why we must take better account of the vulnerability of women
12:23 p.m., April 2, 2021
In this article, neurobiologist Catherine Vidal, member of Inserm’s Ethics Committee, explains why it is important to take gender into account when it comes to the effects of the environment on health. “In France, the Public Health law provides for the realization every five years of a” National Health and Environment Plan “(PNSE). The 4th of these action plans, covering the period 2020-2024, was made public last October.
Among its stated objectives is support for research, in particular with a view to improving knowledge on “exposure and the effects of the environment on the health of populations”. Emphasis is placed on a concept proposed in 2005 by British epidemiologist Christopher P. Wild: the exposome, defined as “the lifelong integration of all the exposures that can influence human health”.
Taking the gender dimension into account in exposure to health nuisances is an integral part of the concept of exposome: men and women are not exposed to it in the same way. However, research projects on the exposome devoted to the social, professional and economic environment rarely take into account the notion of gender as such, which poses a problem. Explanations.
The exposome, at the heart of health policies
In the United States, the concept of exposome has been present since 2012 in all strategic plans of the National Institute of Environmental Health Sciences. In France, it is a “structuring element of health policies” in the law to modernize the health system 2016.
More specifically, the exposome project aims to complete data on the human genome, by looking at all the conditions chemical, physical, and biological to which an individual is exposed, from conception to adulthood. All this while integrating social, cultural and economic factors linked to living conditions.
Naturally, many parameters must be taken into account: chemical pollution (pollutants, fine particles, indoor or outdoor air, water, soil), but also the standard of living, working conditions, food, consumption of drugs, microbial infections, noise and light pollution, radiation, etc.
The challenge is to consider the multiplicity of these exposures, their interactions and their cumulative effects over time, throughout life.
Gender: a necessary consideration
Taking into account the gender dimension in the differentiated exposure of women and men to health nuisances is an integral part of the concept of exposome. But paradoxically, in the majority of research programs on environmental health, the notion of gender is not considered as such.
Two areas of research are exceptions. The first is that of sexual and reproductive health: in terms of research on the endocrine disruptors and chemical pollutants, the decline in fertility of women and men, the vulnerability of pregnant women and fetuses are major themes. The second area is that which concerns research on the situation of worsened vulnerability of women due to climate change, in particular in the countries of the South: drought, food shortage, migration, etc.
Beyond these concerns, among the research projects on the exposome devoted to the social, professional and economic environment, few highlight health inequalities linked to gender.
The Covid-19 health crisis has, however, highlighted the vulnerability of women in the face of the deterioration of professional and domestic living conditions. It therefore seems essential to us to broaden the reflections on environmental health, by explicitly taking into account the socio-cultural and economic factors, the accumulation of which weakens women more than men.
Women are overexposed to occupational risks
We note the existence of a hierarchy in the importance of the occupational risks associated with male and female occupations, which is primarily due to job segregation.
Men, the majority in industry and construction, are exposed to asbestos, thinner solvents, carrying heavy loads, noise, etc. Women, more numerous in trade, services and personal care, are exposed to pollutants contained in cleaning products, cosmetics, receipts (bisphenols, etc.), etc.
In practice, jobs that are predominantly female are often considered easier and less dangerous. Now this perception is in contradiction with the real hardship of many jobs.
Whether nurses, home helpers, cashiers, or workers, women are overexposed to carrying loads that often exceed the standard of the Labor Code, namely twenty-five kilos. Result, the musculoskeletal disorders are more important in them – and this is particularly the case for employees. As for cancers of occupational origin, they are less often recognized in them. A recent Inserm study shows, however, that night work increases the risk of breast cancer by 26%.
We should add that exposures are not confined to physical and chemical factors of the professional environment. We must also take into account the psychosocial risk factors linked to the organization and constraints of the work. Now they are more frequent in predominantly female occupations, where the positions are low-skilled, atypical schedules, fragmented work, with a lack of autonomy, but also discontinuities and breaks in the professional career, etc.
Women are among the most precarious
Today, women constitute the majority of people in precarious situations. More specifically, they represent 70% of working poor, hold 82% of part-time jobs, and form 85% of single-parent families, including one in three lives below the poverty line.
Everyone knows that this lack of resources is accompanied by increased health risks. Unsanitary housing can indeed cause or accentuate many pathologies: lead poisoning related to paints, respiratory diseases related to humidity, infectious diseases favored by insufficient sanitary equipment, etc.
In addition to these risks, there is a deterioration of the hygiene of life, with a bad diet, the consumption of alcohol and tobacco, or the lack of physical activity. So many factors that promote obesity, diabetes, cardiovascular diseases, depressive disorders … Not to mention that the lack of financial resources constitutes one of the first reasons for giving up treatment.
Mental burden and domestic violence
Beyond constituting the bulk of single-parent families, the majority of women are responsible for domestic and parental activities, including when they are working. They are also more numerous than men to help relatives with loss of autonomy. And to reconcile it all represents a mental load which increases the risks of developing anxiety and depressive disorders.
In addition, violence within the couple and sexual violence constitute a major risk to women’s health : traumatic and gynecological injuries, psychic and psychosomatic disorders, sleep and eating disorders, anxiety, depression, post-traumatic syndrome, addictive behavior, suicidal ideation, etc.
Decompartmentalize disciplines: an imperative
Research on the exposome involves many disciplines: biology, medicine, physics, chemistry, epidemiology, sociology, public health, etc. However, dialogue between “hard” sciences and social sciences is not always straightforward, which complicates the awareness of researchers of the importance of the concept of gender in the health risks linked to the environment.
This situation invites us to broaden the approaches to the exposome, by bringing together the themes of “health-environment”, “health-work”, and “health-gender”. It is indeed a question of enriching the knowledge of researchers, of bringing out cross-cutting questions by promoting exchanges between different scientific communities. But it is also a question of refining the reflections on the means of prevention and information for vulnerable populations, and women in particular.