Choose to challenge gender inequality in health

TODAY marks International Women’s Day, a day to celebrate women’s achievements and raise awareness about women’s equality. The campaign theme for 2021 is “Choose To Challenge”, specifically gender bias and inequality.

Gender inequalities occur in different aspects of life, including health, education, employment, protection, politics and power.

Excess maternal mortality, inadequate sexual and reproductive health service, intimate partner violence, unequal healthcare service access and sex disparities in care quality are examples of gender inequalities in health.

Malaysia has the highest prevalence of diabetes in the Asean region. Achievement of ABC goals among diabetes patients is universally recommended – A for the A1C test of blood sugar control over three months, B for blood pressure and C for LDL-cholesterol, ie bad cholesterol.

However, data from high-income countries show that women are less likely than men to achieve A1C and LDL-cholesterol goals. Similarly, a local study found that women with diabetes had a poorer LDL-cholesterol trend over five years, even after accounting for their age groups, disease duration, comorbidities, complications and treatments.

While biology does play a role in the observed difference, gender differences in psychosocial factors, health behaviour, and healthcare access are also critical. Women with diabetes are shown to have a higher prevalence of depression.

The lower levels of psychological well-being are related to lower levels of satisfaction with treatment, diabetes empowerment and self-care attitude. These can reduce adherence to prescribed medications.

Socio-economic inequality further poses barriers to accessing good nutrition, physical activities and healthcare. There are also employment and wage gaps between genders.

Such interrelated factors may partly explain why diabetic women have a higher prevalence of obesity than men – 34% vs 27% respectively as reported in a local study.

Evidence suggests that women are less likely to receive recommended care. Some medicines used in diabetic patients have different side effects in men and women, affecting adherence level. However, clinical guidelines rarely recommend sex-specific treatments.

Addressing gender inequality in healthcare is a real public health challenge requiring actions both within and outside the health sector.

We can narrow the gender gap at the healthcare level through optimal evidence-based treatment, high-quality research on sex-specific differences in outcomes, and educational activities among patients and healthcare providers.

But health depends on more than health systems. The deeply embedded structural inequality – such as in employment, education and power – needs to be tackled.

One simple thing that we can all do now is to challenge the gender stereotype. A challenged world is an alert world. And from challenge comes change.

Let us all play our role and choose to challenge inequality, call out bias, question stereotypes and help forge an inclusive world. #ChooseToChallenge

PROF DR MOY FOONG MING, PROF DR NORAN NAQIAH HAIRI & DR WAN KIM SUI , Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya

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