The opioid epidemic's disproportionate impact on women is the latest, and most destructive, symptom of wider gender-based disparities that leave millions of American women in worse health than men.
Data show that deaths among women from opioid overdose have increased at a much faster rate than for men, 400% compared with 265%. And states where doctors write the most opioid prescriptions per 100 residents are also the states with the widest overall disparities between men's and women's health.
Alabama has the worst ranking in the assessment I did of gender-based health disparities. It is the nation's biggest dispenser of opioids, with 125 prescriptions written for every 100 residents in 2015. And it is just the beginning. In all, seven of the 10 worst states for gender disparities also show up in the Centers for Disease Control and Prevention's ranking of the 10 states that lead in opioid prescriptions. The correlation is most striking when examining both the overall population and whites specifically, the group hit hardest by the opioid crisis.
California's position in the middle of the rankings for both opioid prescriptions and gender-based disparities hides serious problems in rural counties. In tiny Del Norte County, 147 opioid prescriptions were written for every 100 residents. The rate was 137 per 100 residents in Lake and Butte counties, and 133 in Shasta County. Available health data for these counties aren't broken down by gender, but they do show a high prevalence of chronic problems typical of women in high-disparity states, such as hypertension and smoking.
The outsized impact of opioids on women signals a much larger problem of poorer health and poorer access to care that make women more susceptible to addiction and, once addicted, more likely to die as a result.
And what affects women affects families. In most American homes, women are the primary caregivers and their well-being usually determines the well-being and the future of our children. Evidence of this abounds in hospital neonatal units across the country, where the number of infants born with symptoms of opioid addiction increased five-fold from 2000 to 2012 — a trend that will exact a price in the form of higher medical costs and social burdens for decades to come.
Some simple, low-cost steps that are being taken to reduce the risk of opioid addiction suggest how to begin addressing the larger problem of gender-based health disparities.
Because of greater awareness of addiction risk, doctors are writing fewer opioid prescriptions today. Although this decline has yet to catch up to the national rise in overdose deaths, there are signs we are moving in the right direction. The death rate fell in Massachusetts during the first nine months of this year — the only state to record a decline — a result associated with fewer prescriptions and better emergency-room treatment.
Education campaigns have also begun to change dosage standards for women: Gender-neutral dosages are too high for most women because of their lower body weight and because they typically are prescribed opioids for longer periods of time than men.
Now we need to raise awareness among doctors in high-disparity states that women in their care will disproportionately suffer from obesity, high blood pressure, diabetes and heart problems. Women in all states also experience a higher rate of mental health issues than men. More knowledge about these trends would increase appropriate treatment strategies and the efficiency of state and local healthcare systems, without significant investment.
The best remedy for women is also the most difficult to achieve: We must improve the overall quality of healthcare in states where the disparities are greatest, which are also the places where overall health quality is poorest for both sexes. Success will demand the courage to buck a political trend favoring cuts in healthcare insurance coverage, in programs like Medicaid and Medicare, and in supplemental nutrition for low-income individuals and families. Such courage is not a feature of American politics now. We need to summon it. The long-term consequences of ignoring the gender gap in health should frighten us more than political tempests.
Ken Sagynbekov is a health economist at the nonprofit, non-partisan Milken Institute in Santa Monica, where his research focuses on applied microeconomic analysis of health and crime.