COVER

New Attitudes and Solutions

The system is hearing the call

MARK NICHOLS January 12 1998
COVER

New Attitudes and Solutions

The system is hearing the call

MARK NICHOLS January 12 1998

New Attitudes and Solutions

The system is hearing the call

MARK NICHOLS

COVER

WOMEN’S HEALTH

In the spring of 1993, Sherri Wojcik, a Winnipeg mother of three, felt a lump in her right breast and immediately went to a doctor. The physician assured her it was only a cyst. “He told me not to worry about it,” recalls Wojcik, who works as a clerk at the local Wal-Mart. “So I didn’t worry.” But a year later, the lump was still there—and by the summer of 1995, it had grown larger and was sore. “I told the doctor that I wanted something done,” says Wojcik. He sent her for a mammogram, which was followed by a biopsy. Finally, a surgeon scheduled an operation in ‘August. Even then, Wojcik thought she was having a harmless cyst removed—“but when I woke up, I didn’t have a breast.” Says Wojcik: “The devastating thing was not just that I had cancer. It was that my doctor hadn’t listened to my concerns—and then I was lied to. I felt cheated.” Wojcik, 37, who subsequently had successful breast reconstruction surgery, thinks that what happened to her may occur less frequently in the future because doctors are being trained differently. The physician Wojcik now sees regularly is a man about her own age who “has more up-to-date ideas, and takes the time to listen.” That kind of departure from attitudes prevalent a generation ago is part of a transformation that is gradually reconfiguring the relationship between women and traditionally male-dominated medicine. That trend is examined in the following 11 pages focusing on women’s health issues. Yielding to the influence of a women’s health movement that dramatically gained momentum two decades ago, the North American medical establishment has started to alter ingrained habits. “Problems of bias and paternalism towards women are still endemic in the system,” says Dr. Penny Ballem, vice-president of women’s health programs at the British Columbia Women’s Hospital in Vancouver. “But the system is beginning to change. Some doctors are keeping up to date and learning to communicate better with women.”

There are other highly visible signs of change: women’s hospitals and clinics have sprung up in many parts of the country, and regulatory agencies are pushing for clinical trials of new drugs— once routinely tested mainly on men—to include women as well. And male doctors are witnessing an erosion in the sheer superiority of numbers that existed a few decades ago. Today, one-quarter of Canada’s practising physicians are women—up from about 17 per cent in 1985. And where perhaps 15 per cent of first-year medical students a generation ago were female, women now make up about half the enrolment in schools across the country—and in some institutions outnumber men. The achievements include an increase in funding directed to women’s health—even if the percentage is still relatively small. According to the federally backed Medical Research Council of Canada, in the current fiscal year more than 12 per cent of the $156 million in federal funds allocat-

ed for medical research will be spent on women’s health issues. That compares with less than eight per cent a decade ago. The money is paying for research into diseases and conditions that include breast cancer, osteoporosis and depression, which strikes women in far greater numbers than men. Social patterns, meanwhile, are creating new challenges in women’s health. More women are having babies later in life, for instance, and the first wave of the female baby boomers have begun menopause.

Yet many critics argue that a much larger effort is needed in researching women’s health—and meeting the medical needs of women generally. “I think we’ve done a lot in terms of raising awareness about women’s health,” says Dr. Donna Stewart, head of women’s health at the Toronto Hospital and holder of Canada’s first chair in women’s health at the University of Toronto. “But in terms of researching the ways in which women differ medically from men—that’s in its infancy.”

In a different kind of research thrust, experts at the five regional Centres of Excellence for Women’s Health, set up by Ottawa in 1996 with about $10 million in funding over a five-year period, are studying issues once considered outside the scope of medicine—ranging from poverty and male violence to the media’s influence on women’s health. At the same time, many women are taking better care of themselves, by eating healthier diets, walking more, flocking to the gym and generally keeping fit. A1995 survey by the Ottawa-based Canadian Fitness and Lifestyle Research Institute found that about one-third of women between the ages of 18 and 44 were physically active (meaning they walked an hour or expended an equivalent amount of energy each day). That is less than the 40 per cent of men in the same age-group who are physically active, but it was a significant increase over a 1988 study that found that only 22 per cent of women over 18 were active. ‘We know that people who are active have lower rates of heart disease, stroke, diabetes and other diseases,” says Art Salmon, an exercise physiologist at Participaction, a Toronto-based nonprofit agency that promotes physical fitness. “There’s no question that if you’re physically active you’re going to be healthier.”

In the view of many women, the growing attention being paid to their health is overdue. For too long, they say, women have been discriminated against by a male-dominated health-care system and— because of male attitudes about them—subjected to ineffective and sometimes harmful treatment. They complain that many doctors apparently have had difficulty understanding that cardiovascular disease is the number 1 killer of women as well as men in Canada. Some women showing up at hospitals with heart attack symptoms, says Ballem, “would be treated for stress and sent home—because women in their 40s weren’t supposed to have heart attacks.”

There is abundant evidence, too, that physicians prescribe tranquillizing drugs and sleeping pills for Canadian women at far higher rates than for men. Provincial data show that, in the past year, British Columbia doctors prescribed a tranquillizing drug to 22 per cent of women over 65, compared with 12 per cent of older men. And a 1994 Quebec study showed that doctors prescribed mood-altering drugs to 40 per cent of men—and 54 per cent of women—over 65. Doctors, say critics of male-dominated medicine, are more likely to interpret symptoms experienced by women as being emotional in origin. While conceding that women suffer higher rates of depression than men, experts say that many doctors are too ready to prescribe moodaltering drugs to women. The overprescribing of tranquillizers for women, says Nancy Hall, director of health promotion at the B.C. Women’s Hospital, “reflects a systematic bias in the system.”

In their wide-ranging examination of the social forces that affect women’s health, researchers are also zeroing in on illnesses they consider to be “socially constructed.” Activists blame the movies, television and fashion magazines for an epidemic of eating disorders because of the unrealistically skinny image they promote of the ideal female physique. Similarly, pervasive media images of swelling breasts are blamed for persuading more than 100,000 Canadian women to undergo silicone implant surgery between 1969 and 1993, when Ottawa ordered that type of implant off the market as a health risk.

Women are pressing as well for more action against an issue they say can be a major factor in their health: male violence. According to a 1993 Statistics Canada survey, half of all Canadian women had experienced at least one violent episode at the hands of a male since the age of 16, and one-quarter were victims of violence inflicted by a marital partner. Violence, says Barbara Wiktorowicz, executive director of Winnipeg’s Women’s Health Clinic, “is a major issue for many women—it affects their self-esteem, their sense of their own bodies, and their health.” Critics of male-dominated medicine say hospital emergency room staff often fail to detect evidence of violence—or treat victims with sedatives and send them home. That is changing, but activists argue that more of an effort is needed to train healthcare workers to respond and treat victims of violence—and to conduct medical examinations that will stand up as evidence in court.

Some critics fear that even as women strive for greater equality in health care, they remain vulnerable. Georgina Feldberg, a professor of social sciences at York University in Toronto who heads a centre of excellence in women’s health that links social scientists across Canada, says that because women occupy a disproportionate number of “front-line” jobs as bank tellers, schoolteachers and nurses, they are more exposed to the health-threatening stress that comes with government spending cuts and corporate downsizing—when their jobs are likely to be the first to go. Medical education is beginning to put more emphasis on training doctors to pay attention to what patients tell them, says Feldberg. But, she adds, the fee-forservice payment system and shrinking health-care budgets mean that most doctors cannot take the time to listen. The women’s health movement, concludes Feldberg, “has taken some big steps—but a lot more steps still need to be taken.” □