The Gender Gap in Healthcare: Beyond Biology and Into Bias
In 2013, the US Food and Drug Administration made a seemingly logical, but ultimately flawed, recommendation: women should receive a lower dosage of the insomnia drug zolpidem than men. The justification? Women metabolize the medication more slowly, potentially leading to dangerous side effects. However, a 2019 study by Tufts University revealed a shocking truth: the difference in zolpidem metabolism wasn’t related to sex at all, but to body size. This revelation highlighted a pervasive issue in healthcare: the reliance on sex as a proxy for other, often more relevant, characteristics.
This isn’t an isolated incident. Angela Saini, author of The Patriarchs: How Men Came to Rule, argues that many disparities in health outcomes between men and women stem not from inherent biological differences, but from gender-based biases in diagnosis and treatment.
"They were using sex as a proxy for body size because we tend to collect data about sex; we don’t collect data about body size," Saini explains. "This is the perverse way that sometimes medicine works: You base your diagnostics on the data you have rather than the data you need."
While biological sex undeniably plays a role in some aspects of health, like reproductive health and physiology, research increasingly demonstrates that often, the differences in health outcomes between men and women are marginal and largely due to gender. This includes differences in disease symptoms, drug efficacy, and patient experiences within the healthcare system.
"The differences that do exist are down to gender," Saini emphasizes. "Differences in the way people are treated and thought about and the assumptions we make about them."
Take, for example, the common misconception that women experience atypical heart attack symptoms, distinct from men’s. This myth, fueled by societal biases, has been debunked by a 2019 study funded by the British Heart Foundation. The study, involving nearly 2,000 patients, found that 93% of both men and women reported chest pain as the primary symptom, with similar percentages experiencing left arm pain.
"The problem of underdiagnosis of women is because health professionals and even the women themselves who are having a heart attack believe heart attacks are something that mostly happens to men," Saini explains. The detrimental impact of this bias is stark: estimates show that differences in care have led to approximately 8,200 avoidable deaths due to heart attacks in England and Wales since 2014.
"It’s not about men discriminating against women; this is often about women not being listened to—sometimes by other women," Saini contends.
Another telling example is a 2016 Canadian study that examined patients hospitalized with acute coronary syndrome. The study revealed that patients who performed gender-stereotypical female roles – like doing more housework and not being the primary earner – had higher rates of recurrence, regardless of their biological sex.
"This was because people who carried out a female social role were more likely to be anxious," Saini concludes.
These examples underscore the crucial role of gender in shaping healthcare outcomes. The biases and assumptions surrounding gender influence how patients are perceived, diagnosed, and treated, ultimately leading to disparities in care.
If these disparities stem from how patients are perceived and treated, the solution, according to Saini, is clear: "We need to be careful to diagnose the problem where it is, not where we imagine it to be."
She points to the success of Jennie Joseph, a British midwife who founded the Commonsense Childbirth School of Midwifery in Orlando, Florida. Joseph addresses the alarming disparity in maternal mortality rates – Black mothers in both the US and the UK are three times more likely to die during childbirth than white women – by providing culturally sensitive and attentive care to minority women.
"Joseph lowered maternal mortality rates among minority women simply by improving the quality of their care, listening to their concerns, and responding when they say they’re in pain," Saini says. "We don’t need technology to solve this issue. We just very simply can’t allow our biases and prejudices to get in the way."
The solution to bridging the gender gap in healthcare isn’t simply about acknowledging biological differences; it’s about challenging ingrained biases and creating a healthcare system built on equity, empathy, and evidence-based care. This means actively seeking information beyond traditional sex classifications, fostering a culture of active listening and respect, and ensuring that all patients, regardless of gender, receive the best possible care.
