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In many areas of health, women receive worse care, and suffer worse outcomes, than men. Women experience higher rates of adverse drug reactions. Across hundreds of diseases, they are diagnosed later than men. Women are more likely to suffer from common mental health conditions. In moments of acute pain, women are less likely to be given painkillers.
One small positive is that this gender health gap is finally getting the attention it deserves. “We’re much more aware of these issues now than we were previously,” says Angela Saini, a journalist and the author of Inferior: How Science Got Women Wrong. “It’s become a huge topic right across academia, medical research, health institutions, everywhere. Even everyday people see it in the press all the time.”
Seeing this health gap is one thing. Knowing what causes it is another—as only then can it be fixed. Ahead of speaking at WIRED Health in London on March 19, Saini sat down with WIRED to talk about how the gender health gap is misperceived and what needs to change for it to be closed. This interview has been edited for clarity and length.
How is the gender health gap being misunderstood?
We make assumptions about sex and gender which may not explain the gaps that we’re seeing. It’s very common for people to make very bold assertions about men’s and women’s bodies being completely different, and needing a completely different system of health care, needing different regimes of research, when in fact, sex only really matters in certain contexts when it comes to health.
Very often what we’re seeing in terms of gender health gaps are failures to do with sexism, and misdiagnosis because of assumptions based on history and myths in health research.
Take heart attacks. Women are very likely to have them. But society associates heart attacks with men. When a man has typical heart attack symptoms, people—and I mean everyone, men, women, health professionals—are much quicker to identify that as a heart attack than when a woman has exactly the same symptoms. We don’t think of women as having heart attacks in the same way as men. That’s not a sex difference—it’s about the gender assumptions that we have that we associate with certain conditions.
Where we’re at now, there’s public awareness and academic awareness about gender health gaps. But work needs to be done at a much deeper level, from condition to condition, to understand what the actual reasons are underlying the differences we’re seeing. Is it a sex difference? Or is it sexism?
Where are these things being confused?
Consider the sleep drug zolpidem. Here’s a medicine the US Food and Drug Administration approved years ago, with guidance to doctors on different dosages for men and women. There are very few drugs like this. If you look at drug labeling, it’s very unusual to have different doses for men and women.
The reason given was that researchers noticed women were processing the drug more slowly than men. So in the morning, if they had taken this as an insomnia treatment the night before, women would still be feeling sleepy, which would be a problem if they had to drive a car or operate heavy machinery. So they said women should take half the dose.
But what later research revealed was that the difference doctors were seeing was less due to some innate sex difference and more to do with weight. The size of your body also impacts how quickly or how slowly you process a drug.
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Well, if weight here is being used as a proxy for sex or gender, a larger woman would need the higher dose; a smaller man a lower dose. So why would you just not use weight as the measure for what dose a person should get? That would be a much more effective way of deciding. But because we collect data along certain lines and not others, then guidelines get written along certain lines and not others.
To give another example, sometimes women’s pain is not fully appreciated when they come forward. Women are statistically more likely to go to a doctor when in pain compared to a man. But then common myths and assumptions start to emerge: “It’s not that serious.” “She’s being hysterical.”
So there are lots of things to pick apart here. It’s the picking apart that we often don’t bother with. We just see a difference, and then that gets ascribed to something without us really knowing what the root cause is.
So how can we get better at picking apart sex differences and sexism to reduce the gender health gap?
For me, it’s about taking medicine to the next level of investigation, which is at the level of the social determinants of health. Many of the things that kill most of us have a huge social or environmental component. Things like diet, stress, the way that we are treated in society.
It’s only relatively recently that research started to be done into the impact of sexism and racism on health, and the impact of other social factors. The job that you do, your status as a married person or not, these can also have health outcomes.
So there’s all these little pieces where research is needed, and it’s an ongoing project. It's not as though you’ll only do a study once into the effects of being married or being a stay-at-home wife on your health. Because those social factors are always changing.
Sex and gender is an aspect of this social story. But it’s important to understand where it can be appropriately invoked. Sometimes gender is relevant, sometimes it’s not. Sometimes sex matters, sometimes it doesn’t.
What’s standing in the way of things getting better?
Well, research funding agencies are much more interested in looking inside our bodies for explanations for why things are as they are. The outside world is much more difficult to study, because social circumstances are always changing. They can be very different between households, even within households. It’s much harder to collect data on social circumstances.
But we’re at the stage where we can learn so much from people’s mobile phones tracking their activity. Data is being collected on what people are eating, their movements, how active they are. Eventually we’ll be able to build personalized pictures of people, and stop generalizing about people in groups and assuming that they’re typical of that group, and then understand them as a complex individual.
Who is making progress on understanding and closing the gender health gap?
Sarah Richardson’s team at Harvard University—she runs the GenderSci Lab—has done incredible work breaking down the causes of gender health disparities. They’re getting medical researchers to think very carefully about the context of the conditions that they're investigating.
The team did brilliant work during the pandemic. At the beginning there were all these very wild claims about gender differences with the virus—for instance, that women were protected because on average they have a stronger immune system. They showed that if you looked at the data this didn’t really hold up. They helped dispel this very pseudoscientific assumption that the virus was hitting all populations uniformly, and helped end the neglect of demographic patterns as a factor in Covid, the kind of jobs that people were doing, who were frontline workers, and so on.
This work around sex contextualism, as Richardson calls it, is a really compelling model for how to think about sex and gender in research.
Hear Angela Saini speak at the 10th anniversary of WIRED Health on March 19 at Kings Place, London. Get tickets at health.wired.com.
