In today’s society, women’s bodies can elicit differing responses: they can be revered and desired, for example, but they can also be a source of bewilderment and misunderstanding. But does this misunderstanding also apply when it comes to healthcare?
Both historically and today, ingrained attitudes about differences between men and women greatly impact all aspects of women’s lives — including, perhaps most damagingly, access to equitable healthcare via the gender health gap. This gender health gap continues to exist across the world, and as long as gender bias and lack of research on women in medicine persists, women will pay the price — sometimes with their lives.
To shed some light on what the gender health gap is and how it impacts women, we spoke with Dr. Robin Mason, Scientist at Women’s College Hospital, and Dr. Paula Rochon, Founding Director of Women’s Age Lab at Women’s College Hospital.
What is the gender health gap?
“When we speak of the gender health gap, we are describing the ways in which how one identifies can negatively influence health and access to healthcare,” says Dr. Mason. Traditionally, healthcare has not taken into account the impact of sex and gender differences, meaning many women are overlooked and underserved. And for women in marginalized and disadvantaged communities, that gap becomes a chasm.
As Dr. Mason points out, “The gender health gap has particularly impacted those who identify as women, as their experiences and needs have not been fully integrated into health research with the result that they have sometimes received inappropriate or inadequate healthcare.”
When we speak of the gender health gap, we are describing the ways in which how one identifies can negatively influence health and access to healthcare,
Recently, when chatting with a male friend, I mentioned the gender health gap, and my liberal, inclusive and left-leaning friend asked the question, “Does that still exist?” Commonly, it seems that men don’t worry whether they will be taken seriously when they go to the doctor — if they experience pain, they will very likely be prescribed pain medication, and quickly. Women, on the other hand, are far less likely to be prescribed effective painkillers and are instead often given anti-anxiety medication or referred for mental health support.
Dr. Mason explains, “Women experience more pain-related conditions (think of endometriosis and migraines as examples) but as another study has just reported, the pain women experienced is considered less intense than men’s pain and, in comparison with men, women are more likely to be referred for psychotherapy instead of medication.”
Similarly, a 2014 study in Sweden found that, on average, women wait longer and are more frequently classed as non-urgent in emergency departments than men. There is a disconcerting trend that pain is “in our heads” — psychological rather than physiological. And, pain is just one of many examples of how women’s health issues can be glossed over.
What is gender bias?
According to an article in Critical Care Nurse, gender bias is defined as “prejudice in action or treatment against a person on the basis of their sex” and as “discrimination on the basis of gender.” When it comes to healthcare, this can translate to women receiving lower quality care (assessment, diagnosis and treatment) than men who complain of the same issues.
Why does the gender health gap exist?
Dr. Mason believes our history of patriarchy, which has for too long characterized women as inferior to men, is a key reason for the gender health gap. “The consequences of being so long overlooked are still being felt today, where women are not considered in the development of pharmaceuticals and medical devices, and as participants in health research, including clinical trials,” she states.
Dr. Rochon’s research explores the societal health challenges that older adults face, in particular how men and women experience health and healthcare differently. She explains that up until the 1990s, women were not required to be included in studies funded by the National Institutes of Health in the United States. She says, “It was not until just very recently that older adults were required to be included in these studies. As a result, relatively few older women are in these trials.”
As well as being included in health studies, Dr. Rochon highlights the importance of conducting population-level studies using health administrative data in order to gather information about older women. She says, “This provides the opportunity to study all older people — men and women — and to learn about the experiences of these different groups.”
Conditions can present differently in men and women
Men represent the majority of health research studies, so our clinical guidelines and standards of care are aligned with their symptoms and treatment outcomes. Conditions that are common in both sexes often present quite differently in men and women, making it less likely a physician will diagnose women accurately or in a timely manner.
Take the example of a heart attack. Everyone knows the tell-tale signs: crushing chest pain and pain in one or both arms. In fact, however, women report these symptoms far less than men, and more often report upper back pressure, jaw pain, dizziness or shortness of breath. Sadly, women are 50 per cent more likely to die from a heart attack than men.
Stroke is another condition that can present differently in women. In addition to the common symptoms like confusion, weakness on one side of the body and loss of speech, women often experience fainting, vomiting, hallucinations, dizziness or headaches. This makes misdiagnosis more frequent, especially in younger, non-white females.
Women’s reproductive health and gynecological issues
According to an article in Human Reproduction, on average, it takes up to seven years to diagnose endometriosis, a condition where the tissue that lines the uterine walls grows outside the uterus. This painful condition can affect the ability to conceive, and is often brushed off as bad period pain with women seeking help from three or four physicians before finally receiving a diagnosis.
The cost of being silenced about our reproductive and intimate health issues can prolong unnecessary suffering or even miss cancer diagnoses.
A big hurdle for many women is feeling comfortable discussing intimate health issues with their doctors. Gynecological cancer charity The Eve Appeal conducted research through YouGov that found that women, trans men and non-binary people with gynecological organs are five times more likely to feel dismissed when raising issues about their reproductive health, and 20 per cent of those asked said they felt they’d raised a trivial issue at their appointment. The cost of being silenced about our reproductive and intimate health issues can prolong unnecessary suffering or even miss cancer diagnoses.
The need for funding and research
Female-specific conditions like polycystic ovary syndrome, endometriosis, vaginismus, menopause and pregnancy-related issues are often under researched. Dr. Rochon highlights the importance of obtaining comprehensive information about all women. She emphasizes the need to “…make sure that all research considers the specific needs of women by age group. This would allow important information about older women to be obtained from all funded research.”
What can we do?
When women’s health continues to be de-prioritized, underfunded and under-researched, even well-intentioned medical professionals can end up being ill-equipped. We can start closing the gender health gap by making healthcare accessible to women (providing supervised childcare), destigmatizing women’s reproductive issues, exploring the social, political and economic forces that influence women’s health and becoming aware of implicit gender bias in medical training.
Dr. Rochon also highlights the importance of collecting data that is separated by sex and age in all research. “This will allow for differences between older women and men to start to be recognized. Recognizing these differences is the first step to considering therapies tailored to the needs of older women and men.” If this approach is taken, the same would go for women of all ages.
The gender health gap is a complicated and critical topic, one that deserves a lot more time, space and energy than it is currently given. If you feel dismissed in relation to any health problem, seek a health practitioner who listens to you — it is your right to be heard, respected and given the quality of care you — and all women — deserve.