• Pre-Collegiate Global Health Review

Alexa: Play “This Is A Man’s World” by James Brown

By Akshara Ramasamy, The Woodlands College Park High School, The Woodlands, TX

From medication to cell phones to apparel, almost everything in the world has used men as the standard. Surgical instruments are designed for a man’s hands (Wiklund et al., 2006). Car seats are manufactured to protect a man’s body (Bergmann, n.d.). Artificial Intelligence speech recognition is engineered to detect a man’s voice (Feast, 2019). Workspace temperatures are based on a man’s metabolic rate (Goldberg, n.d.). In short, women are living in a world designed for men.

As the medical and scientific communities continue their fight against COVID-19, an implicit sex bias present within studies of ACE2 (the receptor that allows the COVID-19 virus to infect cells) has surfaced. According to Dr. Branka Stanic, a postdoctoral COVID-19 researcher at Georgetown University, 1,426 primary literature works have been published on ACE2 as of July 27, 2020. However, she found that the vast majority of these studies on the receptor used male animals. Only 9.45% of these studies were conducted on both sexes, and 10.84% did not even report the sex of the animal studied.

Not only are females underrepresented in animal studies but even in human clinical trials. Historically, heart disease has been defined as a ‘male’ disease (Möller-Leimkühler, 2007; EUGenMed et al., 2016). As a result, clinical standards tend to be based on male pathophysiology, and women are often mis- and under-diagnosed (EUGenMed et al., 2016; Bairey et al., 2010). Even the National Institute of Allergy and Infectious Diseases considered sex only “as part of subgroup analysis” for Phase 1 of a potential coronavirus vaccine (Goldberg, n.d.). Although women's bodies differ from men’s on both an anatomical and physiological level, current medical research is based on knowledge obtained from male cells, male humans, and male animals. This male-centric model is not only misguided but also poses a threat to women’s health. Therefore, it is imperative that the sexes are equally represented in all phases of clinical trials and cohort studies.

Furthermore, COVID-19 is not a sex-neutral killer. Researchers have widely reported that the COVID-19 mortality rate is disproportionately higher among males globally, comprising 53.6% of deaths in the U.S. (CDC, 2020). Among healthcare workers, however, women accounted for 73% of at least 9,000 U.S. healthcare workers who had been infected with the coronavirus by early April (CDCMMWR, 2020). Retail sex biases in product design and development could be to blame. Traditionally, the focus is misplaced on promotional strategies for products, rather than on crucial biological and behavioral differences. Given the major facial anthropometric differences between both sexes, such an approach with personal protective equipment (PPE) poses health risks for women (Zhuang et al., 2010). In fact, in qualitative fit testing, first-choice N95 respirators were successfully fitted in 95% of men but only in 85% of women (McMahon, et al., 2008). Consequently, the absence of a sex analysis within retail has proved detrimental to health and must be addressed in PPE design.

However, sex biases do not just exist in the healthcare industry. These biases are ubiquitous, even extending into the household. As COVID-19 cancels activities and initiates virtual alternatives, electronic device usage is dramatically increasing. Women, on average, have smaller fingers with a highly developed sense of touch (Society for Neuroscience, 2009). Yet, current keyboards are designed mainly for male hands, causing the woman’s smaller hands to do 30% more work performing the same typing tasks (Sohn, n.d.). Prolonged electronic exposure can cause severe musculoskeletal injuries, making a task as simple as typing potentially harmful for women (Menéndez et al., 2009). Therefore, to augment safety and quality of life for both men and women, the ergonomics of the conventional keyboard should be reconsidered.

The COVID-19 pandemic has also revealed sex biases beyond the borders of the U.S. India has one of the lowest female labor force participation rates in the world (“Fighting Gender Inequality,” 2020). As lockdowns continue and unemployment rates soar, Indian women are faced with the risk of a permanent exit from the labor market (“Fighting Gender Inequality,” 2020). Women are also seeing large reductions in their working hours in Bangladesh, the Maldives, the Philippines, and Thailand (UN Women Data Hub, 2020). Furthermore, in Bangladesh and Pakistan, women are less likely than men to be covered by health insurance and receive information about COVID-19 (UN Women Data Hub, 2020). Without awareness of sex biases, COVID-19 will only deepen inequalities for women across the Asia-Pacific region.

As the COVID-19 pandemic offers an opportunity to observe and learn about sex differences, the public must work on raising awareness of such biases for the health and safety of all. Failure to do so will only lead women to be disproportionately harmed with short-sighted designs and increased health risks. In order to improve the safety and quality of life, it is important to look at the world through an impartial lens.

References

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Bairey Merz, C., Mark, S. Boyan, B., Jacoba, A., Shah, P., Shaw, L., Taylor, D., & Marbán, E. (2010). Proceedings from the Scientific Symposium: Sex Differences in Cardiovascular Disease and Implications for Therapies. Journal of Women's Health, 19 (6), 1059-1072. https://doi.org/10.1089/jwh.2009.1695


CDCMMWR. (2020). Characteristics of Health Care Personnel with Covid-19—United States, February 12–April 9, 2020. MMWR. Morbidity and Mortality Weekly Report, 69. https://doi.org/10.15585/mmwr.mm6915e6


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Zhuang, Ziqing, et al. “Facial Anthropometric Differences among Gender, Ethnicity, and Age Groups.” The Annals of Occupational Hygiene, vol. 54, no. 4, Oxford Academic, June 2010, pp. 391–402. academic.oup.com, doi: 10.1093/annhyg/meq007.

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