Inequities in health care for women can delay treatment, have lasting health impacts
Pat Roberts’ mother, Nancy, was 76 when she first began to worry that her stomach had become swollen and hard. She made an appointment with her family doctor, who told her not to worry. “This just happens to women when they get old – they get a distended belly,” he said.
Roberts, who had accompanied her mom to the doctor’s office, disagreed. “The doctor didn’t even turn around from his desk,” she says. “He didn’t touch her. And I sensed my mom felt there was something wrong.”
When Roberts pushed her mother to get another opinion, the second doctor diagnosed a baseball-sized tumour. “A few months later, my mom died,” says Roberts. “It still bothers me. My mom was the type to just brush things off. She was always apologetic about ‘bothering’ the doctor. I wonder if she had addressed it sooner and she’d had the right doctor, if she might have survived.”
Unfortunately, Roberts’ experience isn’t unusual. Research studies consistently show inequities in the way women are treated by the health-care system that can lead to sub-optimal results.
Dr. Rulan Parekh, vice-president of academics at Women’s College Hospital, says those inequities can be traced back to a history of gender inequality in research around women’s health, as well as unconscious gender biases that sometimes affect the way doctors approach and treat patients.
Take heart disease, for example. “A woman dies in Canada every 17 minutes from heart disease,” says Dr. Parekh. “It’s the leading cause of death in women.”Yet, a report by the Heart and Stroke Foundation shows women who have a heart attack are less likely than men to get treatments and medications in a timely fashion.
Part of the problem, she says, is heart disease in women may go unrecognized. “Women’s symptoms are sometimes different than men’s,” she says. “They might describe burning or nausea. If you (the doctor) are dealing with a 55-year-old woman, you might not immediately recognize heart disease, and you may not
Compounding the problem, she says, is a perception among doctors that women live longer and healthier and are less likely to develop heart disease.
On paper, that’s true. Canadian men are two times more likely to develop heart disease than Canadian women, and on average they’re diagnosed 10 years younger. But the overall trend can blind the medical system to what is right in front of them.
“There are many determinants of health,” points out Dr. Parekh, including family history, lifestyle factors (such as smoking and lack of exercise) and social determinants (like poverty). “I think by focusing on the sort of crude sex difference, people miss things,” she adds.
The results of such biases can be dire. In 2019, 20 per cent more women in Canada died of heart failure than men, and 32 per cent more women than men died of stroke, according to the Heart and Stroke Foundation.
Doctors aside, Dr. Parekh says, women themselves need to be reminded to be assertive about their own health. It’s important to recognize your risk factors (perhaps you’ve had diabetes, kidney disease or hypertension during pregnancy, or you have a family history of breast cancer) and take preventative steps.
“We need to raise awareness among women to think about these things and raise them with their physician,” she says. “Make sure you’re proactive about your own health, even though you may be busy raising children or caring for others.”