Widening gender health gap leads to calls for more Inclusive research
A widening gender health gap with women’s health remaining under-studied, under-recognised and under-treated, has led health experts to call for more inclusive research.
More than 2000 surgeons gathered in Christchurch this week for the Annual Scientific Congress, the largest multi-disciplinary surgical meeting held in the southern hemisphere.
Dr Erica Whineray Kelly, the chief medical officer at Southern Cross Healthcare, had a message for those surgeons: include morewomeninyourresearch.
Women in New Zealand face particular barriers to equitable, cohesive and accessible healthcare and health outcomes, Kelly said.
“Whilst women have a longer life expectancy, a gender health gap exists with women spending more of their life in poor health compared to men, termed the ‘health-survival paradox’.”
Historically, Kelly said, women’s healthcare has tended to focus on female-specific conditions, ignoring the fact women are most likely to die from cardio-and cerebrovascular disease, while Māori women are most likely to die from lung disease.
“When suffering a heart attack, men typically present with crippling chest pain, while women may feel their bra was too tight that day.”
The emerging trend is a consequence of the majority of modern medicine being based on research performed exclusively on cisgender men and male lab rats, Kelly said.
“It has only been three decades since it was mandated that women were included in medical trials and research.
“We do have a gender health gap which most of us won’t be that aware of. If we compare diseases between men and women, women are likely to do worse.”
That is because most of the research and clinical trials have been done on men.
“Most drug trials that we use are all measured on men and men can metabolise them quite differently so that’s why women have a higher rate of side effects from most standard medication.
“When we think about women’s health and women’s health needs we go straight to ‘bikini medicines’ so we think of the dis
“It has only been three decades since it was mandated that women were included in medical trials and research. We do have a gender health gap which most of us won’t be that aware of. If we compare diseases between men and women, women are likely to do worse.” Dr Erica Whineray Kelly
eases hidden by the bikini as being what our problems are but actually most of us won’t die of breast cancer or gyny cancer.”
It only became mandatory for women to be included in trials in 1993.
“So you can imagine if you’ve got decades of evidence for say cardiac drugs they’re not going to go back and repeat those.”
Often the trials only report outcomes, without saying if they’re men or women, Kelly said.
Increasingly, scientists and physicians are recognising the presentation and treatment of up to 700 conditions can vary between males and females.
“Biologically, women are very different to men. They have different hormone and inflammatory profiles, experience different side-effects and often don’t do as well as men when recommended a course of treatment.”
“Women are 50% more likely to die from an acute cardiac syndrome, to suffer side-effects from medications and experience significant delays in diagnosis and treatment.”
It was in part due to the “male bias of historic research,” which often saw women excluded from studies, Kelly said.
“Women were felt to be difficult to trial on because they had periods and monthly cycles. So the male body was easier because they didn’t have to worry about hormones.”
There needed to be a greater understanding of how to effectively treat men and women, because the presentation of serious and potentially life-threatening conditions can be “vastly different” depending on your gender, Kelly said.
Women are likely to present with slightly different pathologies to men in relation to illness like cardiac disease. “So if we’re doing the same tests then we’re not actually going to find it in women.”
While research has improved, scientists and physicians must ensure enough women are included in trials and the findings are published, she said.
“As doctors, we should not treat men and women the same. We must consider other possibilities and ensure female patients are aware of their risk factors.”