1  Introduction

This is one in a series of needs assessments regarding protected characteristic groups to support compliance with the public sector Equality Duty (The Equality Act 2010).

The document is intended to raise awareness of the key public health, and health & social care considerations relevant to people of different sex/gender; and to provide a starting point to inform the development of Equality Impact and Needs Assessments.

Sex (or gender) is a protected characteristic under the Equality Act 2010, and refers to people as male or female[1].

  • The term ‘sex’ is used to describe biological differences between women and men.
  • The term ‘gender’ refers to the wider social roles and relationships which structure men’s and women’s lives[2]

2  Background

Gender inequality exists in many aspects of society and refers to lasting and embedded patterns of advantage and disadvantage.

In relation to health and health & social care, men and women can be subject to differences in:

  • Risks relating to the wider determinants of health and wellbeing (e.g. employment and educational opportunities, burdens of caring for others).
  • Biological risks of particular diseases (e.g. men – prostate cancer; women – cervical cancer and reproductive health).
  • Behavioural and lifestyle health risks (e.g. men – violence and low health care attendance rates).
  • Awareness of particular health issues and appropriate access to health & social care (e.g. CHD in women).
  • Rights and risks of exploitation (e.g. women – sexual and domestic exploitation).

In terms of service provision, it is recommended that public bodies consider[3]:

  • Is service user information disaggregated by sex?
  • Do women and men use the service in different ways?
  • Do women and men have different needs from the service?
  • Are there particular groups of women or of men (for example, disabled women, or men from particular ethnic groups) who do not use or under-use a service or who are less satisfied with it?
  • Is there evidence that a one-size-fits-all service is not appropriate?
  • Is sex segregation necessary or preferable (e.g. sexual health services, hospital in-patients, care homes)?
  • Are there big discrepancies in service outcomes by sex?

3  Local picture

In Richmond, the numbers and proportions of men (91,149: 49%) and women (95,849: 51%) are roughly equal overall, and across life-course age-bands until later life. As women experience longer life expectancy than men, by the time people are aged 85 years and over there are more than twice as many women as men.

This pattern has a number of implications for the needs of women. For instance, the older age profile of women means that they suffer higher rates of chronic disease and require access to appropriate models of chronic disease and elderly care services, and it needs to be recognized that they are more likely to be living alone without a partner/ carer.

Figure 1. Number (1,000s) of men & women by age band in Richmond (2011)

Figure 1. Number (1,000s) of men & women by age band in Richmond (2011)

Source: 2011 Census data, ONS

3.1.  Life expectancy

Despite Richmond having a smaller gap between the life expectancy of men and women, as discussed above, the resulting differences in sex in older age groups is still notable. Also, the fact that the difference between healthy life expectancy between men and women is much smaller than total life expectancy, due to the high risks of chronic disease and disability in older age.

Table 1. Life expectancy at birth: By sex/gender, Richmond (2009-11)




Life expectancy at birth



Healthy life expectancy at birth



Source: Public Health Outcome Indicators (2013)

3.2.  Causes of death & illness

As a consequence of the mixture of health risk differences experienced by men and women outlined earlier, patterns of the key causes of death, illness and disability differ notably between the sexes.

Table 2. Health outcome measures: By sex/gender

Health Outcome Measure




Suicide & injury undetermined                         (15+ years of age)



Bronchitis, emphysema and other COPD



Coronary heart disease






All cancers



Lung cancer



Breast cancer


Colorectal cancer



Prostate cancer



COPD prevalence**



Coronary heart disease prevalence**



Stroke prevalence**



All cancer incidence***



Lung cancer incidence***



Breast cancer incidence***


Colorectal cancer incidence***



Prostate cancer incidence***


Sources: *Directly age-standardised death rates, per 100,000 population, all-ages, 2010-12 3-year average, unless specified (

**Estimated prevalence: APHO 2011 disease prevalence models, over 16 years of age (

*** Cancer incidence: directly age-standardised, per 100,000 population, all ages, 2009-11 3 year average ( [Describe the severity/frequency/extent of the issue in Richmond borough]

4  Service Provision

A comprehensive range of public health programmes[4], and health & social care services are designed, planned and delivered to meet the needs of Richmond’s population.

The following mechanisms are in place to ensure that consideration is given to the diverse population and individual needs of residents, including those of protected characteristic groups.

  • Development of needs assessments to research local population health and wellbeing needs.
  • Liaison with a range of local community organisations, including gender related groups
  • Tailoring of the design and delivery of services to maximise their appropriateness and accessibility to all residents, including the targeting of services and initiatives at populations with diverse needs, including protected characteristic groups. For example:
  • A recent local review of the NHS Health Check service in Richmond. The review concluded that additional efforts should be made in marketing NHS Health Checks to men, including work with sports clubs and in pubs, and exploring issues in a focus group.
  • The LiveWell Richmond healthy lifestyle service provides activities on a one-to-one basis and sex/gender preferences can be accommodated. Also, information sessions have been run with women-only groups, and efforts are being made to increase service use by men.
  • Monitoring outcomes of the Richmond Kick It stop smoking service in 2012/13 shows that quit rates for men and women setting a quit date are very similar (66% vs 67%).
  • A number of national cancer screening programmes target the specific health risks faced by women, including those for breast and cervical cancer.
  • Audits, reviews, and evaluations of existing services including consideration of equality and diversity issues.
  • Equality Impact Needs Assessments (EINAs) of new services and changes to existing services.
  • Monitoring of service use by key population characteristics, including some protected characteristic groups.
  • Adoption of equality requirements in service specifications and monitoring processes as part of contracting requirements for services and their providers.
  • Annual reviews of compliance with the Public Sector Equality Duties.
  • Implementation of the NHS Equality Diversity System by local NHS commissioners and providers.

The council has undertaken an audit of provisions for protected characteristic groups in public health programmes and the findings are under consideration

5  Conclusion

A number of further actions are underway or being considered by Richmond Borough Council, including:

  • Development of a detailed Equalities Profile for the Borough based on the results of the 2011 Census. This will further support general consideration of protected characteristic group equality issues across council responsibilities and beyond.
  • Work to support Richmond CCG in their planned update of their Public Sector Equality Statement and implementation of the NHS Equality Diversity System.
  • Review of service specifications for the commissioned services included in public health programmes, to ensure an adequate and consistent approach to equality issues relating to the protected characteristic groups.
  • Review of access to data essential to undertaking adequate equality monitoring of key public health services, particularly immunisation and screening.

6  References

[1] Equality & Human Rights Commission (EHRC) website accessed 10/03/2014

[2] Equal Opportunities Commission (2006). Gender Equality Duty Code of Practice England & Wales.

[3] Equal Opportunities Commission (2006). Gender Equality Duty Code of Practice England & Wales.

[4] NHS Health Checks, LiveWell Richmond health lifestyle service, Kick It stop smoking service, School nursing and the National Child Measurement Programme, Sexual health and contraception services, Substance misuse services, Screening programmes, Immunisation programmes.

Document information

Published: July 2014
For review: July 2017 
Topic lead:
 Jane Bailey, Public Health Lead