In health, as in education, labor markets and other sectors of society, there are significant gender gaps. According to the most recent World Economic Forum report, women spend about 25% more of their lives with health problems and are more likely to face barriers to accessing health care services. This gender gap in health equates to 75 million years of life lost each year due to ill health or premature death.
Elinor Cleghorn in her book “Unwell Women: Misdiagnosis and Myth in a Man-Made World”, reviews these historical inequalities. The Lancet also recently published a systematic review of the health differences between women and men in the main causes of health burden, with little progress in reducing these inequalities between 1990 and 2021. In this context, one of the gaps that often goes unnoticed is the gender gap in pain measurement and treatment: What is the situation in Latin America and the Caribbean? Furthermore, what can – and should – we do to close it?
Radiography of Gender Inequalities in Pain
According to the latest data on the burden of disease in Latin America and the Caribbean, women bear a significantly higher burden of disease than men for health conditions that cause chronic pain. For example, the impact of low back pain and headache disorders is significantly greater in women, with a disability burden almost double that of men. In the case of arthritis, the overall burden is also higher in women.
Note: A DALY is a measure that calculates the number of years lost due to premature death or disability. One DALY is equivalent to one year of healthy life lost. This measure combines both mortality and morbidity impacts, providing a comprehensive view of the total impact of health conditions on the population.
The few Latin American studies available report a predominance of chronic pain in women. In Brazil, for example, the prevalence of chronic pain is almost 5 times higher in women than in men (85% vs 16%). A similar gap is found in the case of Colombia (79% vs 21%). In Chile, although the difference is not as high, women report a higher prevalence of requesting medical leave with prescription (sick leave), with 61% vs. 39% of men.
This vulnerability to pain is largely attributed to social factors that accentuate gender gaps, such as early exposure to stress, long periods of interrupted and poor-quality sleep -particularly during the breastfeeding and upbringing period-, as well as poorer working conditions from an early age. Added to this is the challenge of reconciling caregiving roles -which generally fall on women – with work and domestic responsibilities, and the lack of family support. However, it is not only social conditions that determine the differences in pain between the sexes.
Scientific findings in recent years indicate that neurophysiological and neuroimmunological responses are different in women and men. For example, research with newborns has found that girls have a greater brain response to pain as evidenced by greater brain activation to painful stimuli such as blood sampling. These findings indicate the early emergence of greater anatomical and functional connectivity in the brains of females from birth. This suggests that diagnosis and therapies to combat pain should be made with these biological and social components in mind.
A growing number of studies suggest a gender bias in the measurement and response to pain by healthcare systems. Although women are more likely to suffer from chronic diseases that manifest themselves in pain (e.g., fibromyalgia, osteoporosis, or lupus), their symptoms are more likely to be considered emotional or psychological rather than bodily or biological in origin. According to the latest measurement of the Haleon Pain Index 2023, which collects data from more than 30 countries globally, one in two women report feeling stigmatized when suffering from pain. This bias often leads to delayed diagnosis and the development of more severe health problems due to untreated conditions.
Where to Focus Efforts to Close the Health Gap
Pain represents a significant burden on women’s health, and improving health services in terms of quality and access is critical to addressing this problem. This requires a comprehensive approach that recognizes gender differences in the experience of pain and ensures that women receive the diagnosis, treatment and support needed to manage pain and improve their quality of life. In this regard, there is a need to improve the approach in clinical practice guidelines, train health professionals and develop campaigns that raise awareness of existing gender gaps and the role of health services in addressing them.
It is also essential to address the gaps in the research field, making revisions and adjustments to research protocols, considering the impact that pain has on public health and the burden it carries as a disease. Although women tend to have more health problems than men (e.g., they lose more years of healthy life to diseases such as low back pain), most studies tend to focus on diseases with high mortality, ignoring those that lead to disability. Ninety percent of Lupus cases, for example, occur in women between the ages of 15 and 44. Fibromyalgia affects women in a ratio of up to 9:1 compared to men, and 60% of patients with osteoarthritis are women. These diseases generate disability, which has a direct impact on participation in the labor market and accentuates the gender inequalities that already exist in the labor market in Latin America and the Caribbean.
In conclusion, addressing the gender gaps in pain requires a collective effort to change the way we measure, diagnose, and treat pain in women. With adequate investment in research and policies informed by gender-specific data, we can move toward a future where women can avoid or reduce pain and improve their quality of life.
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