This is the second review of my 10 books of Summer.

I have related elsewhere Perez’ story of the loos in the Barbican

But loos are the least of the gender data gap problems, a symptom of a much wider malaise.  Structural male bias is everywhere.  Accurate data is vital for research and appropriate solutions.  Yet accurate data is not available if half the human race is excluded from its gathering simply because no-one has thought to consider whether one size really does fit all.   If you base your research on skewed data, you get a skewed result.   This is obvious, perhaps, when it is baldly stated but not at all obvious in the accepted course of knowledge production which has been going on for millennia.  This term ‘gender data gap’ is something I barely understood before reading Perez;  now I understand it, it is frighteningly omniscient, and it is costing female lives.

I have chosen to look at two areas that the author discusses, health and the formulation of GDP.

I start with health – the most important thing for a human being before you get to the wealth or happiness bit.  Go into any bookshop (assuming you can still find one) and look at the medical and anatomy sections, Perez suggests,     you will discover that the human figure is male. The author found that:

‘as recently as 2017, the covers of books labelled ‘Human Anatomy’ ‘were still adorned with be-muscled men’

Because it is assumed that the human body is male and that on a one-size fits all model (ie, apart from the reproductive bits there is not much difference)   what works for the guys will work for the gals.   Horrifically this appears to be current medical thinking!  Women are as a result largely being excluded from medical research. Why?  Because the results of clinical trials are being presented as valid for both men and women, even when women have been excluded from the study and even though as a result of this data on whether a particular drug will be efficacious for a woman is unknown.

This despite the fact that researchers have found sex differences in every tissue and organ system in the human body as well as in the ‘prevalence, course and severity’ of the majority of human diseases.

“Sex differences appear even in our cells:  in blood-serum biomarkers for autism; in proteins, in immune cells used to convey pain signals; in how cells die following a stroke.  A recent study also found a significant sex difference in the ‘experssion of a gene found to be important for drug metabolism’.  Sex differences  in the presentation and outcome of Parkinsons disease, stroke and brain ischaemia … have also been tracked all the way to our cells …”

The inclusion of sex specific information in textbooks is dependent on the availability of sex specific data, but because women have largely been excluded from medical research this data is severely lacking.  And because this data is lacking, it is not being taught in medical schools.

For example:

• Most early research into cardiovascular disease was conducted on men
• Women represent 55% of HIV positive adults in the developing world … we also know that women experience different clinical symptoms and complications due to HIV.   Yet a 2016 review of the inclusion of women in HIV research found that women made up only 19.2% of participants in antiretroviral studies, 38% in vaccination studies and 11.1% in studies to find a cure.
• And because of their routine exclusion from clinical trials we lack solid data on how to treat pregnant women for anything.  Perhaps it is understandable that pregnant women would not want to take part in clinical trials,  but that is no reason Perez states to throw our hands up in despair and do nothing.
• The absence of female representation in clinical trials also means that drugs are not sex specific and drugs that work for men are finding their way into general use without anyone knowing if they work for women.   Conversely, drugs that do not work for men are discarded during the clinical trial process without anyone finding out whether they would have worked for women.

The formulation of a country’s GDP is an inherently subjective process,  states Perez.

She quotes Diane Coyle, Professor of Economics at Manchester University.

‘A lot of people think GDP is a real thing.  But actually it’s a confection, with lots of judgements that have gone into its definition.  And a lot of uncertainty.

Measuring GDP is, she says, not like measuring how high the mountain is.’

In the 1970s – a period which has always been seen as a ‘golden’ window for productivity GDP rose (in the UK).

But what was actually happening during that period is that women were leaving the domestic sphere and starting to do out to work.    Work in the home had never been counted as part of GDP,  as presumably it still is not.

So the things done in the feminised private sphere which were invisible, suddenly got visible and added to the male-dominated public sphere.

Perez writes:

The failure to measure unpaid household services is perhaps the greatest gender gap of all. Estimates suggest that unpaid care work could account for up to 50% of GDP in high-income countries and as much as 80% in low-income countries.  If we factor this work into the equation, the UK’s GDP in 2016 was around $3.9 trillion (official figures $2.6 trillion).  In 2015, unpaid care and domestic work in Mexico was valued at 21% – ‘higher than manufacturing, commerce, real estate, mining, construction and transportation and storage’.

None of this is the result of some dire scheming or deliberate policy, it is because of structuralised, self-perpetuating sex discrimination which has become so natural to us that we no longer see it.   Because women are invisible, it is not deemed to be necessary to collect sex specific data.   Because there is no sex specific data, women are invisible.

“Failing to collect data on women and their lives means that we continue to naturalise sex and gender discrimination – while at the same time somehow not seeing any of this as discrimination.  Or really we don’t see it because we naturalise it – it is too obvious, too commonplace, too much just the way things are to bother commenting on.  It’s the irony of being a woman: at once hyper-visible when it comes to being treated as the subservient sex class, and invisible when it counts – when it comes to being counted.”

“There is an overwhelming need for women to be more involved in research, the author concludes.  “When women are involved in decision making, in research, in knowledge production, women do not get forgotten.”

This book must have entailed a huge amount of work.  It is thorough researched and detailed.  Thank you Perez for showing us the male bias by which our still achingly patriarchal society is structured.  Sisters, there remains a long road ahead of us.

Caroline Criado Perez is a writer, broadcaster and award-winning feminist and human rights campaigner.  She is best known for getting a woman put on the Bank of England banknotes and for campaigning for a statue of suffragist Millicent Fawcett to be erected in Parliament Square.