Addressing gender inequality within healthcare

gender inequality
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Peggy Maguire, Director General of the European Institute of Women’s Health, outlines the key risks posed by gender inequality within healthcare, for both patients and healthcare providers.

One of the biggest challenges facing societies is maintaining health across the lifespan, particularly considering an increasingly ageing population. Europe has the highest proportion of older women in the world. Women are on the forefront of ageing due to their greater longevity than men, their multiple carer and societal roles. Despite women’s increased lifespan, their older years are disproportionately burdened by ill health and lower financial resources. Women outlive men by more than five years, but the difference in healthy life expectancy is less than nine months. A comprehensive and supportive approach, including physical and mental health, must be taken to empower and support women to actively and healthily age, reducing gender inequality.

Women make up the largest proportion of the older population and are the heaviest users of medicines. Yet, women have a 1.5 to 1.7 times greater risk of developing adverse drug reactions compared to men as women are not sufficiently represented in clinical trials, weakening the evidence base for women as well as for older people. The New Clinical Trials Regulation is a major step forward in increasing clinical trial data transparency.

Biological and social influences (sex and gender) are critical to health. Many factors outside of the health sector such as socioeconomic status, education, culture, and ethnicity also affect behaviour and resource access. Lack of resources or decision-making power, unfair work divisions, and violence against women all impact health. These social determinants have large repercussions for health and access, so strategies must account for this gender inequality.

Women have higher rates of diseases such as, breast cancer, osteoporosis, and autoimmune diseases (such as MS). Other diseases affect men and women differently, including diabetes, depression, and cardiovascular disease.

Women are at the epicentre of the Alzheimer’s crisis. In the EU, Alzheimer Europe estimates that close to six million women have dementia. The proportion of women aged over 75 is expected to double by 2060 (from 5.5% to more than 10% of the total population). Given these trends and the strong impact of ageing on dementia risk, it is projected that the numbers of older women with dementia will increase substantially in the coming decades. There are women-specific risk factors for dementia, like pregnancy induced hypertension, and pre-eclampsia. Pre-eclampsia has been associated with higher risk for cardiovascular disease and cognitive impairment later in life. Hysterectomy and oestrogen loss after menopause may increase risk in women.

Progression of dementia is different between men and women. It has been reported that women experience more pronounced symptoms of dementia compared to men. However, clinical data are rarely stratified by sex, and evidence supporting these reports is required. Women experience the strain of caring for family members with dementia more acutely, reporting higher levels of stress, depression, and anxiety symptoms as well as lower levels of quality of life.

Major diseases such as cardiovascular disease, cancer, and respiratory disease account for nearly four-fifths of women’s (and men’s) deaths on the continent (Eurostat 2017a). Mental health and neurological disorders are the third highest cause of death in the EU when stroke (which accounts for 35% of deaths from neurological disorders) is included. These include neurodegenerative disorders such as Parkinson’s disease, Alzheimer’s and other dementias, and mental disorders including schizophrenia, depression, bipolar disorder, alcoholism, and drug abuse. This includes the UK, as cited in the Global Burden of Disease Study 2017 (EU-28).

Data and evidence overwhelmingly outline the scale of gender inequality in healthcare and health systems that are systemically failing women, from research to implementation of policy and programmes, treatment, and care.

Innovation efforts are not always aligned to public health needs. For example, there is a certain knowledge gap in the treatment area of safe medicines used during pregnancy and breastfeeding, as well as medicines for older people with several comorbidities. It is important to create awareness of the safe use of medicines including vaccines during pregnancy and lactation in the development of new initiatives and health tools to combat infectious diseases. The IMI funded project Conception is addressing the lack of information on medicines during pregnancy and lactation for both women and their healthcare providers.

In its new Regulatory Science Strategy 2025, the European Medicines Agency (EMA) has addressed various unmet medical needs for certain population groups such as pregnant and breastfeeding women, and older people. We therefore welcome the Commission’s proposal to enable innovation for unmet medical needs by harnessing the benefits of the digital technology. However, we would argue that EMA needs to be given the necessary resources to enable the Agency to address this currently unmet medical need.

Focusing on women’s health is about acknowledging that women and men are different. In the past, medical research worked on the premise that, with the exceptions of breast cancer, obstetrics, and gynaecology, women are the same as men. It was not unusual for medical studies and drug trials to exclude women, even though women were affected by the condition being studied or would eventually be prescribed the drugs that were being tested. Research that uses a gender lens benefits everyone.

Apart from reproductive health, it is rare that sex and gender are considered in healthcare professional education curricula. Over the last 10 years, the importance of sex and gender in medical healthcare research and treatment of medical conditions has been increasingly recognised. However, the need for integration of this knowledge into healthcare professional education curricula remains a challenge. One example of where this has been done well is at Monash University in Australia, where sex and gender issues have been integrated in all parts of the undergraduate medical curriculum, as well as in tutorials and cases for teaching, meaning that gender competence is included also in the assessment of doctors.

Acknowledging the impact of sex and gender inequality in medicine increases the quality of provision and thus, the quality of healthcare professional education. A patient-centred evidence-based sex and gender perspective is required throughout healthcare professional curricula, including all levels of undergraduate, graduate, and continuous education for medical, nursing and pharmacy as well as all allied healthcare workforce across Europe. Incorporating information generated from the growing discipline of sex and gender-based medicine in education and training programmes improves access to high-quality healthcare and, thereby, improves patient outcomes.

High-quality education and training are fundamental to achieving high-quality healthcare. Professional knowledge, skills and competences must be updated continuously. High-quality education and training at all levels must respect ethical and professional codes and enshrine up-to-date evidence-base for practice and treatment. There are the moral and ethical obligations to counteract avoidable health inequalities, which can be caused by a variety of factors. Historically, there has been a male-bias in healthcare professional education and training that needs to be corrected. Medical knowledge and science have developed largely in the absence of consideration of sex and gender.

Patients can support healthcare professionals in the increase of health literacy – in the use of personally targeted health information to educate and to support patients in managing their health and avoiding potentially adverse outcomes and higher costs. Making sure patients are both physically and emotionally comfortable helps to build trust and connection, which is vital to providing the best quality care possible and improving patient outcomes. Being patient-focused is making sure patients, both women and men, really understand every aspect of their condition and its treatment. All stakeholders in the process of health profession’s education should be actively involved in the development and implementation of new, contemporary curricula on women’s health, gender, and diversity, to connect the contemporary education to the future healthcare needs of women, minorities, and all disadvantaged populations. Europe should establish an EU health profession’s coalition to effectively integrate sex and gender into education and to develop the appropriate European level recommendations.

Peggy Maguire
Director General
European Institute of Women’s Health

This article is from issue 19 of Health Europa Quarterly. Click here to get your free subscription today.

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