In Australia, we are lucky enough to have a fairly well-functioning healthcare system that ostensibly allows everyone access to the care they need, regardless of their financial circumstances. Unfortunately, our healthcare system still operates in a society that is rife with oppression. Some oppression is obvious – like our continued racist treatment of Indigenous people within medical institutions – some of it less evident but deeply damaging nonetheless. Thus, there arises the need for an intersectional approach that considers access to healthcare as well as other cultural and financial barriers in order to examine this issue in the detail it deserves.
There is ample evidence of how women in general are disadvantaged by health services, but this grows exponentially worse when the women in question belong to any so-called minority group – that is to say, if they’re not white, well-off, straight and able-bodied. Some of it is due to outright discrimination, but the effects of unconscious bias and inadequate education can be far more insidious.
The explanation for the disparities in the healthcare system is complex and multifaceted. In some cases, it’s caused by blatant gendered discrimination. Roughly 70% of chronic pain sufferers are women, and studies suggest that women feel chronic pain both more frequently and severely than men. Despite this, pain is frequently undertreated in women, apparently due to archaic beliefs that women are predispositioned to be hysterical and less able to accurately report the degree of pain they’re experiencing. Horrifyingly, in a 2014 survey, nearly half of women with chronic pain were told that the pain was ‘all in their head’.
Another common mantra – largely heard from male doctors – is that pain caused by ‘female diseases’ like endometriosis is just a normal part of being a cis woman. It isn’t hard to link these disturbing facts to the lingering misogyny of healthcare providers and the institutions that back them.
Additionally, beyond a brief dip into the reproductive system, XX-chromosome physiology is rarely taught in medical schools. In fact, the regressive practices around treating females has earned itself the nickname ‘bikini medicine’, derived from the fallacy that the only differences between the sexes are the parts covered by a bikini – the breasts and genitals. Fatally, this practice completely fails to recognise that, for instance, symptoms of issues like heart attacks can vary hugely between sexes. As a result, many diagnostic failures when screening tests or lists of symptoms do not include the symptoms or signs experienced by XX-chromosome patients. In fact, a study in 2000 found that cis women were seven times more likely than cis men to be misdiagnosed and discharged during a heart attack because their symptoms didn’t align with the male-centric symptoms taught to healthcare staff.
While it’s true that genetic factors can increase disease risks for people from a given ethnic background, it seems obvious that many disparities in healthcare suffered by women of colour are caused by social factors; statistically, women of colour have much higher rates of pregnancy-related complications and mortality. Additionally, misogyny experienced by African-American women is clear in the fact that they are 20% less likely to be prescribed pain medication, more likely to suffer strokes and less likely to survive them, and more likely to suffer mistreatment or under diagnosis of breast cancer. Hispanic women suffer higher rates of cardiovascular disease and diabetes. Asian-American women are less likely to be screened for cancer, even though cancer is the leading cause of death in Asian-Americans. There’s plenty more statistics to be quoted, but the trend is clear; in this white supremacist patriarchy, societal bias manifests in worse health outcomes for women of colour.
Though it may seem counterintuitive to some, having any kind of disability can worsen your experience with healthcare. Reproductive and sexual health is a particular issue for patients with disabilities, with some patients with disabilities discouraged from having sex or bearing children, and even undergoing forced sterilisation. In addition, many disabilities are poorly understood, especially in the case of ‘invisible’ conditions like chronic fatigue syndrome or neurological disorders. Such patients are often dismissed as lazy, weak or attention-seeking when they seek help. Similarly, healthcare staff may take prescriptivist approaches to treating patients with disabilities, telling them that they should lower their expectations of their life instead of encouraging them to demand the best possible treatment. Healthcare professionals should be working with patients with disabilities, but far too often, they ignore the lived experience of the patients they’re supposed to help.
It is abundantly clear that our healthcare services are failing women across the board, and it is women of colour, disabled women and queer people who suffer most. We cannot boast about our healthcare system being one of the best in the world until we begin to address the deep structural oppression within it, and effect real positive change for the women and non-binary people who are being hurt most by its failings.