Women and Healthcare Presentation
In 1993, the National Institutes of Health Revitalisation Act was passed, which required medical trials to include women and minorities in research. This was an important stepping
Heart Attack Symptoms, Women vs. Men. https://theheartfoundation.org/2017/03/29/heart-attack-men-vs-women/
stone in the fight for medical equality that is still being waged today.[i] Women experience various pathologies differently from men. For example, heart attacks. Most medical literature and knowledge are based on men. The male experience of a heart attack is the common representation, but a woman may not feel any pres
sure within her chest. Even when women do recognise symptoms, they often assume they have the flu or acid reflux.[ii] The longer a person goes without treatment, the more damage that will occur.[iii] The average time between the onset of a heart attack and treatment in men is 16 hours and in women 56. Women are also less likely to be prescribed medication than men. These issues make heart attacks more fatal in women.[iv]
The gender gap in health care is slowly closing, but only for the most privileged women. To understand the situation fully, we must take an intersectional approach.
Socioeconomic Status
While able-bodied, straight, cis-gender white women are least discriminated against when compared to other groups of women, they still do not receive the same quality of health care as men do. Socioeconomic status is a major factor in how white women are treated in medicine. Low SES people’s health is declining on the whole.[v]
Data from 1998 reveals that people with low income are more likely to report fair or poor health when compared with high earners. They are also three times as likely to report a chronic condition which impacts daily living. Access to medical care is a problem for low SES people. Poor women with pre-existing conditions were less likely than men with pre-existing conditions and three times less likely than wealthy people to have seen a doctor in the past year. From 2011-2013, 38% of households with a similar income reported being in fair or poor health. The economic top 1% of women lived 10 years longer than the bottom 1%.[vi]
Immigrant Experience
In America, immigrants encounter a multitude of problems. Immigrant women are
Formaldehyde Warning. https://www.accuform.com/safety-sign/danger-danger-formaldehyde-may-cause-cancer-causes-skin-eye-and-respiratory-irritation-authorized-personnel-only-MCAW182
disproportionately in low paying jobs. Many of the women working in nail salons are routinely exposed to dangerous chemicals. Formaldehyde is an ingredient in many nail products and can cause cancer. The U.S. Occupational and Safety Administration (OSHA) recommends that all nail technicians wear a respirator while working.[vii] These women are rarely paid well, with many not being paid at all and surviving off of tips. The New York Times investigated this issue and met a young woman named Jing Ren. When she wasn’t being overworked in a nail salon, she was at home in a one-bedroom apartment, shared by 6 people.[viii] These women are forced into the lowest bracket of SES, which affects their health even more.
Some immigrants have issues with English proficiency. People with limited health literacy along with generally low English proficiency are more likely to report poor health.[ix]
Illegal immigrants have even more barriers to health care. Hispanic women are at greater risk for cervical cancer, which can usually be prevented through screenings. However, these women do not have the same access to preventative health care as legal immigrants. This lack of access is due to lack of money, lack of information and Spanish-speaking practitioners, and fear of deportation.[x]
African American Perspective
African American women do not receive the same level of health care as white women overall. For example, compared to
Newspaper Clipping on Eugenics.
A Protest on Eugenics. https://medium.com/@aliceminium/the-feebleminded-woman-a-brief-history-of-eugenics-in-1920s-america-8a198d1b6e40
white women, African American women are less likely to receive diagnostic tests and surgery to remove cancerous cells.[xi] White women are more likely to receive treatment for menopause and other hormonal issues.[xii] This leaves African American women more vulnerable to osteoporosis and other health conditions that menopause can cause.[xiii] White women also, on average, live longer than African American women. This gap may be mediated by socioeconomic factors.[xiv] However, morbidity in African American women is rising.[xv]
In America, ideological eugenics reached its peak around the 20s and 30s.[xvi] By 1940, 30 states passed legislation supporting sterilising anyone they determined to be ‘feebleminded’. This term was intentionally vague and allowed sterilisations of the disabled, poor, people of colour, and anyone else who was deemed unfit to reproduce.[xvii] The ‘Mississippi Appendectomy’ was the non-consensual sterilisation of African American women from 1920-1980. Medical students would use these women to practice their surgical skills.[xviii]
LGBTQ+ Issues
LGBTQ+ people have had a difficult history with health care and medicine. Institutionalisation, electroconvulsive therapy and
A Protest Against Conversion Therapy. https://medium.com/james-finn/a-brief-history-of-lgbtq-change-therapy-ec4f060f7459
conversion therapy were used to enforce heteronormativity. While the first two aren’t practised now, conversion therapy has only been outlawed in 20 states.[xix]
Aversion therapy, a type of conversion therapy, is still practised today. 698,000 living LGBTQ+ adults have experienced conversion therapy, with 350,000 being 18 or younger at the time.[xx] In 2018, the Williams Institute estimated that a further 16,000 under-18s would experience conversion therapy from a licenced health care practitioner. A further 57,000 were estimated to experience some form of conversion therapy from religious figures.[xxi] In young LGBTQ+ people who experience rejection based on their sexual orientation are eight times more likely to have attempted suicide. They are also three times as likely to use illegal drugs and contract HIV and other sexually transmissive infections.[xxii] Also, 22% of LGBTQ+ adults live in poverty. All of these factors exasperate health conditions.
In 1989, Cosmopolitan magazine released an issue which had an article about women and AIDs. This article claimed that there was no risk of HIV/AIDs from heterosexual sex. However, heterosexual contact is the leading cause of infection for women, with only 18% of cases from drug use.[xxiii]
Disabled Women
12.7% of all female Americans have a disability.[xxiv] In 2008, healthy American women were 1.26 times less likely to have access
Chronic Illnesses That Predominately Affect Women. http://www.chronicpainresearch.org/public/CPRA_WhitePaper_2015-FINAL-Digital.pdf
to medical care, while women with disabilities are 2.26 times less
likely to have appropriate access.[xxv] When disabled people manage to get seen by a doctor, they often face inaccessible equipment, such as examination tables, or no accommodation for blind or deaf people.[xxvi] People with disabilities are more likely to have serious health conditions, such as cardiac disease, diabetes, and stroke. They are also less likely than non-disabled people to receive preventative care. Disabled people have higher medical costs on average.[xxvii]
Women make up 70% of all people who experience chronic pain, while 80% of pain medication has not been tested on women at all. Chronic and invisible illness is much more common in women than in men. Some of these conditions include Fibromyalgia Syndrome, Myalgic Encephalomyelitis, Irritable Bowel Syndrome, and Endometriosis, and in 2015, the Chronic Pain Research Alliance estimated around 50 million Americans suffer from these conditions.[xxviii]
Establishing Health Care
There have been numerous attempts at reforming healthcare during the twentieth and twenty-first centuries. In 1944 President Roosevelt called for an Economic Bill of Rights to support “full employment, adequate income, medical care, education and decent housing for all Americans”.[xxix] In 1945, Democrat President Truman asked Congress to support a program of national health insurance but unfortunately, it died
President Obama Signing the Affordable Care Act. https://www.britannica.com/topic/Patient-Protection-and-Affordable-Care-Act
down.[xxx] In 1950, unionized workers with contracts were afforded health care insurance plans, but non-unionised workers were not.[xxxi] In 1965, President Johnson managed to garner support for ‘Medicare’ for over sixty fives.[xxxii] However, by the early 1990s tens of thousands still lacked any health insurance.[xxxiii] President Clinton signed a Bill in 1996 which broadened access to health insurance.[xxxiv] The most successful attempt to reform health care was by President Obama in 2015, which brought sixteen million previously uninsured Americans into the health care system.[xxxv]
[i] Paula A. Johnson, Therese Fitzgerald, Alina Salganicoff, Susan Wood, and Jill M. Goldstein, Why Women’s Health Can’t Wait: A Report of the Mary Horrigan Connors Center for Women’s Health & Gender Biology at Bringham and Women’s Hospital (2014) <https://www.brighamandwomens.org/assets/bwh/womens-health/pdfs/connorsreportfinal.pdf> [Accessed 7 April 2020].
[ii] American Heart Association, Heart Attack Symptoms in Women (2015) <https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women> [Accessed 7 April 2020].
[iii] Catherine Erlinger, Heart Attack: Men vs. Women (2017) <https://theheartfoundation.org/2017/03/29/heart-attack-men-vs-women/> [accessed 7 April 2020].
[iv] Harvard Heart Letter, The Heart Attack Gender Gap (2016) < https://www.health.harvard.edu/heart-health/the-heart-attack-gender-gap> [accessed 7 April 2020].
[v] National Research Council (US) Committee on Future Directions for Behavioural and Social Sciences Research at the National Institutes of Health, ‘New Horizons in Health: An Integrative Approach’ (Washington, DC: The National Academies Press, 2001) https://doi.org/10.17226/10002.
[vi] Kimberly Amadeo, Health Care Inequality in America (2020) <https://www.thebalance.com/health-care-inequality-facts-types-effect-solution-4174842#citation-2> [Accessed 7 April 2020].
[vii] Dina Fine Maron, These 4 Chemicals May Pose the Most Risk for Nail Salon Workers (2015) <https://www.scientificamerican.com/article/these-4-chemicals-may-pose-the-most-risk-for-nail-salon-workers/> [Accessed 7 April 2020]
[viii] Sarah Maslin Nir, The Price of Nails (2015) <https://www.nytimes.com/2015/05/10/nyregion/at-nail-salons-in-nyc-manicurists-are-underpaid-and-unprotected.html> [Accessed 7 April 2020]
[ix] Tetine Sentell, and Kathryn Braun, ‘Low Health Literacy, Limited English Proficiency, and Health Status in Asians, Latinos, and Other Racial/Ethnic Groups in California’, Journal of Health Communication, 17, 3 (2012), 82-99 <https://doi.org/ 10.1080/10810730.2012.712621>
[x] Jane R. Montealegre, Beatrice J. Selwyn, Keith Sabin, Sheryl A. McCurdy and Jan M. Risser. Cancer Epidemiology, Biomarkers & Prevention, 20, 10 (2011), B30 < https://doi.org/10.1158/1055-9965.DISP-11-B30>
[xi] G. S. Cooper, A. Yuan, C. S. Landefeld, and A. A. Rimm, ‘Surgery for Colorectal Cancer: Race-Related Differences in Rates and Survival Among Medicare Beneficiaries’, American Journal of Public Health, 86, 4 (1996), 582-586 <https://doi.org/ 10.2105/ajph.86.4.582>
[xii] J. V. Marsh, K. M. Brett and L. C. Miller, ‘Racial Differences in Hormone Replacement Therapy Prescriptions’, Obstetrics & Gynecology, 93, 6 (1999), 999-1003 <https://doi.org/ 10.1016/s0029-7844(98)00540-7>
[xiii] NHS, Overview: Hormone Replacement Therapy (HRT) (2019) <https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/> [Accessed 8 April 2020]
[xiv] National Research Council (US) Committee on Future Directions for Behavioural and Social Sciences Research at the National Institutes of Health, ‘New Horizons in Health: An Integrative Approach’ (Washington, DC: The National Academies Press, 2001) https://doi.org/10.17226/10002.
[xv] G. K. Singh, G. P, Daus, M. Allender, E. K. Martin, C. Perry, A. A. L. Rayes, I. P. Vedamuthu, ‘Social Determinants Of Health In The United States: Addressing Major Health Inequality Trends For The Nation, 1935-2016’, International Journal of Maternal and Child Health and AIDS, 6, 2 (2017), 139-164 <https://doi.org/10.21106/ijma.236>
[xvi] Teryn Bouche, and Laura Rivard, America’s Hidden History: The Eugenics Movement (2014) <https://www.nature.com/scitable/forums/genetics-generation/america-s-hidden-history-the-eugenics-movement-123919444/> [Accessed 8 April 2020]
[xvii] Adam Cohen, interviewed by Terry Gross, 7 March 2017
[xviii] Kidi Tafesse, What the ‘Mississippi Appendectomy’ Says About the Regard of the State Towards the Agency of Black Women’s Bodies (2019) <https://blackwomenintheblackfreedomstruggle.voices.wooster.edu/2019/05/01/what-the-mississippi-appendectomy-says-about-the-regard-of-the-state-towards-the-agency-of-black-womens-bodies/> [Accessed 8 April 2020]
[xix] Movement Advancement Project, Conversion “Therapy” Laws (2020) <https://www.lgbtmap.org/equality-maps/conversion_therapy> [Accessed 8 April 2020]
[xx] Williams Institute, LGBT FAQs (n.d.) <https://williamsinstitute.law.ucla.edu/quick-facts/lgbt-faqs/> [Accessed 8 April 2020]
[xxi] Christy Mallory, Taylor N. T. Brown, Kerith J. Conron, Conversion Therapy and LGBT Youth (2019) <https://williamsinstitute.law.ucla.edu/publications/conversion-therapy-and-lgbt-youth/> [Accessed 8 April 2020]
[xxii] Human Rights Campaign, The Lies and Dangers of Efforts to Change Sexual Orientation or Gender Identity (n.d.) <https://www.hrc.org/resources/the-lies-and-dangers-of-reparative-therapy> [8 April 2020]
[xxiii] Centers for Disease Control and Prevention, HIV: Women (2020) <https://www.cdc.gov/hiv/group/gender/women/index.html> [Accessed 8 April 2020]
[xxiv] Kristen Bialik, 7 Facts about Americans with Disabilities (2017) <https://www.pewresearch.org/fact-tank/2017/07/27/7-facts-about-americans-with-disabilities/> [Accessed 7 April 2020]
[xxv] Diane L. Smith, ‘Disparities in Health Care Access for Women with Disabilities in the United States from the 2006 National Health Interview Survey’, Disability and Health Journal, 1, 2 (2008), 79-88 <https://doi.org/10.1016/j.dhjo.2008.01.001>
[xxvi] Lisa I. Iezzoni, Austin B. Frakt, Steven D. Pizer, Uninsured Persons with Disability Confront Substantial Barriers to Health Care Services, Disability and Health Journal, 4, 4 (2011), 238-244 < https://doi.org/10.1016/j.dhjo.2011.06.001>
[xxvii] Amanda Reichard, Hayley Stolzle, Michael H. Fox, ‘Health Disparities Among Adults with Physical Disabilities or Cognitive Limitations Compared to Individuals with No Disabilities in the United States’, Disability and Health Journal, 4, 2 (2011), 59-67 < https://doi.org/10.1016/j.dhjo.2010.05.003>
[xxviii] Gabrielle Jackson, ‘Why don’t doctors trust women? Because they don’t know much about us’ (2019) < https://www.theguardian.com/books/2019/sep/02/why-dont-doctors-trust-women-because-they-dont-know-much-about-us> [Accessed 7 April 2020]
[xxix] Eric Foner, Give Me Liberty, Brief Fifth Ed. (W.W. Norton & Company. New York. 2017). p.692.
[xxx] Eric Foner, Give Me Liberty, Brief Fifth Ed. (W.W. Norton & Company. New York. 2017). p.725.
[xxxi] Eric Foner, Give Me Liberty, Brief Fifth Ed. (W.W. Norton & Company. New York. 2017). p.737.
[xxxii] George Tindall and David Shi, America. A Narrative History, Brief Seventh Ed. (New York. W.W. Norton & Company. 2007). p.956.
[xxxiii] Eric Foner, Give Me Liberty, Brief Fifth Ed. (W.W. Norton & Company. New York. 2017). p.848.
[xxxiv] George Tindall and David Shi, America. A Narrative History, Brief Seventh Ed. (New York. W.W. Norton & Company. 2007). P.1038.
[xxxv] Eric Foner, Give Me Liberty, Brief Fifth Ed. (W.W. Norton & Company. New York. 2017). p.900.
Leave a Reply