Women'S Health Issues

Women constitute 51% of the U.S. and 50% of the world's population. The familiar paradox of women's health, that women live longer than men but have poorer health throughout their lives, continues to be true. In most developed countries, women live about 6.5 years longer than men, on average. Women's mortality advantage has been reduced somewhat in recent years, reflecting decreased heart disease and cancer death rates among men, but not women. Women's morbidity and mortality are influenced by a variety of conditions that preferentially affect them, as noted below.

Women's health is a broad topic that has gained recognition as a discipline. Multiple definitions have been proposed with more recent definitions focusing on the variety of factors that influence a woman's health during her life span. For example, the National Academy on Women's Health Medical Education defines women's health as devoted to facilitating the preservation of wellness and prevention of illness in women; it includes screening, diagnosis, and management of conditions that are unique to women, are more common in women, are more serious in women, or have manifestations, risk factors, or interventions that are different in women. As a discipline, women's health also recognizes (a) the importance of the study of gender differences; (b) multidisciplinary team approaches; (c) the values and knowledge of women and their own experience of health and illness; (d) the diversity of women's health needs over the life cycle and how these needs reflect differences in race, class, ethnicity, culture, sexual preference, and levels of education and access to medical care; and (e) the empowerment of women to be informed participants in their own health care.

One issue for women's health research, reporting, and interpretation is the conflation of the terms sex and gender. Sex is a biological phenomenon, whereas gender is a social construction resulting from culturally shaped norms and expectations for behavior. Biological differences may not be taken into account because they are regarded as a product of cultural influences; on the other hand, differences in the socialization of women are sometimes not taken into account in the exploration of sex differences. Thus, the conflation of sex and gender is problematic and may obscure questions such as whether women experience pain differently than men—a sex difference—or have been trained to seek care more frequently—a gender difference. Nonspecific use of the terms sex and gender has had an impact on the equitable treatment of women in biomedical research and clinical medicine and on how sex differences have been conceived, studied, and addressed in biomedicine.

Not long ago, women were routinely excluded from large-scale clinical trials. For instance, most trials for the prevention of heart disease studied middle-aged males and excluded women because of a complex and sometimes conflicting set of assumptions. On the one hand, women's hearts were assumed to be the same as men's; therefore, it was unnecessary to include both sexes in the trial. On the other hand, women were assumed to be sufficiently different from men (because of hormonal and reproductive factors, for instance) to justify their exclusion from trials. This paradoxical attitude toward sex difference in clinical trials persists [Page 1098]today and highlights the complexities of addressing sex differences in health. Human subject guidelines, and the National Institutes of Health grant requirements, have mandated women's inclusion in clinical trials and research, yet the question remains as to how similarities and differences between men and women will be conceived, studied, and compared. The way research questions are posed will dictate the answers investigators obtain and will have implications for women's treatment and overall health. For instance, it is well recognized that woman are diagnosed with depression in greater numbers than are men. Is this difference a sex difference (Are women at higher risk of depression by virtue of being women?), a gendered difference (Are women more likely to seek care for depression than men?), or is it something else (Are doctors more likely to diagnose depression in women than in men?)? Precision of language and thought demands that we focus on the ways we measure and report differences between men and women and allows us to specify what these differences mean for biomedical research and ultimately for patients care.

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