Health

The medicine gap

Health specialists are addressing the historic imbalance in research and care of women

MARK NICHOLS August 12 1996
Health

The medicine gap

Health specialists are addressing the historic imbalance in research and care of women

MARK NICHOLS August 12 1996

The medicine gap

Health

Health specialists are addressing the historic imbalance in research and care of women

Ask women which disease is most likely to threaten their lives, pollsters report, and the majority will say breast cancer. It is a widespread impression, and it is wrong. Among women as well as men in North America, heart disease is the No. 1 killer. But poll respondents are not alone in being poorly informed about women’s health risks. Because women usually have heart attacks later in life than men, and have different symptoms, doctors often fail to diagnose their heart problems until it is too late. Such doctors, say experts campaigning for a new approach to women’s health issues, are usually older men—the kind who, out of sheer ignorance, may attribute a woman’s chest pains to a panic attack, rather than an impending heart attack. “It’s still very much a problem,” says Penny Ballem, a senior administrator at the British Columbia Women’s Hospital in Vancouver. ‘We still have doctors patting women on the head and telling them not to worry.”

Throughout North America, health-care specialists are making major efforts to address that problem and others that can re-

sult in women receiving substandard health care. In one of many such initiatives, Canadians and Americans active in the fastdeveloping field of women’s health are gathering for a conference in Ottawa at the end of this week. Aimed at encouraging a cross-border information exchange on is-

sues ranging from breast cancer to violence against women, the meeting involves about 300 doctors, researchers, government officials and women’s health advocates. It is the first Canada-U.S. conference on the subject to be sponsored by both governments. And it comes at a time when activists’ demands for programs tailored to women’s needs are increasingly being recognized. “There’s been quite a lot of

progress,” said Dr. May Cohen, a professor of family medicine at McMaster University in Hamilton and a prominent figure in the field of women’s health. “But we’re still at an early stage.”

Women are beginning to move into senior positions in the health-care system, and hospitals, clinics and research centres devoted to women’s health are springing up across the continent. Much of the activity has flowed from the efforts of a small but vocal group of crusaders. Says Ballem: We’ve managed to make a lot of noise.”

One of the principal goals of the movement has been to shift the health-care system away from the outmoded medical belief that women—apart from their reproductive functions—are essentially like men. “Medical teaching,” says Cohen, “until fairly recently, was on the basis of a 155lb. male.” As a result, medical research and drug trials routinely concentrated on men—a 1988 U.S. study showing that ASA could help prevent heart attacks was based entirely on male data, which meant that the findings could not be applied to women. Now, major U.S. funding agencies require researchers to study both sexes, and Ottawa’s Medical Research Council is moving in the same direction. At the same time, advocates have campaigned to channel more research money into diseases such as breast cancer, osteoporosis and heart disease that afflict women more often, or differently, than men. Says Cohen: “We’ve

come to understand women’s health in very different ways than before.” Advocates are also pressing for a quantum leap in understanding by demanding that doctors view women’s health not only in medical terms, but in social, cultural and economic contexts as well. As a case in point, critics blame the near-epidemic of eating disorders among North American women on the influence of ubiquitous images of willowy females in advertising and movies. “The pressure on high-school girls to have beautiful bodies is just immense,” says Ballem.

“And the health-care system is not equipped to handle the eating disorders that result.”

At the same time, advocates say that income levels are one of the principal determinants of women’s health. “If a woman is facing heavy responsibilities looking after her family and she is poor and not well nourished,” says Donna Chow, a medical researcher at the University of Manitoba in Winnipeg, “she’s going to have health problems.”

And then there is male violence, one of the most pervasive health problems faced by women. A 1993 Statistics Canada survey reported that nearly 30 per cent of women who were married or living in common-law relationships « had been physically or Ï sexually assaulted by « their partners. And a pag per prepared for the Otg tawa meeting puts the | social, medical and eco£ nomic costs of sexual vie= olence against Canadian * women and girls at $4.2 billion a year.

Despite that, women’s health advocates say that doctors and other health-care workers frequently fail to identify violence as a factor in women’s health. “We want doctors to be able to spot abuse victims,” said conference co-chairwoman Abby Hoffman, a 1960s and ’70s-era track star who now directs the federal government’s Women’s Health Bureau, “rather than sweeping the issue under the carpet and sending women away with a sedative.” At a time when a growing number of women are getting AIDS—usually from having unprotected sex with infected males—experts are pressing for more research into the effects of the disease on the female

body. Nearly 900 Canadian women currently have AIDS—and more than 560 have died of the disease. According to some activists, women infected with AIDS do not live as long as men who have the disease—perhaps because their early symptoms are often wrongly diagnosed and treatment is started later.

While progress is being made on many fronts in the women’s health campaign, some experts fear that in an era of fiscal retrenchment by governments, the cause of women’s health may suffer setbacks.

Treatment and research centres devoted to women are springing up across the continent

“When governments cut social programs and off-load responsibilities to the community,” says McMaster’s Cohen, “a lot of the burden falls on the unpaid labor of women, whose health can be affected as a result.” Offsetting some of that concern, Health Minister David Dingwall announced a $10-million program in June to set up five research centres in women’s health across the country during the next she years. It was further encouraging evidence that new approaches to women’s health are gradually overcoming a legacy of ignorance and neglect.

MARK NICHOLS