LETTER | Choose to challenge gender inequality in health

LETTER | March 8 marks International Women’s Day, a global day to celebrate women’s achievements and raise awareness about women’s equality. The campaign theme for 2021 is “Choose to Challenge”, specifically on gender bias and inequality.

Gender inequalities occur in different aspects of life, including health, education, employment, protection, politics and power. Excess maternal mortality, inadequate sexual and reproductive health service, intimate partner violence, unequal healthcare service access and sex disparities in care quality are examples of gender inequalities in health.

Malaysia has the highest prevalence of diabetes in the Asean region. Achievement of 'ABC' goals among diabetes patients is universally recommended. (A for A1C that reflect the blood sugar control over the past three months, B for blood pressure and C for LDL-cholesterol or bad cholesterol).

However, data from high-income countries show that women are less likely than men to achieve A1C and LDL-cholesterol goals. Similarly, a local study found that women with diabetes had a poorer LDL-cholesterol trend over five years, even after accounting for their age groups, disease duration, comorbidities, complications, and treatments.

While biology does play a role in the observed difference, gender differences in psychosocial factors, health behaviour, and healthcare access are also critical. Women with diabetes are shown to have a higher prevalence of depression. 

The lower levels of psychological well-being are related to lower levels of satisfaction with treatment, diabetes empowerment, and self-care attitude. These can reduce adherence to prescribed medications.

Socioeconomic inequality further poses barriers to accessing good nutrition, physical activities, and healthcare. There are also employment and the wage gap between genders. Such interrelated factors may partly explain why diabetes women have a higher prevalence of obesity than men (34 percent vs 27 percent respectively as reported in a local study).

Evidence suggests that women are less likely to receive the recommended care. Some medicines used in diabetes patients have different side effects in men and women, affecting adherence level. However, clinical guidelines rarely recommend sex-specific treatments.

Addressing gender inequality in health is a real public health challenge requiring actions both within and outside the health sector. We can narrow the gender gap at the healthcare level through optimal evidence-based treatment, high-quality research on sex-specific differences in outcomes and educational activities among patients and healthcare providers.

But health depends on more than health systems. The deeply embedded structural inequality, such as in employment, education, and power, needs to be tackled. 

One simple thing that we can all do now is to challenge the gender stereotype. A challenged world is an alert world. And from challenge comes change. 

Let us all play our role and choose to challenge inequality, call out bias, question stereotypes, and help forge an inclusive world. 

#ChooseToChallenge

The writers are from the Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.