Gender Inequalities in Health Care

By Umair Jamal

Gender differences and inequalities have resulted in differences in health status and health care between men and women. In our society, women tend to have less access to health care than men. Socio-cultural factors often prevent women from accessing certain health care resources that are easily available to men. Women are also more prone to develop a variety of diseases and disorders including mental health problems, which are expensive to treat. According to World Health Organization, examples of such disorders can be anxiety, depression, or eating disorders.  Social factors such as violence and discrimination against women can have a negative effect on their health. In general, men have greater access to health care than women because men are more likely to have more resources, their disease and mental disorder rates are lower, and they face less violence and discrimination as compared to women. For women, exposure to more violence is associated with greater health problems. As an attempt to solve these issues, there are health agencies and organizations raising awareness of women’s health and are taking action to improving the quality of health for women. .

Throughout the world, on average, women are receiving less cash income than men, so men are more likely to afford healthcare . More women than men tend to have unpaid employment, economic dependency, and child-care responsibilities. They tend to have better education, better jobs, and are out at work all throughout the day so they partake less than women in child-care responsibility. 

In addition to these social factors, which are associated with less access to health care for women, another major factor is mental disorders. According to WHO, females have a higher prevalence than males in developing anxiety, depression, eating disorders, or other mental health conditions. If these are left untreated, additional physical health problems may arise. Co-pays and deductibles can be highly expensive for these services, and costs add up which results as a problem not only for women without health insurance, but also for those who do have it. Many health insurance plans do not include mental health services, and it becomes difficult for women to seek the treatment they need. 

Women have a greater chance of heart attack. Women are less likely to survive a heart attack than men, and are more likely to have atypical symptoms from the attack. Those females who survive a heart attack have a higher rate of a second myocardial infarction as well as higher rates of congestive heart failures than men. Since women have a higher possibility of being diagnosed with such diseases, they are charged more for health insurance, and the cost may be to high for them to afford.. 

Violence and discrimination can also have negative health consequences for women. Violence against women has serious health consequences which can result in physical injuries and health problems related to mental health and HIV/AIDS,. Women who experience violence are more exposed to HIV/AIDS and STDs. Violence can also have negative outcomes to mental health. Women who fear violence may be prevented from learning or sharing their HIV status and from receiving treatment. 

In addition, violence and discrimination against female infants results in a high rate of infanticide and neglect. These infants face malnutrition and the illness is not addressed in young girls. There are higher rates of  malnutrition because of the low social status of women, and, it contributes to higher mortality rates for women and infants. With neglect, low status for women, as well as these negative health consequences, it would not be easy to obtain access to health care. It is becoming a serious problem that women are not having access, that major initiatives are needed in order to increase awareness on the health issues of women and solve the problem. 

The American Heart Association launched the “Go Red Campaign,” which had people to wear the color red and decorated national monuments in red which brought attention to women and heart disease. In addition to this campaign, a program in Florida, called “Take It To Heart,” was a collaboration between companies, organizations, and the media in order to convey the message of gender inequalities to health care. “Take It To Heart,” has attracted a lot of people. Large amounts of crowds have attended health fairs and conventions centered on women’s issues. In addition to these awareness campaigns, more can be done to improve health and health care access for women.

The National Council of Women’s Organizations believe that it is important to improve programs and policies to address female’s physical wellbeing throughout their life. The organization’s agenda is to eliminate    inequalities and discrimination that affects many women. In terms of women’s health, they support universally accessible health care in mental health, long-term care, and HIV/AIDS services.  

In order for women to utilize more health care services, women have to overcome barriers set by gender inequality. One  strategy is to reduce the cost of health care. Another strategy includes improving and expanding services. This is intended to make health services more available in the community to reach the poorest and most remote areas. Another strategy is to reduce inequality and empower women. Some of the ways to empower women is for them to receive education, employment, mobility, and social networks. Decreasing discrimination is an example of reducing inequality. 

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About the Author: Umair Jamal graduated from UC Berkeley in 2011 with a major in Public Health. His interests in Public Health include Global Health, Community Health, and Biostatistics. As an undergraduate, he was also a member of the International Health Committee in the CalUPHC. As of now, Umair is doing a post-bac at Berkeley in the Pre-Health professions program. He plans on pursuing medicine in the future.

Breastfeeding at Home and Abroad

Can you imagine a readily available medicine that increases immunity to all kinds of diseases and decreases intestinal problems and obesity? If it sounds like the kind of miracle drug that can’t possibly exist, think again - it’s breast milk! While the WHO recommends that babies be fed breast milk exclusively for the first six months of their life, there are, unfortunately, many obstacles to breastfeeding both at home and abroad. In the heartbreaking and frustrating New York Times article “The Breast Milk Cure,” the author discusses the common misconception that babies need to be given water on hot days. In developing countries, this is extremely dangerous to the babies’ health because of the high risk of contaminated water that can quickly cause death in an infant. And when formula is used in developing countries, the risk of illness is again high due to improperly sanitized baby bottles and the probability of contaminated water being mixed with the formula. A third problem relating to breastfeeding is the cultural practice of colostrum denial. Colostrum is the yellow substance produced during the first days after delivery; it contains many antibodies to build the immunity of infants. When women delay nursing for even a few days, they may have increased difficultly in establishing breastfeeding, in addition to forgoing the opportunity to provide critical antibodies to the infant. New mothers that deny their infants colostrum are also more likely to feed their babies contaminated water until milk is produced. If more women practiced ideal breastfeeding, a substantial amount of infant mortality could be prevented – 1.4 million deaths per year, according to The Lancet.

While “The Breast Milk Cure” focuses on Africa, the state of breastfeeding in the US also shows considerable room for improvement. For example, the CDC released a report this summer stating that US hospitals fail to adequately support mothers in breastfeeding. This article discusses the CDC report and explains that hospitals can actually support formula use, as opposed to breastfeeding, through the use of free formula samples for new parents. An Associated Press article published last week explained the reasons why free formula samples undermine breastfeeding: because samples are given to the new mothers by the hospital, people really think it must be good for their babies. Formula industry representatives defend the practice of the free samples by saying that they provide an important source of nutrition to have available for the baby if needed for any reason, and that the information included with the sample instructs parents in how to use formula safely, such as making it clear that formula cannot safely be watered down. It is my opinion that hospitals should not be allowed to distribute free formula samples because they are obviously intended to encourage formula use, which goes against the WHO recommendation that exclusive breastfeeding for the first six months of life is the healthiest way to nourish a baby.

Returning to the CDC report, I was astounded to read that only about 1/3 of US hospitals keep the mother and baby together at all times. Having a separate nursery for babies seems like something from a movie that belongs in another era, but it is still the circumstance in which many American babies begin their lives. This harmful and easily changeable practice makes it much more difficult for mothers to establish breastfeeding and to receive help for any problems they have with it while they are still in the hospital. As we can see, there is much work to be done both at home and abroad to increase the prevalence of breastfeeding.

If you would like to read more on this important public health issue, here is a selection of other articles on the topic:

The Wall Street Journal

The Center For Disease Control

The Huffington Post

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About the Author: Mara Constantine is a 4th year sociology major and California native. She is currently a research assistant for Professor Kristin Luker. In addition to writing for the Public Health Advocate blog, Mara is also an active member of the Cal Cooking Club and a tutor in the YWCA’s English-in-Action program. Her public health interests include maternal and child health, health of immigrant populations, and health disparities.About the Author: Mara Constantine is a 4th year sociology

About the Author: Mara Constantine is a 4th year sociology major and California native. She is currently a research assistant for Professor Kristin Luker. In addition to writing for the Public Health Advocate blog, Mara is also an active member of the Cal Cooking Club and a tutor in the YWCA’s English-in-Action program. Her public health interests include maternal and child health, health of immigrant populations, and health disparities.About the Author: Mara Constantine is a 4th year sociology major and California native. She is currently a research assistant for Professor Kristin Luker. In addition to writing for the Public Health Advocate blog, Mara is also an active member of the Cal Cooking Club and a tutor in the YWCA’s English-in-Action program. Her public health interests include maternal and child health, health of immigrant populations, and health disparities. major and California native. She is currently a research assistant for Professor Kristin Luker. In addition to writing for the Public Health Advocate blog, Mara is also an active member of the Cal Cooking Club and a tutor in the YWCA’s English-in-Action program. Her public health interests include maternal and child health, health of immigrant populations, and health disparities.

This just in! Healthful Foods Won't Break the Bank

Is it more expensive to make a healthy meal of chicken and vegetables at home, or to take the kids out to McDonalds? Many working class Americans as well as political commentators would say the latter is the affordable option. Indeed, the “fact” that vegetables are more expensive than eating at McDonalds is often used as an explanation for why increasing numbers of Americans are overweight and obese. The New York Times op-ed “Is Junk Food Really Cheaper?” by Mark Bittman seeks to set the record straight – for less than the price of a meal for four at McDonalds, one can cook a meal at home that is both healthier and has more calories. The clear graphics provide convincing evidence that a meal of chicken and vegetables really is less expensive and more nutritious than a meal of hamburgers and chicken nuggets. However, when time is money, McDonalds and similar fast food restaurants do seem like the better option for many parents after a long day at work. Bittman suggests that eliminating food deserts would help counter this problem by allowing individuals, especially those without cars, to reach grocery stores with less time expenditure. Additionally, a cultural shift in which cooking is once again seen as a normal part of life and not as an unnecessary chore is vital in combating the obesity epidemic; projects such as FoodCorps and Cooking Matters lead the way in teaching children about cooking and nutrition, but parents need to take an active role in this as well.

Check out this article for more information.

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About the Author: Mara Constantine is a 4th year sociology major and California native. She is currently a research assistant for Professor Kristin Luker. In addition to writing for the Public Health Advocate blog, Mara is also an active member of the Cal Cooking Club and a tutor in the YWCA’s English-in-Action program. Her public health interests include maternal and child health, health of immigrant populations, and health disparities.

Health Privacy and the Presidential Race

"I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know." - Hippocratic Oath

When determining who to vote for as President of the United States, do the citizens have the "right to know" the detailed health status of the candidates? In this special situation, many ethical and political implications cloud the usually clear and highly-respected confidential relationship between physician and patient. A President's medical concerns could have serious consequences for both America and the world. Does the significance of the President's role in so many lives justify the complete elimination of the President's medical privacy? Does becoming President invalidate the President's right to medical privacy? And if so, where is that grounded in the law? Without a clear standard for disclosure, the privacy of candidates for president fall victim to the unpredictable whims of society. What is more important: ethics or politics?

Why does privacy matter?

The privacy of a patient’s medical records matters for several reasons:

1. Right to privacy – As evidenced by the Hippocratic Oath, history has treated medical information as a private matter worthy of protection. In 1996, the US extended this protection when it passed HIPPA, which set national standards for protecting medical records and personal health information and put limits on how and when this information can be used.

2. Efficient and Accurate Diagnoses -- A patient's confidence in the right to privacy is critical for full and honest patient disclosure. Without a protected right to privacy, patients would be more likely to withhold important medical and personal information from their doctors for fear of negative consequences of disclosure (such as their sexual or mental health history, drug use etc.)

3. Stigma -- Many diseases and health conditions are highly stigmatized by society. It is important to protect patients from the wrath of a judgmental society. People struggling with health conditions should not be forced to be a martyr for their illness.

4. Human Genome Project -- With constantly developing genetic technology, it might become possible to predict with reasonable accuracy a person’s future health outcomes based on that person’s DNA. If medical records for Presidential candidates are open to the public, citizens could chose their president based in part on genetic make up. If elections were determined this way, would FDR have ever been elected to office -- let alone elected to the Presidency three times? Genes may predict future health conditions, but they are not likely to predict with any accuracy the effectiveness of our country's leaders.

Extremes

History is littered with the extremes of both sides of this debate. President Ronald Reagan had his colonoscopy broadcasted on network television for all of America to watch. Despite this initiate openness regarding his health, President Reagan was later furious when his doctor, post-colorectal surgery, said that he "has cancer" instead of "had cancer."

During President Clinton's candidacy, he refused to disclose his medical records until after the election. He asserted that asking for the medical records of the President is a much more legitimate request than of candidates. An article in The New York Times accused President Clinton of being "less forthcoming about his health than any Presidential nominee in the past 20 years," an accusation that sounds to me like coercion.

Limitations on privacy

There are, of course, two sides to every coin. The right to privacy has some recognized limitations including:

1. Infectious Disease - If a patient has a serious infection that could be the beginning of an epidemic, doctors must inform the authorities (CDC and other relevant agencies) to prevent a public health crisis.

2. Threat to oneself or others -- If a clinical psychologist’s patient threatens harm to the patient or others, the doctor must [report this to the proper authorities to prevent bodily harm.

If the Commander-In-Chief of one of the largest militaries in the world has a medical condition that may result in poor judgment, doesn't that pose a threat to "the lives of others?" Under this stipulation then, doesn't the doctor not only have the right to but the obligation to disclose the President's personal medical information, at least if it could affect cognition or judgment? This needs further investigations to set a standard, grounded in the law, for medical disclosure.

Today's Campaign

Very recently the public found out that Candidate Michelle Bachmann takes medication for migraines. The media immediately began asking whether this would affect her ability to lead the nation. People wanted to know which medications she has been prescribed, how often she takes them, the severity of her headaches -- the list goes on and on. We need a legal basis to determine whether Presidential candidates must disclose some or all of their medical information. The standard should not be an ad hoc one based on mass-media and public demand. Candidates should not be coerced into disclosing. Instead, we should have thoughtful debate and develop a policy to deal with this situation. Of course, a candidate could always choose to disclose more than was required by law.

As a nation, we need to decide what is more important in this situation - ethics or politics. We need the collaborative input of the public health community, the legal community and those involved in politics. The elected officials passed legislation to protect our right to privacy. Isn’t it time to protect theirs?

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About the Author: Cecilia Bonaduce studies Public Health with a concentration in infectious disease at UC Berkeley. As Chief Blog Editor of PHA Blog, she enjoys contributing articles in addition to her duties as Editor. Cecilia plans to take a year off to work in the public health field before applying to medical school. Additional interests include cooking, singing and Cal Boxing Club.

Alice Huang

My name is Alice Huang and I am a sophomore at UC Berkeley, with a major in Molecular and Cellular Biology. I love to write and writing has become my way of expression for the occurrences in my daily life! I am extremely energetic, optimistic, and highly motivated for the things that interest me. I am interested in public health primarily because I like learning about nutrition and I feel that maintaining a healthy body is more important than trying to find cures to the variety of diseases out there in the world. If we can prevent people from getting sick, the excess need for healthcare could be lessened. Also, I want to look into opportunities that can get me involved in the community projects through the city or county health departments. For me, that is called "making a difference!" Aside from my studies, I like to spend time working out in the gym and learning martial arts that I can hopefully use in the future for self-protection. I have a habit of exercising regularly and I feel that is necessary to keep me functioning at an optimum level so that I don't get swallowed up by the intense workload every day. My hobbies are virtually everything because I am a very curious person and always ready to pick up new things! One fun and random fact about me is that I once laid on a beach by myself for the entire night just looking at the stars (don't even ask)!!!

Umair Jamal

Umair Jamal graduated from UC Berkeley in 2011 with a major in Public Health. His interests in Public Health include Global Health, Community Health, and Biostatistics. As an undergraduate, he was also a member of the International Health Committee in the CalUPHC. As of now, Umair is doing a post-bac at Berkeley in the Pre-Health professions program. He plans on pursuing medicine in the future.

Mara Constantine

Mara Constantine is a 4th year sociology major and California native. She is currently a research assistant for Professor Kristin Luker. In addition to writing for the Public Health Advocate Blog, Mara is also an active member of the Cal Cooking Club and a tutor in the YWCA’s English-in-Action program. Her public health interests include maternal and child health, health of immigrant populations, and health disparities.