The Gender Gap in Health Care

"Although women are special, we are not a special population", said Martha Gulati, a cardiologist specializing in women's heart health. When one reads this comment, its meaning and intention might not be immediately clear. One usually assumes that being considered as a 'special population' can only be beneficial because it ensures that specific issues that only women face are given adequate attention. I only recently realized that it can also have a downside.

If women are viewed as a "special population" requiring separate focus or intervention, it can sometimes lead to neglect in broader or more universal programs that should apply to all people, regardless of gender. For example, heart disease is the leading cause of death in the United States for both men and women. The medical field did not fully acknowledge that women experience different symptoms of the disease compared to men until 1999. This is just one such case. Some studies show that women have more intense side effects to pharmacological drugs and that some drugs are more effective in men than women. This raises the important question: why?

Historically, medical professionals have considered women's bodies atypical ('special') and men's bodies as the norm, resulting in systematic exclusion of women from clinical trials concerning conditions affecting both women and men. Researchers were concerned that women being 'special' with complex hormone cycles and fluctuating reproductive health, might confound the study. Thus, using just men for clinical trials would give a more consistent result in the experiments.

Although policy and social changes in the 1990s (NIH Revitalization Act, 1993, made it compulsory to include women in research and clinical trials funded by the NIH) have helped turn the tide, women still remain underrepresented. Many medical researchers even avoid conducting studies on female mice due to higher costs associated with purchasing and housing both sexes. Besides this, is the ongoing challenge of retaining women in clinical trials, due to historical biases and policies designed to protect the unborn child from being exposed to drugs and treatments. Even when women are included in adequate numbers in such studies, researchers often fail to do the analysis necessary to determine whether the gender of the participant affects the results of the study. The lack of research on medications and interventions across a diverse population of women has led to women experiencing adverse drug effects and reduced effectiveness of pharmaceuticals and medical devices.


Created on Canva @ThinkHer

With this said one would assume therefore that the 'special population' status may have helped address the issues that only affect women, like periods or menopause. But no!! That is also not the case. Society pays relatively little attention to the study of health concerns that are specific to women. The majority of studies in the field of ageing do not consider menopause, according to a paper in Nature, 'Aging'. Conditions that primarily affect women receive significantly less funding compared to those that predominantly impact men. Scientists working to bridge this gap face challenges in data collection. For instance, the NIH’s funding taxonomy does not categorize certain aspects of women’s health research in a way that enables researchers to easily access the necessary information (NIH hasn’t assigned menopause a unique identification code, like for other conditions such as prostate cancer). It is important to note here that women make up almost 50% of the world's population and yet women's health has rarely been a priority for health systems. It is nothing short of scandalous that something affecting half of humanity is studied so less.

As to whether women should be considered a 'special population', it depends on the situation that is being addressed. Acknowledging gender differences where it is relevant while ensuring that it does not lead to exclusion, othering, or ignorance towards gender specific considerations is the key. A balanced approach is essential and if you think about it, it's not so hard is it?


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