By Liesbet Debecker
Recently, I was struck down by one of the severe migraines that have plagued me since puberty. In between trying not to cry or vomit from the pain, I struggled for an answer as to why there was no efficient cure for something so debilitating. As it turns out the answer is not a pleasant one: migraines predominantly affect women and as a result of this, according to multiple academics, have remained largely ignored by science. Unfortunately, this is not the only way that gender affects health. From the actual ailments suffered to diagnosis and treatment, there are a lot of differences based on sex in the way healthcare is received.

Last year, the World Health Organisation released a report on men and health, looking into the reasons why men’s life expectancy is so much lower than women’s. According to this report, there are two main factors that influence men’s health: individual factors (such as access to economic resources, sexual orientation) and societal factors (such as levels of national wealth and income inequality, gender equality, cultural adherence to traditional gender norms).[1] Yes, you read that correctly: gender equality and traditional gender norms influence men’s health. Gender is even quoted as one of the ‘most important sociocultural factors influencing health and health-related behaviour’ and ‘traditional stereotypes of masculinities are related to worse health outcomes in men’.[2]

Traditional concepts of masculinity have a significant impact on men’s health. Stereotypical male lifestyles are unhealthier, featuring, for example, higher tobacco use, alcohol consumption and unhealthier diets. In addition, when men feel the need to fit within patriarchal economic roles the stress of being the ‘breadwinner’ in the household increases social pressure on men, with men generally working longer hours, causing higher levels of hypertension and increased smoking or other harmful coping mechanisms. This social pressure also means that unemployment is an even greater stress for men than women: long-term unemployment has been linked with depression, alcohol and drug abuse and even weight gain and an increased risk of heart diseases. On top of that, men are less likely to seek healthcare than women. All of these factors seem to contribute to some of the main causes of death for men: noncommunicable diseases such as cardiovascular diseases, cancer, diabetes and respiratory diseases on the one hand; injuries such as unintentional injuries (such as road-traffic accidents), self-harm (suicide) and interpersonal violence on the other.[3]

“Traditional concepts of masculinity have a significant impact on men’s health.”

This, however, does not mean that everything is better for women in terms of health and medical care. Even though women’s health may overall be better, and their life expectancy longer, they often face problems when seeking healthcare. One example of this can be seen with what is described as the Yentl syndrome.[4] Often when women have a disorder their symptoms present different from men’s, which is the presumed default in medical theory. This can lead to misdiagnosis, mistreatment or even dismissal that the symptoms exist. This can have deadly consequences. For example, when men suffer a heart attack, they usually notice chest pain. Women generally do not, suffering symptoms that are more flu-like. According to a study published in 2000, this makes it seven times more likely that women will be discharged or misdiagnosed when having a heart attack.[5] Women under 50 are twice as likely to die of a heart attack than men of the same age.[6] This lack of diagnosis is not limited to life-threatening conditions, but also other diseases which seriously disrupt women’s quality of life, particularly those that disproportionately or only affect women. Even when presenting severe, debilitating symptoms, women are often not believed by doctors, sometimes visiting numerous different consultants without receiving a satisfying answer. A quick Google search provides a multitude of stories of women suffering from endometriosis (which takes an average of 8 years to be diagnosed in the UK and 10 in the US) or rare heart conditions who have not been believed by doctors.[7] Instead, these women are prescribed antidepressants or advised to see a psychiatrist. These problems are even more prominent for women of colour. A Marie Claire article states that black women are more likely to die from having a stroke than white women and are also more likely to receive incorrect treatment for cancer.[8]

The problems do not end there. Even when there is treatment for a particular condition, it is not always fit for use by women; again medical care sees men as the default. Women are also less likely to receive aggressive[A1] [H2]  treatments.[9] Likewise, their pain is more easily dismissed: women are prescribed sedatives instead of strong painkillers more often than men. Even when such painkillers are prescribed, it is usually in lower, non-proportional doses.[10] This phenomenon is so common that is has gotten a name: the gender pain gap. Another issue lies in the standard set for drug doses. These too are designed for men, not taking into account that women’s bodies function differently because of hormonal cycles, smaller organs and a higher body fat composition.[11] This can cause them to process medication differently from men.

“This phenomenon is so common that is has gotten a name: the gender pain gap.”

Finally, there are the conditions predominantly experienced by women that go largely unresearched. This takes us back to where this blog post started. Despite migraines being the sixth most disabling disease worldwide, it has taken a disproportionately long time to be taken seriously, with health professionals once arguing they were merely psychosomatic.[12] Still, they are not close to finding a cure.[13] When one considers that the US National Institute for Health only has a yearly budget for migraines of around $20 million, as opposed to around $50 million for small pox (a disease not reported in the US since 1949) it might take a while too.[14]

For both men and women, our gender impacts our health considerably. Some of the problems raised in this blog could easily be addressed, others will require long term strategies. What is certain is that nothing will change if we do not start taking gendered differences in health seriously. It will help us save lives of both genders.

Liesbet did a bilingual bachelor in law at the Brussels campus of the Catholic University of Leuven. After that, she obtained her masters in law at the Catholic University of Leuven, spending one year of her master’s on exchange at the University of Vienna. Her specialisations were criminal law, international and European law, but she wrote her thesis in human rights law. Her main interest is gender issues in law.

---

[1] ‘The health and well-being of men in the WHO European Region: better health through a gender approach’ (World Health Organization 2018).

[2] Ibid, 30-31.

[3] Ibid (summary of the report).

[4] Sigal Samuel, ‘Women suffer needless pain because almost everything is designed for men’ Vox (Washington D.C., 17 April 2019).

[5] Elizabeth G. Nabel, ‘Coronary Heart Disease in Women – An Ounce of Prevention’ (2000) 343 The New England Journal of Medicine 572; Kayla Webley Adler, ‘Women Are Dying Because Doctors Treat Us Like Men’ Marie Claire (New York City, 25 April 2017).

[6] Webley Adler (n 5).

[7] Caroline Criado Perez, ‘From ADHD to endometriosis, women are often misdiagnosed. Why? The world was made for men’ The Lily (Washington D.C., 21 March 2019); Laura Kiesel, ‘Women and pain: Disparities in experience and treatment’ (Harvard Health Blog, 9 October 2017) <https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562> accessed 6 May 2017.

[8] Webley Adler (n 5).

[9] Laurie Edwards, ‘The Gender Gap in Pain’ The New York Times (New York City, 16 March 2013); Diane E. Hoffman and Anita J. Tarzian, ‘The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain’ (2001) 29 The Journal of Law, Medicine and Ethics 13.

[10] Dawn Foster, ‘The gender pain gap is real. Doctors, stop dismissing women’s conditions’ The Guardian (London, 26 November 2018).

[11] Edwards (n 9).

[12] Becca Stanek, ‘Why isn’t there a cure for migraines?’ The Week (New York City, 28 August 2017); David Cox, ‘Everything you always wanted to know about migraines (but were in too much pain to ask)’ The Guardian (London, 7 November 2016).

[13] Ryan Bradley, ‘Will doctors ever cure migraines?’ Popular Science (Harlan, 29 February 2012).

[14] Stanek (n 12); ‘Estimates of Funding for Various Research Condition, and Disease Categories (RCDC)’ (National Institute for Health, 19 April 2019) <https://report.nih.gov/categorical_spending.aspx> accessed 6 May 2019.

---