Election 2022: the secret force stopping gender pay equity

Labor has made a big commitment to close the gender pay gap if elected. There’s lots of rhetoric and reannouncements of things announced as much as a year ago, but little detail, and beyond the thin policy is a glaring issue: if you don’t deal with the structural sexism in health care, it’s all going to come to a big fat nothing.

The commitment from Labor to close the national pay gap of 13.8% is detailed by a grand total of four dot points:

• Strengthening the ability and capacity of the Fair Work Commission to order pay increases for workers in low paid, female dominated industries.  
• Legislating so companies with more than 250 employees will have to report their gender pay gap publicly.  
• Prohibiting pay secrecy clauses and giving employees the right to disclose their pay, if they want to.  
• Taking action to address the gender pay gap in the Australian Public Service. 

The first and last of these will make some difference, the middle two are just feel-good stuff. If you’re not really across this issue and want to learn more, there is a really great independent agency called the Workplace Gender Equality Agency (WGEA) – you can read more on their site here.

There’s a couple of different ways they measure the gender pay gap, and different causes/ways they try to address it, most of which are not supported by this campaign commitment. Some of the key assumptions around gender pay gaps are:

• Women are paid less because women’s work is paid less (roles such as cleaners or carers are traditionally paid less than stereotypically men’s work such as labourers)
• Structural sexism that persists in our workplaces results in men getting paid more for the same job, and men getting promoted more than women
• Women are paid less across their life times because they do more of the caring and take time out of work for children etc.

Apologies to those work in this area for dramatically simplifying this really important issue for the purposes of a blog post, I do acknowledge there is a lot more going on here.

But the one thing that is almost universally overlooked is health sexism and its flow on effects to workforce participation and the gender pay gap.

Doctors and public health people acknowledge that there is deeply ingrained sexism throughout the health system, and this is why common, chronic and difficult to manage conditions – with the go-to example being migraine – have been dismissed for literally centuries as just a minor complaint, unworthy of research or even the attention of any doctor serious about their career. They only recently developed a full 3D anatomical model of the female body for doctors to study that is actually female, not the male anatomy with breasts! The structural sexism within health causes women to be denied equitable access to appropriate care and treatment, with significant delays in diagnosis, complications, and much higher rates of disability.

That structural sexism in health care then has flow on effects to the workplace. In the case of migraine, which ramps up in intensity right at the point when most people are ramping up their careers, literally millions of Australian women are taking a step back rather than a step forward right when it matters. They don’t get proper diagnosis and care when it’s a minor issue, so it becomes a major one and affects there ability to work, and in the case of nearly half a million Australians in any given year, so bad they may have to stop work altogether or significantly reduce what they try to do. That’s more women disabled by severe chronic migraine in any given year than give birth.

As a migraine advocate, I know what happens, I’ve heard the same story over and over again. First they take all their sick leave. Then all their annual leave. Then they change jobs – hopefully jumping before they get “managed out”. Then they go part time. Then they go casual or freelance, or if they’re able, start their own business. Then unemployment. It’s only at this point of debilitation – when they can barely work at all – that they’re finally getting referred to specialists, and it will be another two years before they’ve exhausted all the treatment options and can apply for disability support pension and insurance.

If they manage to luck on a treatment regime that works – and given how little we know about migraine at this point, it is pure luck – it will take another two years to stabilise enough to go back to full time work. Then all you have to do is explain that 4-10 year hole in your career to your potential employer…

If you are unlucky, and continue to be debilitated, then the structural sexism of health kicks in again. The stigma and bias against chronic conditions that predominantly affect women flows straight into our welfare systems without any filter whatsoever, and the DSP and NDIS claims of seriously debilitated people – who by this point will be struggling to get out of bed and some will require care – will be rejected over and over and over again. Because health doesn’t take it seriously, so why would they?

The sexism of health also flows into our data on health. The Australian Institute of Health and Welfare has never done a report on migraine, and told me that they would need to do primary research because there simply isn’t enough available Australian data available for them to do a report on migraine. And if you don’t have the data, and you don’t have the reports, then the big heavy machinery of government won’t even acknowledge the thing let alone do anything about it.

Fixing the gender pay gap is a nice idea, but you have to do more than say nice words.

According to Deloitte Access Economics, up to 45% of women in the key 25-55 age group – and more women in any year than those having babies – are unable to fully participate in the workforce and pursue their career because of migraine. That number gets higher when you add in all the other chronic conditions that overwhelmingly affect women like fibromyalgia, EDS, and so on, all of whom do not get equitable access to effective health care because of sexism in health. If you do not deal with that absolutely massive elephant in the room of sexism in health, and particularly the barrier that migraine is to full female participation, then no tinkering with the public service or pay rates of cleaners is going to matter, and gender pay equity will never be achieved.

It’s time to bring migraine #OutOfTheDark.