Gender Bender
They can vote. With apron strings no longer indelibly fixed to their waists, they have become powerbrokers and have acceded to the highest echelons of Corporate America. Their numbers swell the ranks of the most prestigious institutions of higher learning that this nation has to offer. They are tough, rugged, honest, sincere, caring, and now running for the highest political office of the land. In short, the “fairer sex” has come a long way, but not without hitting speed bumps and impasses along the way. Yes, it was long overdue, and, yet, with every lump of sugar comes a grain of salt. Women’s health has become a bitter pill to swallow. After all, having their cake and eating it, too, has put women in the crosshairs of the same acute and chronic maladies afflicting their testosterone-infused, hairy, king of the jungle, Rambo-like husbands and significant others. So, perhaps it would be time well spent, examining the differences between men and women on a clinical and public health stage. Perhaps a reality check will be accorded, when the notion that gender matters in health is “slam dunked.” Let the reader beware, that what follows is not a pretty picture, and has ramifications that go beyond the circle of influence of a simple “gender bender.”
It is conventional wisdom that women outlive men, and this has been the case since the turn of the century. Reductions in the mortality surrounding maternity, labor, and birth have played a role in women’s longevity. Lo and behold, however, since 1980, the gap in life expectancies between Rambos and Rambas has been narrowing, and men’s gains in life expectancy now exceed those of women. How can this be accounted for? What or who is to blame? The answer, Dear Brutus, lies not in the stars, but in the higher rates of morbidity and psychological distress experienced by the carriers of two X chromosomes. Women, in fact, for better or worse, in this case, are subject to higher incidence and prevalence rates of anxiety, depression, worry, and demoralization. An uncertain world and a vacillating U.S. economy do not brighten immediate prospects, either.
There is a paradox here, which needs some form of explanation. Why do men continue to meet their Creators at younger ages than women, and, yet, are stricken by chronic illnesses at much lower rates than the latter? Gender differences in the patterns of disease might be revelatory on that score. Case in point, men, for whatever reason, are more often the victims of life-threatening chronic diseases such as coronary heart disease, cancer, cerebrovascular disease, emphysema, cirrhosis of the liver, kidney disease, and atherosclerosis. Women, on the other side of the coin, are more frequent targets of chronic disorders, including anemia, thyroid conditions, gall bladder disease, migraines, arthritis, colitis, eczema, and the list goes on and on. It doesn’t end there, either, as women have more than their share of acute conditions such as upper respiratory infections, gastroenteritis, and a proverbial potpourri of short-term infectious diseases.
Women are not immune to the life-threatening chronic diseases afflicting men. They just experience them later in life. Clinicians, researchers, and public health professionals have been slow to realize this, and, consequently, there has been a gender bias in health care research and clinical practice directed at those mortal conditions. A “women don’t have heart attacks” perspective has not only been abusive and dangerous, but has shaped clinical research studies. It is now clear, beyond any shadow of doubt, that treatments developed by studying men are not necessarily generalizable to women. Biological differences between men and women must be understood, with an eye to health advantages in one sex being employed to develop new pharmaceutical interventions to benefit members of the opposite sex.
Comparing the health of men and women is far from an easy task. Factors such as who specifically is being compared, the social and environmental causes of disease, the places where chronic conditions lurk, and the practice situations and social characteristics of the dominant group of medical professionals-physicians must all be considered. It is not a simple question of XX versus XY, as differences in men’s and women’s morbidity and mortality are a function of the combination of both social and biological factors, which tend to operate in opposite directions. While women derive advantages in longevity from sex differences that allow them to carry a fetus to term, men’s claims to decreased morbidity appear to be related to lower levels of role stress, role conflict, and the demands of work and play. There is, however, some controversy on the biological side. Their stronger immune systems and estrogen contribute to women’s greater longevity by lowering their risk of coronary heart disease prior to menopause, and, yet, their biology is hard-pressed to explain why women get sick more often then men.
Behavior and the socialization process between the sexes may also influence health. Women are taught from birth to accommodate others, and men to express anger and frustration more readily than the opposite sex. Those social characteristics may, in effect, account for the greater risk of psychological maladies, such as depression, in women. Social roles and their connection to disease will become fertile research terrain in the future.
It is conventional wisdom that women outlive men, and this has been the case since the turn of the century. Reductions in the mortality surrounding maternity, labor, and birth have played a role in women’s longevity. Lo and behold, however, since 1980, the gap in life expectancies between Rambos and Rambas has been narrowing, and men’s gains in life expectancy now exceed those of women. How can this be accounted for? What or who is to blame? The answer, Dear Brutus, lies not in the stars, but in the higher rates of morbidity and psychological distress experienced by the carriers of two X chromosomes. Women, in fact, for better or worse, in this case, are subject to higher incidence and prevalence rates of anxiety, depression, worry, and demoralization. An uncertain world and a vacillating U.S. economy do not brighten immediate prospects, either.
There is a paradox here, which needs some form of explanation. Why do men continue to meet their Creators at younger ages than women, and, yet, are stricken by chronic illnesses at much lower rates than the latter? Gender differences in the patterns of disease might be revelatory on that score. Case in point, men, for whatever reason, are more often the victims of life-threatening chronic diseases such as coronary heart disease, cancer, cerebrovascular disease, emphysema, cirrhosis of the liver, kidney disease, and atherosclerosis. Women, on the other side of the coin, are more frequent targets of chronic disorders, including anemia, thyroid conditions, gall bladder disease, migraines, arthritis, colitis, eczema, and the list goes on and on. It doesn’t end there, either, as women have more than their share of acute conditions such as upper respiratory infections, gastroenteritis, and a proverbial potpourri of short-term infectious diseases.
Women are not immune to the life-threatening chronic diseases afflicting men. They just experience them later in life. Clinicians, researchers, and public health professionals have been slow to realize this, and, consequently, there has been a gender bias in health care research and clinical practice directed at those mortal conditions. A “women don’t have heart attacks” perspective has not only been abusive and dangerous, but has shaped clinical research studies. It is now clear, beyond any shadow of doubt, that treatments developed by studying men are not necessarily generalizable to women. Biological differences between men and women must be understood, with an eye to health advantages in one sex being employed to develop new pharmaceutical interventions to benefit members of the opposite sex.
Comparing the health of men and women is far from an easy task. Factors such as who specifically is being compared, the social and environmental causes of disease, the places where chronic conditions lurk, and the practice situations and social characteristics of the dominant group of medical professionals-physicians must all be considered. It is not a simple question of XX versus XY, as differences in men’s and women’s morbidity and mortality are a function of the combination of both social and biological factors, which tend to operate in opposite directions. While women derive advantages in longevity from sex differences that allow them to carry a fetus to term, men’s claims to decreased morbidity appear to be related to lower levels of role stress, role conflict, and the demands of work and play. There is, however, some controversy on the biological side. Their stronger immune systems and estrogen contribute to women’s greater longevity by lowering their risk of coronary heart disease prior to menopause, and, yet, their biology is hard-pressed to explain why women get sick more often then men.
Behavior and the socialization process between the sexes may also influence health. Women are taught from birth to accommodate others, and men to express anger and frustration more readily than the opposite sex. Those social characteristics may, in effect, account for the greater risk of psychological maladies, such as depression, in women. Social roles and their connection to disease will become fertile research terrain in the future.
All’s fair in love and war, but biological, environmental, and social skirmishes between men and women on the health front benefit no one. They drive up health care costs at a time when the U.S. economy is barely limping along. So, like the “good hands people,” in the future, steps must be taken to ensure that a simple gender bender never reaches the proportions of a full-fledged “head on.” Men and women are different. Their bodies are different. Their health is different. The sooner that lesson is drilled home, the sooner ripe, old ages can be reached together.
posted by Dr. Al at
4/27/2008 10:51:00 AM
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