In a world rife with divisions—be it age, gender, race, religion, political or socioeconomic status—the healthcare system stands as a glaring example of inequality. While healthcare should ideally be the great equalizer, the reality is far from this utopian vision, especially when it comes to gender. This article aims to delve deep into the systemic gender inequalities that pervade healthcare, from the historical origins of certain treatments to the underrepresentation of women in medical research and practice.
(Note: About Us, a reference bibliography, related books and videos are all found at the end of this article.)
Historical Context: The Origins of Gendered Therapies
The History of Hysterectomies
The term “hysterectomy” originates from the Greek word “hystera,” which translates to “uterus.” This surgical procedure, which involves the removal of the uterus, has a history deeply rooted in gender bias. Historically, hysterectomies were often used as a catch-all solution for a variety of “female problems,” many of which were poorly understood or even misdiagnosed. The practice dates back to the 19th century when it was used to treat conditions ranging from ‘hysteria’ to ‘melancholia!’
The concept of “hysteria” itself is a glaring example of medical sexism. The term was used to describe a range of emotional and psychological symptoms in women, often attributed to disturbances in the uterus. This reflects a long-standing tradition of medical practices that disproportionately affect women, often to their detriment. The use of hysterectomy as a treatment for such nebulous conditions reflects not just a lack of understanding but also a systemic bias against women in healthcare. This illustration highlights an issue that is endemic to our healthcare system and can not be overstated.
The Medicalization of Female Bodies
The history of medicine is replete with instances where female bodies were medicalized to fit societal norms. The concept of “female hysteria” was often used to pathologize normal female behavior. This led to a range of treatments that varied from the absurd to the horrific, such as the use of pelvic massages or even clitoridectomies.
The Legacy of Ancient Greece
The roots of gender bias in medicine can be traced back to ancient Greece. According to an article by Time, Aristotle, in the third century BCE, described the female body as the inverse of the male body. Women were medically defined as faulty, defective, and deficient based on their anatomical differences. This perspective laid the foundation for centuries of medical practices that subordinated women.
The Social and Cultural Impact
The medicalization of female bodies has not only been a scientific issue but also a social and cultural one. Medicine has historically absorbed and enforced socially constructed gender divisions, often ascribing power and dominance to men. This has had a profound impact on women’s healthcare, from the types of diseases that are researched to the kinds of treatments that are developed.
The Modern Residue of Historical Biases
Even today, the residue of these historical biases stains contemporary biomedical knowledge. The healthcare system often fails women, especially in the treatment of chronic pain. Women are more likely to be offered minor tranquilizers and antidepressants than analgesic pain medication. This is a manifestation of the historical—and hysterical—idea that women’s “excessive emotions” have profound influences on their bodies.
Diminished, Belittled, and Secondary: Women’s Needs in Healthcare
Research and Diagnostics
Gender Bias in Pain Management
The gender bias in healthcare is deeply rooted in current research and diagnostics. A 2018 study by Medical News Today highlighted that doctors often perceive men with chronic pain as “brave” or “stoic,” while women with similar symptoms are labeled as “emotional” or “hysterical.” This bias extends beyond mere perception; it has tangible consequences. Women are often prescribed less pain medication than men for similar conditions, leading to prolonged suffering and poorer outcomes.
Fibromyalgia: A Case Study
Take fibromyalgia, for instance, a condition that predominantly affects women. Despite its prevalence among women, it is often misdiagnosed or dismissed, leading to inadequate pain management. This is a glaring example of how systemic biases against women manifest in healthcare.
The Gender Gap in Cardiovascular Research
Cardiovascular diseases, often considered a ‘man’s disease,’ have been disproportionately researched in men. This has led to a significant gap in understanding how these diseases manifest differently in women, often resulting in misdiagnoses and ineffective treatments.
Heart Attacks: Symptoms and Misdiagnoses
Women often experience different symptoms during a heart attack compared to men. While men may experience the ‘classic’ chest pain, women may have symptoms like nausea, fatigue, and dizziness, which are often dismissed or attributed to stress or anxiety, leading to delayed or missed diagnoses.
Drugs and Therapies
The ‘One-Size-Fits-All’ Approach
The gender bias also extends to the development of drugs and therapies. Clinical trials have historically been male-dominated, which has led to a ‘one-size-fits-all’ approach. This lack of diversity in clinical trials can lead to adverse drug reactions and ineffective treatments for women.
Hormonal Contraceptives: A Double Standard
For example, hormonal contraceptives have been primarily designed for women, yet their side effects, ranging from mood swings to blood clots, are often downplayed. Meanwhile, a male contraceptive trial was halted due to side effects like mood changes, showcasing a double standard in how side effects are tolerated for men and women.
Mental Health and Gender Stereotypes
Mental health conditions are another area where gender bias is evident. Conditions like depression and anxiety are often considered ‘female disorders,’ leading to a lack of research focusing on men. This not only perpetuates harmful gender stereotypes but also leads to inadequate treatment for both genders.
Eating Disorders: Gendered Perceptions
Eating disorders provide another example. While these conditions affect both genders, they are often stereotypically associated with young women. This stereotype can lead to underdiagnosis in men and older women, further entrenching gender biases in healthcare.
The Glass Ceiling in White Coats: Underrepresentation of Women
As Medical Professionals
Gender-Based Harassment and Discrimination
The gender bias in healthcare extends far beyond patient treatment and into the professional sphere. A 2020 study revealed that older women doctors face age- and gender-based harassment, discrimination, and salary inequity throughout their careers. This is not an isolated issue; it’s a systemic problem that affects the quality of healthcare for everyone.
The “Maternal Wall” in Medicine
One form of discrimination that women in medicine often face is the “maternal wall,” where they are passed over for promotions or face job insecurity due to pregnancy or family responsibilities. This not only hampers career progression for women but also deprives the healthcare system of potentially excellent leaders.
The Leadership Gap
Women make up a significant portion of the healthcare workforce but are woefully underrepresented in leadership roles. This lack of representation perpetuates the gender bias in healthcare, as policies and practices are often decided by male-dominated leadership teams.
The “Lean In” Paradox
The popular notion of “leaning in” suggests that women can break through the glass ceiling by taking charge and asserting themselves. However, in male-dominated fields like medicine, women who adopt this approach often face backlash, being labeled as “bossy” or “aggressive,” further widening the leadership gap.
In Medical Research
The Exclusion of Female Subjects
The underrepresentation of women is glaringly evident in medical research. Historically, female subjects were often excluded from clinical trials due to concerns about hormonal fluctuations affecting the results. This exclusion has led to a skewed understanding of diseases and their treatments, which disproportionately affects women.
The Thalidomide Tragedy: A Cautionary Tale
The Thalidomide tragedy of the 1950s and 1960s serves as a cautionary tale. The drug was not adequately tested on women of childbearing age, leading to severe birth defects. This incident underscores the importance of including women in clinical trials to understand the full range of a drug’s effects.
The Lack of Gender-Specific Research
Even when women are included in research, studies often fail to analyze data by gender. This leads to a lack of gender-specific recommendations, affecting everything from drug development to public health policies.
Breast Cancer vs. Prostate Cancer Research
Take, for example, the disparity in research funding between breast cancer and prostate cancer. While breast cancer receives more attention and funding, the research often lacks a gender-specific focus, leading to gaps in understanding how the disease affects men, who can also be diagnosed with breast cancer.
Mental Health Research: A Gender-Blind Approach
Mental health research often adopts a gender-blind approach, failing to consider how conditions like depression and anxiety manifest differently in men and women. This lack of gender-specific research can lead to ineffective treatments and perpetuate gender stereotypes in healthcare.
The Way Forward: A Blueprint for Gender Equality in Healthcare
Policy Changes
Implicit Bias Training
Addressing gender bias in healthcare requires a multi-pronged approach, starting with implicit bias training for all healthcare professionals. This training should be mandatory and ongoing, not a one-time event. It should cover not only gender bias but also other forms of discrimination, such as racial and age-based biases, as they often intersect with gender issues.
Equitable Treatment Guidelines
Medical institutions need to develop and implement equitable treatment guidelines that are gender-sensitive. For example, pain management protocols should be revised to ensure that women’s pain is taken as seriously as men’s. This involves not just changes in prescription guidelines but also in diagnostic criteria that have been traditionally biased against women.
Gender Diversity in Research and Leadership
Promoting gender diversity in research teams and leadership roles is crucial. Diverse teams are more likely to question gender biases and develop more inclusive studies and treatments. Medical institutions should set clear diversity targets and create mentorship programs to help women advance in their careers.
Public Awareness
Educational Campaigns
Public awareness campaigns can play a significant role in changing societal attitudes towards gender bias in healthcare. These campaigns should aim to educate people about the specific ways in which women are disadvantaged in healthcare, from misdiagnoses to inadequate treatment.
Social Media Activism
The power of social media should not be underestimated in raising awareness. Hashtag campaigns, interactive webinars, and collaborations with influencers can reach a broad audience and create a demand for more equitable healthcare practices.
Grassroots Movements
Grassroots movements, often spearheaded by patients and healthcare providers, can put pressure on institutions to change. These movements can use a variety of tactics, from organizing protests to lobbying for legislative change.
Cultural Shifts
This is a deeply endemic issue that traces its roots to the perception of women in modern-day society. Achieving healthcare equality for women will require a broader cultural shift towards gender equality. This involves not just changes in healthcare but also in education, media representation, and workplace policies.
Conclusion
Gender inequality in healthcare is a multifaceted issue that requires immediate and sustained attention. From the historical bias in treatments like hysterectomies to the current underrepresentation of women in medical research and practice, the healthcare system has a long way to go in ensuring equal treatment for all. As we move forward, it is crucial for everyone, from policymakers to the general public, to be part of the solution. This is not just a ‘women’s issue’; it’s a human issue that affects the quality of healthcare for everyone.
By implementing comprehensive policy changes, raising public awareness, and fostering a cultural shift towards gender equality, we can pave the way for a healthcare system that serves all genders equitably. It’s a monumental task, but one that society cannot afford to ignore.
All text © 2023 James M. Sims and all images exclusive rights belong to James M. Sims and Midjourney or DALL-E, unless otherwise noted.
Reference Bibliography:
Related Cielito Lindo Articles
Sims, J. M. (2023, September 10). Women and Dementia: The Female Factor in Alzheimer’s Risk. Cielito Lindo Senior Living. https://cielitolindoseniorliving.com/women-and-dementia-the-female-factor-in-alzheimers-risk/
Articles and Guides
Colino, S. (2018, May 22). Medical Myths About Gender Roles Go Back to Ancient Greece. TIME. https://time.com/5285457/medical-myths-about-gender-roles/
Gander, K. (2018, November 19). What to Know About Gender Bias in Healthcare Today. Medical News Today. https://www.medicalnewstoday.com/articles/323432
Pan American Health Organization. (n.d.). Gender Equality in Health. PAHO. https://www.paho.org/en/topics/gender-equality-health
UN Women. (2021). Bearing the Brunt of Under-Resourced Systems. UN Women. https://www.unwomen.org/en/news/stories/2021/3/feature-women-healthcare-workers-bear-the-brunt-of-under-resourced-systems
Websites
Pan American Health Organization. (n.d.). Gender Equality in Health. Retrieved from https://www.paho.org/en/topics/gender-equality-health
UN Women. (2021). Bearing the Brunt of Under-Resourced Systems. Retrieved from https://www.unwomen.org/en/news/stories/2021/3/feature-women-healthcare-workers-bear-the-brunt-of-under-resourced-systems
Research Papers
Miller, V. M., & Harman, S. M. (2019). Sex Differences in Cardiovascular Aging: A Scientific Statement From the American Heart Association. Circulation Research, 124(7), e120-e147. https://doi.org/10.1161/RES.0000000000000172
Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Research and Management, 2018, 1-14. https://doi.org/10.1155/2018/6358624
Books
Green, C. R., Baker, T. A., Smith, E. M., & Sato, Y. (2011). Pain and Gender: A Biopsychosocial Perspective. Springer. ISBN: 978-1441970822
Shuster, S. (2021). The Gendered Brain: The New Neuroscience That Shatters The Myth Of The Female Brain. Knopf. ISBN: 978-1524747036
Resources:
Video: Gender Disparities in Healthcare | Cedars-Sinai
Highlights:
0:00 – Patient describes years of misdiagnosis and pain before proper diagnosis.
1:07 – Patient shares being dismissed and mislabeled by healthcare professionals.
1:53 – Patient seeks a second opinion at Cedars-Sinai for a correct diagnosis.
2:24 – Patient receives life-changing news of having a mass and cancer.
3:36 – Patient emphasizes the importance of women advocating for their health.
Video: Closing the Gap – Addressing Gender Inequities in Healthcare
Highlights:
0:10 – Introduction to the gender health gap.
1:00 – Gender gap in healthcare research.
2:51 – Disparities in care and outcomes for women with chronic conditions.
4:29 – Gender disparities in cardiac health research.
5:10 – Lack of awareness of heart attack symptoms in women.
05:28 – Women may experience symptoms like unusual fatigue or sleep disturbance before a heart attack.
05:39 – Women may have shortness of breath, weakness, and fatigue during a heart attack instead of chest pain.
05:46 – Women are 36% less likely to participate in cardiac rehabilitation after a heart attack.
06:07 – Social determinants like socioeconomic status, geographic location, race, and ethnicity widen the health gap for women.
06:42 – Women from low socioeconomic backgrounds face barriers in accessing healthcare and are less likely to be screened for cancers.
07:08 – Rural women have higher mortality rates due to lack of access to healthcare services.
07:29 – Rates of diabetes and mortality related to women’s cancers vary based on race and ethnicity.
08:23 – Women are disproportionately affected by domestic violence, sexual assault, substance abuse, and addiction.
Video: Gender Bias Creates A Culture Of Disbelief For Female Patients | Colene Arnold | TEDxPortsmouth
Gender bias in healthcare leads to significant delays in diagnosing and treating women’s medical conditions, with women facing longer delays in chronic illness and cancer diagnosis. The bias affects how healthcare providers perceive and treat women’s pain, often resulting in under-treatment or dismissal. The historical belief that women are overly emotional about pain contributes to this bias. The speaker, a gynecologist, emphasizes the importance of believing women’s pain to improve diagnosis accuracy and timely treatment. She urges both healthcare providers and patients to advocate for better care and recognition of women’s health issues. Efforts to address gender bias in medical education are underway but require broader implementation to create lasting change.
View the video here.
Highlights:
0:32 – Women take longer to be diagnosed with chronic illnesses compared to men.
0:48 – Women face a two-year delay in cancer diagnosis compared to men.
1:31 – Women are twice as likely to die after a heart attack compared to men.
2:03 – Gender bias affects healthcare practitioners’ ability to believe women’s pain.
3:09 – Stereotypes about pain affect the treatment women receive in healthcare.
4:08 – Women are more likely to receive sedatives instead of pain medication for the same level of pain as men.
6:00 – Women’s pain, especially related to sexual health, is often dismissed or ignored.
9:17 – Women’s pain is frequently dismissed, leading to emotional suffering and delayed treatment.
10:01 – Believing women’s pain leads to better diagnosis and treatment outcomes.
Book Review: Invisible Women – Exposing Data Bias in a World Designed for Men by Caroline Criado Perez
This is a groundbreaking exploration of how gender bias in data collection and analysis affects women in numerous aspects of life. This book sheds light on the pervasive and often invisible ways in which the world is designed to fit men, systematically excluding and disadvantaging women. The core thesis is that a significant gender data gap leads to widespread discrimination against women, influencing everything from healthcare and technology to urban planning and the workplace.
Core Thesis
Perez argues that our world is fundamentally designed around the male experience, leading to a systemic gender data gap that perpetuates discrimination against women. This bias is not just a minor inconvenience but a critical issue that impacts women’s health, safety, and well-being.
Supporting Evidence
Perez supports her thesis with a wide array of case studies, research findings, and personal stories. Some key examples include:
- Healthcare: Medical research often uses male bodies as the default, leading to incorrect diagnoses and treatments for women. For instance, women are more likely to be misdiagnosed or given ineffective drugs because clinical trials predominantly involve male participants.
- Technology: Many tech devices are designed based on male dimensions, making them less suitable for women. Perez points out that smartphones are often too large for the average woman’s hand, and voice recognition software frequently struggles to understand female voices.
- Safety: Women are at a higher risk of injury in car accidents because crash-test dummies are based on the “average male” body. As a result, safety features in vehicles are not adequately designed to protect women.
- Workplace: The unpaid work done predominantly by women, such as caregiving and household chores, is often undervalued and unrecognized in economic data, leading to policies that fail to support women adequately.
Argument Structure
The book is structured thematically, with each chapter focusing on a different aspect of life where gender data gaps exist. Perez meticulously details how these gaps manifest and their real-world consequences. She uses a combination of statistical data, expert interviews, and personal anecdotes to build a compelling narrative.
Counterarguments
Perez addresses potential counterarguments by acknowledging that some progress has been made in recognizing and addressing gender bias. However, she emphasizes that these efforts are insufficient and that more systemic changes are needed. She also tackles the misconception that gender bias in data is accidental, demonstrating that it often results from historical and cultural norms that prioritize male experiences.
Conclusion
In the conclusion, Perez calls for a concerted effort to close the gender data gap. She argues that doing so is not only a matter of justice but also of efficiency and productivity. By designing a world that includes women, society can improve outcomes for everyone. Perez leaves readers with a powerful message: recognizing and addressing gender bias in data is crucial for creating a fairer, more equitable world.
Critical Reception
Invisible Women has been widely acclaimed for its thorough research and compelling arguments. Critics praise Perez for highlighting an often-overlooked issue and making a strong case for change. The book has been described as a “rallying cry” and a “game-changer,” with reviewers urging readers to share it widely to raise awareness about gender data bias.
Implications for the Future
Perez’s work has significant implications for various fields, including public policy, healthcare, and technology. By drawing attention to the gender data gap, she advocates for more inclusive data collection and analysis practices. This shift could lead to better-designed products, more effective policies, and a greater understanding of women’s unique experiences and needs.
Invisible Women is a vital read for anyone interested in gender equality and data-driven decision-making. It challenges readers to rethink the status quo and consider how a more inclusive approach to data can lead to a more just and equitable world.
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