D6

Elsie Hambrook

Stumble Upon

del.icio.us

Digg

Facebook

Print

Email

Speak Up

"From the clothes we wear to our taste in movies, women are different than men. In fact, research shows we are different all the way down to our knees."

So begins an advertisement for the "gender knee," an artificial knee designed for women. It's a medical success story but also a hard-hitting reminder of what not to do: beware of the one-size-fits-all approach in health care.

As the number of women getting knee replacement surgery grew in recent years -- women are 60 per cent of knee replacement patients in Canada in 2006/07 -- surgeons often ran into trouble using traditional implants. "We ended up having to do things to a woman's knee that you wouldn't want to do in order to make it fit," said one surgeon. Even so, after surgery women often experienced more pain, reduced range of motion and longer recovery times than men.

That's because the unisex prosthesis ignored significant anatomical differences, like women's wider hips and the smaller bone in the front of their knee.

Enter the gender knee, commercialized in the U.S. in 2006 and licensed by Health Canada that same year. With a design based on computer imaging of women's and men's joints, it is narrower, thinner and tracks at a different angle to better match women's shape and size.

The company says an artificial hip designed for women is next, which could improve the quality of life for the 14,000 Canadian women who had hip replacement surgery in 2006/07, accounting for close to 60 per cent of these procedures.

Tailored initiatives like these are few and far between, says Dr. Joy Johnson, scientific director of the Institute for Gender and Health in the federal government health research agency.

Speaking to an audience of aspiring nurses last month in Fredericton, she said that sex and gender -- the biological and socio-cultural differences -- matter in every aspect of health care: in access to drugs, devices and therapies, in choice of treatment and in results. Health care providers and researchers, but also policy makers and the public have an interest in remembering that, let alone women.

Women's status can affect their health and the health care they receive. Women earn less than men, live longer with lower incomes and spend far more time caring for children and relatives.

They experience pregnancy and childbirth and are chiefly responsible for contraception and for coping with unintended pregnancies.

Girls and women experience sexual and physical violence and the long-term health fall-out more often than boys and men. Unequal gender relations, poverty and discrimination make women more vulnerable to pressures to have unsafe sex, even as their physiology can increase their risk of contracting HIV.

Everyone in Canada has equal access to quality health care, right?

There's research that is punching holes in that assumption.

For some conditions, it has been shown that men get health care interventions more readily than women. For example, women suffer from more hip and knee pain and disability than men, but are less likely to get joint replacement surgery -- women get 60 per cent of such replacements but are an even larger proportion of Canadians with hip and knee pain and disability.

Some research suggests women may be less likely to ask their doctors about the possibility of surgery. Other studies show women who have knee replacement surgery arrive with more severe symptoms than men.

A recent University of Toronto study using 'undercover' patients showed that even when they go to their family doctor or surgeon with the same set of symptoms and complaints and ask directly about knee replacement, women are less likely than men to get recommended for surgery.

The discrepancy is startling: family physicians were twice as likely and orthopedic surgeons were nine times as likely to recommend total knee replacement surgery to a male patient than a female patient.

Gender bias may be to blame, according to the lead researcher, so doctors need to know about unconscious stereotypes -- including that men only see doctors when the situation is critical, which might be why some doctors may take men's complaints more seriously.

A recent Ontario study of adults admitted to hospital found that among patients 50 years or older, women were less likely than men to be admitted to an Intensive Care Unit and to receive selected life-supporting treatments such as mechanical ventilation, and more likely than men to die after critical illness.

Women's experience with prescription drug policies and practices in Canada is another area of unequal treatment. A new book by a national working group, The Push to Prescribe, tackles issues from the inadequate testing of many drugs on women in clinical trials to the problems with products such as hormone therapy and silicone gel breast implants.

I could go on, but you get the point.

When it comes to women and health care, much depends on women's power, or lack of it, where it counts.

The biggest decisions about health policy and funding are made in provincial and federal legislatures, where women generally occupy less than a quarter of all seats, little more than one-tenth in New Brunswick.

It's encouraging to see the growing numbers of women who train as physicians, but women remain under-represented in the upper echelons of the health care system and women don't have a fair share of health research.

There is much we don't know about how gender affects health issues, prevention and treatment measures and unmet needs.

When it comes to health care, ignoring the differences between women's and men's bodies and their lives is unfair -- and can be dangerous.

* Elsie Hambrook is Chairperson of the New Brunswick Advisory Council on the Status of Women. Her column on women's issues appears in the Times & Transcript every Thursday. She may be reached via e-mail at acswcccf@gnb.ca