“Health is not only a question of biology, it is above all a matter of society”, for Catherine Vidal

"Health is not only a question of biology, it is above all a matter of society", for Catherine Vidal

“Taking sex and gender into account for better care: a public health issue”. This is the name of the report that came to present to the Delegation for Women’s Rights of the Senate, on November 17, Gilles Lazimi and Catherine Vidal, members of the High Council for Equality between Women and Men (HCE). In 2020, the HCE submitted this report to the Minister of Solidarity and Health, Olivier Véran. Its conclusion is edifying: if there are indeed biological specificities linked to sex contributing 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 medical care for women.

Women’s health and work, access to care, socio-economic inequalities, endometriosis, sexual and sexist violence, are all fundamental issues in access to women’s health that were mentioned during this hearing.

“Social norms and gender stereotypes influence the attitude of doctors and patients”

According to the WHO, cardiovascular disease is the leading cause of death among women. They would even be so exponentially: “For 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 take an interest in other theories, explains the author of the report.

Among the explanations mentioned by the researchers, that of the bias in the diagnoses of women and in their access to care: “The infarction is considered to be a male disease, of a man stressed at work in his fifties. For the same symptoms of chest pain, those of women are 3 times more likely to be attributed to emotional reasons than to heart problems. There is also a delay in the care of women in the emergency room compared to men in the event of a suspected heart attack: “Women minimize the symptoms and delay calling the emergency room”. For Catherine Vidal, these facts, observed in many countries, “illustrate to what extent social norms and stereotypes linked to gender 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 again, we find a preponderant role of the social norm linked to gender: “A young child who presents behaviors of withdrawal into himself, with a lack of social interaction, in a girl we will qualify this attitude of shyness or reserve , in a boy we will worry about a potential communication disorder”.

This is indeed one of the cardinal points of the report presented by Gilles Lazimi and Catherine Vidal: depending on the “so-called feminine or masculine” diseases, the social codes linked to gender influence patients in the expression of symptoms and the recourse care, but also the interpretation of clinical signs in the care staff leading, most often, to late diagnoses.

Endometriosis: “School nurses and occupational medicine must be trained. We have to make an effort in this area. »

About 10% of French women of childbearing age are affected by endometriosis in France, ie 1.5 to 2.5 million women. “It is the leading cause of work stoppage for women in France” recalls the author of the report.

However, it was not until the 1990s that endometriosis began to be recognized by the medical profession as a pathology 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 to see the first national plan for the fight against endometriosis 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. See the latency time it took to recognize this disease, the complaint of women about this disease has been too often overlooked. “says Catherine Vidal. And as the report of the HCE recommends, if it is fundamental 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”.

Hardship at work: “The hardship criteria are not suitable for women! »

This is a sadly known figure 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 pointed out by Gilles Lazimi, co-chairman of the “Health, Sexual and Reproductive Rights” commission, particularly with regard to the most vulnerable women: “There must be no equality but equity requires more for those who need it most. For example, migrant women have fewer screenings, they are also less supported in the face of gender-based and sexual violence”.

Also, the impact of arduous work on women’s health is not sufficiently taken into account by medicine according to the two members of the HCE. 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 the greater occupation of so-called “unskilled” positions by them.

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 on mainly male criteria. It therefore becomes difficult for women to have them recognised, particularly with regard to domestic and family responsibilities, this double working day that the majority of women occupy.

Training of caregivers: “Our profession is steeped in stereotypes”

Among the 40 recommendations made by the HCE, the training of caregivers against violence and gender stereotypes is one of the essential axes. “We really have to make sure that the training is done at the university and in the health centres. On the subjects of gender and health, violence, or inequality: there are only 3 days of training per year for health professionals. It’s 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 in the same way, my colleagues tell me “of course! “. But I know that’s wrong, this report proves it. Gender stereotypes need to be deconstructed. continues the general practitioner.

To enable doctors to train, these are real public policies and training for caregivers that the HCE report calls for. “We need active steps, we have to ensure that this is done effectively through public policies”. It is also, according to him who is also Lecturer in a faculty of medicinefrom the benches of the school 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. Today nothing has been done”. However, for Gilles Lazimi it is essential in the training of future doctors. He explains: “nearly 40% of students suffer moral harassment, 18% sexual harassment […] this inevitably has an impact on the care of women and women who are victims of violence. »

Finally, the feminization of the profession, particularly in positions of responsibility, is one of the keys to raising awareness in the profession on gender and women’s health, as Gilles Lazimi points out. Because if we observe a greater proportion of women in management positions, the glass ceiling is far from having broken: “The number of positions of university professors-hospital practitioners or heads of department is still predominantly male “says Gilles Lazimi. In 2018, only 33% of general managers of university hospitals and hospital managers were occupied by women.

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