May the 28th is Action for Women’s Health Day. Why do we need a day like this?
It has long been known that there are gender biases in our medical system. This can have serious and fatal consequences. A study done in 2000 found that women were seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack! Why is this? Because medical understanding of most conditions is based on male physiology. Historically, most medical research was performed on men. As recently as 30 years ago, women of reproductive age were actively excluded from most clinical trials.
Many studies support the claim that gender bias in medicine routinely leads to denial of pain relief for female patients. When they are in pain, women wait longer in emergency departments and are less likely to be given effective painkillers than men. And if you are a woman from a minority group, it is likely that you will wait even longer! Extensive evidence suggests that healthcare professionals routinely underestimate pain reported by women. I have even seen a study where women who had coronary bypass surgery were HALF as likely as men to be prescribed painkillers!
A 2001 study found that some doctors believe women have “a natural capacity to endure pain”. There is no evidence to support this. In fact, recent research indicates that women are more sensitive to pain and experience greater levels of pain. This is due to many factors that are not yet fully understood – different numbers of receptors, different processing of nerve signals and hormone differences, including the possible protective influence of testosterone.
This could explain why 70% of chronic pain sufferers are women. But even so, 80% of pain experiments have been conducted on men. Even in the laboratory environment, male-only rats have been used! (And, as the woman of colour sitting next to me at the recent pain congress commented, they all seemed to be white too!)
What I was very pleased to hear at this congress, was that there was now more awareness of these biases and a large drive to change them, so hopefully we will see things changing on a much larger scale.
So, is the medical profession the only industry that has not been helpful when it comes to women’s health? Here’s a shocker – cars and seatbelts were designed for men and resulted in higher risks of women dying or sustaining serious injuries! Crash test dummies were designed on the “average male”. The result was that women were at greater risk of internal injuries from frontal collisions (47%-71% depending on where you look) and three times as likely to sustain a whiplash injury from rear collisions. Female crash test dummies were later introduced, but are not always used and are in some cases not “female” at all, just scaled down version of the male dummies.
So, are we as women now safer in our cars? As recently as 2019, a study found that women wearing seatbelts had a 73% greater chance of being seriously injured in frontal car crashes than men. And were 17% more likely to die!
What about occupational health? The formula to determine standard office temperature was developed in the 1960s based on the metabolic rate of men. A recent study found the average metabolic rate of young women to be lower by as much as 35%, meaning that current offices are about 5 degrees too cold for women. It makes sense why we see female office workers wrapped up in blankets while their male counterparts are perfectly comfortable. But it’s not just about comfort and productivity. Serious injuries at work have been significantly decreasing for men (which is wonderful), but there is some evidence that they might actually be increasing for women! There are many reasons for this – from equipment that is designed around men, protective gear designed around men and little data on what is actually safe for women.
Men and women have different immune systems and hormones, which can play a role in how chemicals are absorbed. Women tend to be smaller than men and have thinner skin, both of which can lower the levels of toxins that they can be safely exposed to. This is compounded by women’s generally higher composition of body fat, in which some chemicals can accumulate. Let’s keep this in mind when we think about the considerable rise in breast cancer in the industrialised world.
We need more research on women and more pressure on regulatory bodies to consider their health and safety.
Juli-Ann Riley, BSc Physiotherapy, Stellenbosch
