By Tiana Gao, Northwood High School, Irvine, California, USA
The inclusion of gender diversity in education, the workplace, and the justice system has proliferated throughout the past decade. By detecting social injustice in these systems and implementing solutions, advocates and scholars can foster a more inclusive social climate. The attention currently averts to healthcare: male bias in medical research and clinical practice often results in the deficiency of female-specific treatment options. Social and behavioral psychology concepts can help explain the formation and effects of healthcare disparities in gender. Specifically, stereotype threats can explain how people think, and implicit bias can explain how people choose avoidance coping and have poor adherence when confronting healthcare issues. Furthermore, solutions concerning racial healthcare disparities can be used in the context of gender healthcare disparities, and modified to promote changes in this field.
According to the World Health Organization (WHO), health is one of the most fundamental rights of every human being “without distinction of race, religion, political belief, economic or social condition” (WHO, 1946). However, even the world’s most prominent health organization overlooks gender or at least understates it. For centuries, medical research had been heavily geared toward men. The Physicians’ Health Study found that taking a daily aspirin may reduce the risk of heart disease; the study drew conclusions solely from data including 22,071 men and zero women. The long-term effects of not including women in medical research are evident: between 1997 and 2000, eight out of the ten prescription drugs removed from the market by the US Food and Drug Administration caused greater adverse effects in women than in men. Unsurprisingly, a 2018 study attributed this to serious biases in basic, preclinical, and clinical research toward males (Dusenbery, 2019). To address this disparity, the NIH Revitalization Act in 1993 mandated that women and minorities are included as subjects in medical research. While this lifted the systemic barrier that impedes females from achieving optimal health, health disparities based on gender continue to exist due to societal biases and stereotypes that influence the way women’s health concerns are perceived and addressed.
WHO’s Constitution states that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946). Therefore, evaluating the psychology behind healthcare disparities based on gender can help us better understand the root, effect, and potential solutions of such discrimination. This article will examine health disparities between men and women using a social and behavioral psychology perspective, including concepts such as stereotype threats and implicit bias.
A Social Psychology Perspective
Stereotype threat refers to a psychological state in which individuals feel anxious or uneasy about confirming negative stereotypes associated with their social identity, such as their race, gender, ethnicity, social class, and sexual orientation (Steele & Aronson, 1995). Stereotype threat can explain why a white student, for example, may feel unconfident when told that Asian students are better at math, as they may negatively correlate race with academic excellence. Similarly, in the context of healthcare, stereotype threat demonstrates how women could feel ashamed or stigmatized by issues such as menstruation and sexual violence due to the fear of conforming to negative stereotypes. The following section will examine the impact of stereotype threat on women's perceptions of menstruation and sexual violence, and how these negative stereotypes perpetuate women's undesirable thoughts and experiences.
Menstruation is a natural process that affects billions of girls and women worldwide, yet research shows that women’s physical, social, and mental well-being are catastrophically disrupted during this process (Critchley et al., 2020). The Bible depicts women during their menstrual cycle as stained, influencing the societal perception of women in Christian Europe by creating cultural taboos and shame (Philip, 2006). In modern-day rural Nepal, women during menstruation are restricted from entering the temple, touching plants or male family members, and attending religious gatherings as part of Nepali religious ritual. Furthermore, an interview conducted with girls aged 9-18 revealed that commercial and educational materials perpetuate stereotype threats about menstruation by focusing on it as a hygienic crisis; this offers perplexing messages, for instance, that menstruation is normal but must be concealed (Whisnant et al., 1975; Stubbs, 2008). In addition with this ingrained belief, the series of stresses experienced by women during their menstrual cycle led them to treat menstruation as a stigma, associating it with negative experiences and lack of good performance. However, this association is simply incorrect. Studies have found that women experience heightened sensory cognition during their menstrual cycle, which enhances their sensitivity toward environmental cues and improves their relationship and practical problem-solving skills (Wister et al., 2012). Therefore, inaccurately correlating menstruation and a lack of positive feelings create beliefs tinged with bias, which inversely cause women to feel unconfident. Such feelings arise from stereotype threat, which “elevates blood pressure and induces anxiety” (Aronson, et al., 2013). Therefore, women’s lack of performance and confidence does not stem from menstruation but from stereotype threat.
The Bureau of Justice Statistics (BJS) found that female members who reported experiencing sexual assault decreased from 40% in 2017 to 25% in 2018. Yet, the rate of actual rape or sexual assault doubled within the same time period (Bureau of Justice Statistics, 2018). This data is collected from the National Crime Victimization Survey (NCVS), which measures reported and unreported crime from the victim’s perspective. For victims, reporting their encounter means that they are circulated with assumptions and responsibilities. Observers’ questions such as “[w]hy didn’t you just fight it?” and “[w]hy didn’t you say no?” reveal their inability to understand and rationalize the victim’s perspective, creating a perception that experiencing sexual violence is uncommon. This builds an impregnable boundary for rape victims who will correlate reporting with being perceived as irrational and disgraceful, leading to the formation of stereotype threats and generate fear due to negative preconceived notions they might form regarding victims of sexual violence (Smith, 2022).
A Behavioral Psychology Perspective
To receive proper health care, patients must seek it. Stereotype threat can hinder patients’ process of seeking healthcare through environmental barriers, while implicit bias, which refers to automatically stereotyping people based on social groups, can prevent effective communication and optimal treatments from physicians. From a physician’s standpoint, thinking in a stereotypical way can paint patients in a negative light, which impedes physician-patient interactions (Van Houtven, et al., 2005). Particularly, implicit bias influences physicians' decision-making based on patients’ characteristics. This produces differences in medical treatments and escalates healthcare disparities. Furthermore, because this bias operates on a subconscious level, physicians are unable to recognize it, which would perpetuate existing healthcare disparities (Leonard et al.,2020).
Solutions to Gender-based Healthcare Disparities
Little research efforts have been devoted to solving health disparities based on gender; However, many schemes have been proved effective in alleviating racial discrimination in healthcare. Utilizing the solutions to these issues, we can draw inferences to potential methods that would improve current gender conditions in healthcare.
Research on health disparities concerning race found that diversifying the entity of medical professionals helps minimize implicit bias. Using the Race Attitude Implicit Association Test, researchers found that Black doctors expressed little to no racial discrimination, while White doctors showed a propensity for White male patients. Moreover, Hispanic female doctors had no implicit or explicit bias, while Hispanic male doctors possessed strong implicit attitudes that favored White Americans (Sabin et al., 2012). To apply this finding in the context of gender, because doctors from minority backgrounds are likely to implement non-stereotypical judgments in interacting with patients, enacting a more inclusive environment can potentially mitigate gender bias in healthcare disparities and foster more effective communications.
Other approaches sought to transform the healthcare system by promoting education and activities that mediate implicit biases. For example, social desirability allows people to hide their prejudice and develop a common group identity, or simply empathy, when confronting minority groups (Blair, 2002); the creation of counter-stereotypes suppresses gender stereotypes by imagining a counter stereotypic image in detail (Blair & Banaji, 1996). Therefore, institutions can mandate implicit bias training like social desirability and counter stereotypes during medical school and residency. Hospitals can also hold regular professional development sessions for doctors to learn about inclusivity and check their biases. To ensure that everyone receives proper healthcare, it is necessary that individuals work to promote inclusivity globally. Conquering implicit biases and stereotypical threats through the aforementioned methods will allow us to alleviate not only gender discrimination but also any discrimination that exists in global health.