When drawing up a provisional assessment of the Covid-19 pandemic in order to consider whether it would be possible to do better for the future and/or in view of a possible another pandemic, the question of prevention is fundamental.
By dissecting the subject, we come to wonder if this prevention would not benefit from being gendered – or at least from taking more into account the inequalities between men and women which have been exacerbated during the last three years of pandemic.
Behavioral differences
Hindsight and studies on the subject highlight many gender disparities. First, it appears that it is men who are most at risk of developing serious forms of the disease and of dying from it. In March 2022, two researchers from the National Institute for Demographic Studies (INED) have published an article on the subjectin which they show that the excess mortality linked to Covid was higher among men, especially from the age of 55.
If there are purely biological disparities – women seem intrinsically less at risk of developing serious forms – the researchers also point the finger at social and behavioral factors. “Women are biologically less fragile than men, but the differences come mainly from their activities and their behavior. Throughout life, men take more risks than women and engage in unhealthy behaviors more frequently – including smoking more and drinking more alcohol. Women, for their part, are generally more attentive to their health and consult doctors more often., point out Gilles Pison and France Meslé. Consequently, men have more comorbidities – diabetes, hypertension, cardiovascular diseases, dyslipidémies– which expose them more to the risk of serious forms of Covid.
In addition, the study conducted during the first wave shows that, while there was a higher mortality from Covid-19 in men aged between 25 and 34, this mainly concerned “people born abroad, in particular in Africa or Asia, because often residing in the regions most affected by this wave (Ile-de-France or Grand Est), and exercising professions that do not allow teleworking and exposing many to infection”.
Moreover, and somewhat counter-intuitively, the two authors hypothesize: “Men would thus have been more attentive to their health than women in the case of vaccination against Covid-19, or at least more obedient to health directives. While we most often observe that men have less health-promoting behaviors than women.
That said, a column published in early January in Le Journal du dimanche nuance these remarks somewhat. Professors Sylvie Borau, Hélène Couprie and Astrid Hopfensitz mention a lesser commitment of single men in terms of prevention: «Our studyconducted in sixty-seven countries with 46,000 respondents, shows a notable difference in acceptance of health prevention measures between single men and married men, regardless of the age and culture of the individuals interviewed.
They also note: “It’s not so much an uninhibited relationship to risk, a way of posing one’s virility, by taking individual risks, that makes the difference. According to our research, the element that especially distinguishes the single man from the married man is his lesser attention to others, his more limited altruism in relation to the group and the community. He has, less than the married man, moral scruples and above all a lesser feeling of belonging to a collective.
We therefore have a male population that is less committed to prevention in general, which puts itself at greater risk of serious forms and some of which (at the very least) are less quick to adopt specific prevention measures for Covid-19.
Women more exposed and weakened in their mental health
What about women now? As we have said, they are less at risk than men of dying from Covid and generally more concerned about issues of prevention. But, at the same time, they seem to have been more contaminated by the virus. This is explained by the fact that they were more present in the care and service professions and that they more often occupied precarious or subordinate professions, which did not allow them to telecommute during the confinements -on think, for example, of supermarket cashiers and nursing home staff. Women are also, regardless of their profession, the traditional carers of sick people and more frequently in contact with their children.
In addition, women appear more at risk of developing a long Covid. Paradoxically, if they are quicker to take an interest in preventive measures, it seems that they were able, at least in the early stages, to be more often resistant to vaccination against Covid than men.
But women have also been collateral victims of the health crisis more often than men. Indeed, several studies have shown that this crisis had widened the inequalities between men and womenparticularly in terms of employment (and loss of employment) and income, as well as the sharing of household chores and time spent with children, and this in almost all social settings.
To this mental load is sometimes added the (increasing) incidence of domestic violence. In addition, women’s health has suffered more from the health crisis, with lower access to sexual and reproductive rights. But also because they have been more weakened in their mental health, for example in terms of anxiety and sleep disorders.
Why a female distrust of vaccination?
In the light of all these elements, we are therefore asking ourselves the question of whether it would be appropriate to gender prevention more, that is to say, to carry out public health actions that are more targeted according to gender. For us, the question is not settled: it seems to us on certain aspects that it is important to carry out in a balanced way between men and women campaigns intended to promote vaccination, the wearing of masks, ventilation or isolation in the event of a positive test.
Regarding vaccination specifically, we emphasize the importance of transparent communication and in particular of studying the adverse effects of gender-related vaccines and informing the people concerned. Indeed, some of the female distrust of vaccination may have been linked to its possible effects on menstruation – with longer cycles and increased bleeding in the weeks following the injection.
It is to be feared that these effects could have been considered by representatives of medical expertise in health agencies, more often men, as “problems of good women”, since fertility was not altered. Yet, from the perspective of menstruating people, such effects may have generated legitimate concern.
In addition, women may also have been more wary of vaccination, because they were more worried about adverse effects in the people they were caring for – children and the elderly. Here again, we find the importance of transparency and education at the root of trust in health interventions.
A prevention model to review
To these first considerations, we must add other aspects where more gendered public health policies could be justified. What is the weight of our patriarchal traditions in the perception by our Western societies of care and emergency medicine, provided by men, and which reflects a virile vision of health? Conversely, is prevention less about action and more the prerogative of women?
It seems crucial to us to work so that prevention is no longer seen as this feminine aspect of health. Is there a need for specific communication aimed at men, centered on the risks of certain behaviors (consumption of alcohol, smoking, physical inactivity, road safety)? How to get them to consult early in order to detect diabetes, hypertension, excess cholesterol or weight, before they are symptomatic?
Prevention cannot rely solely on women in the home. How to make the male sex more involved in matters relating to his health, as well as that of his family? When there is a family: we have indeed spoken above of single men. To their destination, professors Sylvie Borau, Hélène Couprie and Astrid Hopfensitz propose “to take care to fight against the isolation of single men, in order to arouse their sense of belonging and their desire to protect others. Include them more in the social fabric, help them to create a link. These measures, for the moment never envisaged, could contribute to improving their respect for the instructions, thus promoting their own life expectancy and generally reducing the risks of contagion.
But if we wanted to see public policies involving men more in prevention, being still light years away from such a paradigm shift, this would require carrying out major sociological research beforehand.
The benefits of gendered prevention
This would ultimately result not only in better male health – with a reduction in vulnerability to severe forms of Covid, influenza or asthma – but also better public health due to better collective protection.
This would also result in a relief of the female physical and mental burden linked to prevention and family care. Because, and this is again this other line of thought for gendered prevention that we are calling for, it is also crucial to ensure that women are no longer collateral victims of a health crisis, such as that of the Covid-19. This therefore requires a better distribution of tasks related to the family and concern for care. This also requires better prevention and better recognition of domestic violence – whether physical, psychological, sexual or even financial.
Finally, the anticipation and planning of health crises should include the preservation of access to health, including sexual, reproductive and mental health.
Considering gendered prevention would call for changes in methods of care – but also in our own stereotypes – which would require better consideration of the particularities of women and men in terms of public health, and which would invite the medical profession, that of the education and society as a whole to get rid of the many sexist biases that still persist today – out of ignorance, even cultural habits, more than out of malevolence.
These changes would allow our society to be more resilient and better armed in the face of new health crises, epidemics and the demographic challenges of aging.