Women in Scotland face higher mortality and poorer outcomes from major conditions despite similar hospital admissions to men, according to Chest Heart & Stroke Scotland. Against a backdrop of persistent gender inequalities across cardiovascular, respiratory and Long COVID, the charity’s first Women’s Health Strategic Advisor, Jessica Wilson asks: why does Scotland still understand men’s health better than women’s?

“Heart disease, stroke, respiratory, and Long COVID conditions continue to claim and limit the lives of thousands of women in Scotland, and yet they are still too often absent from the mainstream conversation about women’s health.

When we look at the data, a consistent pattern emerges. Women in Scotland are more than twice as likely to die from heart disease as from breast cancer and, following a cardiac event, they are less likely than men to be prescribed medications that help prevent a second heart attack.

Although the stroke mortality rate is slightly higher in women, they are less likely to receive optimal secondary prevention post-stroke compared to men.

In respiratory health, women account for 66% of asthma deaths in Scotland and are almost twice as likely as men to die from the condition. COPD incidence and mortality are also slightly higher among women compared to men in recent years.

Long COVID, too, shows higher prevalence in women.

This pattern in health outcomes reveals a persistent gender health gap.

This is not about apportioning blame. It is about recognising that health systems, research models and public messaging have historically evolved around the male physique. As a result, our understanding of risk, diagnosis and recovery has not always fully reflected women’s experiences.

Scotland has made important progress. The publication of phase two of a national Women’s Health Plan signalled a welcome commitment to improving outcomes. However, if we are serious about closing the gender health gap, the next phase must go further.

First, government must ensure that stroke, respiratory, and Long COVID conditions are explicitly embedded within women’s health and brain health policy. These conditions are not peripheral issues; they are central to women’s life expectancy and quality of life.

We need consistent, gender-specific data collection and reporting across NHS services. Outcomes should routinely be analysed by sex and deprivation. Transparent reporting is not about criticism; it is about identifying where improvement is needed and directing resources accordingly.

Professional training must also evolve. Mandatory gender-specific education, calibrated triage protocols and ongoing quality improvement programmes can help reduce variation in diagnosis and prescribing. When women present with chest pain, breathlessness or fatigue, those symptoms must be assessed and treated against up-to-date evidence, not outdated archetypes.

There is still a misconception that heart attack symptoms are entirely different in women. In reality, core symptoms such as pain in the chest, jaw, back, arms, shoulder and/or neck, breathlessness, nausea, sweats and fatigue are broadly similar. The challenge is ensuring they are recognised and acted upon consistently. Missed or delayed diagnoses can have lifelong consequences.

Government also has a critical role in strengthening public awareness. Many women do not realise that heart disease poses a greater risk to their lives than breast cancer. National campaigns must reflect the true scale of risk and equip women with the knowledge to recognise symptoms and seek help early.

Prevention must sit at the core of this agenda.

Pregnancy-related hypertension and gestational diabetes increase long-term cardiovascular risk. Menopause brings metabolic changes. And, certain autoimmune conditions, which can be more common in women, further elevate risk. Public health strategies should incorporate these factors more clearly, supporting earlier intervention and informed lifestyle decisions.

Services, too, must reflect women’s realities.

Caring responsibilities and employment patterns can limit access to traditional nine-to-five appointments or rehabilitation programmes. Policymakers should prioritise flexible, community-based models of care that remove practical barriers to participation.

At Chest Heart & Stroke Scotland, we are working to support that change. We are actively recruiting women with lived experience to our Voices of Lived Experience Panel to help shape our strategic direction. Our refreshed Women’s Health Plan, publishing this Summer, is being developed in collaboration with women across Scotland.

Through our Advice Line, Health Defence Hubs, Community Healthcare Support Services, education programmes and women-focused peer support and physical activity initiatives, we are strengthening awareness and improving access to support. But meaningful system change requires partnership between the third sector, NHS leaders and government.

Closing Scotland’s gender health gap will require sustained political commitment, targeted investment and a willingness to recalibrate systems that were not originally designed with women’s needs at their centre.

This is not about comparing men and women’s health. It is about ensuring equity in understanding, prevention and care. When women’s cardiovascular and respiratory risks are recognised with the same clarity and urgency as other conditions, we will move closer to a system that truly serves everyone.

By improving awareness, strengthening evidence, supporting prevention and designing services that reflect women’s lived realities, we can ensure that no woman’s health is overlooked, and that no life is half lived.”

 

The views of columnists and people who write guest insight articles are their own.

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