Disparities in Women Health

Despite that slightly more than half of the population is female, disparities in health care for women continue to be an issue. Most people tend to think about issues with women’s health in other parts of the world where women have a lower social-economic status. However, we can still see these differences here in the US.

Health Disparities

Health disparities or differences in some populations of people are greater across gender, ethnicity, age, and economic level.  Illnesses have worse health outcomes in some populations as compared to others that cannot be explained by disease alone.

Why the Differences

Various health concerns exist that are unique to women such as ovarian, breast, and cervical cancers. Other health concerns exist that impact women to a far greater degree than men such as eating disorders, women are also major consumers of health care services and prescription drugs.  Women and men differ biologically in two health indicators, for instance, women tend to have higher rates of illness and disability than men but also tend to live longer than men.

Gender Bias in Medical Trials

Gender bias is prevalent in medical research and diagnosis. Historically, women were excluded from clinical trials which affect the use of medical trials in populations other than the population studied.  Throughout clinical trials, Caucasian males were the normal test subjects and findings were then generalized to other populations. 

Women were considered more expensive and complicated subjects because of variable hormone levels that differ significantly compare to male hormones.  Specifically, pregnant women were considered an at-risk population and thus barred from participating in clinical trials. 

In 1993 the US Food and Drug Administration published guidelines for the study and evaluation of gender differences in the clinical evaluation of drugs overriding the 1977 decision to bar all pregnant women from clinical trials. Through this, they recommend that all women be included in clinical trials to expose to differences in sexes. Specifically required the clinical trials to include the population to whom the drug will be prescribed, this mandated the inclusion of female participants in clinical trials sponsored by the National Institutes of Health.

In 1994 the FDA established the Office of Women’s Health which promotes that gender as a biological variable should be explicitly considered in research studies. The FDA and NIH each have several ongoing formal efforts to improve this study of gender differences in clinical trials.

Gender

Not only do women live longer they do not necessarily have better health. Women spend about 15% of their lives in unhealthy conditions compared to 12% for men, thus they carry a heavier disease burden than men.  Given their crucial role in the health of their spouses and children, this burden is shared by their families but more directly by children.  Many female health disadvantages stem from biological differences between the sexes, women are subject to risks related to pregnancy and childbearing, and gender.

Here is an example: for many years women were considered immune to coronary artery disease yet many were found to have abnormal changes in their EKG (turned silent MI) during screening examinations.  This is an example of health disparities in women and heart disease. In fact, there was a half a million woman in the USA, compared to their male counterparts that die of MI (myocardial infarct or heart attack) annually.

 There are many reasons why this health disparity happened, first MI occurs more in women than in men during the post-menopausal years. Secondly, estrogen was considered to be protective against heart disease and women were not routinely screened for heart disease risk factors.  Third, women may present with classic symptoms of MI but they also present with other symptoms usually call atypical.

Age

For us here in RX Health and Wellness, the focus is women over forty. There are also, health disparities based on age.

Health needs are substantially greater among older women compared with men, but women have fewer economic resources.  Controlling for health needs did little to explain gender differences in preventive care and increased gender differences in the use of hospital services. Women were less likely to have hospital stays and had fewer physician visits than men with similar demographic and health profiles. In contrast, the greater use of home health care among women was almost entirely explained by the greater health need frequency than men.

Women with healthcare problems may thus be more isolated, limited in their ability to obtain medical care. This concern is underscored by the fact that economic status is not the driving force for the difference. 

Health Disparities Between Black and White Women 

Disparities in access to health care and outcomes are strikingly different between Black and White women. Black women have a much higher risk of pregnancy-related complications such as deaths, 12-fold higher than White women.

Black women also have a higher risk of diabetes, high blood pressure, preeclampsia, and hemorrhage.  According to the CDC, 20.1 million women in the US are at risk for unintended pregnancy and were in need of public funding contraception. Contraception services are an essential part of Women’s Health. Lack of access to contraceptives drives unplanned pregnancies and abortions it also increases the risk of HIV and other sexually transmitted diseases.

Poverty

Poverty is another factor that facilitates the continual existence of gender disparities in health. Poverty is often directly linked with poor health. However, indirectly it affects factors such as lack of education, resources for transportations that have the potential to contribute to poor health, in addition to economic constraints there is also a cultural constraint that affects people’s ability and likelihood to enter a medical setting. 

Women’s Health disadvantages like childbirth, pregnancy, susceptibility to HIV/AIDS are augmented by poverty. In the US, it was found that there were no significant gender differences in diagnosis and treatment of chronic conditions. In fact, women were diagnosed more often, which was attributed to the fact that women had more access to health care due to reproductive needs or from taking their children in for checkups. 

Poor women in underdeveloped countries are at greater risk for disability and death. Lack of resources and improper nourishment is often the cause of death and contributes to issues of preterm birth and infancy. 

In many developing countries and regions where men experience a high level of mortality, many of these deaths result from maternal mortality. The high prevalence of HIV and AIDS infection is a large contributor. Women tend to have poor health outcomes than men for several reasons, ranging from greater risk to two diseases like HIV/AIDS.

What Can be Done About Health Disparities? 

More awareness, education, and research from agencies such as the Center for excellence in women’s health and the Department of Health, Human Services Office of Women’s Health, and NIH’s institutes of heart, lung, and blood.

Sadly, disparities are common in many aspects of health care such as gender-based disparities, racial and ethnic disparities. In socioeconomic disparities, we know for example that although the prevalence of breast cancer is higher in non-Hispanic White women than in African American women, they die at higher rates. Disparities arise because of cultural, racial, and ethnic differences, gender differences limits on access to healthcare, socioeconomic factors, environmental factors, communication barriers, literacy, medical literacy, and patients varying levels of trust in their health care providers.