Minding the gender health gaps

Minding the gender health gaps

While it may be obvious that men and women are built differently, there needs to be greater awareness of how sex and gender can affect your health. Priya Kulasagaran takes a look at how one’s biological sex, and perceived gender roles, play a part in healthcare for both men and women

Are you male or female? The answer to this seemingly simple question can have a major impact on your health.

Increasingly, science has found that one’s sex and gender can make a difference in the risk you have of certain diseases, how you respond to medication, and even the way you seek medical care. This is why more researchers are now looking into the links between sex, gender and health.  While many people use sex and gender as interchangeable terms, they are rather distinct concepts.

Sex versus gender

Generally, “sex” refers to the one’s biological makeup, namely in terms of anatomy and physiology – the differences in genitalia between men and women is an example of this. Your sex is determined by your genetics; while everyone has 46 chromosomes, women have two X chromosomes, while men have an X and a Y chromosome. The hormone level present are also different, with women having higher levels of oestrogen and progesterone, while men having more testosterone.

While we tend to see sex as two distinct categories, some researchers believe that this perceived binary is not entirely accurate. Take the case of ‘intersex’ babies, who are born with a mix of male and female genitalia and account for around one in 1,500 births.

Gender meanwhile, is a social construct where society determines the culture roles and norms of each sex. How you view your gender depends on your family, peers, the media, education, as well as the norms of your community. Although gender roles vary from society to society, a common example is how women are often seen as homemakers and men are assumed to the primary breadwinners.

However traditional such gender roles appear, they are not set in stone; in fact such constructs are surprisingly fluid and shift according to a given society’s values. For instance, modern parents may think that pink is the ideal colour for girls, while boys are best suited to the more ‘masculine’ colour of blue, and this concept is particularly prevalent in Western societies. But some 100 years ago in the Western world, the scenario was the complete opposite; boys were more likely to be dressed in pink as it was seen as a ‘stronger’ colour, while blue was considered ‘delicate’ and more suited for girls.

Difference in biology

According to the University of London’s Institute of Medicine, every cell in our bodies has a sex, which means men and women are different at a cellular level.

Despite this, medical research for the past few decades tended to conduct research almost solely on men, assuming that the results were equally applicable to women. In some cases, as incredulous as it sounds, men are more likely to be the subjects of clinical trials even when it comes to drugs for women. An initial trial of Addyi, a drug to help encourage sexual desire in women, was tested in 23 men and just two women to test its effects when taken with alcohol.

More recently, science has shown that women metabolise some drugs differently from men. For example, zolpidem, which is usually prescribed as a sleeping pill, has been shown to remain women’s bloodstreams far longer than in men. This means that some women may take longer to focus on tasks that require concentration such as driving for a longer period. The finding in fact, has led to the United States’ Food and Drug Administration to issue warnings that the zolpidem should be prescribed at lower doses for women.

Sex and gender even appear to affect the way some diseases present themselves or are diagnosed.

When we think of heart attacks, we tend to picture a dramatic scenario as portrayed in the movies; a person clutching his or her chest, before collapsing onto the floor. This is true to a certain extent, as the most common heart attack symptom in both men and women is chest pain or pressure. However, women are more likely than men to have a heart attack without chest pressure, and instead display other symptoms such as nausea, dizziness, shortness of breath, or jaw pain. Women also seem to have a higher tendency of experiencing ‘silent heart attacks’ compared to men.

Sometimes, these gender differences play out in rather unexpected ways when it comes to the diagnosing diseases, as well the subsequent health impact faced by patients. For instance, women worldwide statistically have higher rates of depression, and are three times more likely to attempt suicide – but men have higher suicide rates as a whole. Some researchers say that this may due to the way depression is defined and diagnosed in the first place; the theory here is that men may be display their depression in different forms, such as rage or substance abuse, that are not typically identified as depression in mental health screening tests.

Going beyond stereotypes

For quite some time, it was deemed common sense in public health circles to target women when implementing wide scale nutrition programmes. The reasoning was that as women tend to be the ones responsible for meal preparations and childcare, it was reasonable to recruit their support in making such programmes successful.

However, subsequent research has found that involving men to improve general health outcomes, as well as women’s and children’s health, is crucial. Commenting on the need for this inclusion, a study published in the Journal of Health Population and Nutrition in 2007 stated that with nutrition programmes for instance, men should not be excluded as they are “heavily involved in the production, sale and purchase of food”. Similar research on vaccination programmes in Ghana for instance, showed that programmes that involved both fathers and mothers can significantly increase immunisation rates.

As such, not only should more attention be paid to biological differences in the sexes when it comes to healthcare, but gender stereotypes and assumptions should be critically examined for the well-being of both men and women.

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