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Making women visible to the health sector:it starts today!

Making women visible to the health sector:it starts today! When it comes to health, women and men are not in the same boat! Minimized or even ignored pain, incorrect diagnoses…, the norm still too often remains the male body. How to make things happen? Update with our experts, Muriel Salle, health historian and Dr Gilles Lazimi, former member of the High Council for Equality between Women and Men.

It's a fact. Women live longer than men:83 years on average against 78. We could rejoice if it is not that they spend more years in poor health!

Today, if we hardly ever die during childbirth, we die more of so-called “male” diseases:infarction, cancer of the lung, liver, pancreas, COPD… Partly responsible, sexist medicine. Because for a long time, "medical knowledge has been built by taking the male body as the norm, which remains "the measure of the world", denounces Muriel Salle, lecturer at the Claude Bernard University of Lyon 1. "D on the one hand because the people who historically produced this medical knowledge were men, on the other hand because the medical profession was forbidden to women until the 1880s in France.

Women, “are seen in essence as physiologically pathological and dysfunctional”. Biologically different, certainly, but also small natures, weak and less tolerant of pain than men. Particular attention has nevertheless been given to them, confined to an essential function, their exclusive function, both biological and social:bringing children into the world.

Sex and gender:a way of integrating the determinants of health status

Even today, we think above all of health by referring to men and women's health, which is essentially a matter of "bikini medicine" (breast, ovaries, uterus). It is still common to think that a man comes for treatment when he is really in pain, while women, with their “bobology”, complain too often, when it is not in their head! All this is documented, we even speak of “Yentl syndrome” to describe this observable difference in treatment between women and men in the context of their care and their medical follow-up. And the expression is not new:it was coined in 1991, by the American cardiologist Bernadine Healy.

As medical studies are carried out with a predominantly male population, physiological differences are insufficiently taken into account. Although this has evolved in recent years, women are often excluded from prevention campaigns and only 33.5% of them are included in clinical research protocols, due to their hormonal variations and menstrual cycles, which are supposed to complicate things.

How can we be surprised then that they suffer 1.5 times more than men from side effects when swallowing drugs? Gender stereotypes don't just die hard. They condition the behavior of caregivers who may have a different listening and diagnosis depending on the sex of the patients. As a result, inequality ends up emerging when equal opportunities are not ensured, when a lack of diagnosis, access to care or follow-up appears because of the person's gender. For example, 200 women die every day from cardiovascular diseases.

Deconstructing stereotypes

"It's time to get out of this androcentrism", insists Muriel Salle, also co-responsible for Equality Mission at the Institute of Political Studies in Lyon, the idea that men are the norm. Because if women pay a heavy price for cardiovascular disease, men also bear the brunt of health inequalities. This is particularly the case for osteoporosis or depression, diseases deemed “feminine”, less diagnosed in the latter. A belief with dramatic consequences:men with depression have a suicide death rate 3 to 5 times higher than that of women.

"If we want equality in health, we must start by raising our boys and our girls in the same way," says Dr. Gilles Lazimi, general practitioner at the Romainville health center. “Demonstrate pedagogy with both the general public and health professionals. Learning to unlearn, even if it won't happen overnight. To break stereotypes, you have to teach little boys to cry, girls to play football or rugby. At home, we must promote the sharing of tasks from an early age. Ensure that games or activities in nurseries or at school are the same for everyone. Concretely, extending paternity leave by a few days is good. But that is not enough. Why are women most often the ones who stop working when their child is sick?

In my practice, I had to unlearn what I had been taught because the discourses were completely unsuited to reality. I had to get out of my comfort zone, in order to listen more to my patients, their lives and their vicissitudes to understand them. I learned not to be satisfied with visible symptoms to identify intra-family violence in particular. How? 'Or' What ? Trying to put myself in the place of women. By “daring” to ask them certain questions. In particular:“Have you been the victim of physical violence? Sexual? Psychological? Are you afraid of your partner? .

Many studies show that the simple fact of asking them the question helps to free the floor, the relationship existing with the doctor being made in confidentiality and in confidence. To take an interest in their lives and the violence they suffer, the conditions in which they live, their work, their mental load, is to deconstruct the sexist stereotypes of our society. We must continue to raise awareness, to inform through posters in the waiting room, flyers… Hearing their complaint is not enough, we must also question ourselves, as men and fight for equality” .

Gendered medicine:essential for both sexes

To develop equality in health, “an impetus is needed. France has fallen a little behind its neighbors because the first report dedicated to women's health was published in 2020. The future medical profession must be trained in gendered medicine, as is already done at the Charité medical faculty. in Berlin, Germany, the Netherlands, Switzerland, Sweden, the United States or Canada,” says Muriel Salle. We should see more women in positions of responsibility in health and research.

Defend a more specialized medicine, taking into account all the parameters of the patient:biological of course but also socio-cultural and economic, which would allow a diagnosis and more targeted therapies and therefore, a healthier life. But before that, you have to unlearn the stereotypes. Because even if today 60% of medical students are women, many of them are the heirs of knowledge and practices transmitted by men. We must teach them that the measure of the world is the human being”. And convince them that in the end, the man is just a woman like the others!

READ:Women and health, still a men's business? ". Ed Belin
WATCH:"Women:the forgotten of health", Le monde en face, France 5, program of April 20, 2021

Stronger awareness campaigns

“Gender and health:beware of clichés! This was the theme of the awareness campaign led by INSERM in 2017. Six one-minute videos highlighting prejudices about women's and men's health, to better take gender into account in medicine and the research. In the United States, some spots do not hesitate to show a stressed mother, taking care of her small tribe before leaving for school, juggling between bowls of chocolate and schoolbags. Once the children have left, she collapses in her kitchen, victim of a heart attack. Trash ? Not realistic. Raising awareness of the risk factors for cardiovascular disease, preventing rather than curing thanks to a better lifestyle, is also the objective of the Heart Bus campaign supported by AÉSIO Mutual in September. Buses equipped with screening centers will be deployed in the underprivileged neighborhoods of the largest cities in France and will meet women in precarious health and social situations.

Remember that in France, 85% of single-parent heads of families are women and that one in three families lives below the poverty line. Taking care of themselves in these conditions being almost impossible, this has a strong impact on their health. Moving the cursor for these "forgotten health" is a real public health emergency. It is in this dynamic of raising awareness and raising awareness that AÉSIO Mutuelle has mobilized with the women's magazine Marie Claire to publicize the results of a survey conducted* with Harris Interactive. This study on women's relationship to prevention, health and their perception of cancer aims to better identify the differences and specificities between men and women as well as their expectations and health needs today.

* Interactive AÉSIO &Harris survey on women's health, survey conducted online from April 29 to May 6, 2021. Sample of 2,027 people representative of the French population aged 18 and over.

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