At Independence Blue Cross (IBX), we’ve made a powerful commitment to
advancing health equity in the communities we serve. That starts with
acknowledging health inequities wherever they exist.
In our previous
health equity blogs, we’ve discussed challenges in such diverse areas as behavioral health,
maternal health, breastfeeding, health literacy, and LGBTQIA+ health. In
this one, we’d like to focus on women* — a population that has
historically experienced, and continues to experience, inequities in health
care.
We comprise half of the U.S. population, but:
• Our health care experiences are not as positive as they should be.
• Our health needs have not been studied as thoroughly.
• We often find it harder to access care.
It’s time to close these gaps.
Symptoms Ignored in Health Care Settings
Women often have their symptoms downplayed or dismissed
by health care professionals. This is an objective, well-established
phenomenon that affects the care women receive.
Even women physicians experience this. I’ve experienced it myself.
This is not meant as a criticism of health care professionals. There are
still imbalances in our society that stem from patriarchal norms. No matter
what our gender is, we’re all exposed to cultural biases our whole lives
that can unconsciously color our attitudes and decisions.
And these biases clearly come into play in the health care arena. According
to a
Kaiser Family Foundation study:
• 29 percent of women aged 40 – 64 said their doctor didn’t listen to their
health concerns, compared to 21 percent of men.• 19 percent of women noted that their doctor had made assumptions about them
without asking.• 13 percent said their health care providers had blamed them for their health
problems.• These negative experiences were even more common among women aged 18 – 35,
women of color, women in lower-income households, and women who were
uninsured.
Gender biases also affect the care we receive. For instance, compared to
men, women are less likely to be
prescribed medication to manage chronic pain
or
recommended to receive knee replacements.
Moreover:
• Only 35 percent of women aged 40 – 64 say they were
informed what to expect during menopause.• It wasn’t until
August 2024
that the Centers for Disease Control and Prevention began recommending
anesthesia for women during intrauterine device (IUD) insertion, which can
be extremely painful.• And the U.S. has a
higher maternal mortality rate
than most other developed countries, especially among Black women.
These are all good indicators that women’s health needs are not being
prioritized the way they should be.
Overlooked in Medical Research
Before 1986,
women were very rarely included in clinical trials. Maybe researchers assumed that we’d respond to treatments the same way men
do. However, that’s not the case. For example, we generally experience
more negative drug reactions
than men.
In 1986, the National Institutes of Health began encouraging researchers to include
more women in medical studies. However, even today, we’re
still underrepresented. And research into women’s health has also been
chronically underfunded, especially when it comes to
older women. So, in many areas, not nearly enough is known about our health needs.
Critical Health Issues Go Underdiagnosed
Cardiovascular disease is the
number one cause of death in both men and women, but research shows that it is
underdiagnosed in women. The reasons for this are complex. But, for example,
the symptoms of heart attacks often differ
between men and women. Both sexes usually experience chest pain, but women
are more likely to also experience nausea, sweating, vomiting, and neck,
jaw, throat, abdomen, or back pain.
Women also have
different risk factors for heart attacks. For example, if we’ve had
endometriosis,
preeclampsia, or
gestational diabetes, we’re at a higher risk of heart attack, chest pain, or blocked arteries.
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And if underdiagnoses occur with something as prevalent and well-understood
as heart disease, other health conditions are also likely to go
underdiagnosed in women. Health professionals who do not take gender
differences in symptoms and risk factors into account may make diagnostic
errors, or send female patients home with no diagnosis at all.
Women are also underdiagnosed with:
• Endometriosis, a serious and painful condition in which cells that are supposed to form
inside the uterus begin to grow in other areas where they do not belong.• Attention deficit/hyperactivity disorder (ADHD), which manifests differently in women than in men.
• Serious mental illness, which is almost twice as common among women. According to the Substance
Abuse and Mental Health Services Administration (SAMHSA), seven percent of
U.S. women have one or more behavioral health disorders versus four percent
of men.
Unequal Access to Care
There is a lot more that could be said about inequities in women’s health
care. But for now, I’d just like to make a few additional points:
• Our
overall health care costs tend to be higher than men’s, even when pregnancy-related expenses are excluded. Yet
our income is typically lower.• We’re
more likely to skip medical appointments
due to long wait times and transportation issues.• We’re
more likely to be cast in the role of caregivers, so we may tend to
ignore our own health issues
while we’re worrying about other people.• In a health emergency, we’re
less likely to receive CPR from bystanders, perhaps because they’re afraid of hurting us or being accused of
inappropriate touching/sexual assault.
When you factor in our all-too-common experience of not being listened to in
health care settings, it’s no surprise that
we often neglect or defer our own health needs.
We must advocate to have our symptoms taken seriously and get the treatments
we need. We must push for better inclusion in medical research. We must
prioritize our health despite all the barriers we face. And we must work to
create a society in which our health needs are valued and respected.
*For the purposes of this article, by “women” I mean
cisgender
women. It’s well documented that transgender, nonbinary, and gender
non-conforming individuals experience their own significant health
inequities, and we’ve discussed that in
other blogs.
This content was originally published on
IBX Insights.
About Dr. Nuria Lopez-Pajares
Dr. Nuria Lopez-Pajares joined Independence Blue Cross in 2018 after
practicing primary care and population health for 18 years. With a
background in public health and preventive medicine, she is now a medical
director involved in utilization management, case management, and quality
improvement. What she loves about this job is the opportunity to put
prevention into practice and educate.
