A Medley of Potpourri

Saturday, November 11, 2023

Health in the United States

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Health_in_the_United_States

Health may refer to "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.", according to the World Health Organization (WHO). 78.7 was the average life expectancy for individuals at birth in 2017. The highest cause of death for United States citizens is heart disease. Infectious diseases such as sexually transmitted diseases impact the health of approximately 19 million yearly. The two most commonly reported infectious diseases include chlamydia and gonorrhea. The United States is currently challenged by the COVID-19 pandemic, and is 19th in the world in COVID-19 vaccination rates. All 50 states in the U.S. require immunizations for children in order to enroll in public school, but various exemptions are available by state. Immunizations are often compulsory for military enlistment in the United States.

Most schools within the United States require vaccination, beginning in the 1850s. This became a source of controversy across the country as individuals had opposed the mandate of vaccinations. and became a popular political debate in the following years as schools and locals became more passionate about their cause. Vaccination rates are currently declining in the United States, with one notable measles outbreak stemming from a popular Disneyland park and eventually spreading to 17 states across the United States.

Climate change has been effecting the United States by exacerbating existing health threats and creating new challenges for the healthcare community to face. Air pollution, wild fires, food and waterborne disease, and mental health crisis are all observable effects of climate change.

In the context of ensuring the continuation of medical services, concerns of a current and future shortage of medical doctors due to the supply and demand for physicians in the United States have come from multiple entities including professional bodies such as the American Medical Association (AMA), with the subject being analyzed as well by the American news media in publications such as Forbes, The Nation, and Newsweek. In the 2010s, a study released by the Association of American Medical Colleges (AAMC) titled The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 specifically projected a shortage of between 37,800 and 124,000 individuals within the following two decades, approximately.

Chronic conditions

As of 2003, there are a few programs which aim to gain more knowledge on the epidemiology of chronic disease using data collection. The hope of these programs is to gather epidemiological data on various chronic diseases across the United States and demonstrate how this knowledge can be valuable in addressing chronic disease.

In the United States, as of 2004 nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64. The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. The most common chronic conditions are high blood pressure, arthritis, respiratory diseases like emphysema, and high cholesterol.

Based on data from 2014 Medical Expenditure Panel Survey (MEPS), about 60% of adult Americans were estimated to have one chronic illness, with about 40% having more than one; this rate appears to be mostly unchanged from 2008. MEPS data from 1998 showed 45% of adult Americans had at least one chronic illness, and 21% had more than one.

According to research by the CDC, chronic disease is also especially a concern in the elderly population in America. Chronic diseases like stroke, heart disease, and cancer were among the leading causes of death among Americans aged 65 or older in 2002, accounting for 61% of all deaths among this subset of the population. It is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions. The two most common chronic conditions in the elderly are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported among the elder population.

In examining the statistics of chronic disease among the living elderly, it is also important to make note of the statistics pertaining to fatalities as a result of chronic disease. Heart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer's disease. Though the rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among elderly are nearly identical across racial/ethnic groups.

Chronic illnesses cause about 70% of deaths in the US and in 2002 chronic conditions (heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer's disease, mental illness and kidney diseases) were six of the top ten causes of mortality in the general US population.

Sexually transmitted diseases

Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. CDC estimates that there are approximately 19 million new STD infections yearly. The country experienced a reduction in reported STDs early in the COVID-19 pandemic, likely due to reduction in care devoted to them, but rates have rebounded in ensuing years. The two most commonly reported infectious diseases with 1.5 million total cases (2009) are chlamydia and gonorrhea. Adolescent girls (15–19 years of age) and young women (20–24 years of age) are especially affected by these two diseases.

Chlamydia

Chlamydia remains the most commonly reported infectious disease in the United States. There were more than 1.2 million cases of chlamydia (1,244,180) reported to CDC in 2009, the largest number of cases ever reported to CDC for any condition. The rate reached 1.6 million cases in 2020, which was actually a decrease from 2016.

Gonorrhea

There were 301,174 reported cases of gonorrhea in 2009 (10 percent less than in 2008), making gonorrhea the second most commonly reported infectious disease in the U.S. In 2009, the gonorrhea rate for women was slightly higher than for men. By 2020, there were more than twice as many cases reported, about 678,000, a 45% increase from 2016.

Syphilis

In 2009, there were 13,997 reported cases of primary and secondary syphilis — the most infectious stages of the disease — the highest number of cases since 1995 and an increase over 2007 (11,466 cases). The number of cases was ten times the 2009 figure by 2020, about 134,000, more than a 50% increase from 2016. According to a report from the Centers for Disease Control and Prevention on April 11, 2023, syphilis is now at a rate not seen since the 1950s, increasing by about 30 percent between 2020 and 2021, a big jump from syphilis rates recorded in the early 2000s, where only about 30,000 cases were recorded each year.

Specific outbreaks, plagues, and epidemics in the United States

Foodborne illness outbreaks in the United States

Vaccination

The Advisory Committee on Immunization Practices makes scientific recommendations which are generally followed by the federal government, state governments, and private health insurance companies.

All 50 states in the U.S. mandate immunizations for children in order to enroll in public school, but various exemptions are available depending on the state. All states have exemptions for people who have medical contraindications to vaccines, and all states except for California, Maine, Mississippi, New York, and West Virginia allow religious exemptions, while sixteen states allow parents to cite personal, conscientious, philosophical, or other objections. An increasing number of parents are using religious and philosophical exemptions; researchers have cited this increased use of exemptions as contributing to loss of herd immunity within these communities, and hence an increasing number of disease outbreaks.

The American Academy of Pediatrics (AAP) advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound). Under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect and should be reported to state child protective services agencies.

See Vaccination schedule for the vaccination schedule used in the United States.

Immunizations are often compulsory for military enlistment in the U.S.

All vaccines recommended by the U.S. government for its citizens are required for green card applicants. This requirement stirred controversy when it was applied to the HPV vaccine in July 2008 because of the cost of the vaccine, and because the other thirteen required vaccines prevent diseases which are spread by a respiratory route and are considered highly contagious, while HPV is only spread through sexual contact. In November 2009, this requirement was canceled.

Schools

The United States has a long history of school vaccination requirements. The first school vaccination requirement was enacted in the 1850s in Massachusetts to prevent the spread of smallpox. The school vaccination requirement was put in place after the compulsory school attendance law caused a rapid increase in the number of children in public schools, increasing the risk of smallpox outbreaks. The early movement towards school vaccination laws began at the local level including counties, cities, and boards of education. By 1827, Boston had become the first city to mandate that all children entering public schools show proof of vaccination. In addition, in 1855 the Commonwealth of Massachusetts had established its own statewide vaccination requirements for all students entering school; this influenced other states to implement similar statewide vaccination laws in schools as seen in New York in 1862, Connecticut in 1872, Pennsylvania in 1895, and later the Midwest, South and Western US. By 1963, 20 states had school vaccination laws.

These school vaccination resulted in political debates throughout the United States, as those opposed to vaccination sought to overturn local policies and state laws. An example of this political controversy occurred in 1893 in Chicago, where less than 10 percent of the children were vaccinated despite the twelve-year-old state law. Resistance was seen at the local level of the school district as some local school boards and superintendents opposed the state vaccination laws, leading the state board health inspectors to examine vaccination policies in schools. Resistance proceeded during the mid-1900s and in 1977 a nationwide Childhood Immunization Initiative was developed with the goal of increasing vaccination rates among children to 90% by 1979. During the two-year period of observation, the initiative reviewed the immunization records of more than 28 million children and vaccinated children who had not received the recommended vaccines.

In 1922 the constitutionality of childhood vaccination was examined in the Supreme Court case Zucht v. King. The court decided that a school could deny admission to children who failed to provide a certification of vaccination for the protection of the public health. In 1987, a measles epidemic occurred in Maricopa County, Arizona, and another court case, Maricopa County Health Department vs. Harmon, examined the arguments of an individual's right to education over the state's need to protect against the spread of disease. The court decided that it is prudent to take action to combat the spread of disease by denying un-vaccinated children a place in school until the risk for the spread of measles has passed.

Schools in the United States require an updated immunization record for all incoming and returning students. While all states require an immunization record, this does not mean that all students must get vaccinated. Opt-out criteria are determined at a state level. In the United States, opt-outs take one of three forms: medical, in which a vaccine is contraindicated due to a component ingredient allergy or existing medical condition; religious; and personal philosophical opposition. As of 2019, 46 states allow religious exemptions, with some states requiring proof of religious membership. Only Mississippi, West Virginia, California and New York do not permit religious exemptions.18 states allow personal or philosophical opposition to vaccination.

Over the last decade vaccination rates have been declining in the United States. Although the rate is fairly limited on a larger scale, vaccine-preventable disease outbreaks are occurring in pockets across the U.S. “In 2012, exemption rates ranged from a low of approximately 0.45 percent in New Mexico, to a high of 6.5 percent in Oregon. The outbreaks have significant correlations with unvaccinated children, and state policy exemption processes. California, which is currently in the process of changing its state exemption policies, dealt with a 2015 measles outbreak stemming from the popular Disneyland park. Significantly, most of the afflicted were unvaccinated, which eventually spread to over 17 separate states across the U.S. If the federal government works to provide an equal vaccination regulation nationally, immunization rates should begin to rise, while preventable outbreaks should diminish.

Old age

In 1790, people over the age of 65 were less than 2% of the American population. In 2017, they were about 14%.

Impact of climate change on health

Climate change continues to affect every country in the world and the United States is no exception. In the U.S. the average temperature has increased between 1.3°F - 1.9°F since record keeping began in 1895, with most of the increase having occurred since about 1970. Additionally, hurricanes and winter storms have increased in both intensity and frequency and the length of the frost-free season has been increasing nationally since the 1980s, affecting ecosystems and agriculture. Climate change and climate variability has many potential effects on the health of Americans. It can exacerbate existing health threats or create new public health challenges through a variety of pathways. It is also important to note that although all Americans will face some health effect from climate change, certain individuals are more vulnerable than others due to levels of exposure, sensitivity, and ability to adapt (See Table).

Determinants of Vulnerability of Human Health to Climate Change
Determinant	Definition	Example
Exposure	The degree to which an individual is susceptible to contact with a stressor induced by climate change.	A family in a low-income NYC neighborhood may not be able to afford air conditioning and therefore be more likely to die of heat stroke.
Sensitivity	The degree to which the individual could be harmed by the exposure.	A child with asthma is more susceptible to negative health effects from poor air quality than his classmates.
Ability to Adapt	The degree to which the individual can adjust and respond to a harmful situation caused by the exposure.	Someone with a physical disability may have a tougher time evacuating during a storm warning.

The Center for Disease Control (CDC) has identified nine national health topics relating to climate change.

1. Air pollution

Ground-level ozone (a key component of smog) is associated with multiple health problems. Examples include diminished lung function, increased hospital admissions and emergency room visits for asthma, and increases in premature deaths. Health-related costs of the current effects of ozone air pollution exceeding national standards have been estimated at $6.5 billion (in 2008 U.S. dollars) nationwide, based on a U.S. assessment of health impacts from ozone levels during 2000–2002.

2. Allergens and pollen

Climate change will potentially lead to shifts in precipitation patterns, more frost-free days, warmer seasonal air temperatures, and more carbon dioxide (CO2) in the atmosphere. These occurrences will lead to both higher pollen concentrations and longer pollen seasons, causing more people to suffer more health effects from pollen and other allergens. In a recent study looking at pollen metrics from 60 metric stations in North America between 1990 and 2018 scientists found that pollen seasons were starting up to 20 days earlier and lasting for up to eight days longer.

3. Diseases carried by vectors

Within the United States the impact of climate change from domestically acquiring diseases is uncertain due to vector-control efforts and lifestyle factors, such as time spent indoors, that reduce human-insect contact. However, the impact on the geographical distribution and incidence of vector-borne diseases in other countries where these diseases are already found can still impact Americans, especially due to travel and trade.

4. Food and waterborne diarrhea

Diarrheal diseases are more common when temperatures are higher, although location and pathogen can also affect the pattern. Extremely high and low precipitation has also been linked to an increased frequency in the occurrence of diarrheal diseases. Additionally, sporadic increases in stream flow rates, often followed by rapid snowmelt and changes in water treatment, have also been linked outbreaks. Risks of waterborne illness and beach closures resulting from changes in the magnitude of recent precipitation (within the previous 24 hours) and in lake temperature, are expected to increase in the Great Lakes region because of climate change. In the United States, those who are exposed to inadequately or untreated groundwater are most likely to be affected. Additionally, children and the elderly are most vulnerable to serious outcomes.

5. Food security

Food production, quality, distribution, and prices can all be affected by climate change. Not only are crops affected by changes in rainfall and extreme weather, but livestock and fish are also being impacted. The related health effects will vary. Due to rising prices, poor persons will turn to “nutrient-poor but calorie-rich foods and/or they endure hunger, with consequences ranging from micronutrient malnutrition to obesity.” Additionally, nutritional quality will be impacted because “elevated atmospheric CO2 is associated with decreased plant nitrogen concentration, and therefore decreased protein, in many crops, such as barley, sorghum, and soy. The nutrient content of crops is also projected to decline if soil nitrogen levels are suboptimal, with reduced levels of nutrients such as calcium, iron, zinc, vitamins, and sugars. This effect can be alleviated if sufficient nitrogen is supplied.”

6. Mental health and stress related disorders

Extreme weather and high temperatures can affect mental health in a variety of ways for both individuals with, and without preexisting mental health conditions. Additionally, the symptoms can be short-term or long lasting. For example, studies done after Hurricane Katrina hit the United States Gulf Coast showed that children affected by the hurricane have found high rates of depression, anxiety, behavioral problems and post- traumatic stress disorder (PTSD).

7. Precipitation extremes

The United States has seen an increase in the frequency of heavy precipitation events, and the upward trend is supposed to continue throughout the different regions of the country. These events such as floods and droughts present immediate risks to the health of Americans during the occurrence but can also affect health in the period following the catastrophe. For example, flooding can cause water damage to buildings leading to mold or need for demolition. These events can necessitate the forceful relocation of an entire family which may be distancing them from schools, primary doctors and other resources that they may have gotten used to.

8. Temperature extremes

Increasing concentrations of greenhouse gases lead to an increase of both average and extreme temperatures. This is expected to lead to an increase in deaths and illness from heat and a potential decrease in deaths from cold. Days that are hotter than the average seasonal temperature in the summer or colder than the average seasonal temperature in the winter cause increased levels of illness and death by compromising the body’s ability to regulate its temperature or by inducing direct or indirect health complications. Loss of internal temperature control can result in a cascade of illnesses, including heat cramps, heat exhaustion, heatstroke, and hyperthermia in the presence of extreme heat, and hypothermia and frostbite in the presence of extreme cold. Temperature extremes can also worsen chronic conditions such as cardiovascular disease, respiratory disease, cerebrovascular disease, and diabetes-related conditions. Prolonged exposure to high temperatures is associated with increased hospital admissions for cardiovascular, kidney, and respiratory disorders.

9. Wildfires

In 2021 we have seen an increase in the news and social media coverage about wildfires spreading throughout California as shown in the image at the end of the section. No doubt, one of the many effects of climate change, these wildfires have many harmful (short and long term) effects on the health of Americans. Not only do many people lose their homes, livelihoods and even lives in these fires, but smoke exposure has many negative effects on physical health as well. It increases respiratory and cardiovascular hospitalizations; emergency department visits; medication dispensations for asthma, bronchitis, chest pain, chronic obstructive pulmonary disease, and respiratory infections; and medical visits for lung illnesses.

Impact of poverty on health

Poverty and health are intertwined in the United States. As of 2019, 10.5% of Americans were considered in poverty, according to the U.S. Government's official poverty measure. People who are beneath and at the poverty line have different health risks than citizens above it, as well as different health outcomes. The impoverished population grapples with a plethora of challenges in physical health, mental health, and access to healthcare. These challenges are often due to the population's geographic location and negative environmental effects. Examining the divergences in health between the impoverished and their non-impoverished counterparts provides insight into the living conditions of those who live in poverty.

A 2023 study published in The Journal of the American Medical Association found that cumulative poverty of 10+ years is the fourth leading risk factor for mortality in the United States, associated with almost 300,000 deaths per year. A single year of poverty was associated with 183,000 deaths in 2019, making it the seventh leading risk factor for mortality that year.

Occupational sexism

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Occupational_sexism

Occupational sexism (also called sexism in the workplace and employment sexism) is discrimination based on a person's sex that occurs in a place of employment.

Social role theory

Social role theory may explain one reason for why occupational sexism exists. Historically women's place was in the home, while the males were in the workforce. This division consequently formed expectations for both men and women in society and occupations. These expectations, in turn, gave rise to gender stereotypes that play a role in the formation of sexism in the work place, i.e., occupational sexism.

According to a reference, there are three common patterns associated with social role theory that might help explain the relationship between the theory and occupational sexism. The three patterns are as follows:

Women tend to take on more domestic tasks;
Women and men often have different occupational roles; and as well as pay gap
In occupations, women often have lower status

These patterns can work as the foreground for the commonality of occupational stereotypes.

An example

One example of this in action is the expectancy value model. This model describes how expectancies may be linked to gender discrimination in occupations. For example, women are expected by society to be more successful in health-related fields while men are expected to be more successful in science-related fields. Therefore, men are discriminated against when attempting to enter health-related fields, and women are discriminated against when attempting to enter science-related fields.

Social role theory effects

History

Occupational sexism is caused by the social role theory and different stereotypes in society. The social role theory has many effects on women, many of them pertaining to occupations. Before World War II, women were usually found in the home, performing traditionally womanly duties such as cooking, cleaning, and taking care of children. However, since World War II, women have shifted the gender roles and have begun performing the jobs that men would have typically been performing, such as joining the military, becoming mechanics, driving trucks, etc. The original occupations women participated in were based on the social role theory, but women have been attempting to counteract the theory by participating in jobs that would be seen as "unusual" for them.

Stereotypes

Despite multiple acts attempting to seal the gap between women and men in the workplace, women still face issues based on stereotypes embedded in society caused by the social role theory. Whether it is intentional or not, there is discrimination of women based on gender-related stereotypes. It has been studied by Tiina Likki, who is a part of a Behavioral Insights Team, that removing stereotypes about women in occupations is difficult because, despite job training, people still acquire stereotypical thoughts. Many stereotypes are embedded into our lives through society, which causes a constant continuation. This makes it difficult to steer away from these stereotypes as they have been prominent in society for hundreds of years.

Continuation of Sexism

The place where women choose to live and work determines the sexism that is encountered.

Trouble Advancing in Occupations

In occupations, women rarely are awarded managerial positions. This is caused by sexual roles within organizations. Men are viewed as superior in occupations because of the stereotype that they are stronger and more capable of dealing with their emotions than women. This is a possible reason for why women have trouble obtaining positions in occupations that put them above men. If women were to rise to a higher position in an occupation, there is likelihood that they will be treated differently than if a male were to obtain that same position.

Fights against the theory

The idea of gender roles has caused different reactions in women in modern society as well. Women have been fighting against gender roles and the stereotype that women can only perform certain duties in occupations. There is an entire feminist movement that focuses on the inequality of women in different aspects of society, including the treatment of women in occupations based on gender roles. Feminists have been working towards gaining equality between men and women and eliminating the social role theory, along with stereotypical assumptions, to ensure women obtain and keep their basic human rights.

Emotion politics

Sexism also arises in the workplace through the beliefs concerning which emotions are appropriate for employees to show. Stereotypically, women are expected to be kind and nurturing, communal, and modest, while they are not expected to display anger. Expressing an emotion that doesn't line up with people's beliefs about gender-appropriate behavior could lead to being given a lower status at work, and consequently, a lower wage.

A 2008 study found that men who expressed anger in the workplace were given a higher status, while women who expressed anger in the workplace were given a lower status, regardless of their actual position in the company. A trainee and a CEO who were female were both given a low status when displaying anger. Additionally, women who displayed anger in the workplace were assumed to have something internal influencing their anger, as opposed to having an external reason to be angry. Men more often had their anger attributed to an external cause.

The expression of anger is believed to be related to status, as anger is considered a status emotion. Positive impressions of those who display anger are reserved for people who are stereotypically conferred a higher status. A 2007 study found that male employees who were in a subordinate position in the workplace displayed anger toward higher status employees, while female employees in a subordinate position displayed anger toward higher status employees much less frequently. This suggests that the stereotypical norm of men displaying anger carries over into the workplace, while the norm of women restraining displays of anger also carries over. It also suggests that, although men in low level positions in the workplace possess a low status in this context, they may carry over the higher status that comes with their gender into the workplace. Women do not possess this high status; therefore the low status that low-level women possess in the workplace is the sole status that matters.

Some markers

Wage discrimination
Systematic sex-based hiring and promotional practices (when employers do not hire or promote a person who is "otherwise apparently qualified for a job" solely on the grounds that they are a woman or man)
Sexual harassment
The belief that certain occupational fields or types of jobs, particularly those that are degrading and/or low-paying, are "women's work" or those that are dangerous and/or hazardous are "men's work"
Occupational fatalities
Disparity in retirement age (men work longer than women)

Research

Discrimination against men in the workplace is underinvestigated. OECD reports often include effects against women, but not for men.

Wage discrimination

Howard J. Wall, an economist for the Federal Reserve Bank of St. Louis, states that women make a median hourly income that was equal to 83.8 percent of what men make. In the late 1980s, studies saw that about a fair amount of the gender pay gap was due to differences in the skills and experience that women bring to the labor market and about 28 percent was due to differences in industry, occupation, and union status among men and women. Accounting for these differences raised the female/male pay ratio in the late 1980s from about 72% to about 88%, leaving around 12 percent as an "unexplained" difference.

Death at work

The majority of occupational deaths occur among men. In one US study, 93% of deaths on the job involved men, with a death rate approximately 11 times higher than women. The industries with the highest death rates are mining, agriculture, forestry, fishing, and construction, all of which employ more men than women. Deaths of members in the military is currently above 90% men.

Causes of wage discrimination

Sociologists, economists, and politicians have proposed several theories about the causes of gender wage gap. Some believe that woman's salaries are based on the career path that women choose. They stipulate that the women chose low-paying jobs, clerical work, and to work in services (see also Pink-collar worker). This is said to be relatively true at time because many women who select these careers find it easier to continue working these simple jobs rather that quit them if they choose to raise a family.

Sexism in academia

Universities have been blamed for being sexist in their hiring decisions. In particular, men have been reported to be biased towards male applicants. However, recent data suggest that women have caught up, at least when it comes to the number of faculty positions offered to women (see Table).

Field	% of applicants	% of applicants interviewed	% of applicants offered position
Physics	12	19	20
Biology	26	28	34
Chemistry	18	25	29
Mathematics	20	28	32

Data in table from 89 US universities where women were interviewed for tenure-track jobs.

Challenging occupational sexism

Occupational sexism become institutionalized in the U.S. today when women were originally able to join the workforce by men primarily in the 20th century and were paid up to two-thirds of what male's income were. Since then it is now thought of as "good business" to hire women because they could perform many jobs similar to men, yet give them lesser wages. Groups like the American Civil Liberties Union and the National Organization for Women are established to fight against this discrimination, leading to the creation of groundbreaking laws such as the Equal Pay Act of 1963. However, identifying and challenging sex discrimination in the workplace (on legal grounds) has been argued as being extremely difficult for the average person to attempt and even harder to prove in court.

One successful sexism case that reached the U.S. Supreme Court was Price Waterhouse v. Hopkins. Ann Hopkins, a senior manager at Price Waterhouse, sued her employer, arguing that failure to promote her to partner stemmed not from her abilities—which had been undeniably stellar—but from certain partners thinking she didn't carry herself in a feminine-enough manner. The Supreme Court ruled 6–3 in Hopkins' favor, and a lower court ordered her employer to award her partnership and pay her back wages lost during the case.

Another Supreme Court case, Ledbetter v. Goodyear Tire & Rubber Co., saw a judgment in favor of plaintiff Lilly Ledbetter—which had awarded her back pay and damages for several years of receiving disproportionately low pay in comparison to her male counterparts—overturned because she waited too long to file suit. After a 5–4 decision, the majority cited reasoning that "Federal law states that 'employees must file their discrimination complaints within 180 days of the incident,'" a task that dissenting Justice Ruth Bader Ginsburg claimed was unreasonable considering that quite often women have no reason to suspect discrimination until certain unfair patterns develop and they are made aware of them.

Gender discrimination in the medical profession

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Gender_discrimination_in_the_medical_profession

Gender discrimination in health professions refers to the entire culture of bias against female clinicians, expressed verbally through derogatory and aggressive comments, lower pay and other forms of discriminatory actions from predominantly male peers. These women face difficulties in their work environment as a result of a largely male dominated positions of power within the medical field as well as initial biases presented in the hiring process, but not limited to promotions.

Men who are nurses are often subjected to stereotypic treatment as a result of being in a largely female dominated field. These stereotypes include patients assuming sexual orientation, job title, or not feeling comfortable with a male nurse.

Medical education

Women are underrepresented in leadership positions in academic medicine. Women and men begin their medical careers at similar rates but they do not advance at the same rate. Studies indicate a systematic bias that has resulted in relatively fewer appointments to academic chairs. 32% of associate professors at medical schools are women, 20% of full professors are women, 14% of department chairs are women, and 11% of deans of medical schools are women.

A factor that impedes women's opportunities for advancement in academic medicine is a "stereotype-based cognitive bias". There are two forms of this. The first type is related to clear personal beliefs about women, such as believing that women are less committed to their careers than men and believing that women are worse leaders than men. The second type is implicit bias, which is harder to see because the biases are harder to see, but they still influence one's judgment and actions towards women. Although implicit gender bias still plays a role, explicit bias in academic medicine has significantly decreased during the past half century in the United States as a result of Title IX getting passed. Implicit bias has had little to no improvement. Cultural stereotypes characterize women as "communal", such as kind, dependent, and nurturing, but characterize women as lacking "agentic" traits, such as logical, independent, and strong, which are typically used as a male stereotype. These stereotypes make it difficult for women to achieve in the workforce, specifically in medicine, science, and in leadership. While men are associated with "agentic" traits and women are not, this can lead to women feeling that their work is less valued and they typically receive fewer nominations for opportunities that can advance their career. It has also been found that gender stereotypes play a role in socializing students towards their specialties. For example, women are more likely to go into communal specialties, including family medicine, pediatrics, and internal medicine, while men are more likely to go into surgery, research, and be the chair of a position. If women to go into specialties dominated by males, they typically have lower statuses. Residency is the first time the medical students, or new physicians, get to be in a leadership role. Men who are too communal can be accused of being "wimpy" or "soft" whereas women who are too agentic can be accused of being "bossy" or "domineering".

These stereotypes are due to the lack of gender awareness and role models. Female medical students have reported sexual harassment and discrimination. This is of concern because these obstacles affect "the professional identity formation and specialty choice". Personality differences exist between male and female surgical students. Fewer women choose to specialize in surgery. The lack of female role models may discourage some from choosing a surgical career.

A study by the National Medical Foundation found that 60% of women have reported that gender has had an effect on their educational experience whereas only 25% of males have reported that gender has had an effect on their educational experience. Women said they felt as though they had to be twice as good to be treated equal to men. Additionally, 30.7% of women reported overcoming fear and failure whereas only 19.4% of males reported overcoming fear and failure in education

One response to bias against women academics has been to conduct training for faculty and students to recognize bias and change their habits. The study used professional development, counseling psychology, adult learning, and health behavioral change to development a bias-learning training where data showed that gender biases and habits were not permanent and that they could be shaped and changed.

There is also a persisting class and race gap that is being ignored by contemporary feminist debate, as the discussion about feminism in the medical profession tends to place "too much focus on the opportunities afforded to educated middle class women", most of them white.

Another aspect to look at, is the representation that is seen in the medical education system. The medical education system teaches in the aspect that every patient is a 75-kilogram, white male. Throughout textbook, research, etc. the chances of the patient being a female, especially one of color, is very low. David C. Page, MD, the director of a biomedical research organization, stated in an interview that many areas of biomedical research still use a male-only approach as the standard practice.

Female clinicians

While both men and women are enrolling in medical school at similar rates, in 2015 the United States reported having 34% active female physicians and 66% active male physicians. The lower rates of practicing female physicians is associated with their higher rates of experiencing: sexual assault, wage disparities, gender norms, sexism, and medical school sabotage.

Sexual assault

According to a Medscape survey, more than 10% of female physicians have experienced workplace sexual assault compared to just 4% of men. Among women who have experienced sexual assault and harassment, 50% stated that this experience negatively impacted their career advancement. Sexual harassment is common amongst younger clinicians when they come in contact with male clinicians in power who have more seniority over them. Due to their sense of power over their coworkers and employees, they feel empowered to commit acts of sexual assault. In many cases, female survivors of sexual assault fail to come forward and report these crimes because they are labeled "troublemakers" and have a hard time finding new employment. As a result of this, and Human Relations typically functioning to protect the company/hospital rather than the survivor, female physician survivors are unlikely to report their experiences, resulting in future female physicians also remaining silent if abused, thus continue the cyclical cycle of misconduct within the medical system.

Wage gap

Besides experiencing greater rates of sexual assault in the workplace, female surgeons are also subject to the wage gap. Females were reported to have lower salaries than male surgeons. In a study conducted in 1990, male clinicians were making a mean earnings of $155,400, while female clinicians were making a mean earnings of $109,900; about $45,500 less than their male counterparts. As of 2016, female physicians have statistically been found to make about $18,677 less than male physicians. Pay disparities for female physicians has also been blamed on women not wanting to commit to leadership roles which pay higher salaries. Besides gender biases, it is also believed that female physicians are paid less because they are more likely to bill their patients less (as they fear their patient will be unable to pay their bill) and are less likely to be aggressive when negotiating their salary and contract.Despite female physicians making less money and being less likely to bill, a study done in 2017 across 24.4 million primary care offices showed that they are often the ones spending more time in direct patient care per visit, per day, and per year.

Communal specialties, which women are more likely to go into, often have a lower pay than the specialties in which men typically go into. Women have been found to have a larger representation than men in lower-paying specialties, such as pediatrics and men lave a larger representation in higher-paying specialties, such as cardiology and surgery. In New York State between 1999 and 2008, the average starting salary for men was $187,385 whereas the mean starting salary for women was $158,727. In 2001, it was found that male physicians earned roughly around 41% more than their female colleagues. As of 2017, an updated version then found that the percentage had dropped to roughly around 27.7%. That is roughly around a 100,000 dollar difference in salary per year. However, women who work in radiology are the only women who make more than their male colleagues—the difference is only about 2,000 dollars. A study published in 2005 found that women physicians in the US had an annual earning gap of 11% if they were married, 14% if they had one child, and 22% if they had more than one child. Women typically had household obligations that affected their ability to work as much as men and therefore led to a trade-off of higher earnings for family-friendly jobs.

Traditional gender norms

Traditional gender norms are another barrier female physicians face in the medical field. According to research, having children is a career stopper for female physicians. It is reported that approximately 30% of female physicians have faced discrimination for either being pregnant or needing to breastfeed/pump. Besides this, female physicians are seven times more likely to not work part time when compared to men as their maternity leaves are on average four weeks shorter than what the American Academy of Pediatrics recommends. It was found that the percentage of female clinicians working part-time in either a hospital setting or a general physician's office after having a child is much higher than the percentage of these women working full-time after having a child (92.7%, 96.3% 59.2%, 76.5% respectively). Along with this, female physicians are often paid less because traditional gender norms put child rearing responsibilities on the mother. In addition to already having a stressful job, research shows that the amount of domestic tasks and responsibilities, as well as family care is still the same. This led to the concept of having a work-life balance being more challenging for women.

Patient sexism

Furthermore, female physician narratives have described instances of sexism. Female physicians are often mistaken for nurses by patients. Patients have also been reported to have less trust in their physician if they are female and instead ask for a second opinion from a male physician. Women physicians, on the other hand, have also been found to partake in sexist actions. Female clinicians often treat women patients differently than they do men. Women physicians were found to admit less female patients to intensive care units because they were proactive in treating them in the emergency room, rendering their admittance to more intense care units unnecessary.

Medical school sabotage

Female physicians also face gender bias in medical schools. In 2018, Tokyo Medical University lowered the test scores of its female applicants. Since 2006, the university has been subtracting points from the exams of female applicants while adding, on average, 20 points to the exams of male applicants.

Unfair testing scores are not the only thing that are troubling in medical school; women, especially in more recent times, have been the majority group at medical school, they still face discrimination as men are often given the "decision-making" positions/ supervising positions at medical institutions. This creates a gap for mistreatment through faulty (sexist, discriminating,& etc.) supervisors.

More recently, the percentage of women being admitted to medical school (50.5%) is higher than men (48.5%). Even with an increase in racial and ethnically diversity amongst both genders, there is still underrepresentation in the actual medical profession.

Women in leadership positions

Cardiovascular medicine

From a broad perspective, women hold a larger number of leadership roles in politics and in the workforce than ever before in the United States. Yet, the cardiology specialty remains dominated by men, being that in 2015, only 13.2% of cardiologists were women. Surveys have shown that the reasoning behind this may be due to a desire for a better work–life balance for women and a negative perception of cardiology. Although there is a discrepancy in the number of female physicians specialized in cardiology, women in cardiology have become more involved in leadership roles. These roles may be in research science, health systems administration, professional societies and clinical practice. In scientific research, women have made an impact in scientific inquiry and investigation into the causes and treatments of cardiovascular disease. In leadership roles for the professional cardiology societies, women have increasingly become more involved worldwide. In educational systems, women have become more involved in cardiovascular service and in serving as clinical chiefs and program directors. However, there is still a gap in the number of women serving as deans, chairs of departments, and university presidents. Women make up only 15% of medical school deans and interim deans. Studies have found that women tend to not advance at the same rate as men in the medical field. This could be due to women not receiving independent grants, publications, and leadership positions. Additionally, differences in pay could be attributed to implicit gender and maternal bias. Implicit bias can affect hiring and promoting of women in the medical field because of a belief that women should be held at a higher standard than their male peers. Overall, underrepresentation in the medical field could influence patient care and outcomes. Diversity promotes health equity, and the medical field is continually improving its efforts toward finding the root of the problem of under-representation of women in the medical field.

Obstetrics and gynecology

In 2018, 59% of gynecologists were women, yet there still is a pay gap based on gender in this specialty. Female obstetrician-gynecologists face barriers in advancing into leadership positions and earn around $36,000 less a year than their male counterpart. Although sexism in the medical field has often been associated with women, discrimination has been noted by male populations of obstetricians-gynecologists. Male obstetricians-gynecologists can be negatively impacted by a patient's desire to have a female clinician for a woman's health care needs. Due to socially prescribed roles for men and women, men are often discouraged from entering this specialty and can receive judgement based on unconscious or conscious bias.

A 2018 study, published in the Journal of Obstetrics and Gynecology, found that women in obstetrics and gynecology faced discrimination based on differences in salary, and men in obstetrics and gynecology faced discrimination based on patient preferences.

Gender roles

According to a study done in 2003, the numbers of women in medicine have increased significantly. This trend continues into today. Gender difference have been found in the motivations for applying to medical school. Studies suggest that "male applicants are more motivated by financial, prestige, scientific and technical issues, whereas female applicants stress more "person orientated humanistic and altruistic reasons". Gender differences have also been found in "attitudes toward health promotion".

In addition, male and female clinicians are likely to use different styles of communication. Male doctors were found to be more likely to "speak in an authoritative manner, give direct commands to patients, interrupt more, are perceived as more imposing and presumptuous, spend less time with patients, make fewer positive statements and smile and nod less". Some studies have found that female doctors "provide more intensive therapeutic milieu that could lead to more open exchange and comprehensive diagnosis and treatment". In addition, females have been found to take more precautionary measures and give more tests than men are.

There is also a connection between gender roles in the medical field and family pressures. A 2020 study performed by the British Medical Journal analyzed how doctors combined their working lives with having a normal family life. This study analyzed three different strategies used by men and women in order to cope with managing a normal family life and a work-heavy career. The three different types of strategies that men and women use are "career dominant, segregated, and accommodated". When it comes to the career dominant strategy, about 15% of women and 3% of men adopt this strategy. This strategy "implies a continuous, full time career and a reduced family life—living single or divorced and childless as a consequence of the career". The segregated strategy is composed of 55% of women and 85% of men, and it "implies a continuous, full time career with family roles organized so as to enable more time to be devoted to the career". And lastly, the accommodating strategy is adopted by 30% of women and 12% of men. This strategy "implies that work involvement has been reduced in some way to allow more time for family roles". As can be seen by these statistics, men are more likely than women to devote more time to their job as opposed to their family.

A 2019 study found that female doctors have higher rates of burnout, while 73% of respondents said gender discrimination "has diminished their morale and career satisfaction".

Stereotype threats

A stereotype threat is observed when a stigmatized group is in a situation where negative stereotypes are often used in interpreting their behavior, and the risk of being judged by these stereotypes can elicit a disruptive state that undermines performance and aspirations. As discussed earlier, there are less women in leadership positions in academic medicine. Descriptive and prescriptive gender stereotypes affect women in these roles. A descriptive component consists of beliefs about the inherent characteristics of men and women. At the center of these beliefs is that women are more nurturing, sympathetic kind and caring. Men are often described as agentic or assertive, ambitious and independent. Stereotype threats against women are especially common for women in leadership roles. The stereotype-based perspective towards women has been used to explain the lack of fit for leadership roles in medicine. These stereotypes canter on perceived characteristics, skills and aspirations of women and how they have been perceived to not coincide with what us valued for effective leadership. In a twenty-year study done on stereotype threats, researchers found that stereotype threats can increase feelings of anxiety, mind-wandering, negative thinking, and can decrease the function of working memory. A functional working memory is needed to successfully execute a task in many scenarios. This study also found that individuals experiencing stereotype threats may find it necessary to negate these threats and put forth effort to suppress these thoughts which can be inconsistent with the goals of the task.

Many women face various forms of harassment due to stereotypes held by male coworkers/supervisors as well as their own patients. In a twitter tweet, Dr. Marjorie Stiegle asked her fellow healthcare peers to share their stories on gender bias in medicine. Although she only needed 30 replies, over 200 replies (mainly women) stated they faced a lot of harassment over wanting to or to not have children. Some women quoted they were told that they could not be a mother and a doctor. Some women share their experiences with patients bringing up their body, looks, and the topic of children in unnecessary situations. Although the tweet was supposed to originally be used for a podcast, it ended up showing the different forms of harassment that women and men face in the medical field.

Male clinicians

Males make up approximately 12% of nurses in the United States. Unfortunately, when men enter the profession of nursing, they may encounter barriers that limit their choice of specialty. They run the risk of being labeled and stereotyped, in addition to being relied upon excessively for their strength in lifting patients. These gender biases and role stereotyping occur because many people retain the notion that caring for others is a feminine task, and thus beneath the status of the male.

In a British study, it was reported that the majority of subjects assumed that a nurse referred to a female. This type of stereotyping of men is related to nursing being considered a profession for women. Men tend to face two common stereotypes when it comes to being nurses. The first being the stereotype that male nurses are gay since they are in a "feminine occupation". The other common stereotype is that men are generally hypersexual and that this will inhibit them from being able to provide intimate care to women in nonsexual ways.

Male nurses report being told that a female nurse is preferred and being teased as a child for wanting to be a nurse.

Other questions are often asked of male nurses such as 'why did you go into nursing'? Or they are asked if they are gay, failed medical school, or became a nurse because it was easier. Sometimes a male nurse can be asked if he is a nurse so that he can see undressed women. In some instances male nurses were assumed to be the 'muscle' for other female nurses.

Male nurses may be passed over for work with female patients, or disallowed on birthing or gynecological units, while male physicians are completely welcome in these situations. In addition, male nurses find that they are pushed toward tasks that are stereotypically consistent with their gender role. Some of these might include heavy lifting, administrative roles, or psychiatric nursing.

Despite these drawbacks, male nurses on average make more money than their female counterparts, mostly due to them performing higher-paying tasks.

Gender bias in medical diagnosis

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Gender_bias_in_medical_diagnosis

Gender-biased diagnosing is the idea that medical and psychological diagnosis are influenced by the gender of the patient. Several studies have found evidence of differential diagnosis for patients with similar ailments but of different sexes. Female patients face discrimination through the denial of treatment or miss-classification of diagnosis as a result of not being taken seriously due to stereotypes and gender bias. According to traditional medical studies, most of these medical studies were done on men thus overlooking many issues that were related to women's health. This topic alone sparked controversy and brought about question to the medical standard of our time. Popular media has illuminated the issue of gender bias in recent years. Research that was done on diseases that affected women more were less funded than those diseases that affected men and women equally.

History

The earliest traces of gender-biased diagnosing could be found within the disproportionate diagnosis of women with hysteria as early as 4000 years ago. Hysteria was earlier defined as excessive emotions; adapted from the Greek term, "Hystera", meaning "wandering uterus". These terms stemmed from mind-body associations regarding the uterus affecting women's overall health, especially emotionally and mentally. Within a medical setting, this hysteria translated to the over exaggeration of symptoms and ailments. Because traditional gender roles usually place women at a subordinate position compared to men, the medical industry has historically been dominated by men. This has caused for a misdiagnosis within females due to the large number male workers in the industry holding on to beliefs regarding gender stereotypes. These gender roles and gender biases may have also contributed to why pain associated with experiences unique to women, like childbirth and menstruation, were dismissed or mistreated.

Women's overall health has long been associated with their reproductive abilities; further compounded by traditional views of sex, female gender roles, and femininity. Emotional and mental health were correlated with reproductive functions; menstruation, fertility, labour; as well as societal expectations such as desire for children, motherhood, subservience, and femininity. More specifically, if a woman did not meet the expectations of reproductive functions (such as inconsistent menstruation cycles, inability to conceive or carry to term, as well as display negative reactions such as nausea, pain), it was assumed that she held resentment or non-desire to bear and raise children, as well as being defiant of her feminine nature and role. Conversely, if a woman were not to behave in alignment with femininity and gender role expectations, unable to maintain and care for family and housework, insubordinate, sick or in pain; then it were to mean they were mentally ill or disturbed, often diagnosed with hysteria. In 1948 some women volunteered to take part in an experiment designed to quantify pain in laboring women. During their labor, their hands were burned in order to try to measure their pain threshold with the option to quit at any time and to receive treatment. During childbirth and as it kept progressing, the females were unable to feel an increase in pain insomuch as many of them received second degree burns without realizing.

In a 1979 observational study, 104 women and men gave responses to their health in 5 areas: "back pain, headaches, dizziness, chest pain, and fatigue". When receiving these complaints, it was seen that doctors gave extensive checkups to men more often than women with similar complaints, supporting that female patients tend to be taken less seriously than their male counterparts with regard to receiving medical illnesses.

In 1990, the National Institutes of Health recognized the disparities in research of disease in men and women. At this time, the Office of Research on Women's Health was created, primarily to raise awareness of how sex affects disease and treatments. In 1991 and 1992, recognition that a "glass ceiling" existed showcased that it was preventing female clinicians from being promoted.In 1994, the FDA created an Office of Women's Health by congressional mandate.

The Women's Health Equity Act, passed in 1993, gave women the chance to participate in medical studies and examine the gender differences. Before the act was introduced, there had been no research done on infertility, breast cancer, and ovarian cancer, which are conditions prevalent to women's health.

Clinical trials and research

The approach to women shifted from paternalistic protection to access in the early 1980s as AIDS activists like ACT UP and women's groups challenged ways that drugs were developed. The NIH responded with policy changes in 1986, but a Government Accountability Office report in 1990 found that women were still being excluded from clinical research. That report, the appointment of Bernadine Healy as the first woman to lead the NIH, and the realization that important clinical trials had excluded women led to the creation of the Women's Health Initiative at the NIH and to the federal legislation, the 1993 National Institutes of Health Revitalization Act, which mandated that women and minorities be included in NIH-funded research. The initial large studies on the use of low-dose aspirin to prevent heart attacks that were published in the 1970s and 1980s are often cited as examples of clinical trials that included only men, but from which people drew general conclusions that did not hold true for women. In 1993 the FDA reversed its 1977 guidance, and included in the new guidance a statement that the former restriction was "rigid and paternalistic, leaving virtually no room for the exercise of judgment by responsible research subjects, physician investigators, and investigational review boards (IRBs)".

The National Academy of Medicine published a report called "Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies" in 1994 and another report in 2001 called "Exploring the Biological Contributions to Human Health: Does Sex Matter?" which each urged including women in clinical trials and running analyses on subpopulations by sex.

Although guidelines have been introduced, sex bias remains an issue. A 2001 meta-analysis found that of 120 trials published in the New England Journal of Medicine, on average just 24.6% of participants enrolled were women. In addition, the same 2001 meta-analysis found that 14% of the trials included sex specific data analysis.

A 2005 review by the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use found that regulation in the US, Europe, and Japan required that clinical trials should reflect the population to whom an intervention will be given, and found that clinical trials that had been submitted to agencies were generally complying with those regulations.

A review of NIH-funded studies (not necessarily submitted to regulatory agencies) published between 1995 and 2010 found that they had an "average enrollment of 37% (±6% standard deviation [SD]) women, at an increasing rate over the years. Only 28% of the publications either made some reference to sex/gender-specific results in the text or provided detailed results including sex/gender-specific estimates of effect or tests of interaction."

The FDA published a study of the 30 sets of clinical trial data submitted after 2011, and found that for all of them, information by sex was available in public documents, and that almost all of them included sub-analyses by sex.

As of 2015, recruiting women to participate in clinical trials remained a challenge.

In 2018 the US FDA released draft guidelines for inclusion of pregnant women in clinical trials.

In a 2019 meta-analysis it was reported that 36.4% of participants in 40 trials for anti-psychotic drugs were women.

Medical diagnosis

The possibility of gender differences in experiences of pain has led to a discrepancy in treating female patients' pain over that of male patients. The phenomenon may affect physical diagnosis. Women are more likely to be given a diagnosis of psychosomatic nature for a physical ailment than men, despite presenting with similar symptoms. Women sometimes have trouble being taken seriously by physicians when they have a medically unexplained illness, and report difficulty receiving appropriate medical care for their illnesses because doctors repeatedly diagnose their physical complaints as related to psychiatric problems or simply related to female's menstrual cycle. Clinical offices that rely on healthcare routines become less distinct due to biased medical knowledge of gender. There is a distinct differentiation between gender and sex in the medical sense. Because gender is the societal construction of what femininity and masculinity is, whereas, sex is the biological aspect that defines the dichotomy of female and male. The way of lifestyle and the place in society are often considered when diagnosing patients.

An example of a significant condition from which an extreme gender bias and differential medical attention and treatment can be noted is that of Cardiovascular disease. Of this condition, Coronary heart disease is the most prevalent; with women more often than men reported as fatalities. Due to sex based medical prerogatives, women tend to be more concerned with their primary and secondary sex health characteristics; i.e., gynecological health and breast health especially in terms of cancer; as opposed to heart health. Furthermore, mortality rates of women have increased since 1979; whereas men's conversely have displayed a decline. This can be attributed to differential treatment, specifically; preventative measures, refined diagnostic techniques and advanced medical and surgical capabilities that are directly catered to men's health. One proposed explanation of gender bias pertaining to cardiac concerns and treatment is that men are more likely report or assume symptoms to be cardiac related than women, i.e., stress, (in stressful situations, personal situations or as a controlled variable); however these hypothesis were found to be inconsistent. When addressing women's health in relation to cardiovascular health, sexed based differences are imperative in acknowledging in order appropriately diagnose and treat symptoms. Specific diagnostic criteria for assessing women's cardiovascular health include: evaluating for high levels of triglycerides/low levels of HDL cholesterol (after menopause), diabetes, smoking, metabolic syndrome, gestational diabetes, and pre-eclampsia.

Men and women are biologically different. They differ in the mechanical workings of their hearts and in their lung capacities, resulting in women being 20-70% more likely to develop lung cancer. The differences between men and women are also seen at the cellular level. For example, the ways immune cells convey pain signals are different in men and women. As a result of these biological differences, men and women react to certain drugs and medical treatments differently. One example is opioids. When using opioids for pain relief, women and men have different reactions. Surveys of the literature also conclude that there is a need for more clinical trials that study the gender specific response to opioids.

Although there is evidence pointing to the biological difference between men and women, historically women have been excluded from clinical trials and men have been used as the standard. This male standard has its roots in ancient Greece, where the female body was viewed as a mutilated version of the male body. However, the male bias was furthered in the United States in the 1950s and 60s after the FDA issued guidelines excluding women of childbearing potential from trials to avoid any risk to a potential fetus. Additionally, the thalidomide tragedy led the FDA to issue regulations in 1977 recommending that women should be excluded from participating in Phase I and Phase II studies in the US. Studies also excluded women for other reasons including that women were more expensive to use as test subjects because of fluctuating hormone levels. The assumption that women would have the same reaction to the treatments as men was also used to justify excluding women from clinical trials.

However, more recent studies have shown that women respond differently to a variety of common drugs than men, including sleeping pills, antihistamines, aspirin and anesthesia. As a result, many drugs may actually pose health risks to women. For example, a 2001 study conducted by the Government Accountability Office about drugs removed from the market between 1997 and 2000 showed that "Eight of the 10 prescription drugs posed greater health risks for women than for men."

Pain bias

In recent decades, the disparity between female pain treatment and male pain treatment has been receiving more attention. Chronic pain is more prevalent in women than in men, and women report more severe, frequent, and prolonged cases of pain; however, they are less likely to receive adequate health treatment. Studies show that physicians often perceive women's complaints as emotional responses rather than physiological pain. Women are less likely to be prescribed painkillers after surgeries, according to several studies conducted in the 1980s. For example, after undergoing coronary artery bypass surgery, women received more sedatives rather than pain treatment. Studies from the 2000s showed that physicians dismissed women's pain as inexplicable because they refused to believe the complaints; some physicians even blamed the female patients for their pain.

Western cultural recognition of pain bias

As the issue of pain bias becomes more popular, media coverage of the topic has also increased. In 2014, the National Pain Report conducted an online national survey of almost 2,600 women with a variety of chronic pain conditions. 65% felt that their pain was being given inadequate attention because they were female, and 91% believed that the health-care system discriminated against women. Nearly half of the women were told that their pain was psychological, and 75% were told they must learn to deal with the pain. In 2015, The Atlantic published an article about a woman's experience with acute abdominal pain. She had to wait almost two hours at the emergency room before receiving treatment, but she endured the pain longer than necessary due to a misdiagnosis. In the United States, women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain, while men only wait 49 minutes. A 2019 article published by The Washington Post references a 2008 study that supports the statements made in 2015 The Atlantic article.

Psychological diagnosis

There was an example of gender bias in the psychiatric field as well, Hamberg notes that, "psychiatrists would diagnose women with depression and then, eventually psychiatrists would begin to assume that women were more depressed than men due to the fact that the patients that were examined by the psychiatrists were women and they had similar symptoms. As for the men, they were diagnosed with drug or alcohol problems and they were thrown out of the study." There is a suggestion that assumptions regarding gender specific behavioral characteristics can lead to a diagnostic system which is biased. The issue of gender bias with regard to Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorder criteria has been controversial and widely debated. The fourth DSM (4th ed., text revision; DSM–IV–TR; American Psychiatric Association, 2000) makes no explicit statement regarding gender bias among the ten personality disorders (PDs), but it does state that six PDs (antisocial, narcissistic, obsessive-compulsive, paranoid, schizotypal, schizoid) are more frequently found in men. Three others (borderline, histrionic, dependent) are more frequent in women. Avoidant is equally common in men and women.

There are many ways to interpret differential prevalence rates as a function of gender. Some critics have argued that they are an artifact of gender bias. In other words, the PD criteria assume unfairly that stereotypical female characteristics are pathological. The results of this study conclude with no indication of gender-biased criteria in the borderline, histrionic, and dependent PDs. This is in contrast with what is predicted by critics of these disorders, who suggest they are biased against women. It is possible, however, that other sources of bias, including assessment and clinical bias, are still at work in relation to these disorders. The results do show that the group means are higher in women than in men, an expected result considering the higher prevalence rate of these disorders for women.

The original purpose of the DSM–IV was to provide an accurate classification of psychopathology, not to develop a diagnostic system that will, democratically, diagnose as many men with a personality disorder as women. However, if the criteria are to serve equally as indicators of disorder for both men and women, it will be important to establish that the implications of these criteria for functional impairment are comparable for both sexes. Whereas it is plausible that there are gender-specific expressions of these disorders, DSM–IV criteria that function differently for men and women can systematically over-pathologize or under-represent mental illness in a particular gender. The present study is limited by the investigation of only four personality disorders and the lack of inclusion of additional diagnoses that have also been controversial in the gender bias debate (such as dependent and histrionic personality disorders), although it offers a clearly articulated methodology for studying this possibility. In addition, it provides an examination of a clinical sample of substantial size and uses functional assessments that cut across multiple functional domains and multiple assessment methods. Our results indicate that BPD criteria showed some evidence of differential functioning between genders on global functioning, although there is little evidence of sex bias within the diagnostic criteria for avoidant, schizotypal, or obsessive–compulsive personality disorders. Further investigation and validation across sexes for those disorders would be an important direction of future research.

Considerable evidence indicates a prominent role for trauma-related cognitions in the development and maintenance of posttraumatic stress disorder (PTSD) symptoms. The present study utilized regression analysis to examine the unique relationships between various trauma-related cognitions and PTSD symptoms after controlling for gender and measures of general affective distress in a large sample of trauma-exposed college students. In terms of trauma-related cognitions, only negative cognitions about the self were related to PTSD symptom severity. Gender and anxiety symptoms were also related to PTSD symptom severity. Theoretical implications of the results are consistent with previous studies on the relationship between PTSD and negative cognitions, the self, world, and blame subscales of the PTCI were significantly related to PTSD symptoms. The study correlations indicated that increased negative trauma-related cognitions were related to more severe PTSD symptoms. Also consistent with previous reports, correlations also indicated that gender was related to PTSD symptom severity, such that women had more severe PTSD symptoms. PTSD symptom severity was also positively related to depression, anxiety, and stress reactivity.

Distinguishing between borderline personality disorder (BPD) and post traumatic stress disorder (PTSD) is often challenging, especially when the client has experienced a trauma such as childhood sexual abuse (CSA), which is strongly linked to both disorders. Although the individual diagnostic criteria for these two disorders do not overlap substantially, patients with either of these disorders can display similar clinical pictures. Both patients with BPD and PTSD may present as aggressive towards self or others, irritable, unable to tolerate emotional extremes, dysphoric, feeling empty or dead, and highly reactive to mild stressors. Despite having similar clinical pictures, PTSD and BPD are regarded differently by many clinicians. Results from a 2009 study concluded that patient gender does not affect diagnosis. This finding is consistent with research suggesting that women are not more likely to be given the BPD diagnosis, all else being equal, though it contradicts other findings from studies that have used similar case vignettes. Nor did the data support an effect of clinician gender or age on diagnosis.

A 2012 study examined gender-specific associations between trauma cognition, alcohol cravings and alcohol-related consequences in individuals with dually diagnosed PTSD and alcohol dependence (AD). Participants had entered a treatment study for concurrent PTSD and AD; baseline information was collected from participants about PTSD-related cognition in three areas: (a) Negative Cognition About Self, (b) Negative Cognition About the World, and (c) Self-Blame. Information was also collected on two aspects of AD: alcohol cravings and consequences of AD. Gender differences were examined while controlling for PTSD severity. The results indicate that Negative Cognition About Self are significantly related to alcohol cravings in men but not women, and that interpersonal consequences of AD are significantly related to Self-Blame in women but not in men. These findings suggest that for individuals with co-morbid PTSD and AD, psycho-therapeutic interventions that focus on reducing trauma-related cognition are likely to reduce alcohol cravings in men and relational problems in women.

Female patients

Women have been described in studies and in narratives as hysterical and neurotic, and many feel that physicians take their pain less seriously. Historically, women's health was only associated with reproductive health, and thus has often been called "bikini medicine" because the field largely focused on the anatomy covered by a bathing suit. Until recently, clinical research mainly used male subjects, male cells, and male mice, and many women were excluded from research because they were considered too weak, too variable, and in need of protection from the harms associated with medical research studies. Results from these all-male studies, including studies important in understanding how certain drugs behave in the body, were applied to female patients as well, despite biological differences in the way disease presents in females and males and that women are more likely to have adverse reactions to medication. Modern research on human subjects are made up of approximately an equal distribution of female and male subjects, but female subjects in research are largely still underrepresented in specific areas of medical research, like cardiovascular research and drug studies. Narrative from physicians include reporting that women's complaints are considered exaggerated and may be assumed to be invalid. Women have been historically considered less stable than men, and their physical ailments are often considered by physicians to be a result of emotions. Women's symptoms are often not taken seriously, and women experience high rates of misdiagnosis, unrecognized symptoms, or are assumed to be experiencing a psychosomatic disorder. There has also been a reported difference between treatment of physically attractive patients versus physically unattractive patients, a bias that exists in both male and female patients, but is more pronounced in female patients. Female patients who are considered conventionally attractive are thought to be experiencing less pain than unattractive female patients. Female patients have also been considered more demanding patients, and are considered to be a greater burden than male patients. One observer has stated that, "different forms of female suffering are minimized, mocked, coaxed into silence." In the medical community, women are perceived as having to "prove they are as sick as male patients," what the medical community has deemed "Yentyl Syndrome."

Generally, women are treated less aggressively than men for pain, and over 90% of women with chronic pain believe that they are treated differently by healthcare professionals because of their gender.Women are often referred to psychiatrists for treatment, and are more likely to be prescribed sedatives than pain medicine. This can cause complications if a psychiatric condition is diagnosed, often incorrectly, and can be especially detrimental if drugs are prescribed because antidepressants and psychiatric drugs "are absorbed differently in women and vary in effectiveness" and can have unwanted side effects. Research has indicated that women metabolize drugs differently from men. However, drug dosage is rarely broken down by sex, and this can lead to highly detrimental effects.

A specific example of how misdiagnosis effects women is the care of female heart-attacks. Women who are experiencing a heart attack are seven times more likely to be misdiagnosed and released from the hospital during the heart attack. This is often due to the fact that women generally experience different heart-attack symptoms than men, including flu-like symptoms.

Ageing women

A common health concern associated with ageing women is that of menopause. Menopause is a gradual hormonal change, typically onset between the ages of 48-52 wherein menstrual periods cease, and women are no longer able to conceive and bear children.

A 2001 research interview study examined personal experiences, where age of patients within patient-doctor interactions correlated with negative experiences relating to validity and treatment of health concerns, for menopause specifically. This study, consisting of 61 women; with varying backgrounds concerning age, race, level of education, relationship status and income, found that often patients expressed experiencing symptoms of menopause in their early thirties and late forties; yet were dismissed due to their age not aligning with the estimated averages.

Intersection of gender and racial bias

Specifically, Black women and women of color are at an even greater disadvantage. Black women are twice as likely to have strokes, and their chances for survival are even lower than white women. Black women are also more likely to have adverse maternal health outcomes compared to white women. They also face greater challenges when it comes to breast cancer, and are more likely to be misdiagnosed and more likely to die. In her book, The Cancer Journals, Audre Lorde speaks about her unpleasant experiences as a Black female breast cancer patient, her troubling experiences with physicians and caretakers, and her struggle to find strength after undergoing a mastectomy. In recent years, new outlets have published numerous first and second-hand accounts about Black women and women of color experiencing adverse maternal health care and outcomes throughout the US. Pro-Publica and NPR published a story about racial disparities in maternal mortality and the birth experience of Dr. Shalon Irving, a CDC epidemiologist studying how structural inequality influences health.

Although many women still face gender bias in their experiences with the healthcare system, progress has been made towards a fairer system. The Laura W. Bush Institute for Women's Health at Texas Tech University was founded in 2007, and has supported integration of "sex-specific instruction in medical education." The team at Texas Tech created a curriculum for medical schools to include sex-differences in medical education, and ten schools are using the curriculum.

Avoiding gender bias

In order to avoid gender bias in medical diagnosing, researchers should conduct all studies with both male and female subjects in their samples. Healthcare workers should not assume all men and women are the same, even if they display similar symptoms. In a study done to analyse gender bias, a physician in the research sample stated, '"I am solely a professional, neutral and genderless"'. While a seemingly positive statement, this kind of thought process can ultimately lead to gender biasing because it does not note the differences between men and women that must be taken into account when diagnosing a patient. Other ways to avoid gender bias includes diagnostic checklists which help to increase accuracy, evidenced-based assessments and facilitation of informed choices.

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Saturday, November 11, 2023

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