More and more signals are pointing to gender inequalities in access to health care. Although they are more exposed, women are victims of under-diagnosis, renunciation of care, and difficulties in accessing treatment. At the root of this are persistent prejudices and social and economic factors that it is time to face up to Ms. Mariana Caillaud.
Health: women at greater risk The female advantage in life expectancy is increasingly put into perspective by the facts. Women spend on average 20.4 years of their lives in poor health (compared to 16.9 years for men). On average, they live longer with disabilities or in isolation. They are also 1.5 to 2 times more likely to suffer from a depressive episode* and are more likely to develop dementia or Alzheimer’s disease.
Older age does not explain everything, far from it: the world of work shows marked differences in health between men and women. Despite popular belief, women are more often victims of MSDs (musculoskeletal disorders) than men, and are more exposed to PSRs (psychosocial risks).
This is partly due to the fact that they are more represented in certain arduous jobs, particularly those requiring repetitive movements. In France, they are also over-represented in jobs involving contact with the public, or in shifts (with the exception of night work). The emotional burden, incivilities and violence suffered contribute to absenteeism, which is more marked among women. It is fueled by the fact that many have to cope with both the hardship of the job and domestic burdens.
Women’s health in the world
“No country is immune to the gender gap in health. During her lifetime, one in three women in the world is likely to be a victim of physical or sexual violence. This has serious consequences for health, whether in the form of injury, depression, or unwanted pregnancy” mentioned Ms. Caillaud.
Reproductive health is a source of terrible inequalities, at a time when the right to abortion is under attack even in the European Union. In 2017, an average of 810 women died every day from complications related to pregnancy or childbirth. 94% of these deaths occurred in low-income countries and are almost entirely preventable. Global reports link poverty to worsening women’s health in all countries. According to the WHO, most causes of premature female death are the result of poor habits in adolescence and adulthood, including smoking, physical inactivity, and poor nutrition.
29.3% of women have given up care in the last 12 months
In France, regardless of their professional situation, women are more affected by the phenomenon of giving up care, a real public health issue. According to a survey carried out by 18 CPAMs in 2016, 26.5% of insured persons have given up care in the past year. The percentage rises to 29.3% for women, compared with 23% for men.
Although the explanations are varied, one clear trend highlights the link between mental burden and refusal of care. Single-parent families are a key determinant of the renunciation of care. Women head 85% of these single-parent families (compared with 15% for fathers). Mental burden and women’s health Generally speaking, the tendency to take responsibility for those close to them (children or parents) is costly for women, who put their health in second place. It is in social representations that the gap needs to be bridged: according to an Elabe survey for Axa Prévention, 57% of women feel responsible for the health of their loved ones, compared with 3% of men.
This mental burden leads 71% of women to systematically accompany their relatives to consultations. At the end of the day, 81% of them admit to neglecting their health (compared to 75% of men). 70% only go to the doctor when they have no other choice.
The same survey underlines the lack of care for gynecological care (50% of women do not have regular check-ups), pathologies linked to stress, feelings of oppression or being overweight. The barometer of the renunciation of care (PFIDASS, 2019) shows that dental care and specialist consultations are among the most avoided forms of care. Women’s health: persistent prejudices Even when women access healthcare, they face a phenomenon that is as pernicious as it is unconscious: the under-diagnosis of women. Rooted in tenacious prejudices about women’s health, it is based on statistical inequalities between “women’s diseases” and “men’s diseases”. Whether real (in some cases) or fantasized, these have the effect of pushing many diseases, which often affect women, under the radar.
These gender-related prejudices still influence medical practices. Men’s diseases” include heart attacks, hemophilia, color blindness, lung cancer, cardiovascular diseases, etc.
To remind us that women can also be victims, INSERM and the CNRS have produced a series of short films called “Gender and health: beware of clichés”. They effectively dispel preconceived ideas (in both directions) about depression, osteoporosis, life expectancy, cardiovascular diseases, pain, the brain, etc. “These inequalities in 2022 call for a new approach to women’s health. Ease of access to care will be key. Mutual insurance companies, occupational health programs, and a change in mentality will be needed to tackle the core of one of the most persistent gender inequalities.”