“Taking into account sex and gender for better care: a public health issue”. This is the name of the report that Gilles Lazimi and Catherine Vidal, members of the High Council for Equality between Women and Men (HCE), presented to the Senate Delegation for Women’s Rights on November 17th. In 2020, the HCE presented this report to the Minister of Solidarity and Health, Olivier Véran. Her conclusion is edifying: if in fact there are biological specificities linked to sex which contribute to differences in health between women and men, the influence of gender (social relations between the sexes) is also a factor of inequality in access to care and to medical care for women.
Women’s health and work, access to care, socio-economic inequalities, endometriosis, sexual and sexist violence, are all key issues in women’s access to health that were mentioned during this hearing.
“Social norms and gender stereotypes influence the attitudes of doctors and patients”
According to the WHO, cardiovascular disease is the leading cause of death among women. They would also be exponentially so: “Since 15 years, the incidence of heart attack has increased by 25% in women under 50,” reports Catherine Vidal. For a long time, female heart attack was attributed to a drop in estrogen and aging. It is the rejuvenation of women who have suffered a heart attack that has led the medical profession to become interested in other theories, explains the author of the report.
Among the explanations cited by the researchers, that of the bias in women’s diagnoses and in their access to treatment: “Heart attack is considered a male disease, of a man stressed at work in his fifties. For equal chest pain symptoms, those in women are 3 times more likely to be attributed to emotional reasons than to heart problems. There is also a delay in seeing women in the emergency room compared to men in case of a suspected heart attack: “Women minimize the symptoms and delay the call to the emergency room.” For Catherine Vidal, these facts, observed in many countries, “illustrate the extent to which social norms and gender stereotypes influence the attitudes of doctors and patients”.
Same observation when it comes to detecting autism in young children: “there is a delay in diagnosis in girls” accuses Catherine Vidal. “In the United States, for example, 37% of boys are detected at a young age compared to 18% of girls.” Here too we find a preponderant role of the social norm linked to gender: “A small child who exhibits withdrawal behaviors, with little social interaction, in a girl we would qualify this attitude as shy or reserved, in a boy we would worry about a potential communication disruption”.
This is in fact one of the cornerstones of the report presented by Gilles Lazimi and Catherine Vidal: depending on the so-called female or male diseases, the social codes linked to gender influence patients in the expression of symptoms and in the treatment of recourse, but also the interpretation of clinical signs in care personnel leading, most of the time, to late diagnoses.
Endometriosis: “We need to train school nurses and occupational medicine. We have to make an effort in this area. »
About 10% of French women of childbearing age are affected by endometriosis in France, i.e. 1.5 to 2.5 million women. “It is the first cause of interruption of work for women in France” recalls the author of the report.
However, it was only in the 1990s that endometriosis began to be recognized by the medical profession as a condition in its own right. Thanks to the mobilization of civil society and associations, endometriosis will be exposed to the general public and health policies will finally be adopted for women affected by this disease. In France, it took until 2019 for the first national plan to fight endometriosis to appear. In 2022, a second plan was launched, recognizing endometriosis as a long-term disease.
“It wasn’t until 2020 that endometriosis was incorporated into the graduate medical curriculum. Given the latency time it takes to recognize this disease, women’s reporting of this disease has too often been overlooked. “says Catherine Vidal. And as the HCE report recommends, if it is essential to support research on this disease, it is also on the training of caregivers that we must insist: “We must train school nurses and occupational medicine. We have to make an effort in this area.”
Difficulties at work: “The criteria of hardship are not suitable for women! »
It is a sadly known fact that Catherine Vidal reminded the Senate during her hearing: in France 70% of the working poor are women. This precariousness has the effect of leading to “a renunciation of care, which contributes to a deterioration of physical and mental health” specified the author of the report. The lack of resources in prevention campaigns was also underlined by Gilles Lazimi, co-chair of the commission “Health, sexual and reproductive rights”, in particular with regard to the most vulnerable women: “There must be no equality but equity it requires more for those who need it most. For example, migrant women have less screening, they are also less supported in the face of gender-based and sexual violence”.
Furthermore, according to the two HCE members, medicine does not sufficiently take into account the impact of hard work on women’s health. For example, as Catherine Vidal points out, night work would increase the risk of breast cancer by 26%. Musculoskeletal disorders and psychosocial risks are more frequent among women, due to their greater occupation of so-called ‘unskilled’ positions.
However, as Gilles Lazimi reminds us, “The hardship criteria are not suitable for women! “. According to the HCE report, the criteria for recognizing hardship at work would be based mainly on male criteria. It therefore becomes difficult for women to be recognised, particularly with regard to domestic and family responsibilities, this double working day occupied by the majority of women.
Training of carers: “Our profession is steeped in stereotypes”
Among the 40 recommendations formulated by the HCE, the training of health professionals against violence and gender stereotypes is one of the essential axes. “We really need to make sure that the training takes place at the university and in health centres. On the topics of gender and health, violence or inequality: there are only 3 training days per year for health professionals. Is not sufficient. laments Gilles Lazimi.
“Our profession is steeped in stereotypes. When I question my colleagues and ask them if they treat women and men equally, my colleagues tell me “of course! “. But I know it’s wrong, this report proves it. Gender stereotypes need to be deconstructed. continues the general practitioner.
To enable doctors to train, it is real public policy and training for caregivers that the HCE report calls for. “We need active action, we need to ensure that this is done effectively through public policies.” It is also, according to him who is also Lecturer in a medical schoolfrom school desks that it is necessary to fight against sexist and sexual stereotypes.
“It has been announced that cells to combat gender-based and sexual violence will be set up in universities. Nothing was done today.” However, for Gilles Lazimi it is essential in the training of future doctors. He explains: “almost 40% of students suffer moral harassment, 18% sexual harassment […] this inevitably has repercussions on the care of women and women victims of violence. »
Finally, the feminization of the profession, particularly in positions of responsibility, is one of the keys to raising awareness of gender and women’s health in the profession, as Gilles Lazimi points out. Because if we look at a higher share of women in management positions, the glass ceiling is far from broken: “The number of positions of university professors-hospital workers or heads of departments is still predominantly male,” says Gilles Lazimi. In 2018, only 33% of general managers of teaching hospitals and hospital managers were employed by women.