of the health system. Meeting expectations for meaningful consumer engagement. Equitable prioritisation and funding of women’s health services, with a focus on prevention, early intervention and unmet need. Ensuring there are no significant research gaps into issues that affect women and using research evidence to improve services. Having a responsive and well-trained health workforce that can skillfully deal with issues affecting women. Actively challenging bias and stigma.
The Strategy gives a vision for the future:
“All women, including women with conditions that are more common among… women, experience high-quality, equitable care and improved health outcomes.” (p39)
High-quality, equitable care for women with migraine surely includes access to evidence-based treatments that are available in other countries. The Strategy states that “Health entities need to … prioritise pathways, treatments and services to manage health conditions that … more commonly affect women” (p 40). The Strategy also acknowledges that women have lower incomes, savings and access to resources than men, which creates gendered barriers to unfunded medication, and is another reason that the funding of migraine medication should be a priority.
This high-quality, equitable care must extend to all genders, of course. But improving care for women with migraine will improve care for all people with migraine. If we can use the Women’s Health Strategy to address the many gaps in migraine support, treatment and research in Aotearoa, then that will be a win for everyone.
Further reading
1. Samulowitz, A., Gremyr, I., Eriksson, E. & Hensing, G. ‘Brave Men’ and ‘Emotional Women’: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag (2018). doi 10.1155/2018/6358624
2. Orr, S. L. & Shapiro, R. E. The elephant in the room: How the underfunding of headache research stunts the field. Headache: The Journal of Head and Face Pain (2022). doi:10.1111/HEAD.14396.
3. Mirin, A. A. Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. J Women’s Health 30, 956–963 (2021).
4. Minister of Health. Women’s Health Strategy. (2023). Wellington, Ministry of Health.
