Caroline Creado-Perez [ 24 APR 2020 | Data Literacy | 1:02:29 ] I’ve got Poppy in a bag and I’m just going to give her her own throne. . . if the gender data gap ever becomes too depressing you can just look at her looking deeply unimpressed at me um see there you go she’s already looking unimpressed.
So hello, fellow science nerds. It’s really great to be here. Thank you very much for coming to my session. I am going to be giving you a whistle-stop tour of a bias that affects us all –that’s me as well as you –and the serious impact it has on how we collect and analyze data.
The vast majority of information that we have collected globally –and that we continue to collect– has been collected on men – male bodies and typical male lifestyle patterns.
Everything from economic data to urban planning data to medical data has been collected and continues to be collected on men
This means that pretty much everything in the world –from the office you work in to the public transport you used to get there, to the medical treatment you receive, the phone in your hand, the apps on that phone – have been designed to work for men.
This is the gender data gap
The most important thing to know about the gender dates gap is that it is not the product of a conspiracy
It’s not the evil brainchild of a group of misogynists who want women to suffer and not be able to reach the top shelf and sometimes die.
That’s not what is happening here.
It is simply the product of a way of thinking that, as I said, affects us all and goes back millennia.
This way of thinking begins with a good friend of mine called Reference Man.
Reference man, as you can see, is a Caucasian male –about 70 kilograms– and his superpower is to represent everyone.
Sadly for Reference Man he’s not very good at this and so, really, it’s not a sweet superpower.
I suppose but he does his best.
Reference Man goes back a long way.
In fact, he goes all the way back to another good friend of mine called Aristotle who as well as believing the be crazy believed that the female was a mutilated male body and that the first departure from type this is a quote from Aristotle’s on the generation of animals who’s not very biological treatise the first departure from type is indeed that the offspring should become female instead of male now the one thing I will say for Aristotle is that he did allow that although this was an aberration it was a natural necessity for the procreation of the species thank you very much Aristotle it’s very kind true gentleman now Aristotle’s idea of female as the male turned outside in continued through the sixteenth century when there was an explosion of anatomical drawings medical illustrations and this is an example of one of them and basically the way that the female body was seen was that it was just a slightly up male body so ovaries were female testicles they weren’t given their own name until the 17th century the uterus was the female scrotum which I take issue with because I think is much nicer than a scrotum and and the reason that the female reproductive organs were inside the body as opposed to dropped outside of the body as in normal standard humans was because of a deficiency in vital heat the male body was the sort of ideal that the female body failed to live up to of course what you could do is think about it the other way and say well maybe the men had too much vital heat and that’s why their reproductive organs had dropped out which is clearly an inferior place to have such sensitive organs as I’m sure any man who’s ever had a football in his crotch will attest anyway that’s just a little idea of mine that I’d like to throw it Renaissance medical illustrators anyway this continues through to the 1920s with an influential Swiss architect called liqueur booze yeah which is terribly pronounced I know that I’m not French so I’m sorry about that and I say that because my mum always criticizes me for has she gone to sleep okay good I suddenly couldn’t see her got a bit worried she’d run out into the crowd anyway so now the caboose yeah had this amazing idea that buildings should be designed to fit people rather than just designing buildings that didn’t take into account the human form we should design things to be helpful and to make things easy for people of course you might be able to see where I’m going with this the problem was that for the Cuvier human meant a six-foot man with his arm raised in fact even more specifically a six-foot British police detective it’s interesting apparently that’s the pinnacle of humanity six-foot British police detective any six-foot British police detectives in the crowd if I mean you know you don’t have to put your hands up if you’re embarrassed to be the pinnacle of humanity but you can just quietly sit there being really pleased with yourself and anyway so the female body actually was belatedly considered I suspect someone said to the colbys yeah but remember women exist right I mean there might not be six-foot British police detectives but they do exist but unfortunately the female body was considered not proportionally harmonious and was therefore not included in this human scale and interestingly that is something that comes up quite a lot it’s one of the main things that I came up and came up against noise doing my research about why women weren’t included and it was because basically variants on the female body is not a source of proportional harmony so that might give you a clue to where you might be thinking well she’s just talking about history right so we’re not really doing that anymore that would be crazy you’re right it would be crazy but unfortunately we are still doing it and I’m afraid the spirit of look who the Corp is yet lives on today in for example hotel rooms are the world and as you can see on the I don’t know how to say this the right or the left anyway whatever there’s a picture of a woman who you can’t see her face because the hotel designer has very kindly created a heated patch in the mirror that is too high for her and similar issue with with another woman and but it gets more serious than not being answer to your hair and makeup because Reference Man still reigns supreme in the medical world the for example this here is a poster of the vascular system and viscera as you can see we have the standard pelvis does this have hasn’t got a hasn’t got a little pointy thing that would have been fun anyway anyway you’ve got the standard pelvis the standard genitals female pelvis slightly weird have it one on to one side I mean it’s nice that they included it I guess the nervous system again weird little female saying off to one side there don’t want to pretend that that’s normal representation of humanity on to the muscular system and I’m sure you can imagine there is far too much to unpick here for a 60 minute talk but I think we should just stop for one second to recognize that the flayed lady has still got it and we should respect her for that because it must be hard to think you’re sexy when you’re flayed anyway it’s not just in posters it’s also in medical textbooks so an analysis of a range of textbooks recommended by twenty of the most prestigious universities in Europe the US and Canada found that male bodies were used three times as often as female bodies to illustrate neutral body parts and one of the ways that they found this was that penises were just included in all sorts of pictures that weren’t related to penis analysis so you’d be looking at like the cross-section of the hand just stick a little penis in there and studies of textbooks recommended by Dutch medical schools found that sex specific information was absent even in sections on topics where sex differences have long been established such as depression or the effects of alcohol on the body and results from clinical trials were presented as valid for men and women even when women were excluded from the study I just want to stop for one second there to give you an example of when how this has happened fairly recently so some of you may remember a few years ago there were a lot of articles about this new Female Viagra drug that was being developed and it was all very exciting women were going to be up for it all the time and they discovered the the pharmaceutical company making it discovered that it may interact negatively with alcohol so being a very responsible pharmaceutical company they thought we should probably test that and see what the impact is so they developed a study and they tested it it’s a female drug on 23 men and 2 women to determine the impact of how this drug interacted with alcohol in the female body so that’s just to give you an example of the that it’s not entirely the fault of the text books but it is also slightly the fault of the text books anyway those studies that I’ve just referenced not the viagra one that was more recently but the textbook studies were both from about 2008 which is obviously a while ago now but they are the most up-to-date large-scale studies that I was able to find which in itself tells you something about how seriously this is being taken as an issue you know this is a very very poor representation of women and nobody was bothered to do a follow up and of course thousands of doctors practicing now were trained using these books it’s also in the curriculums when you look at them so a 2016 review of the u.s. online database for med school courses found that the integration of sex and gender based medicine in u.s. med schools was minimal and haphazard and gaps were particularly identified again in the approach to the treatment of disease and the use of drugs now the impact of all of this can be significant because contrary to the idea that men are a standard for humanity and women are basically men with boobs in fact researchers have found sex differences in every tissue and organ system and human body as well as in the prevalence and course and severity of the majority of common human diseases I’m just going to give you a few examples women can metabolize certain drugs differently to men for a range of reasons including higher body fat and less lean body mass the blood flow to fat tissue is greater in women in men it’s greater to skeletal muscle that can affect the metabolism of drugs women have generally lower bile acid composition longer gut transit times slower kidney filtering and KITT there are kidney enzymes sex differences a recent study also found a significant sex difference in the expression of a gene found to be important for drug metabolism and a 2013 nature article pointed to research showing that male and female human cells and I’m quoting now exhibits wildly different concentrations of many metabolites and also to mounting evidence that cells differ according to sex irrespective of their history two sex hormones that’s quite a lot of sex differences that are going to be affecting how drugs are metabolized but although we know this and have known this for quite a long time we continue to conduct the vast majority of medical research in male cells male animals and male humans so for example heart disease it’s the leading cause of death for women in Europe and the US but women made up only 25 percent of participants across thirty-one landmark trials for congestive heart failure between 1987 and 2012 and by the way we’ve known since 1984 that women are more likely to die following a heart attack than men women represent 55 percent of hiv-positive adults in the developing world and the majority of people living with HIV look worldwide in parts of Africa and the Caribbean women aged 5 to 24 are up to six times more likely to be HIV positive than young men at the same age and we also know that women experience different clinical symptoms and complications due to HIV and yet a 2016 review of the inclusion of women in u.s. HIV research found that women made up only nineteen point two percent of participants in antiretroviral studies and 11.1% in studies to find a cure and in fact some of you may have seen a study a story that went around the internet a few days ago announcing that the FDA has just approved a second drug to prevent an HIV infection which is great except they’ve only approved it in men because despite women making up the majority of people living with HIV this drug was not tested in women at all and the maker of this stroke is called and I you not Gilley and they were founded in 1987 which is two years after the publication of The Handmaid’s Tale which I find fascinating and I have not yet managed to dig down into why them call themselves Gilead but don’t worry I am on the trail anyway here is another example in 2017 I read this article which as you can see is illustrated by some nice lady feet and written by a very excited nice lady journalist called Lindsey Holmes but I have bad news for Lindsey because there isn’t really any evidence that this research applies to women because I went and I read the study it was published in a journal called temperature with the subheading a possible treatment for metabolic diseases but no women were included now we know that there are sex differences in metabolism we know that diabetes which was one of the diseases particularly singled out as being relevant to this discovery affects men and women differently and that it is a greater risk factor for cardiovascular disease in women than it is in men but despite all this the paper’s authors consistently failed to acknowledge any relevance of sex differences to their research they cited animal studies that had been conducted in all male populations and the bit that really pissed me off was in the study limitation section the only drawback as far as they could see was their relatively small sample size they didn’t mention the fact that it had been conducted all in men and that all their animal studies had similarly been conducted all in men they didn’t see that as a drawback at all anyway so it was a little coda to this because I decided to keep an eye on these researchers and I found that they did another study too late to include in the book unfortunately it’s very canny of them they must have known it was coming out and again they have presented a gender-neutral paper in sedentary overweight adults that they have tested only in sedentary overweight men anyway this data gap is actually set to get a lot more scary so as you can see only middle-aged men get heart attacks according to Google obviously this is not the case as I said earlier heart disease is the leading cause of death for women in Europe in the u.s. women from lower socioeconomic backgrounds are in fact 25% more likely to suffer a heart attack than men in the same social bracket women are also 50% more likely to be misdiagnosed if they have a heart attack than men and as I mentioned and perhaps unsurprisingly therefore women are also more likely to die if they have a heart attack in 2016 the British Medical Journal reported that young women were almost twice as likely as men to die in hospital and in the same year the American Heart Association raised concerns about a number of risk prediction models because they were mainly conducted in men so the question is why given we know all this do the Google results represent heart disease as a male thing well it’s very simple it’s because that’s the data that we fed it and it gets a lot worse than misleading google images so here is an article that came out a few weeks ago and she’s in The Scotsman delighted to see that it’s illustrated with a picture of a woman clearly The Scotsman has been reading my book so I encourage you all to read but that’s pretty much where the good news ends because again this is presented in a gender-neutral way but when you go and look at the paper it’s not clears them so the paper that the Oscar referred to didn’t mention sex at all and the studies on which the a I was trialed were heavily male-dominated plus there is this issue of sex differences in risk prediction models there are differences in risks for men and women for example smoking as a higher risk factor in women as I mentioned diabetes is a higher risk factor in women so will this AI account for that will this AI in fact be able to predict heart attacks in women five years before they occur it’s impossible to say the researchers didn’t seem interested in finding out either meanwhile as well a doctor tested the Babylon health app I’m sure a lot of you have heard of this app um it is something that is being integrated into the NHS and it contains this chat bot which does digital triage and what this doctor found was that if you were a 59 year old female smoker who presented with sudden onset central chest pain and nausea the chat bot diagnosed you as having a panic attack or anxiety but an identical man with identical symptoms was diagnosed with a heart attack and told to immediately go to A&E now Babylon has defended this actually saying well women tend to get heart attacks 10 years later than men yes they do but younger women are more likely to die if they have a heart attack and also we know that smoking is a risk factor for women in a way that it isn’t necessarily from I mean it is a risk factor for men don’t smoke guys like very bad idea but it is a greater risk factor for women so should this chatbot really been telling a 59 year old female smoker that she’s just a bit anxious and should probably don’t they have a nice glass of wine I would suggest that perhaps they should have mentioned it’s a possibility that she was having a heart attack and maybe she should consider getting it checked out but if that doesn’t scare you enough consider this machine learning doesn’t just reflect our biases it amplifies them so a really fascinating study I came across in the course of my research was a 20-17 paper from the universe Washington that took a one of the most commonly used image datasets and wanted to see how alga algorithms would respond if they were trained on it now in this image data set women were pictures of cooking 33 percent of the time we’re 33 percent more likely to include women by the time the algorithm is done being trained on this it was Labor labeling pictures of cooking as having women in them 68 percent at the time so basically what that means is that the algorithm was labeling men as women just because they were standing in front of a stove and the paper also found that the higher the original bias the stronger the amplification effect I’m sure I don’t need to explain to you how terrifying that is if you take it from an image data set and apply it to let’s say heart disease and how that might impact on diagnosis and so why do we keep doing this for intelligent people why do we continue to insist to not collect data and women and apply data collected on men as if it’s gender neutral well there is one response that I came across again and again and continue to come across whenever I challenge any researcher who is saying oh women can be added at a later stage or something I don’t know once we’ve discovered if the normal humans respond to this that is women are just too complicated can’t test on them because they’re just totally unpredictable you never know what might happen so I’ve been told point blank by medical researchers that the menstrual cycle will interfere with the results and that is why you can’t include women in your study well yeah you’re right it will interfere with the results and that’s why you should study it so far menstrual cycle impacts have been found for antipsychotics antihistamines antibiotics and heart medication some antidepressants will be too high at a certain stage in a woman’s menstrual cycle and too low at other stages women amorous likely to experience drug induced heart rhythm abnormalities and this can be the risk is highest at in the first half of a woman’s menstrual cycle now I’m not a medical researcher but it strikes me as that being the kind of thing you might like to know before you release your drug onto the market call me crazy now I would be remiss if I didn’t address a study that came out last year which hoooray claimed that there’s no evidence of any real problem when it comes to the systemic under-representation of women in clinical trials it’s all fine the women are being hysterical and we are going to tell you how the problem is there were so many gaps in the day sir that led to this analysis ironically many of them deeply gendered that actually the study doesn’t really tell us very much – so to start with sufficient dates that were only available for 38 out of 137 drugs so that’s 28% there’s no way of knowing how representative that data is so what does this tell us well it tells us about these particular drugs so what are these particular drugs tell us they the researchers announced that there was no problem because while women were only represented sorry women were represented at 48 percent and 29 percent respectively in Phase three in two trials but they were only represented at 22 percent and phase one trials but this is Reference Man all over we’ll add the weirdo inexplicable female bodies at a later stage once we’ve determined if the drug works in normal standard humans by the way this study didn’t address human and animal study sorry animal and cell studies where things are actually even worse than they are in human studies and not including female cells animals and humans from the very beginning of the research process does actually matter and it matters because first of all we waste time and money so for example for years medical researchers were puzzled by the unpredictability of transplanted muscle derived stem cells sometimes they regenerates a diseased muscle sometimes they didn’t what were these crazy stem cells doing they were probably women actually they weren’t it turns out that the ones that didn’t regenerate were men male I should say cells aren’t people I’m sorry if there are any cells in the audience and male cells did not promote regeneration and female cells did how much time and money did we waste using male cells just because we hadn’t bothered to sex disaggregate the data and we hadn’t thought it was important to test things right from the beginning on men and women on male and female cells it also matters because we may be giving women bad medical advice or even potentially missing out on treatments for women altogether simply because they don’t work in men on whom we’d start off most research so here’s a tantalizing finding I came across from 2016 where researchers exposed male and female cells to estrogen and then expose them to a virus male cells were not able to do anything with the estrogen and were not able to fight off the virus the female cells were able to use the east region to fight off the virus now what if we had only tested this in male cells we would probably have concluded estrogen doesn’t do anything nothing worth looking into here which is why I get so angry when medical researchers defend their practices to me by saying well we’ll start off with men and if we find anything interesting then we’ll add women that is not the way to do research data gap number three I’m still talking about the very stupid paper that said there’s no problem here ladies shut up its failure to address generic drugs now generic drugs represent 80% of prescriptions filled in the United States FDA research has shown statistically significant differences between men and women for bio equivalents for most generic drugs compared with reference drugs and generic drug trials are conducted almost exclusively in young men why is that because there is no regulation saying that women must be included because it’s so any generic drugs who cares actually it does matter data gap number four I’m sorry I have a lot of bones to pick with this article there is no investigation in this analysis into how the female menstrual cycle was dealt with in these studies and this also matters because the maths recycle probably wasn’t dealt with at all when women are included in medical trials they tend to be included during the early fully follicular phase of the menstrual cycle when hormone levels are at their lowest you can see what they’re doing there it’s when women are most superficially like men the default human and as we’ve seen this is an adequate way to include women in research because as we have also seen yes the menstrual cycle will interfere with your results and you need to know what that interference is going to be but perhaps the biggest data gap in this analysis that tells us everything is fine and we’re all making a big fuss about nothing is that it doesn’t address what studies are even done or not being done in the first place so every day 830 women around the world will die from complications with pregnancy in childbirth over half of these deaths are explained as being a result of problems with contractions and it’s often because the contractions are just too weak for the woman to give birth now we only have one medical treatment one medical treatment anyway for women whose contractions aren’t strong enough to deliver her baby vaginally and that is the hormone oxytocin and it works fifty percent of the time so one drug works fifty percent at the time so fifty percent of women who are given oxytocin will be unable to give birth vaginally and will have to be given an emergency cesarean in the UK weak contractions are the reason given for a vast majority of the 100,000 emergencies Ariens that are carried out each year and because we have no way of knowing whether or not a woman is going to respond to this oxytocin all women who have weak contractions have to go through often days of incredibly painful labor until they are finally given the emergency cesarean they were always going to need that is until hero of mine called Professor Susan ray now she’s a professor of cellular and molecular physiology at the University of Liverpool and because she also works at the I think it’s the better birth center something like that sorry that’s very bad of me um she thought I’m going to look into why this happens like why does it only work 50% of the time if this is one of the things that I find so frustrating about the research into women is such a lack of curiosity why is no one wanted to know why only way it’s 50% at the time before now there will be a reason and Professor Susan Rea believes in fact she has found that reason sheesh so she found that women with contractions that are too weak to give birth have more acid in their myometrium blood so this is the blood in the part of the uterus that actually causes and contractions so they’ve got more acid in this blood and the higher the levels of the acid the higher the likelihood that a woman will end up needing a cesarean because it turns out oxytocin not that effective on women with a very high blood pH sorry nice acidic blood pH so Rae conducted a randomized control trial on women with weak contractions half the women were given the usual oxytocin half were given bicarbonate of soda and then given the usual oxytocin an hour later and the change was dramatic eighty-four percent of women who were given bicarbonate of soda bicarbonate soda an hour before they were given oxytocin went on to give birth vaginally now let’s bear in mind the bicarb dose wasn’t tailored to body weight the women weren’t given repeated doses so the efficacy could turn out to be even higher this was just a very small random controlled trial and as you can imagine this finding could be transformative for the tens of thousands of women who end up having unnecessary surgery could save the NHS fair amount of money compared emergency caesarean to bicarbonate of soda in terms of cost it could save women’s lives in countries where cesarean sections of risky or not readily available which by the way is not only in developing countries you could also be an african-american woman in America where women they’ve got the worst rates of death for women in childbirth in all of the developed world and african-american women are 243 percent more likely should die in childbirth and white women and by the way this isn’t an income thing either because they found that poor white women have better outcomes than middle-class african-american women something very interesting going on there anyway so I’m sure I can fact I can see from your faces you’re all very excited about this research I’m very excited about this research you know who isn’t excited about this research the British Medical Research Council is not excited by this research because when Ray applied for funding and this funding was specifically aimed at benefiting low and middle-income countries which would be actually the number one place that this would benefit because yes it is dangerous to have an emergency cesarean and all sorts of places but it’s particularly dangerous in a low-income setting she was turned down and the reason she was giving was saving women’s lives in childbirth which is what this drug would do and this is the quote not a high enough priority anyway and see you’re all very depressed so we’re going to move on to something more jolly like car crashes I don’t think that this woman emma is being irrationally irritated by the design of her handbrake and actually the handbrake isn’t the only thing she should be worrying about when it comes to her safety driving that car because cars have also been infected by Reference Man so the car crash test dummy that has been used for decades in testing car safety is based on the 50th percentile male Reference Man remember he represents everyone and unfortunately of course he doesn’t and the result of using Reference Man is that there are all sorts of ways that cars just don’t work very well for women so for example seatbelts haven’t been designed to accommodate breast tissue quite a common body part you would think but we just can’t seem to figure out how to do that um we haven’t assigned a seat belt that is safe for pregnant women to use and the number one cause of fetal death from trauma is car crashes and women also sit when it’s called too far forward in the car and moves them outside of what is called the standard seating position and the reason that women are being so silly and sitting too far forward is that they need to be able to reach the pedals quite an important part riving but the result of that is that it puts them at a much higher risk in a frontal collision and in fact women if they are in a car crash a forty seven percent more likely to be seriously injured and we’re talking life-changing injuries here this isn’t bumps and scratches this is serious injuries and seventeen percent more likely to die than a man in the same car crash now there’s a good news story here I did say I was going to be more jolly the EU belatedly realized that women existed in 2015 and they introduced what they called a female car crash test dummy now it’s actually just to scale down male dummy and women are not just scaled-down men all sorts of differences that exist there and as I have been relating but you know there are other differences that I haven’t spoken about like for example muscle mass distribution or differences in pelvises those in fact we did see in those lovely posters with a little female pelvis off to one side and boobs another issue anyway the women are not scaled down men but still this is good news for scaled down men everywhere and now there’s a small just a tiny small fly in the ointment the scaled down man because actually when they introduced these car crash test dummies into the regulatory tests they only introduced them into one out of the five regulatory tests and only in the passenger seat so scaled down men I recommend that you see in the passenger seat probably don’t drive and because there’s no way of telling whether or not you’re going to be safe women it’s just stay at home really stink just don’t bother going out in fact definitely don’t go out to work but there is another issue with Reference Man so 71% of women who work in occupations wear personal protective equipment PPE are required wear PPE that has not been designed to fit their bodies and the effects of this can be serious obviously it’s very annoying for the women in the picture here but it can get well actually wearing bobs that are too big can be seriously dangerous if you’re in an industry where after climbing up things you would happen to use your hands in a dangerous environment things are going to fall out of your hands and but it does get worse than that in fact the emergency services were found to be the worst when it came to ill-fitting personal protective equipment this was the 2017 Tec study I’m and that found that only 5% of women said that their PPE never hampered their work who’s actually getting in the way of them being able to do their job and the the bits of PPE that were highlighted included high vis vests and jackets stab vests and body armor now I am NOT a police officer or an ambulance worker but I feel like if I was in a job where I needed to wear a stab vest I’d like that stub vest to properly cover my body that is not what is happening for women who are needing to use these stab vests because this is becoming a theme they don’t account for breasts just weird right we live in a society that is obsessed with breasts but we can’t design seat belts or bunny armor that accounts for them and the proper with not designing for breasts is that the body armor rises up and so you’ve got an exposed penny also it sort of sticks out funnily here because you might wear a bigger size to account your breasts and so then you’re not protected here women in the military face similar issues the women I spoke to complained about their so-called unisex uniforms which were far too big for them and built for male proportions so as you can see this woman here is hope that she took this picture for me very kind of her the sockets to cover up her name and just to show how much spare material there is and actually that really matters for women in the military because the this sort of contract within the military is that you have to look smart and women are often picked up for looking scruffy and actually they’re not scruffy it’s just everything’s too big for them and so women are having to pay extra to get their uniforms tailored so that they don’t get marked down for being scruffy when in fact what has happened is that the military hasn’t bothered to design uniforms for them but in fact this woman told me she’s wearing the the smallest size that’s available and she also mentioned that they fastened the men’s way so leftover rights Java C again isn’t the end of the world but it does rather show that they haven’t actually designed a female uniform they’ve scaled down a male uniform and clearly not scaled it down enough on that note just like to find share with you a line from a paper that I found really quite funny on the notes of women not being scaled down men hello EU car regulators and so this was a study of the anthropometric data of Defence Force soldiers from four NATO countries and it said designing protective equipment to accommodate female soldier structure was not as simple as scaling down male proportion figures no anyway it gets worse women raised issues with backpacks body armor boots gloves helmets none of them fit properly they were all too big and all designed for male anthropometry body armor again the boob issue many women explained that in order for the armor to fit their breasts it was too big on the waists and arms other women complained that it left the abdomen exposed another woman explained that the width of her body armor was much wider than her shoulder and I’m just going to quote what she said here because I you know obviously don’t know the mechanics of this to operate a rifle you need to be able to fit the butt of the weapon into your shoulder to accurately fire and absorb the recoil without this it is likely the weapon would slip away when fired which is dangerous seems like an understatement to me but that was her words backpacks came in for a huge amount of complaints because they are generators designed around men’s muscle mass distribution so men’s upper body strength is on average 50% higher than women’s but the average sex gap in lower body strength is about half that so what you should be doing when you’re designing a backpack if it’s going to work for women is aiming to distribute the weight so that the hips are absorbing a lot of it but that wasn’t happening and even in fact when a hip strap was included it wasn’t substantial enough to make a serious difference and this is my favorite bit it was too low because it was placed where male hips would be and you just kind of have to laugh actually at certain points when you read this kind of stuff um I a bit in my research that I’ve never stopped laughing at was this sports science study and sports science is really bad for not including women it’s one of the worst areas actually of research worse even than the medical field so well done sports science researchers you’re trying really hard there and they were looking at carb loading which is sort of traditionally been the advice for endurance athletes and I know never really bothered to look into this for women and they found that actually women who were carb loading they would need to carb load so much in order to only get 50 percent of the efficacy that male athletes were getting and that they would have to eat too much and would therefore be sluggish and it would sort of counteract all the benefits of the carbs and so they said well because actually women tend to burn fat before carbs because of the showing about fat lipids I’m not actually a scientist you may know um but anyway women tend to burn fat first and so they said it may be that fat loading would actually be better advice for female athletes unfortunately no one’s done research on women in fat loading so we can’t say that was a very common thing I came across anyway back to the women in the army and so and the low hip strap which I was finding funny which is why I went off on that tangent and a woman contacted me about the latest british army kit called i’ve been reliably informed virtus and and this is meant to have sold the weight distribution problem with load-bearing wire frames that are supposed to spread the weight from shoulders to the hips unfortunately the wire frames have not been designed to account for the fact that woman’s body is kind of curved a bit and so they don’t sits flat on women’s backs and are incredibly uncomfortable and so women end up just pulling them out totally negating the whole design point of them which is so frustrating because you know they’ve clearly tried to do something right and they failed because they didn’t really look into women’s bodies and there’s another example that I think is again very illustrative of the problem of trying to do something right but not really thinking it through properly this was in an Australian paper which found that the their military’s body armor was loose around women’s waists because again it wasn’t designed for the way women’s bodies on average curve and this made it harder to cinch the waist belt of their backpack now the backpack again had been specifically designed to remove weight from the shoulders and shift it to the pelvis so they’re done this really great thing here tried to develop backpacks for women but because their body armor hadn’t been designed to account for women it meant that the design of the backpack was completely useless and didn’t do anything at all and the result was that women were once again more prone to injuries which is in fact a huge problem for militaries around the world as you can see well we need much more data actually it’s another it’s another major data gap but the studies that have been done show that women have a much higher injury rate than men but female soldiers have more problems with kits that boots are too wide for example don’t account for women’s higher arches which may be why women have a higher rate of foot injuries than men and shoulder straps and waist belts again are in the wrong place meaning packs are more unstable and women’s bodies which as we can see it can be exacerbated by body armor right let’s move on to the economy I’m sure women are doing great here right and well again we need more data and but the data we do have shows us this which is a table showing the distribution of unpaid care work between men and women around the world as you can see women are doing a bit more than men globally women do three times the amount of unpaid care work that men do according to the IMF this can be further subdivided into twice as much child care and four times as much housework so I find a very interesting stat twice as much child care four times as much housework it’s going on there guys and anyway all this unpaid work has an economic value McKinsey for example estimates that women’s unpaid care work contributes 10 trillion dollars to global GDP an Australian study found that unpaid child care should be regarded as Australia’s largest industry it generates almost three times the financial and insurance services industry which is the largest industry in the formal economy the problem with all of this is we only actually have estimates because no country is systematically counting women’s unpaid care work we have a data gap now this is because women’s unpaid care work has never been formally included in GDP because back in the twentieth century when we were coming up with a method to accurately measure our economies it was decided that this work that was mainly done by women was too complicated to measure but what this means actually is that we are warping the figures and producing a GDP number that doesn’t accurately reflect reality so for example economists often point to the post-war period in the u.s. up to about the mid 1970s as a golden era of productivity growth but what was actually going on to a large degree was that women were joining the paid workforce and that meant the things that they had previously been doing in the home were being moved into the market economy and suddenly they were been counting counted there wasn’t an increase in productivity it was just suddenly the work that had been done and wasn’t being counted was being done in a place where it was being counted um so basically the productivity that had been there before had previously been invisible to economists and this is a major cost to women being invisible to economists because when we literally don’t value women’s work we literally aren’t assigning it an economic value it is viewed as a cost less resource to exploit and so when countries try to rein in their spending it is often women who end up paying the price which is what has happened in the UK since 2010 where 86 percent of spending cuts have actually fallen on women now the question you have to ask yourself when you hear such an unjust statistic is that how could any government create a policy that is so manifestly unjust 86% on women is it that they hate I am open to this as a possibility oh is it that they don’t have the data and more importantly aren’t using any data that they do have in order to come up with a budget that is equally fair for both men and women now not looking at the data it doesn’t actually just harm women it also doesn’t make economic sense so there’s a really fantastic NGO called the women’s Budget Group that operates in the UK and it’s made up by a bunch of really fantastic feminist economists and they do the work that the government should be doing of gender analyzing every budget that is produced usually finding the women are being screwed over by it anyway the other thing that they do is they come up with solutions and one of their solutions is about looking at how government investment is being spread around so the usual ways that governments will invest in the economy is to build physical infrastructure roads trains any kind of physical network they found that investing 2 percent of GDP in the construction of physical infrastructure like this would generate 750,000 jobs which isn’t bad but an equivalent investment in care infrastructure so that’s childcare social care would generate up to 1.5 million jobs the investment would create almost as many jobs for men as the equivalent investment in physical infrastructure but four times as many jobs for women and also by reducing the amount of unpaid care work women have to do kind of like what was happening in America it would also enable more women to engage with more paid work which means more tax which means the investment could pretty much pay for itself so it’s a no brainer or it seems like a no-brainer and if it’s a no-brainer why aren’t we doing it I would suggest it’s because the people who are making government policy aren’t looking at the data and that’s because we aren’t systematically collecting it but actually it’s not just about not collecting the data it’s also about how you collect it and how you analyze it because if you collect or analyze it carelessly or without an understanding of gender you may end up not sex disaggregating by proxy which is what tends to happen in the transport sector so on the left is how transport planners have additionally collected data they haven’t aggregated travel for care work they’ve split it up into lots of different sections like shopping escorting visits and it’s all mixed up with leisure data so you know shopping for groceries for the family is mixed up with I don’t know shopping for some new shoes and as you can see it makes it look like paid employment is by far the biggest reason people are travelling but if you look at the other table suddenly it doesn’t seem so obvious that you should design your public transport infrastructure around paid employment which is how most public transport infrastructure is designed so this is what happened when an urban planning an urban planner in Madrid collected care related travel data in Madrid and she aggregated it all together instead of the traditional mixing it up and she found that the number of trips made for caring purposes almost equalled those made for employment purposes and when she further refined the data by sexist aggregating it she found that care was the single greatest purpose of travel for women and again designing public transport to support women’s unpaid care work isn’t just a matter of justice although it is but it also makes economic sex sex sense have economic sex if you want countries want to get more women in paid work because increases GDP countries around the world are trying to increase women’s paid work and they’re not actually making the changes that would enable them to do this it is as simple as that more women and paid employment is good for the economy so you have to design your systems in order to enable that to happen sticking with the theme of planning urban environments around women’s unpaid care work I would just like to turn your attention to snow clearing so this is a story from Sweden obviously it’s from Sweden Sweden as the best know better than all of us they’re very smug about it but they’re also very useful for books like mine because they provide great case studies and this is just such a case Cuddy so this is from karlskoga a town in Sweden which realized that it’s snow clearing was sexist obviously it did um so the way they had always done their snow clearing was to clear the major road arteries first and then the local roads and pavements and that sounds probably about right right people need to get to work you need to clear the major road arteries but they realized that because male and female travel patterns are not exactly the same what this actually meant was that they were benefiting male travel at the expense of female travel so what do I mean by that basically men have much simpler travel patterns than women on average men tend to drive and just do a simple commute in and out of work women because of the unpaid care work that they do women do 75% of the world’s unpaid care work are more likely to do what’s called trip chaining so that’s lots of short interconnected trips taking the kids to school before going into work picking up the groceries on the way home that kind of thing just a few statistics for you a woman in paid employment with a child under the age of five will increase her trip training by 54% a man in the same position will only increase his by 19% in London women are three times more likely than men to take a child to school and up to 39 percent more likely to trip chained so there is a sex difference here and when karlskoga officials realised this was happening they thought well let’s just switch it around and do the pavements and local roads first and then the major road arteries because they figured it’s easier to drive a car through three inches of snow than to push a buggy or walk turned out they were right it is easier and the result of this change didn’t just not cost them more money it actually ended up saving them money because they found that the admissions to accident and emergency in icy conditions fell and that is because pedestrians were being injured three times more often than motorists and slippery or icy conditions and accounted for half the hospital time of all traffic related injuries and women made up the majority of those pedestrians who are being admitted into hospital as well as tending to have the most severe injuries and the cost was not trivial in fact one study estimated the cost of all these pedestrian Falls during just one single winter season at around 3.2 million pounds which is twice the cost of the winter road maintenance in fact another step study found that it was three times the cost of the winter own maintenance which was a study in a different area not just that they didn’t agree with the numbers and so anyway in conclusion feminism saves you money now I’ve got about five minutes to tell you everything else so I’m going to very very quick this is the Henry Higgins a head effect which is the most popular way of trying to address the problem with the gender data gap and with sexism and for those of you who don’t know about Henry Higgins Henry Higgins was is from the musical my fair lady and he said in exasperation why can’t a woman be more like a man and and actually this is quite a common way of trying to address this problem is sort of thinking that the problem was with the women one of my favorite um examples of this that I came across in the book was this guy who said that his voice recognition software which didn’t recognize women’s voices very well which is a huge problem by the way I’m Google’s voice recognition software it recognises male voices 70% more accurately than female voices because it’s trained on male biased data and he said that women should undergo hours of lengthy training in order to fix the many issues with women’s voices anyway that’s obviously ridiculous but this tendency crops up in more insidious ways so in a lot of workplace initiatives you know but oh very well-intentioned we should get the women to be more confident they should ask for raises well actually women tend to ask for raises as often as men they’re just less likely to get them but also why are we assuming that men are the standard that women don’t live up to it’s the sort of dropped out genitals all over again we’re just assuming the male way as the best right but let me suggest this to you women have sorry women tend to assess their intelligence accurately studies show this but men of average intelligence think they’re more intelligent than two-thirds of people you do the maths on that and so are women the problem is that the women are under confident or is it the men are overconfident and is the problem with a system that rewards overconfidence and penalizes accurate confidence I would suggest maybe that’s the problem and so very very quickly I want to talk to you about clean cookstoves and so basically this is the way that most women in the developing world still cook and this is a huge impact on their health a woman cooking on a traditional stove in an unventilated room is exposed to the equivalent of more than a hundred cigarettes a day they are toxic fumes and stoves in countries the world between twenty and a hundred times the World Health Organization guidelines these fumes caused three times more deaths every year than malaria indoor air pollution is worldwide the single largest environmental risk factor for female mortality and the leading killer of children under five so a huge issue development agencies around the world have been trying to fix it for a while now in fact they originally started to fix it for environmental reasons because they thought that deforestation was caused by women going and picking up scraps of firewood before they realized that she was largest great scale agriculture and so at that point they were like well there’s no development initiative here so let’s just stop doing the clean cookstoves anyway in the 90s someone thought well women are dying maybe we should try and give this another go um but they kept designing stoves without speaking to women first they designed stoves that increased cooking time and required more attending even though women already cook for three to seven hours a day and need to pump multitask while doing so they design stoves that required more maintenance and that would only accept specifically chopped up pieces of wood both of these things were seen as jobs for men and the men just weren’t really doing X they thought well she can cook on the 3-stone stove they also design stoves that were just too expensive so families couldn’t afford basic needs they’re not going to shell out on an expensive clean cook stove but despite report after report finding this finding that this was the problem report also the reports also came to the conclusion that it was the women that were the problem this is the title in fact of a yale university press release about a study that listed all the problems with the cook stoves and still came to the conclusion that women were being obstreperous and choosing bad cook stoves because they’re idiots and need educating the good news is that someone eventually decided to speak to women and when they spoke to women they found out that actually women did not prefer using pollution causing stoves they just you know needed stoves that fitted to their needs and so they designed this very cheap using scrap metal device that you can stick on top of any existing freestone stove because it’s made its bendable you stick it on top of that and it cut wood use and smoke to levels comparable to those achieved by the more expensive high efficiency cook stoves Plus also didn’t create all the problems that had been created for before right I’ve got 15 seconds to conclude one equality doesn’t mean treating women like men and this is a cue for women queuing for the toilet at some pancreas and I don’t have time now to go into why this happens to women instead of men but let me tell you it is not because women are doing their makeup and if you want to find out why very good reasonably price book just around the corner there and collect sex disaggregated data that is incredibly important hopefully all my ranting about the medical world has explained to you why remember the issue of the female cells responding to Eastridge in the male cells not responding to Eastridge and you cannot start in men and then move on to women if you find something interesting equally you need to sex to segregate your data from the beginning otherwise you’ll continue wasting money implanting male stem cells that aren’t going to regenerate the muscle because you haven’t bothered to sex to segregate and finally the best team for the job and that is basically a message about diversity because diversity is absolutely crucial to collecting the right data it means not only that you will be more likely to collect sex – saibra gated data and to analyze it because that is what the studies have shown that if women are included in the research teams the research is much more likely to include women but it also means that you will be asking the right questions think of Susan Rey being the first person to bother wondering why oxytocin only works in 50% of women think of Apple not bothering to include a period tracker in its comprehensive health tracker out even though you could track your copper intake I don’t I don’t know how to do that and I’m I mean I don’t even know where I’m getting the copper from if I have too much copper – you little copper I wouldn’t know what the right level of copper is anyway and I would strongly suggest that Apple did that not because they are evil and hate women it just they forgot periods exist they didn’t have enough women in their design team and a big problem that we have actually is I think thinking of the oh splashing relat me it’s very angry oh that’s the time where you can’t see it but red angry flashy timer and Rose is also looking at me telling me to shut up so in conclusion I’m going to shut up but thank you very much for coming to listen to me Oh poppy thinks you’re clapping her so Caroline thank you for an absolutely wonderful talk very well-deserved applause um that was jaw-dropping I could see members of the audience shaking their heads the scale of the unjustice –is here i would personally like to thank you for highlighting the scale of these problems your book is incredible it’s hugely important I’m sure many of us must feel what can we do what can I do to to just change the change the situation is there anything personally we can do well it depends it sort of depends who you are and obviously if you’re a medical researcher stop testing just on men that would be nice um but I think the most important thing is for people to look at whatever area they work in or you know even if they’re not engaged in paid employment look at what’s going in in your own home and notice where are things being presented as if they’re gender-neutral but are actually defaulting to mail because that essentially is what is at the heart of all of this you know it it really isn’t you know even the medical researchers who were saying oh we can’t test on women because of the menstrual cycles so you can’t say that they’ve forgotten women unlike Apple which clearly just forgot about women and but they are still sort of working on the bay this bias that they are clearly thinking of men as the default human who’s only if you think that could you possibly think that the menstrual cycle isn’t something you might want to look into so I think the most important thing is getting to grips with the fact that we all have this bias in our own heads and noticing when we’re doing it because we all do it you know I do it as well you know you will often I don’t know assume someone is a man when you only hear their surname and then you have to get told you know Oh what your doctor what did he say Oh your boss What did he say and actually it turns out as a woman that’s male default