Is women's health really all that bad?
‘Men die quicker, women are sicker’ is an adage among medical professionals. But is women's health really worse than men's? Gabrielle Jackson explains in this extract from Pain and Prejudice.
Women have always lived longer than men on average, across cultures. It was once assumed this was due to the fact men are risk-takers and die younger from accidents, workplace injuries and war. But researchers have found that this doesn’t fully account for the disparity in life expectancy. The shocking truth is, nobody knows why women live longer than men.
Some scientists believe the female immune system could play a role. We know it’s stronger and more flexible than the male one, protecting life from its earliest stages, with female premature babies showing consistently stronger survival rates than male ones.
So much for the weaker sex, right? But this flexibility means there’s more scope for things to go wrong, and women pay for this with conditions of the immune system. ‘Men die quicker, women are sicker,’ goes an old adage among medical professionals.
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Women account for three-quarters of people with autoimmune conditions, and for a huge proportion of the global burden of pain. They’re more likely to suffer from persistent pain than men — a 2008 multi-country study found the prevalence for chronic pain was 45 per cent of women and 31 per cent of men.
In all chronic pain conditions, there’s a substantial prevalence of women. That’s not to say men don’t experience chronic pain, but while its distribution evens out in old age, women experience it more during their reproductive years, and so it has a huge impact on their opportunities and quality of life.
As Maya Dusenbery reports in Doing Harm, ‘When it comes to “active” life expectancy — the number of years living free from significant limitations that prevent you from doing everyday tasks — men have overtaken women over the past three decades. Women still live longer, but men live better longer.’
The conditions that affect a higher proportion of women than men are also among the most under-researched, creating a gap in medical understanding that affects how women are treated and perceived by health professionals.
This alone would probably mean that women go to the doctor more frequently than men. But women not only have to see doctors when they’re sick, they’re also often obliged to go for other reasons.
Some of these interactions involve health risks, and medical intervention might be necessary. But there’s no good evidence, for example, to support continued doctor visits over many years of taking the birth control pill.
In 2017 when New Zealand made the pill available over-the-counter at pharmacies after an initial GP assessment, the move was supported by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
The same move was proposed during an Australian state election in 2018 and was supported by women’s reproductive health NGOs such as Plan International and Marie Stopes.
But the Australian Medical Association— the peak body for doctors—opposed the proposal because it ‘would be a missed opportunity for preventative health screening and checks that go along with going to a doctor for a repeat script’. Try to imagine a major medical organisation forcing men to go to the doctor for a condom prescription just as a method of checking up on them.
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One experienced male physician tells me to investigate why doctors must be involved in dispensing the morning-after pill — which, he says ‘is safer than Panadol [paracetamol]’. There’s simply no case for requiring a medical prescription for the morning-after pill, he says, other than an attempt to restrict access.
Other hormonal contraceptives require medical skills for insertion, like IUDs and Implanon, but after insertion, you’re on your own for months or years at a time, so why not with the pill? The oral contraceptive pill and the morning-after pill could easily be dispensed by licensed pharmacists with some control measures put in place.
He also urges me to investigate why abortion isn’t routinely performed in Australian public hospitals. ‘If it’s a legal right, it should be performed in the public system,’ he says. While abortions should obviously be performed by doctors — even medical abortions (those caused by taking a tablet) require medical monitoring because of the health risks involved — they should be performed by more doctors.
In other words, there’s an imbalance between forcing women to see doctors when it’s unnecessary for their health and forcing doctors to see women when it is necessary for their health.
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The near-constant interactions that women must have with health professionals over the course of their lives means the relationship between a woman and her doctor is important. But these interactions take place in a sexist society, which influences this relationship.
Gynaecologist and pain physician Dr Susan Evans is adamant that healthcare is sexist — but not because doctors hate women. Rather, she says, it’s an accumulation of lots of ‘little things’.
‘It’s everything from our cultural backgrounds, which haven’t been pro-women; it’s the fact that women’s pain is pain you can’t see; the fact that our society in general doesn’t listen to women; it’s the fact that pain symptoms are described [by women] in ways that men don’t appreciate; it’s the non-prioritising of issues of importance to women, and that covers the undervaluing of gynaecology compared to other specialities,’ she says.
‘So it’s in the undervaluing of the skills [involved in treating women], it’s the undervaluing of listening, it’s the lack of provision of services . . .; it’s the lack of women in decision-making roles . . .; it’s the sexual connotations that women are not supposed to talk about things “down there”; it’s the economic ability of women to pay for things, which is diminished . . . The add up is not that anybody is particularly mean and nasty, it’s just that every step of the way, the women’s stuff is deprioritised.’
Pain and Prejudice by Gabrielle Jackson is out now (£14.99, Little, Brown).
Gabrielle Jackson is the opinion editor for Guardian Australia. She was previously a senior reporter for The Hoopla and her work has appeared in the Village Voice, CNN, The Sydney Morning Herald and New Matilda.