Sex and Science: Should the Biology of Sex Affect Policy?

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This article is written by Vallika Varshri, a first-year student at Jindal Global Law School (O.P. Jindal Global University)

Sex and gender-based medicine is a branch which studies health and disease through the intersection of both biological sex and socio-culture factors on medicine. It promotes the consideration of the relationship between sex and gender on health outcomes in research and clinical practice. Shortened as SBGM, it has demonstrated significant reports of sex and gender on cardiovascular diseases, stroke et all to name a few. This branch of medicine would do good by inculcating its findings in the current situation of the COVID-19 virus [1].

51%-66.7% Covid-19 patients have been male according to descriptive and observational data from the male who are also at an additional independent risk associated with refractory diseases and death (a 2.8% death rate against a 1.7% for female) [2]. Jin, Bai and et all state that all the data sets of the ages of men and women were comparable. Nonetheless, case series shows a difference of (P=0.035) between the severity of the cases, with male cases being more serious than female ones. Even the mortality rate between men and women is different- the number of males who died was 2.4 times more than female [3].

The doctors concluded that gender is a risk factor for higher severity and mortality in patients with COVID-19 regardless of age and susceptibility despite death rates being higher in significantly older patients. Acknowledge of the gender differences in important since this could correlate with a general demographic fact of a shorter life expectancy in men compared to women in the world in general [4].

This clearly demonstrates that the effects of COVID-19 vary according to biology- men seem to be more vulnerable than women due to COVID-19. However, is a science all there is to it for the construction of COVID-19 or do external factors affect these results? Upon a closer look at epidemiology, it seems COVID-19 trends are influenced by behavioural, cultural and socio-economic factors as well.

Take smoking as an illustration of the statement; it has been implicated as a major contributor to the disease severity. Gender-specific patterns are seen in the data from China, where the smoking rate is higher in men than womxn, 288 million men vs 12.6 million women. Similar data from Italy[1], as well as the US, implies similar realities [5]. Norman puts the socio-economic situation in apt words when she says, “people all over the world are now riding the same storm, they are doing so in very different boats” [6].

She illustrates that while men may be facing a higher degree of health consequences, the economic brunt is borne by women to a larger proportion. Since women tend to do 60% more unpaid care work than men, they have less time for paid labour. As a result of subsequent poverty, they are more likely to rely on social security and public service thereby increasing their risk to exposure to virus. This also means that they will be the first to go as a result of recession and job cuts. Data from Autonomy, a British think-tank, revealed that 77% of 3 million people with high risk jobs are womxn. Moreover, 1/3rd of the vital workers are paid before BPL and 98% neglected workers constitute womxn [7].

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Further, she talks about other factors. Health force workers are over represented in black, Asian and ethnic minorities and additionally, latest figures imply that they are disproportionately affected. The relaxation of norms in Coronavirus Act, 2020 in UK has detrimental effects for disabled people if their assistants need to self-isolate. Norman alleges that pregnant women are overlooked in policies, while domestic abuse continues on a rising trend [8]. What this means is that the science and sociology of COVID-19 is demanding a policy overhaul.

Policy is meant to govern better, and often it results in the consideration of people’s ideology in its formulation. However, a new trend of evidence-based policy making is gaining traction in today’s world. Take the Nobel 2019 Economic Sciences winners-  the use of randomised evaluations (the clinical trials of data) to test effectiveness of social programs and policies was a pioneering work which demonstrated a short in discerning development from an entirely theoretical perspective [9].

Evidence-based policy-making works by placing available data collected at the heart of the policy development and implementing assisting in the best possible out of decision making. Due to the need for explicit scientific evidence, evidence is used as a base in the policy cycle to define issues, shape agenda, make choices of action, identify options, execute them and monitor consequences in contract to opinion-based policy making. As a result, a more systematic, rigorous and rational approach is used in policy making [10]

Our society is no longer what it was- policies are not just about moral and ethical governance over a small group. With the dynamic and rapid changes, a world united by technology and limitless borders, situations penetrate borders and all walks of people. As a result, a policy needs to be something which is all encompassing, takes into account everyone and can be easily moulded to the current situation- and what better way to do that than evidence-based policy? For policies related to COVID-19, a framework based on science and health would be ideal.

[1] Lauren A Walter & Alyson J McGregor. Sex- and Gender-specific Observations and Implications for COVID-19.  WJEM. 21[3]. [May 2020] https://dx.doi.org/10.5811%2Fwestjem.2020.4.47536

[2] Id

[3] Jian-Min Jin, Peng Bai et all. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front. Public Health [29 April 2020] https://doi.org/10.3389/fpubh.2020.00152

[4] Id

[5] Id at 1

[6] Jenna Norman. Gender and Covid-19: the immediate impact the crisis is having on women. LSE [23rd April, 2020] https://blogs.lse.ac.uk/politicsandpolicy/gender-and-covid19/

[7] Id

[8] Id

[9] Dipayan Pal. Evidence-based policy-making is the way forward. The Hindu [24th November, 2019] https://www.thehindu.com/opinion/open-page/evidence-based-policy-making-is-the-way-forward/article30061181.ece

[10] Id

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