Covid has a gender disparity — and so does all medical care
Like many diseases, COVID-19 impacts men and women differently. It causes significantly fewer fatalities in women than men, a distinction that is visible across countries and cultures. Even when women have higher rates of diagnosis, men still have higher rates of death. Scientists are working to identify why this is, investigating men’s rates of smoking and underlying health conditions, as well as the impact of women’s genetics, estrogen or other biological factors. Perhaps a higher fatality rate among men will finally generate significant attention to the gender disparities common in many diseases and treatments and encourage applying a gender lens to all surveillance and research.
The difference with COVID-19 is particularly surprising because so many factors put women at increased risk of becoming infected. According to the U.S. Census Bureau, women are 91 percent of American nurses, and women are more likely to staff nursing homes, more often caretakers of ill family members, more likely to live in poverty and more likely to be in close physical proximity to their young children. But women infected with COVID-19 are still not dying as often as men.
It is the newest manifestation of an issue of which the medical community, and advocates for women, have long been aware. Women and men often present different symptoms for the same diseases and respond differently to medications, medical devices, and treatments. Gender disparities in medicine—among research subjects, and in health care access and delivery—put women at risk for misdiagnoses, ineffective treatments and compromised care.
And while men have been dying more of COVID-19, women have been bearing the disproportionate brunt of its social effects, including lost jobs, domestic violence, increased family care-taking, reduced access to reproductive care, and food, housing, and income insecurity. Caregivers are more likely to put off their own healthcare, skipping appointments and practicing fewer healthy behaviors for themselves. All of these factors have health and economic effects, both in the short and long terms.
The significant dearth of information about women’s and men’s diagnosis and mortality rates limit researchers’ ability to draw conclusions. Data gaps include partial or no sex-disaggregated statistics from countries with high death rates, including the U.S., France, England and Wales, Turkey, and Brazil. Fully collecting and accurately reporting sex and gender information is essential to a comprehensive, multidisciplinary effort to understand and contain this virus. Researchers and policymakers must bring a gender lens to their studies in order to appropriately and effectively tackle its different dimensions.
Let National Women’s Health Week (May 10-16) spur us to examine the gender-specific ways in which COVID-19 impacts women and to encourage the medical community to address gender disparities. Advocating on the legislative, clinical and social levels is an approach Hadassah has long effectively taken in the U.S., and through our Linda Joy Pollin Cardiovascular Wellness Center for Women at Hadassah Ein Kerem Hospital in Israel, staff work in culture-specific ways, tailored to women, to improve health outcomes in some of Israel’s most disenfranchised and poorest populations.
Heart disease, for example, is the number one killer of women, and yet only one-third of cardiac research subjects are women. Studies also show that medical providers are more likely to ascribe women’s pain symptoms to stress or psychological causes when contrasted with men men, who instead receive diagnoses for physical or neurological conditions for similar symptoms.
We support a call put out by the American Women’s Medical Association – a member of Hadassah’s Coalition for Women’s Health Equity – for sex-disaggregated research in all aspects of COVID-19 surveillance reports, and in clinical and basic science research. This information is crucial.
A couple of years ago, writers for Refinery29, an online publication focusing on young women, did an experiment: they didn’t move out of the way for men walking toward them on sidewalks, which they always knew was expected. Instead, they tried what it was like to take up space – literal space – on the sidewalk, and expect the men passing by to step aside for them. Each of the writers was surprised by the results. Not just how many men shoulder-checked them or moved aside, but how their own behavior and perceptions changed.
When women and girls are socialized not to “take up space” physically, that quickly gets internalized, leaving us to believe that we shouldn’t take up space emotionally or psychologically. That can play out in our dealings with doctors — for instance, being reticent about pressing a healthcare provider for more information or hesitating to ask about current research.
We need to proactively change that to approach our own care. It is self-care at the most fundamental level. We must be our own best advocates at home, at work, in the doctor’s office, in our state governments and in Congress.
If we better understand sex/gender differences and health disparities, and are willing to take up more space to advocate for our own health care on both personal and population-wide levels,it will benefit us as individual women, as a community — and ultimately improve everyone’s health.
Dr. Janice Weinman is the ED/CEO of Hadassah.