Zali Steggall: An MP's Take on Menopause Education & Support

[00:10] Sonya: Today I have Zali Stegle joining me, and Zali is the independent member for Waringa in New South Wales, so that means she's a representative in government and federal government. If you are familiar with Australia and politics, you'll know that we're state and we're federal, so Zali is our federal member. Zali, thank you so much for joining us.

[00:31] Zali: Thank you for having me.

[00:32] Sonya: Oh, my absolute pleasure. Now, Zali, you are my local member, which was one of the reasons why I wanted to reach out to you. You are a woman in her perimenopausal years, so it's a great fit for the conversation to start with. You're also an ex athlete and I happen to know you're someone that is really invested in your health and your fitness and your wellness. So I thought that this was a really great opportunity to have a conversation on a few different levels. But specifically, I want to chat to you about the recent Menopause Matters Parliamentary Roundtable that was held in Canberra. I think the first question I have is, what is a Parliamentary roundtable?

[01:14] Zali: Well, look, I think it's where we have that opportunity to discuss issues, policy areas, hear from experts and really talk through. Is current policy addressing this issue properly? Is it properly funded? What would it need? How many people in population does it impact? And what should we be doing? What are the solutions on the table? Is it research? Is it better data collection? There's a lot of elements. And so I think on this usual guy, I turned 49 soon, so I'm smack perimenopausal. Loving all those lovely things like hot flashes when you're about to do a speech in Parliament and a press conference. Just loving all those incidental side effects. But obviously, on a more serious note, women's health, I don't think has properly been addressed by government for quite some time, because traditionally, we've got men around the table making the decisions for them. I guess it's not a priority. What the impacts of women health issues? It doesn't impact them in a direct, personal way. Not that that should really influence decision makers, but I think as a result, the nuance and the differences haven't been appreciated at a policy level. And then that filters down. The classic example that Roundtable gave us was actually traditionally research and trials of medications and things were done on male bodies, not women's bodies. And so if responses were different, that just wasn't computed or factored into it, which I find quite extraordinary, really.

[02:58] Sonya: It's a mind blowing fact. It's something I talk about a lot on this podcast with the many different experts that I have on. And many women have no idea that everything from the fitness industry to the medical industry, the drugs, like you say, the research has all been based on men up until quite recently, really, in the scheme of things. And that impacts how things are prescribed, why things are prescribed when they're prescribed.

[03:28] Zali: And also, there are so many conditions that are particular to women that then haven't been properly appreciated from endometriosis to obviously, I think when you think about it, the whole hormonal journey women go on from when you first get your periods and you ovulate to Perimenopause and their menopause. It is such an incredible journey that your body adjusts to. And yet I don't think it's properly understood. And for many it's fine, but for others it's more complicated. And our system needs to take that into account. When we were at the Roundtable, from a menopause point of view, at the end of the day, 51% of the population is female, which means pretty much 51% of the population will go through this. And so it needs to be better understood and catered for.

[04:26] Sonya: Absolutely. 100%. So let's talk about the proposal that was put forward at the Roundtable. So we had some incredible experts providing information at the Roundtable. We had Dr Kelly teaguel, we had Professor Jayashi Kulkarni. I think Professor Sue Davies was there, and a whole host of amazing people. The proposal that was put forward was the development of a national Menopause Action Plan and we're seeking reform in Australia's approach to the menopausal transition. How do you see government playing a role in that?

[05:05] Zali: Well, I think government obviously policymakers. It comes down to is it medication that maybe needs to be listed so that it's more affordable? Is it better education for doctors so that they understand if it needs to come down from the AMA and sort of from a training point of view, better understanding to facilities like, do we need specific facilities? This is not from a menopause point of view, but, for example, eating disorders. We only have one clinic in the whole of Australia to address eating disorders.

[05:43] Sonya: That's mind blowing.

[05:45] Zali: Which is mind blowing, really. That's another push with fellow female. I guess benches we're pushing is we need to address some of these shortcomings and so around that kind of developing a plan around this is where are the shortcomings in the system at the moment? Where are the obvious easy fixes and what might take longer, but we need to start working on, is it research, is it better data collection? And it is a really tricky area, because one of the datas that really shocked me at that roundtable was the percentage of women who had downscaled their work as a result of the impact of perimenopause and the severity or not of the symptoms. And so women feeling like full time work or going to part time or changing their because between mind fog and just impacts were really throwing them and so having to downgrade their kind of commitments which, when we know women are already in such an inequality when it comes to pay and superannuation and financial circumstances. That's really concerning because it's a period of time go back to normal. But there is planning and then when things sort of settle down, you are able to always the right support, the right hormonal treatment, your productive life continues. And so if we're losing people to the workforce during this period because they're not getting the right support, then that's really poor planning and poor investment. As a society, I want to impact.

[07:31] Sonya: The future of that business as well. Women are often the glue that keeps the family together, but we're often in the workplace the glue that keeps the workplace together as well. And also one of the things that I find so disappointing when we do talk about the women that opt out of careers or they hold themselves back from promotions, which is another common side effect that happens is that the employment sector and our businesses are losing women who are literally hitting the prime of their careers from a wisdom perspective, from a leadership perspective, all the incredible lived experience that they have, as often mothers, as well as caring for aging parents, and they bring all of their skills into the workplace and we're losing them at such an important time. What they could bring to the workplace in those years to come is really underestimated, I think.

[08:27] Zali: Yeah, it's something I actually raised with Sam Mossen and the Women Economic Task Force, because I would like to understand a bit more the data around, in fact, because we know perimenopause menopause is all going to hit when women are professionally probably at their peak because of experience and time in the workforce. How much is that a contributing factor to checking that next progression of getting to the higher level of leadership or executive and pay with better treatment available to support? Could we minimize that, to then maximize opportunity? And it's really hard because women tend to feel really don't want to talk about this because they think men have traditionally often categorized women as well, physically you're different, you're not going to be able to do the job. So that's why it's going to a man. And so all of a sudden we say, right, there's a period of time where we do have physical challenges because of hormonal changes. You don't want that to be used as an excuse to disqualify women from opportunity. But then if we don't acknowledge the challenge, we don't get the right treatment for the challenge, which then makes it even harder anyway. So it was really interesting talking about that with Sam.

[09:46] Sonya: So what did Sam have to say about that? I'm intrigued to know. I know Sam from actually a really long time ago. We worked together and I followed her career and she's an incredible woman doing amazing things. What did she have to say? I'm really keen to know what her feedback was.

[10:00] Zali: She was quite shocked with the statistics of how many women at this period in life choose to downgrade their careers because of the side effects. I wouldn't want to put words in her mouth. But there's that sense of you don't want to kind of reinforce this idea that women are cut out for it because it's not that. It's just that if our support systems aren't there, then the system is set up in a patriarchal way. At the moment. The Women's Economic Task Force was very focused on, I guess really the major discrimination or disadvantage occurring for women is single parents and younger and women finding older women finding facing homelessness, that economic security. And younger women mostly because of the interlink between the single parent payment when stops, when your child finishes, reaches eight and that link that has with domestic violence and women choosing to stay in dangerous situations. So that was their primary focus. But I'll definitely put it on her radar and I'm going to continue pushing to get them to keep looking at it. Because for me, if we look at the women, especially the older demographic, well over 55 are the fastest group facing homelessness in Australia at 55, which is just mind blowing.

[11:37] Sonya: Mind blowing and heartbreaking. As a woman of that age, it's horrifying to think. And when you hear the stories and you sit down and listen to the circumstances that created the women being in some of those positions, it's a good reality check. And it is absolutely heartbreaking.

[11:59] Zali: Yeah. It's not that if you've chosen to work or because of in your relationship, it's made sense to be the primary carer or to work part time or on a casual basis as soon as then any health impacts impact your ability. Your ability to be economically independent, varies relationship breakdowns and really quickly it can happen to many, many women, which is quite I think it's an indictment on our society that we haven't got the right levers in place to value the caring role so that it's equated to the more maybe economic contribution by work. But anyway, we've digressed a little bit.

[12:45] Sonya: That'S okay, that's what we do here, that's completely fine, it's all good topics and we need to be shining a light on as many of these topics as we possibly can because they all impact women. When we talk about women's health, we're talking about mental health as well as obviously physical health as well. So going back to the menopause roundtable, the parliamentary roundtable where we discussed making menopause, one of the things that was really discussed, I believe, was creating equitable access. So let's talk about what some of those barriers actually are that currently exist. So I know if we talk about primary carers to start with, we have a national GP shortage and this impacts women remotely and rurally more significantly than it does women that are lucky enough to live in the cities. What is being done to address that?

[13:43] Zali: Well look, obviously from the workplace shortages, like GP shortages, that's a really big one. And I know the AMA have put forward suggestions in terms of how do we get more people interested in becoming GPS? But then that's not a fast pipeline, that's four years, more than four years. It's quite a long first, but I think it's about eight years of study. So we do have to look at it from a obviously then there's a migration path and does that become a pathway to residency? Our whole immigration system in Australia has been quite interesting. I think for the last 1520 years we've had a very exclusionary approach of making it really hard for anyone to come here on the idea of count yourself privileged if we let you in. But the reality is the world there is a global race for talent around the world and other jurisdictions are more attractive than us. So, for example, Canada offer skilled visas as well as partner visas, as well as family relations, so that if a young couple is choosing where they're going to maybe go and live and work, they look at the whole suite of kind of opportunities for where they're going to go and build their life. Australia is not good with that.

[15:03] Sonya: Is that something we're working on?

[15:05] Zali: It is. Again. The new government is looking at a whole suite of areas because we have got a race for skilled labor. Whether it comes to there's a lot of professions where we don't have the right number of people coming. Through. And we've got shortages and regional areas will be hit worse on every front because they're just I guess the natural effect of where people are choosing to live, where opportunity is versus not, we're just that little bit harder. And so we need to probably build in incentives for GPS when it comes to regional areas. There's a lot of talk around Medicare and the gap payment that just has not kept up with cost. And so for GPS, we found out the hard way through COVID that we rely on our health network heavily as a society. Everything comes to the stop if health is no good and yet I don't think we've invested enough into that system yet. It is quite complicated because remembering our health system is across state and federal funding. It is managed by state, but funding comes also from federal. It's complex, but I think it needs a real review. I think we probably need like a royal commission into our medical, how we allocate funds and responsibility between federal and state, between hospitals, public, private hospitals, GPS what we expect GPS to do. I think GPS need to go towards being a more holistic total care, like in kind of total clinics where you can have psychology, GP, physiology, everything in one go. So more total body health being addressed, but it's going to take some planning and I think some political courage from government to rethink the model rather than just I feel like for many, many years we've been putting bandaids on a lot of areas and not really addressing whether or not are they fit for purpose, for the future.

[17:16] Sonya: Yeah. And when I speak to women, whether it's feedback that I get from the podcast or women that I get through my gym or just when I'm out and about, one of the biggest areas that I see that really does need to be addressed within the Medicare system is that the length of an appointment for a woman is way too short for a woman to sit down with a GP for sometimes five minutes. If they're lucky, they might get 15 and some practices, 15 minutes is a long appointment. The unraveling and joining of the dots that needs to take place in an appointment for a woman, particularly in these midlife years where she is perhaps experiencing a myriad of perimenopausal symptoms and they're not obvious and they can also mimic other health conditions. So there is a lot of ruling out that needs to go on as well. And one of the things that we talk about constantly is women having to do a bit of legwork before they go and see their doctor, do their prep, book a long appointment. But unfortunately you're also talking then about financial barriers for some women that is a bigger outlay of money to sit down and see your GP. So yes, the Medicare system in Australia I think needs some significant looking at.

[18:35] Zali: Yeah, one of the things that AMA have discussed with them is the current system is a reward for how many clicks through the gate you get. Right. So it's not outcome based. So there is no link between the, I guess, public support and actually good health outcomes. And I think that's missing in most other sectors. You look at outcomes, not just how many can go through, how many appointments can we book in? Yeah, but outcomes. I think doctors need to be better rewarded for good outcomes with health. If a client is then all their needs are met and addressed then they're not going to come back and be a pressure point on the emergency department or hospitals or health systems every other sector because it's always a ripple effect. If one system isn't doing well, the other systems all have to bear the brunt of it as well. So I think there is an investment to be made there. I don't think it's an easy thing to do to change to an outcome model, but I do think that we would get better out, we'd get better results.

[19:50] Sonya: Yeah, of course. Another area when we're talking about primary carers that is globally acknowledged is that there is an education gap in our GPS when it comes to women's health. Pretty much 40 plus and definitely around perimenopausal and menopausal education. I know the AMA is running regular webinars, which is amazing for GPS. They get the opportunity to attend these and learn and be educated by the AMA, but these are an opt in basis only. Obviously, if the GPS choose to do that? What would it take to and this may not even be a question for you, because this is obviously talking about our education system at that tertiary level, but what will it take to actually fix that education gap for our GPS in those four to eight years of training that they have?

[20:47] Zali: Yeah, look, I think, again, I'm not a doctor, I can't really say what that's all going to take. I think visibility matters, though, so if as a society, we don't talk about these issues, then they're not addressed in a policy point of view of needing to be catered for. If they don't need to be catered for, then there isn't going to be an investment into the research, the medical aspect, the support, and then the training won't go into the GPS, there won't be any specialists. So I think it's a ripple effect of consequences. And I think traditionally, you just didn't really see middle aged women that much.

[21:32] Sonya: While they were there. Maybe we didn't.

[21:35] Zali: But you didn't see them.

[21:36] Sonya: No. In particular. Yeah. Unfortunately, this has been a topic that's been swept under the rug for a very long time, for many reasons, and there are many reasons as to why. But now that we are in a place where we are talking about it, we are having been conversations, employers are talking about it, government is talking about it, people like me are talking about it, women on the street are finally starting to talk about it. What can we do as a community to keep this topic on the table for our government now that it is out in the open?

[22:12] Zali: Yeah. Keep writing for everybody. Wherever you are, write to your local MP. It's good. I really assess topics that I address in Parliament on the basis of feedback from my community. So people are writing into me about a topic. We are pursuing that topic. It's also writing into the health minister. Really important Mark Butler, get it on his radar, make sure he is focused on it. Prime Minister. Things like the Economic Task Force being involved with whenever there are any inquiries, making submissions, sending in information. It sometimes may feel like that process of writing and giving feedback is slow, but it chips away at the visibility. It just gradually brings more visibility, becoming.

[23:05] Sonya: That squeaky wheel that just absolutely and.

[23:08] Zali: The more that wheel is squeaky, it's not going away. It has to be addressed and also for women to really think through what are the policies that make a difference to them and vote smart. We need more women around the table to make these decisions, to have the visibility. So I think it's a slow process, but it happens. I think it is happening slowly, gradually. Oh, it is.

[23:32] Sonya: Look, I've been in this space for two years now and I actually had a conversation with someone on the phone the other day who was very negative about the whole we're in this really bad place and nobody's talking about it. And I was like, well, actually, let's shift the lens on that a little bit, because I started it two years ago, having these conversations and deciding that this was a space that I wanted to become a bit of an advocate and agitator in. And we've actually made some significant progress in those two years. So things are shifting, but like you say, it takes time. It's the constant conversations, even though it feels like you're having the same conversation over and over again, it's just letting it chip away until it actually makes a big enough dent that you notice.

[24:14] Zali: Yes, it is for people. It's writing in to the AMA Ministers government, your local MP, state MP as well. Don't forget your state MPs, because at the end of the day, state does control a lot of the medical services when it comes to hospitals, for example. So very important. Being involved is really important and sharing your experience. Because I think again, I have so much holes thinking of myself as a politician but I know that's what I am now. But especially as an independent, I am only as good as the feedback I get from the community and I guess the experience and the knowledge and the facts that people share so that we can really get a full depth of what I want to advocate for and how I can represent the community. So it's really important to be involved for people. Don't just think about who you're going to vote for every three years, be involved, make sure they're onto this issue. Because there are roundtables in Parliament, there are discussions and there are 151 Members of Parliament in the House of Reps and they should all be focusing on these issues. And yet we get a handful of people that turn up and we actually mostly have women at the table and it's like, well, we need men at the table. They need to understand this is happening as well.

[25:40] Sonya: Oh, absolutely. And I've done a whole post and social media thing about why it is just as important for men to understand and talk about menopause as it is for women. It really is. Out of interest, the Parliamentary roundtables, is that an opt in option for the Members of Parliament?

[26:01] Zali: Yes.

[26:01] Sonya: And are you happy to share with us how many men were in the room versus how many women were in the room?

[26:08] Zali: It was predominantly female, unless the men that were there in the sector or medical backgrounds or were there there were some, but look, I can't remember. I would be speaking out of school. I don't remember. Yeah, no, it was predominantly women talking about it. But again, you can see a few old fashioned men shifting in their seat, a little bit uncomfortable, but the more we do that, the more it's out in the open.

[26:38] Sonya: Yeah, fantastic. Excellent. Well, Zali, you can take this as a letter from me to keep this topic on the table, to keep shining the light on, breaking down these barriers to equitable access for women remotely regionally within the cities. We need access to good quality GPS. We need access to educated GPS and a health system that supports us. Absolutely awesome. Sally, thank you so very much for your time. Was there anything else that you wanted to share with us before we sign off?

[27:14] Zali: No. Look, I think it's really exciting to see more people being so much more engaged. And when I talk to younger women, they are more and more aware of decision making that's going to be to their benefit and how to get things to change. And so it's great that we're all having these conversations.

[27:35] Sonya: Amazing. Thank you. And thank you for having this conversation with me today.

[27:39] Zali: Thank you.

[27:43] Sonya: Thank you for listening today. I am so grateful to have these conversations with incredible women and experts and I'm grateful that you chose to hit play on this episode of Dear Menopause.

[27:57] Sonya: If you have a minute of time.

[27:58] Sonya: Today, please leave a rating or a review. I would love to hear from you because you are my biggest driver for doing this work. If this chat went way too fast for you and you want more, head over to Stellarwomen.com Au podcast for the show Notes. And while you're there, take my Midlife quiz to see why it feels like Midlife is messing with your head.