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Tuesday, December 7, 2021

It’s time to admit it – our health service has a diversity problem

At the beginning of the pandemic, I tweeted that from the statistics, men were more likely to die of Covid than women. Lifestyle factors such as smoking were involved, as well as pre-existing conditions, but still the figures were showing that the female immune system is better than the male one at fighting infection.

I wasn’t trying to make any kind of big point but within 20 seconds, I was accused of being transphobic for saying that male and female biology is different. I responded by saying this has long been known, as well as the fact that women tend to suffer autoimmune disease more than men because genes that originate from the X chromosome create the possibility of mutations occurring. These mutations cause a whole range of autoimmune illnesses .  

It seemed mad then, and it does still, that to talk of biological difference is somehow taboo. Then, as we then began seeing the faces of the first victims of the first wave so often black and brown, were we to ignore the racial disparities too? Some tried and we were repeatedly told that Covid didn’t discriminate. Yet it became impossible to ignore the issue that some communities were being hit harder by Covid than others, even when factoring in economic conditions.  

It’s a relief to now be able to address this openly. Sajid Javid has announced a review into systemic racism in the health system to understand why people of colour and women may have worse health outcomes. The information that oximeters which show how much oxygen is in the blood work are less effective on dark skin is deeply shocking. How many lives could have been saved if that had been known? ICU units were disproportionately full of BAME patients and Javid is right to ask why nothing was done about medical technology that was not working for black people.  

I would go further and say that so much medicine is based on the default model of the white male body and can be equally useless for women too. This bias is built into the very core of much standard medical practice. MRI scanners, for instance, aren’t suitable for pregnant women.  

Data that is used and the drugs that are tested, as well symptoms that are deemed meaningful often comes from men. Caroline Criado-Perez’s excellent book Invisible Women gives us important examples of how this affects us. In the case of heart disease, women are on average diagnosed seven years later than men. Could this be because, as Criado-Perez reveals, that women made up only 25 per cent of participants across 31 landmark clinical trials for congestive heart failure between 1987 and 2012? If a middle-aged woman presents with chest pain, especially if she smokes, she is 50 per cent more likely to be misdiagnosed with depression or a panic attack than a man with a similar history.  

Women and people of colour repeatedly tell us their pain is not taken seriously. Patients with sickle cell anaemia, which predominantly affects those of African and Caribbean backgrounds, report not being believed even when in severe distress. This experience of having one’s pain dismissed is a very common one for women.

Endometriosis can be ignored for years. The vaginal mesh scandal revealed that doctors were ignoring what their patients were telling them.

The so-called weaker sex is routinely expected to have an incredibly high pain threshold, otherwise why would the insertion of a coil be described as “slightly uncomfortable”? Why have I sat in A&E departments with my daughter in agony with a ruptured ovarian cyst, for her to be told that the solution to her problem was to get pregnant? Why, when I told the doctor that, having had two children, I knew this third pregnancy was not normal, was I ignored until they rushed me into theatre, haemorrhaging from an ectopic pregnancy? Every woman I know has such stories of being told that we do not know our own bodies.

Yet it is the establishment that does not know us. Why are black women four times more likely than white women to die in pregnancy or childbirth? Why do so many black Britons feel they do not get good care from the NHS or mental health services? Many issues are at play here: language barriers possibly but also an inability of some to understand their patients’ experiences of racism or examine their own.

Biology matters. Bodies are all different. To be treated equally our differences have to be respected.

Having a white male as the default patient and, even, medic fails us all. At the height of the pandemic exhausted female medics were reportedly put at risk because their PPE didn’t fit. The masks were designed for male faces, even though 75 per cent of NHS workers are female. Many were left to tape up the gaps. In ICUs, it is literally life-saving to have proper-fitting PPE but the gowns were often way too big.

They were, said one frontline worker, “designed for a 6ft 3in bloke built like a rugby player”.

To design the NHS for all of us, not just the odd rugby player then, is a huge task. But one that is vital. Let’s hope Javid’s review into the system will kick it wide open.

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