AGIR ensemble pour la santé des femmes précaires (Working together for the health of precarious women)

Women's health differs from that of men for biological reasons linked to sex, but also because of gender-specific behaviors that impact our health to varying degrees (1). In terms of health, some medical events are highly specific to women: pregnancy, genital life, contraception, menopause, breastfeeding and childbirth. Others are directly influenced by behavior and the environment, such as smoking, alcohol, work, family life, stress and physical and psychological violence, isolation and financial insecurity. In France, the leading cause of death in the general population is cancer (29%), but in women, the leading cause is cardiovascular disease (2). Heart attacks and strokes are under-diagnosed and under-treated (3). Women are increasingly affected by chronic pathologies classically labelled as masculine. This is true not only of cardiovascular disease, but also, for example, of chronic respiratory illnesses and lung cancer, which is steadily increasing among women (currently +2.8% a year). This should be seen in the context of tobacco-related mortality, which is rising among women by more than 5% a year, whereas it is falling among men. Tobacco is much more dangerous for women, given the same number of cigarettes. Similarly, atheromatous disease is more advanced in women with diabetes at the same stage of the disease. While diabetes doubles the risk of coronary heart disease in men, it triples it in women (4). Specific events such as pregnancy-induced hypertension, pre-eclampsia, gestational diabetes and metabolic changes during the menopause, which are genuine cardiovascular risk factors, are difficult to take into account when calculating female cardiovascular risk (5). Other pathologies, such as sexually transmitted infections, are less frequently detected and treated in women, who are all the more at risk because of their precarious situation.
Precariousness is a particularly serious factor in women's health insecurity. And some figures speak for themselves (HCE. 2017)(6): 84% of heads of single-parent families are women, and 1/3 of these families are below the poverty line; more than half of these women forgo healthcare. Women are less likely to apply for social assistance. They devote more time to their children, spouses and elders .... Precariousness makes access to screening (cervical, breast or colon cancer) even more difficult (31% of low-income women have no smear test).
Premature mortality from cardiovascular disease is three times higher among working-class women (7). But the most striking situation is that of migrant women, whose socio-economic and health situation is dramatic. They migrate as much as men, but find less work and are often in a very precarious situation, exposed to many forms of violence (administrative, physical or psychological) and yet rarely receive medical, psychological or social care (7).
For over a year now, the COVID 19 pandemic has been revealing the inequalities between men and women: women have been very present in the field, but less so in crisis meetings and on the news; the socio-economic and personal impact has been dramatic for them in particular, with an explosion in domestic violence, worsening economic difficulties and mental pathologies.
All in all, there is an imbalance in the way women are cared for, due to a lack of awareness or minimization of the specific physiopathological, clinical and therapeutic features of gender.
So let's all work together for women, as the "Agir pour le Cœur des femmes" endowment fund, of which I'm proud to be an ambassador, is doing, with concrete actions such as "Les Bus du Cœur" (Heart Buses) for cardiovascular and gynecological screening, which will be going out to meet vulnerable women from September 2021; let's support them!


References:
1. report HAS sexe, genre et santé - Rapport d'analyse prospective 2020.
2. Boulat, Ghosn W, Morgand C, et al. Main trends in cause-specific mortality in mainland France between 2000 and 2016. BEH. 2019 ; 29-30; 576.
3. Mehta LS, Beckie TM, DeVon HA, et al. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation. 2016 ; 133(9):916-47.
4. Appelman Y, Van Rijn B, Ten Haaf M et al. Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis. 2015; 241: 211-218.
5. Mounier-Vehier C, Nasserdine P, Madika A-L. Cardiovascular risk stratification in women: optimizing management. Presse Med. 2019; 48: 1249-1256
6. HCE (Haut Conseil à l'Egalité, 2017).
7. Andro A, Scodellaro C, Eberhard M, et al. Migration path, reported violence and self-perceived health status among migrant women accommodated in emergency hotels in ile de France. DSAFHIR studie. BEH 2019; n°17-18; 334 -41.