Reading Caroline Criado Perez's striking book Invisible Women: Data Bias in a World Designed for Men (Abrams Press, 2019) made me angry, and it's likely most readers who identify as female will share that response. With unrelenting force, Perez demonstrates how women around the world are treated as second-class citizens. The book covers data bias in many fields, including health care. Perez shows how violence against nurses goes unacknowledged, and how current medical research often leaves women out, creating potentially harmful treatment gaps. She insists that women's needs and work-paid or unpaid-must be given more respect and credence.
Invisible Women begins with the premise that when women are excluded from data collection, the result is a "gender data gap." Perez offers a vivid example: in Karlskoga, Sweden, municipal planners based snow removal protocols on drivers' needs. In 2011, city officials considered whether prioritizing snow clearing for cars was sexist. Turns out it was, since when traveling, Swedish women tend to walk or take public transportation whereas men tend to drive. In Sweden, under icy conditions, pedestrians are injured three times more often than motorists; the estimated costs of pedestrian falls during one winter in just one Swedish county were roughly $3.4 million. When Karlskoga changed its snow removal protocols to prioritize pedestrians, it saved countless women from injurious falls and its health care system a lot of money.
The entire book is packed with damning statistics that show how women are harmed when our vulnerabilities aren't considered. Perez cites the journal New Solutions: "Research has found that nurses [a majority-female profession] are subjected to 'more acts of violence than police officers or prison guards.'" Occupational health researchers argue that traditional hospital design puts nurses at risk for assault, with long hallways that isolate them from each other and nurses' stations that lack protective barriers. Short staffing can lead patients to become violent as they wait for care. Workplace violence against nurses often goes unreported, largely because when management's response is lacking or insufficient, reporting feels pointless. Yet, as the aforementioned researchers stated, gender is "typically . . . absent from analyses of health sector violence."
The gender data gap also affects female patients, who must seek care from a system that takes the male body as representative of all bodies, even as important differences in male and female physiology continue to be discovered. As Perez notes, "Sex differences in animals have been consistently reported for nearly fifty years, and yet a 2007 paper found that 90% of pharmacological articles described male-only studies." A host of studies have revealed stark physiological sex differences. For example: transplanted female, but not male, muscle-derived stem cells will regenerate new tissue; daytime heart attacks trigger a neutrophil response that increases survival rates for men, but probably decreases them for women; and estrogen exposure prompts female, but not male, nasal epithelial cells to respond more effectively to viruses.
The gender data gap can actually endanger women when it renders their health issues invisible. Women's heart attack symptoms differ greatly from men's symptoms. Yet a 2005 study found that only one in five U.S. physicians knew that more women than men die of cardiovascular disease annually, and many felt unqualified to administer cardiac care tailored to women. Similarly, Perez reports, tuberculosis "kills more women globally than any other single infectious disease" and more women than men develop active tuberculosis. Yet women tend to be underdiagnosed with and undertreated for the disease. Women are also much more likely to experience adverse drug reactions than men. Despite this, pharmaceutical researchers continue to limit their subjects to men, having deemed women's bodies "too complicated" to be easily included in drug studies.
When I finished this book, I felt exhausted but hopeful. Invisible Women reads as a manifesto for seeing women fully because doing so benefits everyone. To begin with, Perez might argue, let's collect and disseminate data that deliberately and consistently include women's lived experiences and physiological uniqueness. Speaking specifically about health care, she concludes, "We need to train doctors to listen to women, and to recognize that their inability to diagnose a woman . . . may be the gender data gaps in their knowledge. It's time to stop dismissing women, and start saving them."