Jaimie Roebuck is a communications specialist at Women’s College Hospital in Toronto. Dr. Robin Mason is a scientist at Women’s College Research Institute and the scientific lead at Women’s Xchange. Dr. Paula Rochon is the vice-president of research at Women’s College Hospital, a senior scientist at Women’s College Research Institute and the lead at Women’s Xchange.
Although universal in name, Canada’s health-care system doesn’t always work the same for everyone. Women are not well-represented in research, and when they are included, the information isn’t reported in such a way that we can distinguish important data differences between the sexes. Yet when it comes to most other industries – fashion, footwear or personal care, to name a few – customization by sex and gender is the standard. So why should we settle for a “one-size-fits-all” model when it comes to our health care?
From research and treatment options to health policy and programs, sex and gender differences have not been adequately considered. Women’s needs, including physiological differences, cultural challenges and life circumstances, are often overlooked. This is the health gap, and taking these factors into consideration is no longer an option – it’s a necessity.
Sex and gender play an important role in affecting a patient’s health, their risk factors, how they experience health care and how health-care professionals provide care. Women, for instance, are more likely to report severe and long-lasting pain, but are typically treated less aggressively than men, and doctors often approach women’s pain as psychological or psychosocial and are more likely to refer women to a therapist rather than a pain clinic. Women also experience depression twice as often as men, yet are more likely to experience barriers when trying to access mental-health care. The prevalence of mental-health issues during the reproductive life stages (including pregnancy, postpartum and menopause) add to the complexity of care and treatment for women. Yet most mental-health research and therapy is based on the male experience. Each year, too, heart disease kills more women than men, yet less than half of patients in heart-disease research studies are women; women are also seven times more likely to be misdiagnosed mid-heart attack and sent home from emergency departments compared to men presenting with identical symptoms.
And the social determinants that often affect health outcomes are imbalanced. One in every five women is living in poverty, and for single women, the poverty rates are higher. More than half of single mothers and half of older women who live alone live below the poverty line. Physiological sex differences, like hormones, greatly impact how patients respond to treatment. The importance of accounting for sex during research is particularly important when developing drug therapies, as our sex can influence how our bodies absorb, metabolize and eliminate medications. Similarly, gender identities and their associated roles and responsibilities also shape our quality of health, behaviours and sometimes even the care we receive. In instances where women and men present with identical symptoms and conditions, they may be treated differently by health-care professionals.
Despite all these imbalances and the need for individualized care, women were excluded from most health-care and medical research studies up until as recently as the 1990s because researchers were thrown by our complex monthly hormonal changes and concerns that we might become pregnant during the study.
Many prescriptions, drug therapies and treatment protocols that are still used today have been disproportionally studied on men, and data are seldom reported separately for the two sexes, limiting the opportunity to tailor prescriptions for women and men.
When research studies do not report differences between women and men, we’re left with a less valuable view of best practices for proper prescribing techniques, effective treatment methods and outcomes. When data do not consider these differences, important information is missed and wasted. Research that incorporates and reports data reflective of the whole population benefits everyone. The inclusion of a sex-and-gender lens in health research creates evidence-based, effective and appropriate health-care policies for all.
Simply put: The routine inclusion of sex and gender data into health research leads to better care. Equal treatment, representation and access to health services should be our country’s mandate. It’s time to bridge the health gap, so that Canada’s universal health-care system lives up to its name.