The Safer Women Health Initiative

Women are more like­ly than men to suf­fer from mul­ti­ple, co-occurring, chron­ic con­di­tions such as chron­ic pain, heart dis­ease and dia­betes.

Women suf­fer from men­tal health con­di­tions such as depres­sion, anx­i­ety and trau­ma sig­nif­i­cant­ly more than men, yet face more bar­ri­ers to access­ing health­care ser­vices.

Social deter­mi­nants of health, includ­ing fac­tors like income, employ­ment sta­tus and hous­ing, all influ­ence a person’s risk for dis­ease or injury and women are even more vul­ner­a­ble to these effects.

(Source: Wom­en’s Col­lege Hos­pi­tal)

 

 

A Call to End Life-Threatening Bar­ri­ers to Effec­tive Health­care for Women

There is a gigan­tic imbal­ance in the equa­tion between the health­care women need and the health­care we receive.  It is plac­ing too many women at risk of avoid­able pain, chron­ic dis­ease and ear­ly death.

The research is per­sua­sive.  But noth­ing is more com­pelling than the voic­es of women who have reached out to The Cen­ter for Patient  Pro­tec­tion over the years to share their heart­felt expe­ri­ences with a dys­func­tion­al health­care sys­tem that leaves too many behind.

The rela­tion­ship between women and health­care providers is fur­ther com­pli­cat­ed when fac­tors such as age, care­giv­ing, sex­u­al vio­lence and sex­u­al harass­ment, as well as sex­u­al abuse and mis­con­duct at the hands of reg­u­lat­ed health­ pro­fes­sionals, are intro­duced. Typ­i­cal­ly, the impact of these fac­tors is felt dis­pro­por­tion­ate­ly by women. The stud­ies not­ed in the links all cite sig­nif­i­cant med­ical and emo­tion­al seque­lae, many of which stem from inad­e­quate care or cir­cum­stances that mil­i­tate against women obtain­ing the care they need.   

Gender-based gaps in care and treat­ment were fre­quent­ly report­ed by vic­tims of sex­u­al vio­lence and sex­u­al harass­ment.  Many have often recount­ed being shocked, and harmed, by the insen­si­tive and inad­e­quate care they received. A gen­er­al lack of trauma-informed aware­ness dis­played dur­ing clin­i­cal vis­its, espe­cial­ly at the pri­ma­ry physi­cian lev­el, was a dis­turbing­ly recur­ring theme. When women do not feel an ade­quate com­fort zone and lev­el of con­fi­dence in their inter­ac­tions with health­care pro­fes­sion­als, they are less inclined to be ful­ly can­did. 

Any bar­ri­ers that con­tribute to a dys­func­tion­al rela­tion­ship or a break­down in trust and com­mu­ni­ca­tion in the health­care set­ting are an open invi­ta­tion to diag­nos­tic errors. One study revealed a longer lag time for female patients between the onset of symp­toms and actu­al diag­no­sis in six of 11 types of can­cer.

There are harm­ful impli­ca­tions in oth­er ways.  One study found that women are 50 to 75 per­cent more like­ly to expe­ri­ence an adverse drug reac­tion than men. 

The Safer Women Health Ini­tia­tive™ was cre­at­ed by The Cen­ter for Patient Pro­tec­tion to raise aware­ness among health­care pro­fes­sion­als, pol­i­cy mak­ers, patients and the pub­lic about spe­cif­ic diag­nos­tic, cul­tur­al and com­mu­ni­ca­tion obsta­cles women face in obtain­ing ade­quate care.  

The evidence-based sta­tis­tics are borne out by the expe­ri­ence of The Cen­ter for Patient  Pro­tec­tion.  Over the years, whether they have been vic­tims of med­ical errors or seri­ous break­downs in care involv­ing them­selves or fam­i­ly mem­bers, an over­whelm­ing num­ber of report­ing par­ties to The Cen­ter and its out­reach clin­ic have been women. The emo­tion­al impact of med­ical errors, and the wall of silence fre­quent­ly encoun­tered by loved ones seek­ing answers, has repeat­ed­ly been found to be a sig­nif­i­cant con­trib­u­tor to emo­tion­al and psy­cho­log­i­cal trau­ma. Much of this falls on women.  

The Safer Women Health Ini­tia­tive™works with health­care providers to elim­i­nate the kind of sys­temic bar­ri­ers to safer care that have been iden­ti­fied in the hun­dreds of patient and fam­i­ly expe­ri­ences shared with The Cen­ter for Patient Pro­tec­tion and The ZeroNow Cam­paign since 2012.

We net­work with oth­er stake­hold­ers that have a proven inter­est in rais­ing the bar for wom­en’s health­care.

Through The Cen­ter’s online out­reach clin­ic, we work with the most vul­ner­a­ble women to help them nav­i­gate through the web of obsta­cles and closed doors that thwart mean­ing­ful com­mu­ni­ca­tions, trans­paren­cy and account­abil­i­ty and which com­pro­mise access to the right kind of health­care.

The Safer Women Health Ini­tia­tive™ is col­lab­o­rat­ing with The ZeroNow Cam­paign’s  Heal­ing­Now™, to advance aware­ness of the seri­ous health risks asso­ci­at­ed with sex­u­al vio­lence and sex­u­al harass­ment and the often dev­as­tat­ing emo­tion­al and phys­i­cal harm that can fol­low when women come for­ward and find them­selves thrown into the jaws of insti­tu­tion­al betray­al.  Over­whelm­ing­ly, most inci­dents of sex­u­al vio­lence and relat­ed abus­es occur against women. The lev­el of harm asso­ci­at­ed with such inci­dents often cas­cades into seri­ous emo­tion­al and med­ical com­pli­ca­tions.  It is part of the unique health­care DNA that defines women.  It deserves to be tar­get­ed robust­ly for fur­ther action.

Clin­i­cal work by Dr. Jen­nifer Freyd in betray­al trau­ma the­o­ry led to the devel­op­ment of her con­cept of insti­tu­tion­al betray­al. Her find­ings con­firm that when a trau­mat­ic inci­dent is fol­lowed by insen­si­tive or abu­sive respons­es by trust­ed play­ers like health­care pro­fes­sion­als, pub­lic insti­tu­tions, gov­ern­ment agen­cies, judges, pri­vate cor­po­ra­tions or law enforce­ment author­i­ties, the risk to a victim’s well-being ris­es sharply.

Depres­sion, anx­i­ety, PTSD, self-harm and adverse phys­i­cal out­comes are among the rec­og­nized seque­lae of betray­al trau­ma iden­ti­fied by Dr. Freyd. The high-profile deaths by sui­cide involv­ing 19-year-old col­lege fresh­man Lizzy See­berg, to which Dr. Freyd refers in her research, and for­mer RCMP con­sta­ble Krista Car­le, which I have writ­ten about, are a vivid, yet so heart­break­ing, reminder of the cat­a­stroph­ic risks asso­ci­at­ed with insti­tu­tion­al betray­al fol­low­ing sex­u­al vio­lence

As acclaimed Yale psy­chol­o­gist Joan Cook, Ph.D notes,

Research on the preva­lence and effects of trau­ma is large and grow­ing. How­ev­er, most health care pro­fes­sion­als, such as psy­chol­o­gists, still only have a cur­so­ry knowl­edge of this sci­ence and lit­tle to no for­mal train­ing in evidence-based psy­choso­cial treat­ments for trauma-related dis­or­ders.

Toron­to’s Wom­en’s Col­lege Hos­pi­tal echoes a sim­i­lar view of the gaps in health­care for women, includ­ing those aris­ing from sex­u­al vio­lence.

Half of all women in Cana­da have expe­ri­enced at least one inci­dent of phys­i­cal or sex­u­al vio­lence since the age of 16, yet not all health­care providers have the knowl­edge or skills to deliv­er sen­si­tive care to these women.

This is part of a more gen­er­al gender-based break­down in care that can occur, accord­ing to WCH.

...many women are over­looked and under­served because health­care has tra­di­tion­al­ly not con­sid­ered the impact of sex and gen­der dif­fer­ences.

Women suf­fer from men­tal health con­di­tions such as depres­sion, anx­i­ety and trau­ma sig­nif­i­cant­ly more than men, yet face more bar­ri­ers to access­ing health­care ser­vices.

Women expe­ri­ence depres­sion twice as often as men yet are three times more like­ly than men to expe­ri­ence bar­ri­ers to access­ing men­tal health care.

More alarm­ing find­ings from WCH:

Women are more like­ly to report severe and long-lasting pain, but are typ­i­cal­ly treat­ed less aggres­sive­ly than men. Doc­tors approach women’s pain as psy­cho­log­i­cal or psy­choso­cial and are more like­ly to refer women to a ther­a­pist rather than a pain clin­ic.

Each year, heart dis­ease kills more women than men but, only 35% of patients in heart dis­ease research stud­ies are women.

Research has shown that fol­low­ing a heart attack, women are 36 per cent less like­ly to enroll and par­tic­i­pate in car­diac reha­bil­i­ta­tion because it is not offered as an option to many women for a vari­ety of rea­sons, includ­ing soci­etal pre­sump­tions or cul­tur­al bias­es.

Here’s anoth­er shock­er: stroke.

Stroke is the third lead­ing cause of death for women (in com­par­i­son, stroke is the fifth lead­ing cause of death for men). Each year, 55,000 more women have a stroke than men. Because in gen­er­al women live longer than men, stroke will have a more neg­a­tive impact on their lives. More women will:

  • Live alone when they have a stroke
  • Be more like­ly to live in a long term health care facil­i­ty after a stroke
  • Have a worse recov­ery after stroke

(Source: U.S. Nation­al Stroke Asso­ca­tion)

Bar­ri­ers to effec­tive care for women, and harms pro­duced by providers that are at times gender-biased, and at oth­er times, obliv­i­ous to the unique gender-based issues that con­front women, are the #MeToo equiv­a­lent in the health­care sys­tem.  Research sup­ports the fact that these bar­ri­ers and harms relat­ed to the care, or absence of it, for women occur in advanced-economy coun­tries from Cana­da and the Unit­ed States to the Unit­ed King­dom and Aus­tralia.  

It is a chal­lenge that can­not be met by silence or inac­tion; nor can it await the glacial pace of reform typ­i­cal­ly shown by health­care pol­i­cy mak­ers.

In Cana­da, a good start at rais­ing aware­ness would be for the Trudeau gov­ern­ment to strike a nation­al task force on gender-based bar­ri­ers to safer health­care for women.  This would include every­thing from the low lev­el of female par­tic­i­pa­tion in med­ical and health­care research stud­ies and the low­er rate of refer­ral for car­diac reha­bil­i­ta­tion as com­pared with male coun­ter­parts to the woe­ful lack of trauma-informed train­ing for health­care pro­fes­sion­als who treat the emo­tion­al and phys­i­cal symp­toms of vic­tims of sex­u­al vio­lence and relat­ed abus­es. The over­whelm­ing major­i­ty of such vic­tims are female.  

When the nation­al spot­light is focused on the expanse of these bar­ri­ers, their shock­ing cost to women and their cost to the health­care sys­tem, and when all the play­ers are gath­ered around the table, the chances of reform are sig­nif­i­cant, and sig­nif­i­cant­ly greater than if the sta­tus quo per­sists.

If you are a health­care provider or pro­fes­sion­al, a pol­i­cy leader or an inter­est­ed stake­hold­er — per­haps even a woman of influ­ence and accom­plish­ment who wants to con­tin­ue mak­ing a big dif­fer­ence — please con­sid­er get­ting behind and sup­port­ing our new Safer Women Health Ini­tia­tive™.  You can con­tact Kath­leen Fin­lay direct­ly.

RELATED:

Stop Let­ting the Sys­tem Assault Vic­tims of Sex­u­al Vio­lence Over and Over
(The Hills Times)

Women Short Changed by Health­care Gen­der Gap
(City News arti­cle and video)

When Toxic Work Cul­ture Adds to the Trau­ma of Sex­u­al Mis­con­duct
(Pub­lished in The Huff­in­g­ton Post)

Stop Sex­u­al Mis­con­duct from Being Fatal
(Pub­lished in The Times Colonist)

Deny and Defend Cul­tures Weak­ens Trust in Health­care Sys­tem
(Pub­lished in The Huff­in­g­ton Post)

Keep Ageism Out of the Hos­pi­tal
(Pub­lished in The Huff­in­g­ton Post)

The Cost of Care­giv­ing — To the Care­giv­er
(Pub­lished in The Huff­in­g­ton Post)

Sex­u­al assault and harass­ment linked to long-term health prob­lems for women

The Health Gap (Wom­en’s Col­lege Hos­pi­tal)

Age and Gen­der Vari­a­tions in Can­cer Diag­nos­tic Inter­vals in 15 Can­cers
(NCBI Pub­li­ca­tion)