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 It's time to end the gender gap in health care


 It's time to end the gender gap in health care

 By Cathy Young, 

11/15/2000 ON MONDAY, in conjunction with the annual conference of the American Public Health Association taking place in Boston this week, a few people gathered at the Midtown Hotel for a press conference announcing a campaign that targets a rarely noticed disparity in health care: a gender gap in which men are on the losing side.

It's a well-known fact that women, on average, outlive men by six years. Between 15 and 44, men's mortality rates are more than twice as high as women's. These shortfalls are noted in ''Healthy People 2010,'' a report issued this year by the Surgeon General and the US Department of Health and Human Services outlining a health care agenda. But Edward Bartlett, a professor of public health at George Washington University and president of a group called Men's Health America, points out that no action has been taken to address such concerns. There are no men's health committees or task forces; the HHS has an Office of Women's Health but no Office of Men's Health. 

The reason for this neglect, Bartlett said at the press conference, is the belief that gender equity requires more attention to women's health concerns. A decade ago, claims that women had been shortchanged by a male-dominated medical establishment caused an outcry from activists and legislators. As it happens, these allegations were little more than a politically driven myth. 

In 1990, the Congressional Women's Caucus raised a ruckus over a government report showing that less than 14 percent of the money spent by the National Institutes of Health in 1987 went to female-specific illnesses. Yet less than 7 percent of the NIH budget was allocated to male-specific problems; the rest was spent on studying diseases that afflict both sexes. 

But weren't those diseases studied almost exclusively in men? No. In 1979, the earliest year for which such data are available, 268 of the 293 NIH-funded clinical trials included both male and female subjects - and of the remaining 25 studies, 13 were all-female.An analysis of medical literature in the Medline database shows a similar picture. Over two-thirds of clinical trials in the 1970s and 80s included both sexes, while single-sex trials were almost evenly divided between all-male and all-female ones.

Women's ''exclusion'' from heart disease research has drawn especially harsh criticism. In fact, nearly a third of clinical trials of heart disease treatment and prevention in 1996-1991 were all-male. This was primarily because it often makes scientific sense to study a disease first in the population in which it occurs most often - and men under 65 are three times more likely to have heart attacks than women.

Remarkably, however, during the same period men were underrepresented as subjects in cancer-related trials (even though they suffer from cancer at higher rates than women). Perhaps the biggest myth is that breast cancer research was put on the back burner due to sexism. Former congresswoman Patricia Schroeder of Colorado once commented that male researchers are ''more worried about prostate cancer than breast cancer.''

Yet from 1981 to 1991, the National Cancer Institute spent $658 million on breast cancer research and $113 million on prostate cancer. Long before the rise of breast cancer activism, medical journals published more reports on breast cancer than on any other type of cancer.

Thanks to the crusade to remedy perceived inequities, it seems that men's health is being short-shrifted. A May 2000 report by the US General Accounting Office shows that men now account for 37 percent of subjects enrolled in NIH research (down from 45 percent in 1994) and just 29 percent in cancer research. In recent years, both Republicans and Democrats have been sponsoring women s health measures such as minimum hospital stays for breast cancer surgery, while men are roundly ignored.

The myth of women's medical neglect has bred needless resentment in many women. It has also hampered efforts to improve health care for men, who are much less likely to get regular medical check-ups or to seek care promptly when they have symptoms of illness, and more likely to be uninsured. At Monday's press conference, Irvienne Goldson, a manager with the Men's Preventive Health Program in Boston, noted that fears of shortchanging women make it difficult for men's health programs to get funding.

But women and men are not isolated from each other. When men die prematurely, the women who love them are affected as well. Isn't it time to stop playing gender politics with medicine and redirect our energy toward providing better care for everyone?

Cathy Young is a contributing editor at Reason magazine. Her column appears regularly in the Globe. 

This story ran on page A27 of the Boston Globe on 11/15/2000.


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