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Sex and Gender in Healthcare Equity

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See also: Gender disparities in health

Sex and Gender in Medicine

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Both gender and sex are significant factors that influence health. Sex is characterized by female and male biological differences in regards to gene expression, hormonal concentration, and anatomical characteristics.[1] Gender is an expression of behavior and lifestyle choices. Both sex and gender inform each other, and it is important to note that differences between the two genders influence disease manifestation and associated healthcare approaches.[1]Understanding how the interaction of sex and gender contributes to disparity in the context of health allows providers to ensure quality outcomes for patients. This interaction is complicated by the difficulty of distinguishing between sex and gender given their intertwined nature; sex modifies gender, and gender can modify sex, thereby impacting health.[1]  Sex and gender can both be considered sources of health disparity; both contribute to men and women’s susceptibility to various health conditions, including cardiovascular disease and autoimmune disorders.[1]

Health disparities in the male population

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As sex and gender are inextricably linked in day-to-day life, their union is apparent in medicine. Gender and sex are both components of health disparity in the male population. In non-Western regions, males tend to have a health advantage over women due to gender discrimination, evidenced by infanticide, early marriage, and domestic abuse for females.[2] In most regions of the world, the mortality rate is higher for adult men than for adult women; for example, adult men suffer from fatal illnesses with more frequency than females.[3] The leading causes of the higher male death rate are accidents, injuries, violence, and cardiovascular diseases. In a number of countries, males also face a heightened risk of mortality as a result of behavior and greater propensity for violence.[3]

Physicians tend to offer invasive procedures to male patients more than female patients.[4] Furthermore, men are more likely to smoke than women and experience smoking-related health complications later in life as a result; this trend is also observed in regard to other substances, such as marijuana, in Jamaica, where the rate of use is 2-3 times more for men than women.[3] Lastly, men are more likely to have severe chronic conditions and a lower life expectancy than women in the United States.[5]

Health disparities in the female population

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Gender and sex are also components of health disparity in the female population. The 2012 World Development Report (WDR) noted that women in developing nations experience greater mortality rates than men in developing nations.[6] Additionally, women in developing countries have a much higher risk of maternal death than those in developed countries. The highest risk of dying during childbirth is 1 in 6 in Afghanistan and Sierra Leone, compared to nearly 1 in 30,000 in Sweden--a disparity that is much greater than that for neonatal or child mortality.[7]

While women in the United States tend to live longer than men, they generally are of lower socioeconomic status (SES) and therefore have more barriers to accessing healthcare.[8] Being of lower SES also tends to increase societal pressures, which can lead to higher rates of depression and chronic stress and, in turn, negatively impact health.[8] Women are also more likely than men to suffer from sexual or intimate-partner violence both in the United States and worldwide.

Women have better access to healthcare in the United States than they do in many other places in the world. [9] In one population study conducted in Harlem, New York, 86% of women reported having privatized or publicly assisted health insurance, while only 74% of men reported having any health insurance. This trend is representative of the general population of the United States.[10]

In addition, women's pain tends to be treated less seriously and initially ignored by clinicians when compared to their treatment of men's pain complaints. [11] Historically, women have not been included in the design or practice of clinical trials, which has slowed the understanding of women's reactions to medications and created a research gap. This has led to post-approval adverse events among women, resulting in several drugs being pulled from the market. However, the clinical research industry is aware of the problem, and has made progress in correcting it. [12][13]

Cultural factors

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Health disparities are also due in part to cultural factors that involve practices based not only on sex, but also gender status. For example, in China, health disparities have distinguished medical treatment for men and women due to the cultural phenomenon of preference for male children. [14] Recently, gender-based disparities have decreased as females have begun to receive higher-quality care. [15][16] Additionally, a girl’s chances of survival are impacted by the presence of a male sibling; while girls do have the same chance of survival as boys if they are the oldest girl, they have a higher probability of being aborted or dying young if they have an older sister.[17]

In India, gender-based health inequities are apparent in early childhood. Many families provide better nutrition for boys in the interest of maximizing future productivity given that boys are generally seen as breadwinners.[18] In addition, boys receive better care than girls and are hospitalized at a greater rate. The magnitude of these disparities increases with the severity of poverty in a given population.[19]

Additionally, the cultural practice of female genital mutilation (FGM) is known to impact women's health, though is difficult to know the worldwide extent of this practice. While generally thought of as a Sub-Saharan African practice, it may have roots in the Middle East as well.[20] The estimated 3 million girls who are subjected to FGM each year potentially suffer both immediate and lifelong negative effects.[21] Immediately following FGM, girls commonly experience excessive bleeding and urine retention.[22] Long-term consequences include urinary tract infections, bacterial vaginosis, pain during intercourse, and difficulties in childbirth that include prolonged labor, vaginal tears, and excessive bleeding.[23][24] Women who have undergone FGM also have higher rates of post-traumatic stress disorder (PTSD) and herpes simplex virus 2 (HSV2) than women who have not.[25][26]

  1. ^ a b c d Regitz-Zagrosek, Vera (July 2012). "Sex and gender differences in health". EMBO Reports. 13 (7): 596–603. doi:10.1038/embor.2012.87. ISSN 1469-221X. PMC 3388783. PMID 22699937.
  2. ^ Fikree, FF; Pasha, O (2004). "Role of gender in health disparity: the South Asian context". BMJ: British Medical Journal. 328(7443) (7443): 823–826. doi:10.1136/bmj.328.7443.823. PMC 383384. PMID 15070642.
  3. ^ a b c Barker, G. [www.who.int/child-adolescenthealth/New_Publications/ADH/WHO_FCH_CAH_00.7.pdf "What about boys? A literature review on the health and development of adolescent boys"] (PDF). WHO. {{cite web}}: Check |url= value (help)
  4. ^ Kent, Jennifer; Patel, Vinisha; Varela, Natalie (2012). "Gender Disparities in Healthcare". Mount Sinai Journal of Medicine. 79 (5): 555–559. doi:10.1002/msj.21336. PMID 22976361.
  5. ^ Courtenay, Will H (2000-05-16). "Constructions of masculinity and their influence on men's well-being: a theory of gender and health". Social Science & Medicine. 50 (10): 1385–1401. doi:10.1016/S0277-9536(99)00390-1. PMID 10741575.
  6. ^ World Bank. (2012). World Development Report on Gender Equality and Development.
  7. ^ Ronsmans, Carine; Graham, Wendy J (2006). "Maternal mortality: who, when, where, and why". The Lancet. 368 (9542): 1189–1200. doi:10.1016/s0140-6736(06)69380-x. PMID 17011946. S2CID 6990187.
  8. ^ a b Read, Jen'nan Ghazal; Gorman, Bridget K. (2010). "Gender and Health Inequality". Annual Review of Sociology. 36 (1): 371–386. doi:10.1146/annurev.soc.012809.102535.
  9. ^ Vaidya, Varun; Partha, Gautam; Karmakar, Monita (2011-11-14). "Gender Differences in Utilization of Preventive Care Services in the United States". Journal of Women's Health. 21 (2): 140–145. doi:10.1089/jwh.2011.2876. ISSN 1540-9996. PMID 22081983.
  10. ^ Merzel C (2000). "Gender differences in health care access indicators in an urban, low-income community". American Journal of Public Health. 90 (6): 909–916. doi:10.2105/ajph.90.6.909. PMC 1446268. PMID 10846508.
  11. ^ Hoffmann, Diane E.; Tarzian, Anita J. (2001-03-01). "The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain". The Journal of Law, Medicine & Ethics. 28 (4_suppl): 13–27. doi:10.1111/j.1748-720X.2001.tb00037.x. ISSN 1073-1105. PMID 11521267. S2CID 219952180.
  12. ^ Liu, Katherine A.; Mager, Natalie A. Dipietro (2016). "Women's involvement in clinical trials: historical perspective and future implications". Pharmacy Practice. 14 (1): 708. doi:10.18549/PharmPract.2016.01.708. ISSN 1885-642X. PMC 4800017. PMID 27011778.
  13. ^ ORWH. "Including Women and Minorities in Clinical Research | ORWH". orwh.od.nih.gov. Retrieved 2017-09-29.
  14. ^ Mu, Ren; Zhang, Xiaobo (2011-01-01). "Why does the Great Chinese Famine affect the male and female survivors differently? Mortality selection versus son preference". Economics & Human Biology. 9 (1): 92–105. doi:10.1016/j.ehb.2010.07.003. PMID 20732838.
  15. ^ Anson O.; Sun S. (2002). "Gender and health in rural China: evidence from HeBei province". Social Science & Medicine. 55 (6): 1039–1054. doi:10.1016/S0277-9536(01)00227-1. PMID 12220088.
  16. ^ Yu M.-Y.; Sarri R. (1997). "Women's health status and gender inequality in China". Social Science & Medicine. 45 (12): 1885–1898. doi:10.1016/S0277-9536(97)00127-5. PMID 9447637.
  17. ^ Gupta, Monica Das (2005-09-01). "Explaining Asia's "Missing Women": A New Look at the Data". Population and Development Review. 31 (3): 529–535. doi:10.1111/j.1728-4457.2005.00082.x. ISSN 1728-4457.
  18. ^ Behrman J. R. (1988). "Intrahousehold Allocation of Nutrients in Rural India: Are Boys Favored? Do Parents Exhibit Inequality Aversion?". Oxford Economic Papers. 40 (1): 32–54. doi:10.1093/oxfordjournals.oep.a041845.
  19. ^ Asfaw A.; Lamanna F.; Klasen S. (2010). "Gender gap in parents' financing strategy for hospitalization of their children: evidence from India". Health Economics. 19 (3): 265–279. doi:10.1002/hec.1468. PMID 19267357.
  20. ^ Uwer, Thomas von der Osten-Sacken ; Thomas (2007-01-01). "Is Female Genital Mutilation an Islamic Problem?". Middle East Quarterly.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. ^ "Female genital mutilation (FGM)". World Health Organization. Retrieved 2017-09-29.
  22. ^ "Immediate health consequences of female genital mutilation | Reproductive Health Matters: reproductive & sexual health and rights". Reproductive Health Matters: reproductive & sexual health and rights. 2015-03-01. Retrieved 2017-09-29.
  23. ^ "Gynecological consequences of female genital mutilation/cutting (FGM/C)". Nasjonalt kunnskapssenter for helsetjenesten. Retrieved 2017-09-29.
  24. ^ Berg, Rigmor; Underland, Vigdis (June 10, 2013). "The Obstetric Consequences of Female Genital Mutilation/Cutting: A Systematic Review and Meta-Analysis". Obstetrics and Gynecology International. 2013: 496564. doi:10.1155/2013/496564. PMC 3710629. PMID 23878544.
  25. ^ Behrendt, Alice; Moritz, Steffen (2005-05-01). "Posttraumatic Stress Disorder and Memory Problems After Female Genital Mutilation". American Journal of Psychiatry. 162 (5): 1000–1002. doi:10.1176/appi.ajp.162.5.1000. ISSN 0002-953X. PMID 15863806.
  26. ^ Morison, Linda; Scherf, Caroline; Ekpo, Gloria; Paine, Katie; West, Beryl; Coleman, Rosalind; Walraven, Gijs (2001-08-01). "The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey". Tropical Medicine & International Health. 6 (8): 643–653. doi:10.1046/j.1365-3156.2001.00749.x. ISSN 1365-3156. PMID 11555430. S2CID 11177182.
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