Your health

In the Equality Act 2010 ‘sex’ means a woman or a man or a group of women or men. Sometimes it is hard to understand exactly what is meant by the term ‘sex’ , and how it differs from the closely related term ‘gender’.

Our sex is determined by the sexual organs we are born with – men are born with a penis, women a vagina.

Gender relates to the types of behaviours society expects of men and women. We learn these behaviours as we grow through a range of images and messages given to us by parents, schools, friends and the media. For example, young girls might be given dolls to play with and princess outfits to play in, while boys may be given guns and soldier uniforms.

Society has a set of gender expectations of women and men that differ for each sex. Currently, masculine characteristics are more highly valued than feminine characteristics and world-wide, this ascribes more power and wealth to men than to women. This in turn reinforces sets of behaviour, which have significant implications for the pathways into poor health.

In terms of gender, some people describe themselves as gender fluid or non- binary The difference between gender fluidity and non-binary people is the fact that gender fluidity is one aspect of the non-binary spectrum. A range of people on the gender identity spectrum do not see themselves as male or female. They could be agendered, trans or simply identify as non-binary

Sex discrimination exists when a person (man or woman) or group of people (men or women) are treated unfairly solely on the basis of their sex. An understanding of gender is important to understanding inequality between women and men. Discrimination on the basis of gender is both subtle and persistent.

Women are expected to be ‘natural carers’ which has led to a huge imbalance in the types of jobs women do, how much they earn, how much housework/ caring they do and disapproval of society if they do not conform to this stereotype.

Men are expected to be ‘strong’ and unemotional, and they can often experience barriers when seeking jobs that require a degree of caring or empathy. Their masculinity can single them out for additional duties that rely on physical capacity rather than capacity to care.

There is a very serious side to this imposed difference. It means that women consistently earn less than men throughout their lives and often live in poverty when they are older. This lack of economic power has also meant that women have less power in society and less access to positions of power in politics.

In most cases we grow up feeling a sense of comfort or acceptance with our gender (as prescribed by biological sex at birth). However, a small number of us (around 1 in 11,500) find as we grow our prescribed gender is so different from our internal sense of where we exist in relation to being a boy/girl, man/women that we express a wish to live in the opposite, more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender people’ also covered by the Equality Act 2010.

Some people describe themselves as non-binary – not seeing themselves as male or female. In recognition that non-binary people experience extreme levels of discrimination in Scotland, the Scottish Government set up a working grouo in 2021

What is sex discrimination? – a short film by the Equality & Human Rights Commission

Sex differences cut across all the other protected characteristics such as age, race and social class.

For example:

• Male life expectancy is six years lower than for females across NHSGGC
• In NHSGGC, there is a nine-year gap in male life expectancy between East Dunbartonshire (77.7 years) and North Glasgow (68.6 years)
• Asian women aged between 15-35 are two to three times more vulnerable to suicide and self harm than their non-Asian counterparts
• Retired women and lone parents are most at risk of poverty and average incomes of women in work are lower

Other inequality issues can prevent people from receiving health services and treatment appropriate to their sex. For example, some disabled women have been told that they do not need cervical smear tests because of assumptions about their sexual behaviour.

NHS evidence has shown that treating women and men the same, without considering the differences between them, means that underlying sex-related links to health problems are ignored and patients’ health needs are not met. 

There is recognition by the Scottish Government that gender discrimination affects women and their health (Scotland’s Women’s Health Plan 2021-2024 – Health Inequalities) The health and societal differences for women and men are shown in the examples below-

• Women are more likely to live in poverty, be lone parents, experience abuse and  have less access to citizenship opportunities than men, due to historical gender stereotyping in society. This affect health differently during the life course.
• One in four women are likely to experience domestic abuse over their life course and that prevalence rates for child sexual abuse are estimated at around 21% of girls and 7% of boys.
• Men are more likely to participate in risk-taking behaviour which leads to premature mortality and to use their power to commit acts of violence and abuse which affect themselves and women and children of both sexes.
• Men are also less likely than women to participate in health improvement activity or to present to primary care in the early stages of illness.
• Where men have experienced abuse in childhood, this experience can manifest itself in a range of health and social problems in both childhood and adulthood but is often not identified as part of medical presentations.
• Women still tend to have multiple social roles as employees, as carers and as the primary managers of households. This imposes stresses that can have physical and psychological impacts on their health.
• Some diseases have been seen solely as ‘women’s’ or ‘men’s’ diseases due to gendered biases in medical research, leading to delays in diagnosis and treatment (e.g. heart disease – leading cause of mortality in UK women but still seen as a ‘male disease’)

Other examples of where gender expectations affect health are:

• In NHSGGC, like the whole of Scotland, women are between two and two and a half times more likely to report experiencing depression and anxiety than men.
• Suicide rates are almost three times higher in men than in women.
• Men are more likely than women to die of injuries outside the home.
• The gap between women’s and men’s smoking rates is changing, with more young girls taking up the habit than boys.
• Young men aged 16-24 are most at risk of becoming a victim of violent crime

‘A Fairer NHSGGC 2016-20 – Meeting the requirements of Equality Legislation’ sets out what the organisation is doing to ensure it meets its responsibilities to promote gender equality and remove sex discrimination across all its services and functions. Most actions in this document involve addressing issues around sex. In addition, actions on closing the health gap between affluent and deprived communities in NHSGGC take into account the different needs of women and men.

Some examples of actions include:

• Equality Impact Assessments undertaken throughout NHSGGC has a strong gender element
• An NHSGGC Gender-based Violence Action Plan has been in place for a number of years
• Women and child poverty work has gained increasing prominence in NHSGGC, endorsed by the Scottish Government funded Healthier Wealthier Children Project
• Sex issues are key within Human Resources Equality Scheme actions (e.g. Equal Pay Audit,Audit of family friendly policies)
• A gender analysis of our equality scheme, ‘A Fairer NHSGGC’, which sets out how we will meet the needs of equality legislation

John’s Story

John is a survivor of childhood sexual abuse. Now in his 40s, he has struggled to cope throughout adulthood with the experience and knowledge of being abused and has felt that many areas of his life have been negatively affected.

“I’d lost family, friends and jobs – that one major incident was affecting my whole life. I knew I needed help to stop the slide, so I spoke to my GP.

“I was referred to nine different counsellors. None of them specialised in childhood sexual abuse issues. After listening to me talking about my abuse experience, they would pass me on to another counsellor.”

The whole experience left John extremely depressed and contributed to a major breakdown.

John finally contacted Thrive, a counselling service for adult male survivors of childhood sexual abuse which is part of the Sandyford Initiative – NHSGGC’s sexual, reproductive and emotional health service.

“The initial telephone contact was really helpful – the person I spoke to was very supportive and put me at my ease. At my appointment, they explained how the counselling service would be run. They told me that counselling could take a long time and I appreciated that, I didn’t want to be kidded on.

“Hearing those words (‘we can help you’) made such a difference.   When I left I cried all the way to the Underground, I was just so full of relief and happiness.”

Dr Rosie Ilett, Head of Planning and Partnerships at Sandyford, developed the original funding application for Thrive and appreciates the importance of gender sensitivity in services. “Thrive has been developed because we know that many men have real difficulties seeking professional help about sensitive issues – it’s just not considered ‘manly’.   Experience of abuse can test men to breaking point.   Understanding what makes men tick and the barriers that living up to a stereotype of masculinity can impose on them helps our counsellors work effectively with the most challenging cases and start the healing process”.

Thrive is based at the Sandyford Initiative in Glasgow. Men can access the service by calling the direct line on 0141 211 8133 or visit the Sandyford Initiative website at: www.sandyford.scot

Add info here…

Publications

• A Guide to Support Services for Children and Young People Experiencing Domestic Abuse in West Dunbartonshire
• Ethnic Survivors Forum
• Everyday Terrorism: How Fear Works in Domestic Abuse
• Facts for Fathers-to-be
• Human Trafficking – Making the links
• Older Women and Work: Looking to the Future
• Women – Where to go for advice, support and information in the Glasgow area
• Women Living with Domestic Abuse in West Dunbartonshire

Websites

• Scottish Women’s Health Plan 2021-24
• Engender
• Non-Binary Scotland
• Equally Safe
• Women’s Support Project
• Men’s Health Forum
• Rape Crisis
• The Sandyford Initiative
• Violence Against Women Prevention Scotland

Ethnicity refers to a common group identity based on language, culture, religion or other social characteristics. This means that people define their own ethnicity, that everyone (and not just those in minorities) has ethnicity and that a person’s ethnic identity may change over time. For example some people might describe themselves as Scottish Chinese.

Race is the group you belong to, or are perceived to belong to, in the light of a limited range of physical factors. The term ‘race’ should be used in relation to legislation only and not to describe people who belong to an ethnic group.

The term BME is often used within the public sector. It’s an abbreviated term for Black and Minority Ethnic and is often used to describe people from minority ethnic groups, particular those who have suffered racism or are in the minority because of their skin colour and/or ethnicity.

Racism refers to the combined use of power with racial prejudice (the belief that some races are inferior to others) which leads to the oppression or discrimination of specific racial or ethnic groups.

Racism can be detected through attitudes, processes, behaviours and actions which impact on any ethnic group/s and can lead to differences in education and employment opportunities, living conditions and health. We all have an ethnicity.

The Equality Act is designed to ensure that large public organisations like NHSGGC promote race equality and challenge discrimination on the grounds of race, colour, nationality (including citizenship), ethnic or national origins. We are required to;

1. eliminate unlawful racial discrimination;
2. promote equality of opportunity; and
3. promote good relations between people of different racial groups.

Following is a short film by the Equality & Human Rights Commission titled ‘What is race discrimination?’.

Racism can be intensified by other forms of discrimination, for example on the basis of sex, disability, age and social class.

1. Black African women are six times more likely to die from pregnancy-related causes than white women.
2. Women from the South Asian community are less likely to attend breast cancer screening and only half as likely to accept an invitation to be screened for bowel cancer than members of the non-Asian community.
3. Evidence suggests the health gap between white and black/minority ethnic communities is greater in older people.
4. Over a third of people from minority groups are in poverty after housing costs are taken into account, compared with 17% of the ‘white British’ group

Race and ethnicity affect people’s health in a number of ways. Our ethnic background can affect our susceptibility to certain diseases and conditions. There is also a clear link between discrimination and health and implications for the way in which health services should be provided.

For example:

1. Black and Minority Ethnic Scots are much more likely to live in poverty, with a poverty rate of 38% for  Mixed, Black or Black British people and 34% for the Asian or Asian British community, compared to 18% for White British people. Poverty is a key factor in poor physical and mental health and creates barriers to accessing health & social care services
2. One third of black and minority ethnic people in Scotland report experiencing racial discrimination. Racially motivated hate crimes are the most reported type of hate crime.
3. Gypsy/Travellers are more likely to report long-term health conditions than the general population. They are also twice as likely to report three or more categories of health conditions. 

How we are addressing race issues

Our Fairer NHSGGC reports explain how the organisation is meeting the requirements of equality legislation. This includes demonstrating how we will assess the impact of the measures we have put in place to ensure race equality for service users and staff.

Areas of work include:

Access to Services

National evidence shows the BME community experience additional barriers in accessing health and social care services.

We are currently working intensively with two services – diabetes and pain management/physiotherapy – to improve access for BME patients. The learning from this has helped develop a Equality Sensitive Patient Pathway for NHSGGC as a whole.

Following consultation with staff and patients current actions include –

Review all patient information for readability and accessibility
Develop information routes for those with lower health literacy around pain
Explore how the opt-in service accommodates the needs of those from BME communities specifically
Develop a route for non-English speakers to ask for advice outwith appointment times via direct patient access to telephone interpreting
Understand how therapeutic group work can work best whilst utilising spoken language interpreters.

Perinatal Care

National evidence indicated marginalised groups, in particular, BME pregnant women; women living in poverty and those experiencing gender based violence, fair worse in accessing and using maternity services.

A local baseline research was conducted with patients, maternity and third sector staff to assess current issues for marginalised groups using NHSGGC maternity services. A review of best practice interventions was also carried out. The focus of the work has been to look at the patient journey through maternity and identify any barriers for BME women.

Actions identified so far to address these issues include –

Develop a leaflet in multiple languages to describe each stage of the maternity pathway, how to access support and highlight emergency routes
Explore how to maximise the value of ante natal classes for non-English speakers
Develop training for Maternity Staff on meeting the needs of BME women thnrughout our pathway
Develop a route for non-English speakers to ask for advice outwith appointment times through direct patient access to telephone interpreting.

Interpreting service

Interpreting services address a number of risks for both service users and staff. For example, patients who have a limited understanding of English:

• may not be able to give informed consent
• may not be able to ask questions or seek assistance
• may not be aware of what services are available to them
• may not be able to use medication properly or follow care plans
• may come from cultures with different understandings of health and illness
• may not understand how to use NHS services
• may not understand their rights and responsibilities within the healthcare system

Ensuring that everyone has an equal opportunity to engage in the health care process benefits all concerned.In addition, equalities legislation stipulates that the organisation must be pro-active in ensuring that this is the case.

NHSGGC’s in-house interpreting service provides interpreters to NHS patients on request. The service is available to a wide range of service areas and departments, including hospital wards, outpatient clinics, medical practices, dental surgeries,pharmacies and opticians located throughout the NHSGGC area.

‘Clear to All’ Accessible Information Policy

Effective information and communication are vital for the provision of high-quality services and care. Many of those who access services have difficulty understanding the information provided. An Accessible Information Policy has been produced to ensure that all information can be made available in various languages and formats to meet the needs of our diverse community.

A toolkit for staff has been developed which helps to provide information and support in the development of accessible information for NHS patients, their carers and the public. The toolkit aims to ensure that the material we develop is clear, consistent with NHSGGC guidance, accurate and in everyday language.

Details are available on the ‘Clear to All’ Accessible Information Policy web page.

Stand Against Racism Campaign

Our workplace should be a place where discrimination is unacceptable and where everyone has the chance to thrive, regardless of their background or identity.

Our anti-racism campaign is based on the words of our own staff from their experiences at work. NHSGGC is an inclusive employer and there is no place for racism in our services.

Briony’s Story

Briony is part of the travelling people’s community and has lived in Scotland all her life.

Briony and her family have lived on the caravan site for 8 of the last 10 years. They were there for three years, moved into a flat for two years, and then have been back at the site for the last five years. When they moved into the flat it was mostly due to her health problems, but they also felt like maybe they would want a change and settle in for a little while. But after a couple of years, they wanted to move back to the caravan site because that is who they are and it was where they wanted to be.

She tells about how it was for her and her family to register with the local surgery when they first moved to the caravan site. There was not just one doctor’s surgery for everyone on the site, so all of the people living there were allocated to different surgeries. Briony herself went around to all of the local surgeries to see if she could register with one, but none would take them on. “They kept telling me ‘you aren’t from this area, so we can’t take you. She had to wait to get a letter from NHS telling her which surgery they had been allocated to and where to go before she could register.

When they moved into the flat, they didn’t have any problem registering with a surgery, and everyone was really nice to her. When asked why she thought there were no problems with getting registered and why they were nice, she says, “Oh, I couldn’t speak for them. But it could because I was in a flat at the time and not from the caravan site. This surgery was one of the ones I went around to when we were first at the caravan site and they said they wouldn’t take us on. But when we were in the flat, they would.

“I‘m still with that surgery now, even though we’ve moved back to the site. And they are still nice”.

Publications

• Amina
• Awaz FM
• Black and Ethnic Minority Infrastructure in Scotland (BEMIS) 
• CEMVO Scotland
• Glasgow Helps
• Govanhill HA
• Scottish Refugee Council

• Find a course | NCL (nclanarkshire.ac.uk)

• Glasgow Kelvin College | Real Opportunities, Real People, Real Glasgow

• Study in Glasgow | Glasgow Clyde College

• City of Glasgow College | Full Time, Part Time, Evening and Weekend College Courses

• Marie trust | Marie Trust (themarietrust.org)

• Nemo Arts – Improving Mental Health and Wellbeing

• Volunteer Glasgow – Services & information on volunteering and engaging volunteers in Glasgow

Restart is an NHSGGC mental health project that works in conjunction with Community Mental Health Teams, in patient and specialist service in the GCHSCP. The main focus of the project is to offer recovery based support to those living with severe and enduring mental health conditions. Trainees are given the opportunity to take part in various vocational training activities.

Each trainee is assigned a Vocational Guidance Counsellor who will work with them to set goals and personal development plans. Trainees will also be able to access support from Psychiatric Nurses and Instructors.

At Restart we can offer individuals the opportunity to:

• Have a greater sense of hope for the future
• Increase self belief and build resilience
• Learn new vocational skills
• Greater feelings of social inclusion
• Support on your recovery journey.

If you wish to refer somebody to Restart project they MUST be a patient in a community mental health team(CMHT) in patient, specialist service or attached to secondary mental health services in GCHSCP. Please refer using our projects referral form – click below for download. 

Referral forms can be returned electronically to the projects email address.

Email: restart.project@ggc.scot.nhs.uk

Client Testimonial

“I came along to Restart to have some structure and work on an interest that I had in Digital Photography, also to be in the company of others as I was feeling isolated. I was struggling on a daily basis feeling down and not having anything to look forward too. Having spent time attending the project and taking part in photography and picture framing I am feeling better both mentally and physically, I have some focus in my life, feel less isolated and my confidence is growing. I would recommend Restart as it takes your mind of your mental health problems, gives you some routine and a sense of purpose”.

Quote by current Restart trainee