Gender Science: A sneaky healthcare risk factor

Gender.jpeg

(Tim Mossholder, Unsplash)

This article was exclusively written for The European Sting by Mr. Jonathan Salim, SCORE project coordinator (PC) in CIMSA-ISMKI Indonesia. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Gender is currently the hot global issue. A person born as a boy may identify himself as a girl and vice versa. Nowadays, there are many states and countries that accept LGBT as a community, marriage, and way of life. Numerous studies have observed an increased risk of thromboembolism, pituitary prolactinoma, heart disease, and other lethal diseases in LGBT community1. Conversely, does the same discrepancy and/or health risk applies to cisgender people who content with their own sex orientation?

From decades ago, gender have discrepancies in voting, healthcare, and community roles. Women are expected to have minimal education and contribute in housework, while men are the family head who roam freely. These segregations stem from the war era where muscly bodies man proved to be superior in battles.

The segregation of rights calmed down after the passing of 1993 NIH Revitalization Act where women and other minorities have the right to participate in clinical trials2. In turn, facts about gender differences in diseases has been uncovered, proving woman having different diseases risk, symptoms, and prognosis.

For instance, women have higher risk for diabetes (OR: 1.65; CI95: 1.43 – 1.91) and obesity (OR: 3.10; CI95: 2.43 – 3.94)3. Clinical differences also observed between coronary heart disease (CHD) in man and woman. The frequency of silent CHD, a CHD with no sign and symptoms, appears more frequent in woman. Sharp-burning chest pain and angina are likely to develop while women resting while men only at exercising4.

Woman also has a specific upbringing that contributes to diseases. Female who have experienced pre-eclampsia, eclampsia, gestational diabetes, and/or other obstetric abnormalities has higher chance to develop cardiovascular diseases.

Theories are out there trying to explain the discrepancies between diseases and gender, one of which is the hormonal immune modulation theory. They describes that female hormones impact the signal and division rate of the innate and adaptive immune system. Researcher has found that after binding with the receptor, estrogen will modulate the immune system by altering macrophage function through controlling NO and iNOS level. The other known immune cells that are modulated by estrogen includes: neutrophil, dendritic cell, T-cell, and B cell5.

Incidentally, gender also impact the nutritional status of a country. Most women are educated on how to prepare and cook food based on the nutritious value, however they usually lack the required ingredients as most men are the one who tasked in the production and purchase of ingredients6. The mistranslation and misapplication of information caused unbalanced nutrition leading to anorexia, bulimia nervosa, and other diseases.

The impact of gender also proven within the mental health through occupation. Studies in Korea has shown a relationship between the 2x higher incidence of mental illness in women toward income7-9. Women have a tendency to be in the lower position, thus having lesser income10. Those conditions are the perfect grounds for depression and anxiety to grow.

Henceforth, the importance to view healthcare toward each specific gender is crystal clear. A transformation in the healthcare system is urgently needed.

References

  1. Lee R. Health care problems of lesbian, gay, bisexual, and transgender patients. Western Journal of Medicine 2000;172:403–8. doi:10.1136/ewjm.172.6.403.
  2. NIH Policy and Guidelines on The Inclusion of Women and Minorities as Subjects in Clinical Research. National Institutes of Health.
  3. Sobers-Grannum N, Murphy MM, Nielsen A, Guell C, Samuels TA, Bishop L, et al. Female Gender Is a Social Determinant of Diabetes in the Caribbean: A Systematic Review and Meta-Analysis. Plos One 2015;10. doi:10.1371/journal.pone.0126799.
  4. Heart Disease in Women. National Heart Lung and Blood Institute.
  5. Khan D, Ansar Ahmed S. The immune system is a natural target for estrogen action: Opposing effects of estrogen in two prototypical autoimmune diseases. Front Immunol 2016; 6:1–8.
  6. Vlassoff C. Gender Differences in Determinants and Consequences of Health and Illness. Journal of Health, Population, and Nutrition 2007;25:47–61. PMID: 17615903.
  7. Fryers T, Melzer D, Jenkins R. Social Inequalities and the Distribution of the Common Mental Disorders. Social Psychiatry and Psychiatric Epidemiology 2003;38:229–37. doi:10.4324/9780203496206.
  8. Muntaner C, Borrell C, Benach J, Pasarín MI, Fernandez E. The associations of social class and social stratification with patterns of general and mental health in a Spanish population. International Journal of Epidemiology 2003;32:950–8. doi:10.1093/ije/dyg170.
  9. Muntaner C, Eaton WW, Miech R. Socioeconomic Position and Major Mental Disorders. Epidemiologic Reviews 2004;26:53–62. doi:10.1093/epirev/mxh001.
  10. Kim I-H, Muntaner C, Khang Y-H, Paek D, Cho S-I. The relationship between nonstandard working and mental health in a representative sample of the South Korean population. Social Science & Medicine 2006;63:566–74. doi:10.1016/j.socscimed.2006.02.004.

About the author

Jonathan Salim currently holds the positon of SCORE project coordinator (PC) in CIMSA-ISMKI Indonesia. During his time, he did research and clinical exchanges to the ophthalmology department of Semmelweis University, Hungary. Simultaneously, he is currently working a medical clerkship in Siloam Hospitals by Lippo Group.

 

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