Women’s health day

On the 28th of May each year we celebrate women’s health day. Or more formally known as, International Day of Action for Women’s Health. In honour of this I would like to share a short article I wrote about some of the inequities women face in healthcare.

Women’s health has been marginalised. Prior to the 1990’s there was limited research on women’s health issues as women have often been ignored in general by medical research. Women’s health has been inappropriately reduced to reproductive health. In 1966 many women with major cervical abnormalities were studied without their knowledge or consent and without receiving treatment. By 1987 many had developed cervical cancer and some had died of the condition. The Cartwright Inquiry (1987-1988) exposed a core dynamic between 20th century medical practice including arrogance by doctors that they know best and are supremely rational, scientific and objective, and, patients, in particular, women, are hysterical, irrational and incapable of making health choices for themselves.

The women’s health movement asserted women’s rights to medical information, bodily integrity, autonomy, reproductive choice, freedom from violence, equity in society, work and pay, and access to education. The New Zealand Health Committee report (1988) stated that women’s health is concerned with maintaining a positive state of physical and mental wellbeing, and does not just occur in hospitals and doctors waiting rooms. It is not just concerned with mothers and babies, reproductive issues, childrearing and food, and not limited to women specific illnesses and treatment services. Women’s health focuses on principles of prevention, involvement and equity.

In the 1990s, women’s health psychology emerged. It recognised that women are diverse. It maintains there are some areas where women have unique or different issues, but some areas which converge with research and theories of general health psychology. Women’s health is impacted by economics, social practices, cultural, political, and relational contexts at different stages of life. Behaviours, attitudes, lifestyles, and interactions between physical and psychological health influence women’s wellbeing within diverse sociocultural contexts. Therefore, the biopsychosocial model (Engel, 1977) which proposed the interrelatedness of biological, psychological, and social factors as determinants of health remains an important factor in the health of women.

More women each year die of Coronary Heart Disease (CHD) than men. Many risk factors for women are risk factors which are also common in men. However, there are also additional risk factors for women such as smoking when young, diabetes, poverty, depression, and anxiety. Women’s CHD is under researched, with just 50% of cardiovascular disease trials conducted between 2006 and 2010 not including gender analysis. This is particularly problematic in the case of CHD as treatment is based on models which suit men. Therefore, all public health information has been constructed around the experience of men. Women can experience the symptoms of a heart attack for days prior to the event, yet this is not focused on in public health. Steingart et al., (1991) found that treatment is less aggressive in women than in men. Women are half as likely to be recommended cardiac catherterization and less likely to receive angioplasty and coronary bypass compared to men. Paramedics are more likely to give morphine to men who complain of pain, but  not to women. A gender bias exists even when there are clear diagnostic and treatment protocols, therefore, it is likely to be worse when clear protocols are not in place, for example, in the case of chronic pain. 

High levels of anxiety and fear surround breast cancer prevalence and death rates (Lerner, 2001). Women are primed to be afraid of breast cancer. When the first reaction is one of intense fear and anxiety, this is associated with being less likely to present for screening, treatment, and to have a good relationship with their GP. A societal discourse feeds women’s anxiety, the way that breast cancer is portrayed as a hidden disease which requires constant vigilance (Lupton, 1994). There is also now a public perception that breast cancer affects younger women than in the past. However, Claridge (2017) analysed MOH reports on breast cancer diagnosis and death between 1995 and 2015, and found incidence, diagnosis and death of breast cancer in young women (20 – 29 years old) has not increased over a 20-year span. More women are being diagnosed overall, but relatively fewer are dying of the disease. There is a perception that more women are affected due to more publicity surrounding the disease and media use, high profile diagnoses are made public, and over diagnosis and public health messaging also contribute to this perception.

Screening is often presented as a way to save one’s life. However, a Cochrane review of screening for breast cancer with mammography (Gotzche & Jorgensen, 2013) found that if 2000 women are screened regularly for 10 years then just 1 woman will avoid dying of cancer. 10 healthy women who would not have been diagnosed without screening will have breast cancer diagnosed and treated unnecessarily. More than 200 women of these 2000 will also experience severe psychological distress including anxiety for years due to false positive findings. It is therefore crucial that women are informed of both the benefits and harms of screening.

Women consistently report higher levels of chronic pain than men (Croft et al., 2010). 90% of those diagnosed with fibromyalgia are women. There is a gender bias in the treatment of pain. If a woman presents with pain it is more likely to be discounted as emotional, psychogenic, or not real and less likely to be treated (Institute of Medicine, 2011). Men are more likely to get pain relief, whereas women receive sedatives. Paradoxical reasons for this include women reporting more coping mechanisms for main and therefore needing less treatment, women look less in pain as they are socialised to pay more attention to appearance, men with chronic pan delay treatment and therefore it is more aggressively treated when they show up, there is a medical bias towards discounting emotional or psychological components of the experience of pain (Hoffman & Tarzian, 2001).

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