A few years ago, the US authorities realized that 80% of the drugs withdrawn from the market were removed because of their side effects on women. There is nothing surprising about this, however, as the various phases of clinical trials are mostly conducted on male subjects. Although consideration of gender in health research involves taking into account the sex of samples in tests, it also goes well beyond that.

Focusing on gender (i. e., the social interactions associated with it, as well as with masculinity and femininity) reveals that what was thought to be "natural" is not.  

For instance, anthropologist Priscille Touraille has shown that women have gradually become smaller than men. By long saving the most nourishing food for themselves and preferring intercourse with smaller partners, men benefited from their social domination and gradually built up such differences in stature and morphology.

Two perfectly defined sexes?

Another apparently obvious fact challenged by research is the separation of the human species into no more and no fewer than two perfectly defined sexes. However, there are several ways of defining sex (gonadal, hormonal, chromosomal, etc)1 and it is known that there are more than two genders for each of them. As another famous anthropologist, the late Françoise Héritier, explained, the sexual divide structures society. As a result, so-called "intersex" people, who probably make up between 1 and 2% of the population, are generally operated on at an early age to "assign" them to either of the two traditional genders. In many cases, not fitting into the binary gender system2 is thus looked upon as a medical condition to be treated, leading to surgery or hormonal treatment.
 

Ksu BU/FOTOLIA

Ksu BU/FOTOLIA

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Female cancer, male autism

Diagnosis and cure are also an issue. Science historian Ilana Löwy recounts how the fight against cancer first focused on women and their sexual organs. As a result, men were long overlooked and poorly treated. Gender also plays a role in many other conditions, either to the detriment of men (male osteoporosis has been less studied and researched in elderly patients) as well as of women (heart attack symptoms are different and far less well-known in women).

A typical example is provided by autism. The study of this condition is based on data about autistic men, which means that fewer cases are detected in female sufferers. Because of differences in education, girls acquire more social codes than boys, and develop strategies to help them overcome their communication difficulties. One of the consequences is that many women with so-called "high-level" autism self-diagnose it, whereas physicians mistake it for other conditions and offer inappropriate treatment. Fabienne Cazalis, a researcher in cognitive science, has shown that it can take a long time before this self-diagnosis is confirmed by healthcare professionals.
 

A gendered relationship to health

Gender relations also affect men and women's knowledge of diseases, in particular AIDS and its prevention. Research in sub-Saharan Africa, particularly in Lesotho, shows that women are more informed about the virus and tests, while men are extremely reluctant to be tested for HIV. In this case, gender is involved in two ways. First, the traditional distribution of roles means that women more commonly visit hospitals or health centers, particularly because they are the ones who monitor their children's health. Their frequent contact with the medical community also makes them more knowledgeable than their partners. However, they rarely share this information with them. This is the second gender-related aspect of the question: it is frowned upon for a woman to talk about sexuality with her companion, who might suspect her of loose morals. What comes into play in this case are behavioral norms in societies where the role of women is to look after the children, and where they are not supposed to be sexually proactive.

In the end, health issues are very much related to gender inequalities. Because of frequently observed family preferences for male children, in many countries boys are better looked after than girls. However, at the other end of the spectrum, family carers who attend to the elderly are usually female. The health of old people therefore weighs more heavily on that of daughters. A new indicator has recently been used to describe ageing differences between women and men, i.e. healthy life expectancy. It has been established that women live longer than men. However, if only healthy years are taken into account, the gap is greatly reduced:  at 65 years of age, French women's healthy life expectancy is only one year longer than that of French men (whereas at this age their total life expectancy is about four years greater, according to figures from 2015).
 

Health and violence

Sexual violence is also strongly gender-based, as the INED's Virage survey  recently confirmed:  14.5% of women aged 20 to 69 are victims of sexual violence in their lifetime, compared with 4% of men. We also know that many more suffer such violence in the couple. This is detrimental to health, to the extent that the WHO did not hesitate to declare it a "public health emergency". Causing depression, pelvic pain, and genital and urinary tract infections, and impacting their sexuality, violence against women affects their health for the rest of their lives. In France, its cost in couples and its impact on children was estimated at €3.6 billion in 2012. 

These are just a few examples of the countless links between health and gender .To better emphasize their importance, the CNRS has participated in six short, irreverent videos by the INSERM, which draw attention to the importance of these interactions. On November 23, an important symposium entitled "Sexe et genre dans les recherches en santé : une articulation innovante" ("Sex and gender in health research: an innovative approach") was held in Paris. It was a milestone in the scientific community's necessary realization of the importance of the "gender" factor.

The analysis, views and opinions expressed in this section are those of the authors and do not necessarily reflect the position or policies of the CNRS.