If you are a woman — or love one — here are some facts that may surprise you.
- Almost three-quarters of the 750,000 Canadians who suffer from Alzheimer’s are women.
- Women are 20 per cent more likely than men to develop lung cancer if they smoke the same number of cigarettes.
- Heart attacks are not recognized in more than 50 per cent of women.
Women and men are different right down to the cellular level, so it’s no wonder diseases progress differently, said Colleen Norris, professor and clinician scientist in Nursing, Medicine & Dentistry, and the School of Public Health at the University of Alberta. Our sex affects our metabolism, body composition, kidney function, drug absorption — the list goes on.
Those are the hard-wired differences we can’t change. Scientists have been learning more about what they mean for women’s health since the 1980s, when funders started insisting that researchers include women as subjects in medical studies.
But there’s more than biology going on when it comes to women’s health outcomes, according to Norris. Gender disparities and gender roles — such as how much time you spend doing housework, whether you are a child’s primary caregiver and whether you have emotional support at home — add up to extra stress that affects women disproportionately, contributing not just to mental health issues but also to cancer, heart disease and other illnesses.
The good news? Knowledge is power — and no one knows your body and your health status better than you.
In keeping with this year’s International Women’s Day theme — #BreakTheBias — Folio asked Colleen Norris for tips on how women can advocate for themselves to get the health care they need.
Make your health a priority
Norris relayed the story of a young mother she knows who had a heart attack in her 30s and had to quit her job as a teacher. Recently, her husband and three kids got COVID-19.
“She told me the silver lining was that she didn’t get COVID herself until two weeks later, so she was able to take care of them,” Norris said. “Women are raised and socialized to take care of everyone else.
“She was experiencing significant angina again, yet she was still reluctant to seek medical attention because she worried about her children’s response to her ‘heart issues’ and also didn’t want to bother her physician.”
My big message? It’s like the oxygen masks on an airplane. You can’t take care of those you love if you don’t take care of yourself first.
Norris, who is scientific director of the Cardiovascular Health and Stroke Strategic Clinical Network for Alberta Health Services, cited evidence that women are less likely than men to seek medical attention, especially during the COVID-19 pandemic, because they don’t want to add to the burden on the system.
“My big message? It’s like the oxygen masks on an airplane,” said Norris. “You can’t take care of those you love if you don’t take care of yourself first.”
Norris pointed out that gender disparities are culturally specific and are linked to economic and social status. She is co-principal investigator with an international group of researchers from five countries (GOING-FWD) who are working to better understand how sex and gender interact to affect health outcomes around the world.
Develop a relationship with your primary care clinician
Seek out a clinician you trust. This could be a physician or a nurse practitioner, who may have more time and training to address all of the factors that affect your health.
“The medical model is cure; the nursing model is care,” said Norris. “Nurses are educated to address not just the physical but the whole psychosocial picture.”
Whoever you see, put it in your calendar to get a checkup at least once a year so you can keep up with regular screening.
It doesn’t matter so much whether you choose a male or female practitioner, Norris said. What’s really important is that they answer all of your questions.
“If you’re leaving the office angry, without getting answers, that’s not the person for you.”
Your clinician should be asking you lots of questions too, Norris noted. That’s because, like all of us, they have unconscious, innate biases that can get in the way of seeing you clearly.
“The minute you walk into the room, they are guessing at your age, and because you’re female, they’re thinking about what they know happens to females in your age group — so if you’re peri-menopausal, they’re thinking you’re more prone to anxiety and depression,” Norris said.
“They will make assumptions about what they know from a medical perspective, before they know anything about your personal history.”
Recognize stress and get help to alleviate it
Norris said it’s on women to know their own health risks, whether it’s eating too many processed foods high in salt or saturated fat, not getting enough sleep or exercise, or inherited factors. One of the biggest risks that often goes unrecognized is stress, which can be traced back to the gender imbalance.
Norris’ research has shown that 300 women a year present at an Alberta emergency department with cardiac symptoms, are discharged and go on to suffer a heart attack within 30 days. But her own research identified that the biggest predictor of a second cardiac event wasn’t their sex. It was their high score on gendered factors related to home life, income, employment and education.
“That result blew me away,” Norris said. “Luckily, it’s something we can intervene on.”
A good health-care professional will help you identify stress and how it affects your health, and look for ways to manage it “so it doesn’t come back to haunt you,” she said.
Find a community of support
Norris said there’s truth to the old saying about social support: men stay healthier when they’re married; women do better when they have a friend or a daughter for support.
“You need support from your posse,” she said.
For example, if you’re having trouble fitting exercise into your daily routine, ask a friend to help you try something new together.
“There’s no use trying to do an exercise routine that you hate. Explore and find something that you love doing, and then do it with someone that you love.”
Be persistent if you think something is wrong
“If you think something is wrong, then something is wrong,” Norris insisted, and your clinician should be responsive.
Some tips to make sure you are heard:
- Take someone with you who can help brainstorm questions with you and take notes during the appointment.
- Make sure you understand all the medical jargon, and ask for definitions if you don’t.
- Recap as the conversation goes on so you’re sure you understand it all and know what actions will be taken next.
- Follow up to be sure you’re getting test results and that prescribed treatments are working.
Norris’s research is funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada and the Strategic Clinical Networks of Alberta Health Services. She is also supported by the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute.
Colleen Norris is among the women’s health experts speaking at a free event on March 8 featuring a discussion of the disparities that exist for women in health research and care, and the importance of women advocating for themselves and their loved ones. Find out more and register.