Recognizing Gender-based Differences

Posted: Oct. 1, 2005

In spite of remarkable medical advances, it took the better part of the 20th century for medical researchers, practitioners and policy makers to directly address the issue of gender-based differences in the diagnosis and treatment of disease.

Throughout most of the century, medical research and practice were based on the male model. One reason for this practice were fears regarding the effects of clinical trials on women of childbearing age. This meant women continued to use medical treatments and techniques that had been tested solely on men.

Women’s health research
In 1991 the National Institutes of Health (NIH) launched a landmark research effort called the Women’s Health Initiative, spearheaded by the first female director of the NIH, Dr. Bernadine Healy.

This 15-year prevention study included over 65,000 women in a controlled, randomized clinical trial of diet modification, calcium and vitamin D supplements, and hormone therapy. Another component, an observational study, looked at predictors of disease in nearly 100,000 women.

Additional research during the 1990s revealed gender-based differences in other areas including disease risk, disease progression, treatment responses and outcomes.

Women’s health concerns
By the end of the 20th century, the average woman’s life expectancy at birth was about 80 years — a gain of more than 30 years compared to 1900, which was largely due to improved public health measures.

A woman today is far less likely to die at a young age from infections or infectious diseases. She is far more likely, however, to die from a chronic disease, particularly heart disease, stroke, cancer, or diabetes – in spite of major advances in the diagnosis and treatment of these diseases.

The Papanicolaou (pap) smear to detect abnormalities in the cervix and uterus before they developed into cancer came into common usage after World War II. This helped reduce cervical cancer deaths in the United States by 70 percent, making it one of the most effective cancer-screening tools known to medicine.

In the 1980s, Acquired Immune Deficiency Syndrome (AIDS) emerged as another major health threat to women. In the 1990s, AIDS was a leading cause of death among women ages 15 to 35. Multi-drug therapies to treat AIDS reduced death rates and slowed the process by which Human Immunodeficiency Virus (HIV) progressed to AIDS. However, the toll of this disease on women and their children remains a serious challenge for the next century since AIDS has reached epidemic status in many parts of the world.

As the population ages, osteoporosis, characterized by low bone mass and deterioration of bone tissue, becomes more prevalent. Four times as many women as men over age 50 are more likely to suffer an osteoporosis-related fracture.

While much changed in women’s health during the 20th century, one important factor did not: the major causes of death and disease remained largely preventable.

In the early 1990s, a landmark study demonstrated that 50 percent of the actual causes of death in the United States were attributed to behaviors such as smoking, poor diet, lack of exercise, alcohol abuse, illicit drug use, unsafe sex, criminal use of firearms, motor vehicle accidents, pollution, and infectious agents. It is these factors that will continue to pose challenges for women’s health in the 21st century.

Source: The National Women’s Health Information Center, U.S. Department of Health and Human Services

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