Law and Policy Approaches to Sex-based Disparities in Musculoskeletal Health Care

Abstract

Women's health care law and policy discussions tend to focus on reproductive health and breast cancer, but there are significant disparities involving other physiologic systems-like the musculoskeletal system. Failure to recognize sex-based differences in health and in health care leads to inequalities in delivery and outcome of medical care-especially negatively impacting young, active girls and women, as well as adult and aging women. For example, in sports medicine, female athletes are two to eight times more likely to tear their ACL (knee) than their male counterparts participating in the same sports and to have worse outcomes after surgical repair. Similarly, older women are more likely to need knee replacement and to do poorly after surgery. Male bias and male norm historically built into musculoskeletal care and research likely contribute to disparities. Only around 6% of practicing orthopedic surgeons are women. Physicians and other providers are generally under-educated in sex-based differences involving the musculoskeletal system and typically deliver care in a gender-neutral manner, which leads to disparities disproportionately affecting women. The causes of disparities are multifactorial and complex with strong influences of biological and social/cultural factors playing a role, which are discussed in this paper. Interdisciplinary approaches involving medical providers, medical educators, medical researchers, lawmakers, policymakers and courts are discussed to address this emerging and important issue. Continuing to acknowledge and embrace sex-based differences in musculoskeletal medical care will lead to improvements in the health and health care for everyone.