Women spend more of their money on health care than men. And no, it’s not just about ‘women’s issues’
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Medicare, Australia’s universal health insurance scheme, guarantees all Australians access to a wide range of health and hospital services at low or no cost.
Although access to the scheme is universal across Australia (regardless of geographic location or socioeconomic status), one analysis suggests women often spend more out-of-pocket on health services than men.
Other research has found men and women spend similar amounts on health care overall, or even that men spend a little more. However, it’s clear women spend a greater proportion of their overall expenditure on health care than men. They’re also more likely to skip or delay medical care due to the cost.
So why do women often spend more of their money on health care, and how can we address this gap?
Women have more chronic diseases, and access more services
Women are more likely to have a chronic health condition compared to men. They’re also more likely to report having multiple chronic conditions.
While men generally die earlier, women are more likely to spend more of their life living with disease. There are also some conditions which affect women more than men, such as autoimmune conditions (for example, multiple sclerosis and rheumatoid arthritis).
Further, medical treatments can sometimes be less effective for women due to a focus on men in medical research.
These disparities are likely significant in understanding why women access health services more than men.
For example, 88% of women saw a GP in 2021–22 compared to 79% of men.
As the number of GPs offering bulk billing continues to decline, women are likely to need to pay more out-of-pocket, because they see a GP more often.
In 2020–21, 4.3% of women said they had delayed seeing a GP due to cost at least once in the previous 12 months, compared to 2.7% of men.
Data from the Australian Bureau of Statistics has also shown women are more likely to delay or avoid seeing a mental health professional due to cost.
Women are also more likely to need prescription medications, owing at least partly to their increased rates of chronic conditions. This adds further out-of-pocket costs. In 2020–21, 62% of women received a prescription, compared to 37% of men.
In the same period, 6.1% of women delayed getting, or did not get prescribed medication because of the cost, compared to 4.9% of men.
Reproductive health conditions
While women are disproportionately affected by chronic health conditions throughout their lifespan, much of the disparity in health-care needs is concentrated between the first period and menopause.
Almost half of women aged over 18 report having experienced chronic pelvic pain in the previous five years. This can be caused by conditions such as endometriosis, dysmenorrhoea (period pain), vulvodynia (vulva pain), and bladder pain.
One in seven women will have a diagnosis of endometriosis by age 49.
Meanwhile, a quarter of all women aged 45–64 report symptoms related to menopause that are significant enough to disrupt their daily life.
All of these conditions can significantly reduce quality of life and increase the need to seek health care, sometimes including surgical treatment.
Of course, conditions like endometriosis don’t just affect women. They also impact trans men, intersex people, and those who are gender diverse.
Diagnosis can be costly
Women often have to wait longer to get a diagnosis for chronic conditions. One preprint study found women wait an average of 134 days (around 4.5 months) longer than men for a diagnosis of a long-term chronic disease.
Delays in diagnosis often result in needing to see more doctors, again increasing the costs.
Despite affecting about as many people as diabetes, it takes an average of between six-and-a-half to eight years to diagnose endometriosis in Australia. This can be attributed to a number of factors including society’s normalisation of women’s pain, poor knowledge about endometriosis among some health professionals, and the lack of affordable, non-invasive methods to accurately diagnose the condition.
There have been recent improvements, with the introduction of Medicare rebates for longer GP consultations of up to 60 minutes. While this is not only for women, this extra time will be valuable in diagnosing and managing complex conditions.
But gender inequality issues still exist in the Medicare Benefits Schedule. For example, both pelvic and breast ultrasound rebates are less than a scan for the scrotum, and no rebate exists for the MRI investigation of a woman’s pelvic pain.
Management can be expensive too
Many chronic conditions, such as endometriosis, which has a wide range of symptoms but no cure, can be very hard to manage. People with endometriosis often use allied health and complementary medicine to help with symptoms.
On average, women are more likely than men to use both complementary therapies and allied health.
While women with chronic conditions can access a chronic disease management plan, which provides Medicare-subsidised visits to a range of allied health services (for example, physiotherapist, psychologist, dietitian), this plan only subsidises five sessions per calendar year. And the reimbursement is usually around 50% or less, so there are still significant out-of-pocket costs.
In the case of chronic pelvic pain, the cost of accessing allied or complementary health services has been found to average A$480.32 across a two-month period (across both those who have a chronic disease management plan and those who don’t).
More spending, less saving
Womens’ health-care needs can also perpetuate financial strain beyond direct health-care costs. For example, women with endometriosis and chronic pelvic pain are often caught in a cycle of needing time off from work to attend medical appointments.
Our preliminary research has shown these repeated requests, combined with the common dismissal of symptoms associated with pelvic pain, means women sometimes face discrimination at work. This can lead to lack of career progression, underemployment, and premature retirement.
Similarly, with 160,000 women entering menopause each year in Australia (and this number expected to increase with population growth), the financial impacts are substantial.
As many as one in four women may either shift to part-time work, take time out of the workforce, or retire early due to menopause, therefore earning less and paying less into their super.
How can we close this gap?
Even though women are more prone to chronic conditions, until relatively recently, much of medical research has been done on men. We’re only now beginning to realise important differences in how men and women experience certain conditions (such as chronic pain).
Investing in women’s health research will be important to improve treatments so women are less burdened by chronic conditions.
In the 2024–25 federal budget, the government committed $160 million towards a women’s health package to tackle gender bias in the health system (including cost disparities), upskill medical professionals, and improve sexual and reproductive care.
While this reform is welcome, continued, long-term investment into women’s health is crucial.
Mike Armour, Associate Professor at NICM Health Research Institute, Western Sydney University; Amelia Mardon, Postdoctoral Research Fellow in Reproductive Health, Western Sydney University; Danielle Howe, PhD Candidate, NICM Health Research Institute, Western Sydney University; Hannah Adler, PhD Candidate, Health Communication and Health Sociology, Griffith University, and Michelle O’Shea, Senior Lecturer, School of Business, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Want straighter teeth or a gap between? Don’t believe TikTok – filing them isn’t the answer
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After decades of Hollywood showcasing white-picket-fence celebrity smiles, the world has fallen for White Lotus actor Aimee Lou Wood’s teeth.
Wood was bullied for her looks in her youth and expressed gratitude for the positive comments she received about her teeth since appearing on White Lotus. She also joked that people shouldn’t take to drastic measures like filing teeth to copy her famous gap.
But social media influencers are promising that teeth filing is a quick way to achieve a straight smile. Some influencers even use electric nail drills to cut gaps between their front teeth.
A few of my patients admit to taking a nail file to “buff” or file jagged edges off their teeth. Many do this without understanding what they are cutting away.
Here’s why you should think twice about filing your teeth at home, and why we as dentists or orthodontists occasionally resort to this.
When might a dentist file a tooth?
Dentists and orthodontists occasionally file a tooth’s enamel, known as enameloplasty, to conservatively smooth-down a chipped tooth, or even-out a smile.
But adjustments to a person’s smile are minute, and always limited to the superficial enamel layer of the tooth.
Why don’t dentists routinely file teeth?
Dentists and orthodontists are particular about what and when we cut because teeth don’t grow back like fingernails or hair.
So what is a tooth? A tooth is like an egg, with an outer diamond-like lustrous crystal enamel coat that envelops the hard yet springy dentine.
The enamel and dentine envelop a central chamber – containing blood vessels, cells and nerves – called the pulp.
The outer periphery of the pulp is surrounded by and nourishes special dentine-making cells called odontoblasts.
The odontoblasts are similar to our bone-making cells but don’t have the capacity to regenerate. These cells eventually give way to age-related changes or trauma.
Our enamel-making cells die when our teeth cut through our gums as children, which means we can no longer make new, or repair damaged, enamel.
So damaged enamel or dentine on the outer surface of the tooth cannot self-repair.
Cutting your teeth without sealing and filling them can leave the tooth exposed, destroying the previously well-insulated pulp and causing sensitivity and pain.
Infections can occur because the bacteria from the plaque inside your mouth travels into the tooth and inflames the pulp.
And just like a cut on your skin, the pulp inflames and swells as part of the healing process. But your pulp is encased in a hard enamel-dentine chamber, so it has no room to expand and swell, leading to a throbbing toothache.
What can you do if you want to change your teeth?
You can change your smile without compromising the integrity of your teeth. Dentists can even create or close gaps.
And we will always offer conservative options, including “no treatment”, to keep as many of your teeth whole and healthy as possible.
Sometimes, your dentists and or orthodontists may offer options to:
- use braces to move teeth. Moving teeth can create a different smile, and sometimes change the shape and position of your jaws, lips and cheeks
- whiten teeth to remove superficial stains to make your smile look more visually even
- adapt white resin fillings or veneers to add and change the shape of teeth, with little or no tooth cutting required.
If you’re concerned about the look of your teeth, talk to your dentist or orthodontist about options that won’t damage your teeth and make them last the distance.
Don’t forget that Aimee Lou Wood’s iconic smile makes her stand out from the crowd. Your smile is what makes you special, and is part of who you are.
Arosha Weerakoon, Senior Lecturer and General Dentist, School of Dentistry, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Minimize Aging’s Metabolic Slump
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I know that metabolism slows with age, are there any waypoints or things to look out for? I don’t know whether I should be eating less, or doing less, or taking some other approach entirely. What’s recommended?❞
Age and sex count for a lot with this one! As metabolism is in large part directed by hormones:
- For men, declining testosterone (often from around 45 onwards) can result in a metabolic slump
- For women, declining estrogen with the menopause does have an effect, but progesterone is the bigger factor for metabolism in the sense you are talking about.
In both cases, simply taking more of those hormones can often help, but please of course speak with an endocrinologist if that seems like a possible option for you, as your circumstances (and physiology) may vary.
If you’d like to go to that conversation well-armed with information, here are some good starting points, by the way:
- The Testosterone Drop, & Topping Up Testosterone
- Menopausal HRT: Bioidentical vs Animal (It Makes A Difference!)
And if you’re wondering about the natural vs pharmaceutical approaches…
- What Does “Balance Your Hormones” Even Mean?
- What You Should Have Been Told About The Menopause Beforehand
About your metabolic base rate
We tend to think of “fast metabolism good, slow metabolism bad”, and that’s a reasonable general premise… but it’s not necessarily always so.
After all, if you could double your metabolism and keep it there all the time, without changing anything else, well… You’ve heard the phrase “burning the candle at both ends”? So, having at least some downtime is important too.
See for example: Sleep Deprivation & Diabetes Risk
What’s critical, when it comes to base metabolic rate, is that your body must be capable of adequately processing what you are putting into it. Because if your body can’t keep up with the input, it’ll just start storing the excess chemical energy in the quickest and easiest way possible.
…which is a fast track to metabolic disorder in general and type 2 diabetes in particular. For more on the science and mechanics of this, see:
How To Prevent And Reverse Type 2 Diabetes
As for portion sizes…
Your body knows what you need, so listen to it. There is no external source of knowledge that can tell you how much food you need better than your own body itself can tell you.
You may be wondering “how exactly do I listen to my body, though?”, in which case, check out:
The Kitchen Doctor: Interoception & Mindful Eating
As for exercise…
When you exercise, your metabolic rate temporarily increases. After most kinds of exercise, your metabolism slumps again afterwards to compensate.
There are two ways to avoid this:
- Exercise Less, Move More ← it’s about maximizing time spent not sitting still
- High Intensity Interval Training ← a special kind of exercise, the only one known to keep the metabolism running high for a couple of hours afterwards, with no counter-slump
…which makes it pretty effective indeed
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Never Enough – by Dr. Judith Grisel
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We’ve reviewed books about addiction before—specifically about alcohol, at least. This one’s more general in that it covers different addictions.
On the other hand, it’s also more specific, in that it covers them from the author’s field: neuroscience.
…and experience too. The author had a plethora of addictions (the serious kind), got sober, and then undertook to study neuroscience. Her hope was to help others avoid, or escape from the same as‚ what she went through.
Dr. Grisel (as she now is) takes a methodical approach in this book. She works her way through the addictive mechanisms of a broad selection of common drugs, explaining each.
The focus here is on neutral explanations, rather than the propagandizing scaremongering that failed at least one generation. Why each drug is alluring, what it really does do—and the neurological price it exacts, down to the molecular level.
She also covers risk factors for addiction; genetic, epigenetic, and environmental. There’s no “if you were stronger”, or “these people made bad choices”, so much as… Many addicts were, in effect, sabotaged from before birth.
That doesn’t mean that to become addicted or not is just fate, but it does mean… There but for the grace of factors completely outside of our control go we.
Why is this useful to us, be we a reader without any meaningful addiction (we’re not counting coffee etc here)? Well, as this book illustrates and explains, many of us could be one (more) mishap away from a crippling addiction and not know it. Forewarned is forearmed.
Bottom line: almost all of us are, have been, or will be touched by addiction in some way. Either directly, or a loved one, or a loved one’s loved one, or perhaps a parent who gave us an epigenetic misfortune. This book gives understanding that can help.
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News of a ‘giant’ baby boy is all over TikTok. Here’s what women really need to know
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Baby boy Cassian is an internet sensation. He was born earlier this year in the United States weighing 5.8 kilograms. But after his mum and the hospital shared the news recently, it wasn’t long before headlines about the “giant” baby spread around the world. These included:
‘Are you OK’?: Woman breaks record with giant newborn baby
Record-breaking baby tips the scales at almost double the average size of a newborn
While baby Cassian was born heavier than average, he’s not unique. There have been other examples in the news of babies born heavier. That includes a baby boy born in Brazil in 2023 who weighed 7.3kg.
These stories might make women all over the world cross their legs. But how common are big babies, and does their birth always lead to complications?
What are big babies?
Macrosomia describes babies born over 4kg or 4.5kg, depending on the definition.
A big baby can also be defined as having a birth weight over the 90th percentile at a particular gestational age. In other words, more than 90% of babies have a lower birth weight at this particular stage of the pregnancy. The term “large for gestational age” is probably a more accurate term as the weeks of gestation is used alongside the weight.
There has been little change overall in the percentage of large babies in the past decade in Australia. While stories of such births hit the media, their proportion hovers around 9–10% of births.
What are the problems for big babies and their mums?
We don’t know the specific circumstances of Cassian’s birth, his health or that of his mother. And we don’t know whether common reasons for larger babies are relevant in this situation.
But, generally speaking, birth complications can be higher for mothers and babies when the baby is big, especially if more than 4.5kg. This is certainly not always the case, however.
There is an increased need for interventions during the birth, such as forceps or vacuum delivery, or a caesarean section the bigger the baby is. Having these interventions can impact a women’s recovery after the birth, and options for the next birth.
For the baby there are higher risks of the shoulders getting stuck in the birth canal during the birth (known as shoulder dystocia).
Midwives and obstetricians also may need to make extra manoeuvres for the baby to be safely delivered. For instance, they may need to try and bring down one shoulder if it’s stuck behind the mother’s pubic bone.
These manoeuvres can damage the baby or lead to oxygen restrictions, with the baby needing to be resuscitated. However, these complications are rare and can occur when a big baby was not expected.
What leads to a big baby?
Big babies are most often healthy babies, and there are a number of reasons for them.
Genetic factors mean babies are always big in some families.
Babies that go over their due dates tend to be a bit bigger as they have more time to grow inside their mothers.
Having diabetes, especially if this is poorly controlled, can lead to larger babies. This is because the mother’s higher blood sugar leads to the baby receiving more energy than it needs, so it stores this extra energy as fat.
Babies of mothers with diabetes diagnosed for the first time in pregnancy (gestational diabetes) are at increased risk of being obese and developing diabetes in the future.
Mothers who are larger before pregnancy, or when pregnant, may also be more likely to have big babies. This is mostly due to the increased likelihood of developing diabetes in pregnancy, and perhaps poorer nutrition choices.
Can you predict a big baby?
Estimations of babies’ weights before they are born are imprecise. That’s why so many women are told they are going to have a big baby and don’t, and others are surprised by a big baby when it arrives.
Midwives and obstetricians routinely feel a woman’s growing uterus when they provide antenatal check-ups. They are looking at the position the baby is lying in the uterus as well as where the top of the uterus is compared to the woman’s belly button. This gives an idea of whether the baby is growing as you would expect at that time.
They also measure from the top of a woman’s belly to the top of her pubic bone with a tape measure. The weeks of pregnancy usually correspond to the measurement within a couple of centimetres.
For example, at 36 weeks of pregnancy the tape measurement would be somewhere between 34cm and 38cm. If there is more or less than a 3cm difference between the measurement and the numbers of weeks of pregnancy then an ultrasound would be offered to look at how the baby’s growing and to estimate the size.
But ultrasounds are poor predictors of actual birth weight. The Big Baby Trial was published earlier this year. It randomised nearly 3,000 women in the United Kingdom to being induced at 39 weeks if suspected to be having a big baby (according to an ultrasound) or waiting for labour to start.
There was little difference in birth weight or poor outcomes, such as shoulder dystocia for the baby, leading to the trial being stopped early. Around 60% of babies screened as being big babies were not actually big at birth, showing the inaccuracy of ultrasounds in predicting birth weight.
What can women do?
The best health advice for women is to try to be a healthy weight (under a BMI of 30) before getting pregnant.
Eat a balanced diet and limit your intake of foods and drinks high in saturated fats and sugar. Try not to put too much weight on during pregnancy and exercise regularly. Talk to your midwife or obstetrician for advice and support about this.
If you have diabetes, or if this has been diagnosed during the pregnancy, close monitoring of your blood sugar and baby’s growth is important.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How Estrogen & Progesterone Affect Your Pain
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It’s been long-established that pain perception in women and men is quite different—on average, at least, since the datasets are usually somewhat overlapping.
If that last statement is confusing, think of it like height: on average, men are taller than women, but the datasets of “men’s height” and “women’s height” will be overlapping, because indeed some women are taller than some men.
So it is with pain also: women generally have heightened pain sensitivity compared to men, although reporting of that pain can vary a lot depending on the circumstances and experimental methodology.
An additional consideration is that women are overrepresented when it comes to people with chronic pain (i.e., more women have chronic pain than men).
In some cases, this is because a given chronic condition (as for example many autoimmune diseases) predominantly affects women for reasons that are often not well-explored, and in other cases, the reason is more obvious (for example, you will not find many men with endometriosis).
See also: What you need to know about endometriosis
Researchers, namely, Dr. Élora Midavaine et al., have found another common reason for the disparity in pain perception:
From estrogen to opioids
It turns out that the main female sex hormones, estrogen and progesterone, can suppress pain by prompting immune cells near the spinal cord to produce opioids.
The immune cells in question are immune-regulatory T-cells (colloquially called “Tregs” by scientists who don’t want to have to say/write that in full every time), whose main job is usually simply reducing inflammation. In other words, they’re the immune cells that tell your other immune cells to kindly chill a little bit and not overdo it.
In this case, the estrogen and progesterone stimulate the Tregs to produce the opioids (specifically, enkephalin) to block the pain signals before they reach the brain.
You may be thinking: but hang on, wouldn’t this mean that women experience less pain than men?
And the answer is: it depends!
A while back we wrote an article about how Alzheimer’s Sex Differences May Not Be What They Appear, and it’s a similar principle in this case: the female sex hormones are protective… Until they’re not!
In other words: in menopause, for example. And just like Alzheimer’s, chronic pain increasingly affects people the older we get, so the majority of people experiencing it at any time will tend to be postmenopausal. Symptoms get brushed off with “well, you are older now”, and while yes indeed many things may be age-related, in some cases their pathogenesis can be very clearly traced to “this hormone was doing the job for you, and now your levels of that hormone are very low, so you no longer get that protection”.
You can find the paper itself here: Meningeal regulatory T cells inhibit nociception in female mice ← yes, it’s a mouse study, but all the systems exist the same way in humans, so there is no reason to assume it would be different for us. Just, scientists can’t persuade an ethics board to let them knock out humans’ Tregs with toxins and then do nerve damage to measure the pain processing.
Takeaway idea: if you are postmenopausal and suffer chronic pain, then it’s an extra reason you might want to consider bioidentical HRT if you haven’t already.
See also: What You Should Have Been Told About The Menopause Beforehand
Want to learn more?
We’ve written quite a bit about pain management, including:
- Before You Reach For That Tylenol…
- How To Stop Pain Spreading
- How To Dial Down Your Pain
- Managing Chronic Pain (Realistically!)
- Get The Right Help For Your Pain
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)
Take care!
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The Forgotten Vitamin That Can Help vs Cancer
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When it comes to eating vs cancer, usually the talk is about macros, for example: Eat To Beat Cancer
Indeed, whole books have been written on that, such as The Cancer Code − by Dr. William Fung
However, today we’re going to talk about an important (and vastly underrated) micronutrient:
Why niacin is extra nice
Niacin, also known as vitamin B3, is (like all vitamins) essential to health (part of the definition of “vitamin” is that we would literally die without it).
But most people have only a vague idea of what most vitamins do, with a common level of knowledge probably being something like:
- Vitamin A: good for the eyes
- Vitamin B1: is this for energy?
- Vitamin B2: who knows
- Vitamin B3: it is a mystery
- Vitamin B4: is this a real vitamin?
- Vitamin B5: energy?
- Vitamin B6: energy?
- Vitamin B7: good for skin, hair, & nails
- Vitamin B8: this isn’t a real vitamin
- Vitamin B9: something to do with pregnancy
- Vitamin B10: why so many B-vitamins?
- Vitamin B11: come on, this is too many
- Vitamin B12: energy!
- Vitamin C: skin!
- Vitamin D: bones!
- Vitamin E: skin!
- … (unlikely people think about the possibilities for vitamins F-J)
- Vitamin K: babies need this one, right?
And to quickly address those without getting too side-tracked: no, there are no vitamins B4, B8, B10, or B11, and all of the rest of them while the guesses were right, they had other important uses too.
You can learn a lot more here: Which B Vitamins? It Makes A Difference
In that article, we listed some of vitamin B3’s top things to know about:
- Function: aids metabolism, supports skin, nerves, and cholesterol levels
- Forms: niacin (nicotinic acid), niacinamide (nicotinamide), inositol hexanicotinate (flush-free niacin)
- Example foods: whole grains, peanuts (literally the best nut for this)
And now, researchers (Dr. Gloria Urgoiti et al.) tested high-dose controlled-release niacin (vitamin B3) alongside standard glioblastoma (a very common form of cancer) treatment and found very encouraging results!
In numbers:
- The participants: patients aged 18–75 with newly diagnosed glioblastoma received standard treatment plus controlled-release niacin
- The safety: the maximum tolerated dose was found to be 2,000mg/day. At 2,500mg/day, dose-limiting toxicities occurred, including severe thrombocytopenia and elevated bilirubin levels. The most common side effect was flushing, reported in 10 of 15 Phase I participants, with most cases being mild.
- The results: among the first wave of evaluable patients, 82.3% remained free of disease progression at 6 months (progression-free survival at six months, or “PFS-6M”).
- How that compares: historical studies of standard treatment report a six-month progression-free survival rate of about 53.9%.
So, that’s quite a difference!
As to how it works, the answer is, put very simply:
❝Niacin treatment rejuvenates immune cells so they can do what they are supposed to do, attack and kill the cancer cells❞
~ Dr. V. Wee Wong, co-author on the study
Want to learn more?
As for why you might want to favor getting this from food if you can, then while the title says “vitamins”, the following book discusses an assortment of vitamins, minerals, and other nutrients; the “other nutrients” category including amino acids (branched chain and essential), prebiotics and probiotics, and triglycerides of various kinds:
Eat Your Vitamins – by Mascha Davis, RDN ← see our review, here
Take care!
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