A recent Swiss study highlights inequalities between women and men in terms of health, partly linked to social factors. Taking gender influence into greater consideration is a key to improving the quality of care, defend its co-authors.
This content was published on February 04, 2021 – 9:47 am
The vital prognosis of women who have had a heart attack is worse than that of men; the latter commit suicide more when they suffer from depression. These are just examples that show that when it comes to health, women and men can face different realities.
Although this observation was made several decades ago, the medical sciences have only recently begun to explore the importance of gender, i.e. all social behaviors beyond biological differences related to sex. With the idea that the disparities observed often arise from a combination of factors.
The case of cardiovascular disease is one of the best documentedExternal Link. Long regarded as male pathologies, they have been mainly studied in men. However, the “typical” symptoms resulting from these observations are less observed in women.
Various stereotypes from the medical profession can also influence the diagnosis. Women are less often asked to see a specialist or undergo a stress test.
“Chest pain associated with a heart attack will be more easily interpreted in women as having another source, such as anxiety,” Carole Clair told swissinfo.chExternal LinkProfessor and medical assistant at the University Center for General Medicine and Public Health (Unisanté) in Lausanne, co-head of the Medicine and Gender UnitExternal Link.
In the case of depression, which is more prevalent in women, an inverse gender bias has been observed at the expense of men. All of these factors can lead to late detection or misdiagnosis.
Medicine and gender, a little history
The “medicine and gender” approach has its roots in the 1970s and in the second wave of the feminist movement, reports the Swiss Medical ReviewExternal Link. The status reserved for women by the medical profession is therefore beginning to be denounced. In Anglo-Saxon countries, health centers for and for women are emerging.
The under-representation of women in clinical trials has become a topic since the late 1980s, first in the United States. In the wake of this mobilization, the sex / gender distinction was integrated into the field of medicine in the 1990s.
The World Health Organization (WHO) has tried to take this perspective into account in its activities since the early 2000s. Member States of the European Union have been invited to do so since 2006.
In Switzerland, the Federal Office of Public Health dedicated a first report to gender from a health perspective in the mid-2000s. However, in 2010 the Swiss medical journal classified this field as “emerging”.
Today, the most cutting-edge research groups in the field are found primarily in Europe and North America. In Switzerland, the “medicine and gender” unit in Lausanne is the point of reference.
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Longer life, lower quality of life
Carole Clair and Joelle SchwarzExternal LinkDoctor of Epidemiology, Sociologist and Head of the Medicine and Gender Unit, have joined forces with the Federal Statistical Office (FSO) to write a publicationExternal Link published in December, including the newspaper Le CourrierExternal Link he echoed. Their work analyzes the results of the latest Swiss health surveyExternal Link 2017 (ESS) through the lens of gender.
We read that in Switzerland women live on average four years longer than men, but that their indicators of general healthExternal Link they are less good.
They are more likely to be living with at least one chronic illness or long-term health problem, to name a general lack of energy, suffering from sleep disturbances or psychological stress. Their healthy life expectancy drops to 71.7 years, compared to 70.7 for men.
The life expectancy gap itself tends to shrink from year to year. This phenomenon, observed in many countries, would largely result from a rapprochement of “male” and “female” lifestyles.
Smoking is an example of gendered behavior, later adopted by women. Since 1980, the prevalence of lung cancer has increased by 94% among Swiss women, while it has decreased by 36% among men.
Unequal in the face of pain
Women report more chronic pain and are more painkiller users. This is shown by the ESS, and by the data on the perception of pain in the European UnionExternal Link (EU) point in the same direction. We see that women are more likely than men to report moderate or severe pain.
From a biological point of view, some pain relievers may be less effective in women. In addition to the issue of clinical trials carried out on male groups, it has recently been shown that different circuits can be activated to produce and control pain.
The hypothesis of the social factor is also advanced. “Women have learned to express their pain more easily than men, which allows them to consult more easily when they are in pain,” the study notes.
However, they tend to receive lower doses of pain relievers than men or even anti-anxiety medications. “We have many examples of underestimating or normalizing women’s pain,” recalls Carole Clair.
A final path could be linked to the gender inequalities existing in society: women would suffer more psychosocial stress and chronic pain, due to their overall more unfavorable situation – because they always bear a greater share of the family and domestic burden, work under conditions worst -paid jobs, etc.
One determinant among others
Gender is a social determinant among others, such as ethnicity, socioeconomic situation or level of education, according to the sociologist of shades Joëlle Schwarz.
And the fact of being active or not also seems to have an influence; men’s health, in particular, seems to be more affected by absences from work. The publication notes that pain or some physical ailments can reach the same level in inactive or unemployed men as in women.
But employment status can hardly be separated from the gender norms of society. “This phenomenon could be explained by heightened social pressure in connection with the male role of main income provider, the male identity being defined much more strongly than for the professional woman,” specifies the study.
“For all the indicators presented, we looked at the differences between women and men and we cross-referenced these data with age categories and education level,” emphasizes Joëlle Schwarz.
The paradox of the thinness injunction
Another disparity relates to weight. In Switzerland as in the European UnionExternal Link, more men than women are overweight or obese. If it can be linked to genetic predispositions, weight also derives from physical activity and diet, from social behavior.
Women are generally more careful about their dietExternal Link, and they are also overall more dissatisfied with their weight than men. This gap could be understood by the strong social factor of thinness injunctions against women, notes Joëlle Schwarz.
“On the one hand, we could say that it protects them from overweight or obesity, but with harmful effects in terms of malaise (…) and, in the extreme, problems with eating disorders, much more common among women”, analyzes the expert.
“Improving Patient Care”
The problem is far from being limited to the indicators presented in this study. “As long as we care, we discover differences everywhere,” says Carole Clair.
Re-examining the data with gender in mind revealed that some chemotherapies caused more side effects in women or had a higher risk of transplant rejection during a kidney transplant, explains the professor. “The other difference, which is more social, is that women donate far more of their organs but are less often recipients.”
Osteoporosis, a disease that mainly affects women, is one of the few areas where research has mainly involved women and where the prognosis is worse for men, the doctor said.
Carole Clair and Joëlle Schwarz have been working since March 2020 to develop such a measurement indexExternal Link. The project, supported by the Swiss National Science Fund (SNF), is aimed at health research in Switzerland.
The goal: “Be finer in our understanding so that we can correct correctable inequalities, with the ultimate goal of improving patient care.”
Gender inequalities have worsened in times of pandemics
The gender-differentiated test found that men died more from Covid-19 than women. But more women have been infectedExternal Link from the virus, overexposed because they make up the majority of health personnel and often also play the role of caregiver.
Several international organizations expect the Covid-19 pandemic to significantly worsen gender inequalities, not only economic and social, but also medical, especially in developing countries.
For whoExternal Linkone of the biggest risks is the disruption of maternal, sexual and reproductive health services, which could lead to thousands of deaths, as well as millions of unwanted pregnancies and unsafe abortions.
Also, according to a surveyExternal Link by the organizations Women Deliver and Focus 2030, conducted in 17 countries in the summer of 2020 and published on January 28, more women than men report experiencing emotional distress and mental health problems in the context of the pandemic (37% of women interviewed on average , compared to 27% of men).
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