By Ellie Glew, Senior Strategist, Inizio Evoke Europe
Many women and people with a cervix report not feeling heard or having their symptoms taken seriously when seeking treatment. More than four in five women have felt they were not listened to by their healthcare professional.[1] Could this be medical gaslighting? Their symptoms are not ‘all in their head’. It's not just down to ‘hormones’. Their symptoms are real. And so is gender bias.
Gender bias in diagnosing, treating, and managing neurological conditions can have a significant and devastating impact on long-term health. We have conducted research, in collaboration with the world-leading Faculty of Brain Sciences at University College London (UCL), outlining the impact of different types of bias on patient outcomes.
In this article, we are focusing on neurological conditions where gender bias is rife and can cost lives. We will touch on mental health conditions too - a topic that warrants its own discourse, but one we can’t ignore when talking about brain conditions.
When it comes to gender bias, you may have heard of the term ‘andronormativity’; this is the subconscious perception that the ‘male’ experience is the default.[2] In turn, it means anything that steps outside of this, i.e. female, could be overlooked. We don’t need to search far in neurology for clear examples of andronormativity in action…
Migraine
The perception of migraine as a "female disorder" can result in the dismissal of symptoms, which could cause delays in appropriate referral and treatment. A study has found that a higher proportion of women than men reported waiting more than 12 months to see a neurologist (32% of women compared to 20% of men). Additionally, more women were reported to have seen their GP five or more times before being referred (43% of women compared to 27% of men). Conversely, a higher proportion of men reported having seen their GP just once or twice before being referred (36% of women to 53% of men).[3]
Stroke
It doesn’t stop there. Women with stroke have a higher mortality rate and poorer functional outcomes compared with men.[4] Despite having worse stroke symptoms and living within comparable distances to comprehensive stroke centres, women with large vessel occlusion acute ischemic stroke (a severe and potentially fatal condition) are less likely to be routed to comprehensive stroke centres compared to men.[5]
Parkinson’s Disease
Meanwhile societal perceptions mean Parkinson’s Disease (PD) can be dangerously stereotyped as a condition that impacts older men. A study found women with PD were disproportionally underrepresented in referrals to deep brain stimulation (DBS) – the main type of surgery used to treat PD – compared to the general PD population.[6]
Alzheimer’s Disease
We are all living longer, and gender bias can present along the full age spectrum. Longer life expectancy is giving rise to sharper increases in neurodegenerative diseases like Alzheimer’s disease and other dementias. A study from 2022 showed that discriminating against women (and sex and gender minority groups) can lead to greater cognitive decline in later-life.[7] UCL research found that women with dementia take more potentially harmful psychotropic medication, have fewer primary care appointments, and receive less medical monitoring (e.g. weight and blood pressure checks) compared to men.[8]
Mental Health Conditions
Psychology and psychiatry are certainly no strangers to gender bias; mental health condition diagnosis and treatment are often skewed as a result. Data shows that healthcare professionals are more likely to diagnose women with depression than men, despite both genders having similar symptoms and health needs. Women are 44% more likely to receive a diagnosis and 31% more likely to use antidepressants than men, even when age, burden of depressive symptoms, and healthcare use are accounted for.[9]
Neurodevelopmental disorders are not immune to gender bias either. One paper, aptly named “Autism, thy name is man”, found women are being diagnosed with autism much later in life than men, and men are diagnosed three times more commonly than women.[10] Similarly, increasing numbers of women are being diagnosed with ADHD later in life because women present differently to men, combined with outdated gender stereotypes.[11]
So, what are we doing about it?
Studies like these support our own systematic review at Inizio Evoke Europe. Our report, ‘Transforming Bias in Healthcare’, has uncovered instances of gender bias across life-threatening conditions where female patients are losing out on the treatment they need and it’s impacting them in the long-term.
We are slowly becoming more aware of the extent of the gender gap in healthcare.
As an industry, we need to push for change. As an agency we are driving that change.
We have designed behaviour change strategies that go beyond knowledge and awareness. We can help our clients to identify and influence key biases in their specific therapy areas with our proprietary behaviour change driven and data-backed omnichannel approach. As part of this, we conduct a behavioural diagnosis and in-depth bias identification to ensure that no patients are left behind.
There’s always more that can be done to challenge and address biases. We also work with clients to uncover potential biases across existing customer journeys and identify approaches to tackle these biases, updating content as we go, as well as creating new content where gaps are discovered.
Even today, in developed countries in the 21st century, women and people with a cervix, are not receiving the same treatment opportunities as men. They’re still struggling to have their voices heard and we’re sick of it.
It’s our goal to create real change. Gender health equity is long overdue, and we must make it a priority.
Let’s take action now. Let’s take action together. Read our report, ‘Transforming bias in healthcare’, where we also explore other biases including age, racial and ethnic biases, and get in touch here.
References
[1] Results of the ‘Women’s Health – Let’s talk about it’ survey, 2022.
[2] Samulowitz A, Gremyr I, Eriksson E, et al. "Brave men" and "emotional women": a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag. 2018:2018:6358624.
[3] The Neurological Alliance. Is there a gender gap in experiences of, and access to, neurological services in England? 2020. Available from: https://www.neural.org.uk/wp-content/uploads/2021/07/Is-there-a-gender-gap-in-access-to-neurological-services-in-England_briefing.pdf.
[4] Benjamin EJ, Muntner P, Alonso A, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–e528.
[5] Tariq MB, Ali I, Salazar-Marioni Set al. Women with large vessel occlusion acute ischemic stroke are less likely to be routed to comprehensive stroke centers. J Am Heart Assoc. 2023;12(14):e029830..
[6] Jost ST, Strobel L, Rizos A, et al; EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group. Gender gap in deep brain stimulation for Parkinson's disease. NPJ Parkinsons Dis. 2022;8(1):47.
[7] Mielke MM, Aggarwal NT, Vila-Castelar C, et al; Diversity and Disparity Professional Interest Area Sex and Gender Special Interest Group. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective. Alzheimers Dement. 2022;18(12):2707–2724.
[8] Cooper C, Lodwick R, Walters K, et al. Inequalities in receipt of mental and physical healthcare in people with dementia in the UK. Age Ageing. 2017;46(3):393–400.
[9] Bacigalupe A, Martín U, Triolo F, et al. Is the diagnosis and treatment of depression gender-biased? Evidence from a population-based aging cohort in Sweden. Int J Equity Health. 2024;23(1):252.
[10] Brickhill R, Atherton G, Piovesan A, et al. Autism, thy name is man: Exploring implicit and explicit gender bias in autism perceptions. PLoS One. 2023;18(8):e0284013.
[11] Additudemag.com. We Demand Attention on the Mental and Physical Health Consequences of Late-Life Diagnoses on Women. 2024. Available from: Life Expectancy Shortened with ADHD: Women Risk Factors Research.