For too many American women, working a 40-hour per week job (if they are fortunate enough to have one), commuting, and then caring for a home and family can be exhausting. And so they stop to pick up fast food for dinner, or take highly-processed convenience foods, stuffed full of salt, sugar, fat and chemical preservatives from their cabinet shelves or freezers. Worried about how Johnny is doing in his studies while she drives him to soccer practice only adds to her stress over finishing up the quarterly reports that are due at work the next day—if she wants to keep her job.
She would probably not be surprised at the results of recent studies on women’s health, if she could ever find the time to read any of them. The June 7, 2016 issue of the Journal of the American Medical Association included a survey titled “Trends in Obesity Among Adults in the United States, 2005 to 2014.” The conclusion, from the abstract:
In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity in 2013-2014 was 35.0% among men and 40.4% among women. The corresponding values for class 3 obesity were 5.5% for men and 9.9% for women. For women, the prevalence of overall obesity and of class 3 obesity showed significant linear trends for increase between 2005 and 2014; there were no significant trends for men. Other studies are needed to determine the reasons for these trends.
According to Julia Belluz, writing for Vox, this is not the only women’s health issue for which the experts have no definitive explanation.
While the death rate for white non-Hispanic men between the ages of 45 and 54 peaked in 2005 and has been declining ever since, the death rate for white non-Hispanic women in the same age group has continued to climb. (As Andrew Gelman pointed out in his blog, the absolute death rate for men is still higher than it is for women.) There is no real explanation for this increase in women’s death rate, although the Urban Institute has found a significant increase in the number of deaths from accidental poisonings, which is related to prescription painkillers and heroin.
The Urban Institute has examined the trends in the death rates of women between the ages of 15 to 54 due to a variety of causes as shown in this chart from their survey. The death rates for traffic accidents and homicides have decreased, but accidental poisonings have increased dramatically.
The suicide rate for women has increased.
Between 1999 and 2014, there was a 45 percent increase in the suicide rate in women (whereas the rise among men was 16 percent during the same period).
And women are dying during pregnancy and childbirth at record levels. Vox reports that an analysis by the Economist attributes this increase to the fact “American women tend to be both fatter and older when they become pregnant these days.” They also lack proper medical care during pregnancy.
This map of the United States from the Urban Wire, based upon work done by the scholars at the University of Wisconsin–Madison, shows the 42.8 percent of U.S. counties in which the female mortality rates have gotten worse between the years 1992-1996, as well as a four-year period in this century, 2002-2006. Only 3.4 percent of U.S. counties saw an increase in male mortality.
When the overall mortality rates of United States women are compared with those of other wealthy nations the difference is stark. Instead of improving, like our peers, our chances of living until the age of 50 are remaining stagnant.
The Urban Institute scholars who conducted the study reported that:
Accidental poisonings increased more than all the other causes combined, but they still explain only half of the total increase in deaths among white women at these ages. In addition to suicide, obesity- and smoking-related diseases are driving these mortality increases. Our findings clearly point to the need for a stronger public health focus on the misuse of prescription opioid drugs, as well as more prevention and treatment of tobacco, alcohol, and other drug use; mental illness; and obesity-related illnesses.
But nobody really knows why we are dying younger, or why we are suffering greater maternal mortality, or why we might commit suicide in greater numbers than we did in the past. Although there are a few reasons that might appear to be obvious, there have been no scientific conclusions drawn, other than the need for more research.
Reporting for Think Progress, Laurel Raymond has shown that medical researchers have avoided studying the impact of sports medicine on women because they get periods. Most clinical research uses men as subjects, because there is no risk if the subjects become pregnant, and because our menstrual cycles make us more complicated subjects to study. When women are used in clinical research, they are used during the stage of the menstrual cycle when their hormones are at their lowest point, making them more similar to men and minimizing the impact of the hormones. This bias toward male subjects extends to even basic scientific research where until recently, only male rats were used—even when studying women’s health issues.
It is simpler for the researchers this way, and in an era of decreased funding for medical research, it makes fiscal sense. Unfortunately, women suffer from the real-life consequences of this policy.
Women are almost twice as likely to have adverse drug reactions as men, which may stem from the fact that medicine isn't tailored to them. And the current body of medical research doesn't necessarily take women's symptoms seriously. Even though women are more likely to suffer from chronic pain -- such as fibromyalgia, which almost exclusively affects women -- they're less likely than men to receive appropriate treatment. Painful conditions that exclusively affect women, like endometriosis, can go undiagnosed for years. And women are more likely to be misdiagnosed and sent home from the hospital when experiencing a heart attack, because the “classic” signs of a heart attack -- crushing chest pain, tingling in the arm -- are classic only for men.
“Hysteria,” the catch-all term that was used to diagnose women whose behavior puzzled our patriarchal society in years past, was only retired from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. It was simpler to tell a woman that her ailments, her pain, were all in her head. Today the term of choice appears to be “psychosomatic symptoms,” which allows some doctors to avoid addressing a problem they don’t understand. “Anxiety” is another diagnosis that allows a pill to take the place of constructive health care. According to a 2014 survey by the National Pain Report, 90 percent of women with chronic pain felt that the healthcare industry discriminated against them.
Those who aren’t scientists, scholars, or statisticians can’t say that the multiple roles that women are forced to play in our society and the accompanying stress levels brought on by our increasing inequality, job insecurity, and shredded safety net have anything to do with the increasing levels of obesity among American women—or with the increase in suicide rates.
Nor is there ready proof that the high cost of medical care coupled with the lack of insurance, and the shuttering of women’s reproductive health clinics throughout the South and other Republican-controlled states contribute to the increase in our maternal mortality.
But is it that great a stretch to suggest that perhaps the refusal to take into account the complicated physiology of women in our medical research, especially in fields like chronic pain management, might have consequences in the medical outcomes of women patients?
Women are different from men. This difference has long been used to deny women the right to fully participate in our society as equals with men. But it has never seemed to penetrate the thought processes of those who fund medical research. Yes, women’s bodies are more complicated and present a greater challenge to researchers, but that challenge can be overcome with adequate funding, which would allow for more complex research that takes those differences into account.
