Gender Differences in Determinants and Consequences of Health and Illness
Research has found differences between women and men in some health The World Health Organization (WHO) recognize sex and gender difference as. as a case study to discuss the relationships between gender and health. Keywords: Female Sex Workers, Gender, Health, Health Communication. Gender, as well as socio-economic status, continues to structure opportunities and life chances. For example, although the difference between men's and.
The subordination of women by men, a phenomenon found in most countries, results in a distinction between roles of men and women and their separate assignment to domestic and public spheres.
The degree of this subordination varies by country and geographical or cultural patterns within countries, however, in developing areas, it is most pronounced. In this section, the example of nutrition will demonstrate how gender has an important influence on the social determinants of food-consumption patterns and hence on health outcomes. Several studies have shown the positive relationship among education of mothers, household autonomy, and the nutritional status of their children 67.
During the first 10 years of life, the energy and nutrient needs of girls and boys are the same. Yet, in some countries, especially in South Asia, men and boys often receive greater quantities of higher quality, nutritious food such as dairy products, because they will become the breadwinners 7 — Das Gupta argued that depriving female children of food was an explicit strategy used by parents to achieve a small family size and desired composition Studies from Latin America also found evidence of gender bias in food allocation in childhood 16 — 18 and, correspondingly, in healthcare allocation In developing countries, most studies show preferential food allocation to males over females.
Nonetheless, some studies have found no sex differences in the nutritional status of girls and boys 20 — 22and others have described differences only at certain times of the life-cycle.
For example, research in rural Mexico found no nutritional differences between girls and boys in infancy or preschool, but school-going girls consumed less energy than boys.
This was explained by the fact that girls are engaged in less physical activity as a result of culturally-prescribed sex roles rather than by sex bias in food allocation Studies from developing countries of gender differences in nutrition in adulthood argue that household power relations are closely linked to nutritional outcomes. In Zimbabwe, for example, when husbands had complete control over all decisions, women had significantly lower nutritional status than men Similarly, female household heads had significantly better nutritional status, suggesting that decision-making power is strongly associated with access to and control over food resources.
Access of women to cash-income was a positive determinant of their nutritional status. In rural Haiti, the differences in nutritional status for male and female caregivers were examined for children whose mothers were absent from home during the day.
Those who were looked after by males, such as fathers, uncles, or older brothers, had poorer nutritional status than children who were cared for by females, such as grandmothers or sisters Ethnographic research conducted by the authors revealed, however, that, while mothers told the interviewers that the father stayed home with the children, it is probable that the father was, in fact, absent most of the day working and that the children were cared for by the oldest child, sometimes as young as five years of age.
The involvement of both men and women in nutritional information and interventions is key to their successful implementation.
Sex, Gender and Health
Unfortunately, in most developing countries, women are selected for nutritional education because they are responsible for the preparation of meals. However, they often lack access to nutritional food because men generally make decisions about its production and purchase. Similarly, men may not provide nutritional food for their families because they have not received information about nutrition. The participation of both men and women is, therefore, fundamental to changing how decisions about food are made and food-consumption patterns and nutrition families The study in rural Haiti referred to above also found positive outcomes through the formation of men's groups which received information on nutrition, health, and childcare.
These men, in turn, were resources for education of the whole community The gender differences are also found in the social determinants of nutrition in industrialized countries, although their manifestations are different.
For example, gender plays an important role in determining risk factors for eating disorders, which influence nutritional outcomes.
The most common of these are anorexia nervosa, bulimia nervosa, and binge eating BED 27 — The root causes are only partly understood. Biomedical and psychological theories include hormonal imbalance, malfunctioning of serotonin in the brain, genetic explanations, and emotional problems expressed by abnormal relationships with food.
Experts agree that a key factor is the desire to please others. Dieting and bingeing may be used for improving body image and self-esteem. Concern with body image is particularly strong in adolescence where the differences in calcium intake and a more sedentary lifestyle are pronounced Results of a study of 1, adolescents in the United States also showed that, during adolescence, intake of fruits and vegetables was generally low for both boys and girls and that their consumption was related to consciousness about controlling their weight Among men, dieting and bingeing seem to be more common among gay men and sports competitors than in heterosexuals Many studies have demonstrated the effect of social support on nutrition in older adults, with a positive impact being seen among those who are married, especially men 32 — This has been explained by several factors—the greater likelihood to skip meals when living alone, or to eat filling but unhealthy products and snacks.
Women who are alone may not be able to afford an adequate diet, or they may be less motivated to cook for themselves when they are accustomed to providing for others 35 — The gender differences in nutritional risk were studied among an older sample of black and white community dwelling residents in Alabama, USA The study took into account social support, social isolation, and social capital as possible determinants of nutritional risk.
Social capital was defined to include neighbourhoods, trust people felt in their security, and religion. The study found important gender and racial differences between different groups, black men being the most affected by poor nutrition if lacking in social support and capital.
White men were in the best overall position, with white women in the second best position, and black women in the third. The study found that social isolation and lower income contributed most to nutritional risk for all groups, except black men, for whom lack of social support and capital were the most important determinants of nutritional risk. The studies discussed in this section demonstrate that gender matters in terms of nutritional outcomes, but, at the same time, generalizations as to how gender affects the social determinants of nutrition can be misleading.
The complexity of social, economic and cultural contexts and also demographic and epidemiological indicators must be taken into account to fully understand the additional impact that gender has. Gender differences in economic determinants of health and illness Productive labour is usually defined as labour performed outside the household in income-generating employment; reproductive labour includes work done within the household, such as food preparation, childcare, housework, care of livestock and kitchen gardens.
Reproductive labour, in addition to reproducing the daily conditions of domestic survival, also assures the reproduction of human values, attitudes, and culture. In both industrialized and developing countries, women spend considerably more time than men in reproductive, volunteer and other unpaid labour, whereas men spend significantly more time in productive, remunerated work 3.
In most cultures, productive and reproductive activities are valued differently. Generally, earning an income brings greater autonomy, decision-making power, and respect in society. Given the greater involvement of men in the paid labour force and their higher earnings even when domestic and other activities of women are costed, they generally enjoy more autonomy and higher social status.
The gender differences in economic status and purchasing power affect the health-seeking behaviour and health outcomes of men and women.
Recent schools of thought have recognized that many types of non-market or reproductive labour are also productive. For example, gender-aware economics includes unpaid caring work in the home in the concept of productive labour and informal paid work, such as home-based income-generating activities and work in non-profit or non-governmental organizations.
Research on gender and the economic determinants of health and illness is relatively scarce, especially in the area of non-communicable diseases. The example of mental health is used here because there is considerable research on this topic in industrialized countries, and some studies can also be cited from developing countries.
The relative paucity of research on gender and economic aspects of mental health in developing countries reflects the fact that mental health services are less numerous and comprehensive than those in industrialized countries.
Nonetheless, interesting studies have been carried out in several countries that demonstrate a clear relationship between economic factors and mental health by gender. A study of gender and mental health in China that combined historical, epidemiological and qualitative data found significantly higher rates of schizophrenia among women than among men, a finding contrary to western studies in which men suffer more from schizophrenia Interestingly, however, men occupied more hospital beds than women in psychiatric hospitals, in which at least three-quarters of patients were suffering from schizophrenia, indicating that hospital-bed occupancy did not reflect the male-female ratio of people affected by the disease.
While several possible reasons for this imbalance were cited, significant gender differences in ability to pay were noted.
Men were much more likely to have health insurance from their employers than women, who tended to be treated more as charity cases. Reports from other parts of the world show that women constitute the large majority of individuals seeking psychological services Given this gender imbalance, services are not positioned to respond adequately to their female clients The gender differences in the economic determinants of mental health were also encountered in South Korea.
A recent study examined the impact on men and women of escalating job insecurity due to increasing numbers of non-standard workers.
The proportion of non-standard workers was considerably higher among women than among men. In general, non-standard workers part-time, temporary, and daily labour were more likely to suffer from mental problems than standard employees, and non-standard female workers suffered more mental illness than men, in terms of self-reported depression and suicidal thoughts Married women reported more psychological problems than single women, and the pattern was reversed for men.
The links among mental health, gender, and economic status were clear in several aspects of the Korean study. Women had about twice the incidence of poor mental health indicators than men, and the mental health problems increased as income declined.
This is also true of other studies 42 — The reasons within the Korean context were explained by Kim et al. Women also had many other family responsibilities which they had to fulfill, in addition to their paid labour.
Results of research in industrialized countries consistently indicate that women have higher rates of anxiety and depression than men, independently of race, time, age, and rural-urban residence. The fact that men have greater control over resources, and decision-making power is one explanation, but there is considerable evidence that even when women have control over resources and income through employment anxiety and depression is not necessarily reduced A national cross-sectional survey of British adults found that people in the most disadvantaged socioeconomic positions reported higher rates of affective disorders and minor physical illnesses than those in higher positions.
The gender differences were found in the other socioeconomic classes.
Among healthy older women, for example, those in the skilled occupational class reported the highest rates of affective disorders, whereas among men, the highest rates were found in the clerical class. Generally, in positions occupied by both the sexes, and among men and women with similar income levels, women reported higher rates of both affective disorders and minor physical morbidity The authors concluded that the experience of a particular social or occupational position might be different for men and women, explaining why women consistently experience more affective disorders and minor physical morbidity.
In an analysis of gender, employment, and mental health, Rosenfield compared men and women from the United States using measures of power in work and family, demands on time and personal control, and symptoms of depression and anxiety Men and women with similar demands on their time in family and work situations had similar symptoms of psychological distress. However, women in situations of higher demands, either as unemployed housewives or as working women with significant familial responsibilities, had higher rates of depression and anxiety than men.
Thus, the gender differences in economic roles strongly influence mental health outcomes. Gender differences in biological determinants of health and illness The gender differences in the biological determinants of health and illness include differential genetic vulnerability to illness, reproductive and hormonal factors, and differences in physiological characteristics during the life-cycle.
Until recently, a male model of health was used almost exclusively for clinical research, and the findings were generalized to women, except for the reproductive period. Clinical trials typically excluded women to protect them and their unborn children from possible negative effects. However, research in the United States in the early s seriously questioned the validity of a male model for female health issues and highlighted significant gender differences in the biological determinants of health and illness For example, protocols for the diagnosis and treatment of heart disease, the number one cause of all deaths in the United States, were based upon findings from middle-aged white male patients.
As a result, women were diagnosed later with more advanced disease and were consequently harder to treat successfully. Questions about gender differences in heart disease, mental illness, and osteoporosis led to the important recommendation that women be included in clinical studies to uncover gender differences and their impact on the prevention, diagnosis, and treatment of disease. Inthe U. Such policies are still not implemented in most of the developing world. The interaction between biological and social determinants is also important when considering gender differences in health.
The biological differences can be amplified or suppressed by socialization and how society responds to sex-specific behaviour. Social norms endorsing particular kinds of behaviour may exacerbate negative tendencies, such as violence, or reinforce positive propensities, such as nurturing. By contrast, socialization can suppress innate negative or positive tendencies. The example of longevity is used here for demonstrating how gender affects the biological determinants of health conditions.
Universally, women live longer than men but the gender gap is greatest in developed societies where women outlive men by about seven years, on average The most apparent gender difference in the ageing process is women's finite period of reproductive functioning. Their menopausal transition is associated with mood fluctuations and a decline in sexual interest relating to hormonal change. As they age, men and women suffer from similar types of illnesses but men tend to suffer from acute illnesses for relatively short periods before they die Women, by contrast, have a longer life, marked by many chronic non-life-threatening disabilities that can greatly affect the quality of their lives.
For example, osteoporosis, due to a natural decline in bone density after menopause, affects mainly women There has been considerably more research on gender and longevity in industrialized countries than in developing countries.
Sex, Gender and Health — Medicus Mundi Schweiz
Senenayake points out that health policies seem to assume that men and women's problems converge after menopause 49whereas, in fact, they continue to be distinct.
She notes, for example, that there is a lack of sex-specific data for elderly people in developing countries. However, the available data reported from developing countries indicate similar gender differences worldwide: Older women in both developing and industrialized countries are more likely to live alone than men As noted above, isolation can severely affect the health of older people, and given the lower economic status of women, they are less likely to be able to seek help A study of elderly males and females in Egypt, for example, found that females who had lived all their lives in rural areas and were living in a fair or poor residence were more likely to be disabled than women in better circumstances For Egyptian males, only illiteracy was associated with disablement.
This was attributed to the fact that literacy is much more prevalent among men, and those who are illiterate are, therefore, more likely to be poor. For women, living in rural areas is associated with having large families and a tendency to rely on traditional healers for births and medical needs.
They are, thus, more exposed than men to poor medical care for reproductive healthcare and, consequently, more at risk of infection. They also have less access to medicines to treat morbid conditions.
For women but not for men, living alone was associated with increased odds of disablement An interesting study by Rahman found important gender differences in elderly mortality in Bangladesh In a longitudinal study in the Matlab surveillance area, a large sample of men and women aged 60 years and older were followed for eight years to determine the impact of several social, economic and demographic variables.
The study found that household heads, whether male and female, had lower mortality, and the presence of a partner had a significant positive impact on men, but a positive impact on women only when their husbands were the heads of the household.
Moreover, the presence of an adult son was correlated with lower mortality among women but not men. These findings indicate that individual access, to resources as opposed to joint access, is an important determinant in the survival of elderly people In industrialized countries, the impact of gender on the biological determinants of longevity is also evident, for example, in the quality of life of elderly people.
In a study of 14, men and women aged 60 years and above living in their homes in Britain, the gender differences were found in living arrangements for people living with severe disabilities Half of these older women lived alone compared to one-quarter of older men.
Most men with severe or moderate disability lived with their spouse and received care from them, whereas most women lived alone and had to rely on help from outsiders. The British study examined self-assessed health to test the validity of the common assumption that women over-report morbidity There was a little gender difference in self-assessed morbidity, once class, income, age, and level of functional disability were taken into account.
In fact, results of multivariate analysis indicated that, when the greater functional disability of older women was included, older women reported less poor health than older men. These findings illustrate the importance of re-examining common gender-based assumptions and of assuring that comparisons between men and women are based on similar socioeconomic and demographic groups.
Moreover, gender relations and their impact on biological factors are changing, as women increasingly assume positions traditionally occupied by men and vice versa.
Gender and health | Inserm - From science to health
In a study of gender differences among men and women aged 70 years or older in Israel, the will to live was found to be affected by the state of health of the elderly, those in poor health more likely to show the gender differences referred to above As in other studies, living with a partner was a significant predictor of the will to live among men, but not among women 61 — Gender differences in consequences of health and illness This section reviews research on how gender affects the social, economic and biological consequences of health and illness, focusing on three non-communicable diseases or conditions: Gender differences in social consequences of health and illness The gender differences in the social consequences of health and illness include how illness affects men and women, including health-seeking behaviour, the availability of support networks, and the stigma associated with illness and disease.
Men and women respond differently when ill, in terms of time before acknowledging that they are ill, recovery time, and how women and men are treated by their families and society.
In developing countries, men seek treatment more frequently at formal health services, whereas women are more likely to self-treat or use alternative therapies. This has been explained by factors, such as multiple roles of women which limit their activities mainly to the domestic sphere and make it difficult for them to go to clinics during opening hours.
Gender and Health
By contrast, traditional healers or community shops are easier to access and will often accept delayed payment or payment in kind or delayed. Traditional healers also provide explanations in ways that are easily understood, in contrast to the more scientific explanations of clinic staff 3. Women are often treated in an inferior way at health services and are blamed for coming late or for not bringing their children for regular immunization or check-ups. This only exacerbates women's reluctance to access healthcare, even when other access barriers are removed Insensitive treatment by health personnel is also a problem in industrialized countries, although in these situations women have more options for restitution.
While both men and women suffer considerable discrimination and from society, women are more marginalized by these health problems. The example of diabetes, a non-communicable disease, demonstrates the gender differences in its social consequences. Research on gender differences in the social consequences of diabetes is limited, especially in developing countries. Even in industrialized countries, the studies in this area are difficult to compare because they deal with different variables, measurement tools, and outcomes.
However, it is possible to draw some conclusions from the existing literature which are relevant from a gender perspective. A recent study from Trinidad found that men with type 2 diabetes mellitus were less compliant with treatment than women and that they were less satisfied with the way they were treated in the dispensary and clinic they attended.
Men tended to smoke and drink alcohol much more frequently and, hence, were predisposed to a wider range of health risks, including hypertension and cerebrovascular and cardiovascular diseases. The authors hypothesized that men with diabetes probably had a lower life expectancy than women Some evidence from India showed that boys have better access to care for insulin-dependent diabetes mellitus IDDM than girls.
The reasons were not studied but it is likely that son preference plays a role here, in keeping with other health-related research findings. Sridhar noted that mothers tended to take responsibility for looking after diabetic children, which could result in alienating fathers and making them uninterested in helping to care for their children A common finding in developing countries is that urban dwellers have a higher prevalence of diabetes than rural residents because of the shift from low to high fat intake 66 — 68 but there does not seem to be a consistent pattern of gender differences within this rural-urban categorization.
Studies on gender differences in diabetes in industrialized countries have focused on how men and women or girls and boys cope with the illness, including the types of coping strategies they develop. Perhaps the most common finding is that women and girls generally have a more negative way of dealing with diabetes than men and boys. Anxiety and depression are more common among females 69 — In a sample of adolescents in the United States, even after controlling for other correlates, such as levels of knowledge about diabetes and metabolic control, girls were less positive about their illness than boys More research is needed to understand the link between diabetes and depression Some researchers have reported a higher incidence of eating disorders among diabetic adolescent girls than among boys with IDDM or than among non-diabetic girls Another possible explanation is that girls may internalize stress more than boys who tend to deal with their stress by more positive behaviour, such as practising sports and following a controlled diet.
Cruickshanks reported that adolescent diabetic girls are engaged in fewer physical activities than boys, possibly contributing to poorer diabetic control As has been found in other studies cited in this paper, the assistance and emotional support received from their spouses has been found to influence health outcomes for people with diabetes.
A study of men and women with diabetes over a year period found that male patients reported more satisfaction with the support received than women Similarly, wives of diabetic patients reported fewer problems in giving medication and in testing blood glucose levels than did husbands of female patients.
Men with diabetes received more support from their partners than women, as demonstrated by the greater attendance of wives in education programmes than husbands of diabetic women. Men reported better self-care, such as eating meals on time, less binge eating, and less late insulin injections.
Men also recounted fewer incidents of ketonuria, better blood sugar levels, and fewer diabetes-related complications. Men generally mentioned greater satisfaction with their diet and their treatment regime. Whereas men were less likely to miss work or activities because of their disease, wives of diabetics reported missing more work because of their husband's condition than husbands of female diabetics This again indicates the greater support received from women by men who are ill than the reverse.
Similar results concerning positive coping behaviour of men and support from spouses have also been reported elsewhere 75 — Research in Sweden on coping strategies of men and women with type 2 diabetes found that women used more negative coping strategies, including resignation, protest, and isolation, whereas men took a more problem-solving approach Another Swedish study found that men under-estimated diabetes-related problems more than women and worried less about long-term complications.
However, they were more concerned about the impact of illness on their personal freedom. Although women were more worried about their health, they were able to find positive aspects in having diabetes. Younger people also had more positive attitudes than older people, although they were more likely to consider that the disease had negatively affected their relationships with others Research in the United Kingdom found similar results as in the Swedish research.
The majority of girls adapted to the illness by incorporating it into their social and personal identities. Boys tended not to identify with the illness but rather to find ways of combating it or keeping it at bay. These findings support the observations of Charmaz 5 and Prout 81 who emphasized the stigmatizing impact that chronic illness can have on males at different ages.
The greater acceptance by girls of their condition had detrimental consequences in that they had lower expectations of themselves and were also less capable of managing their illness by diet and exercise as well as boys did. Boys tended to use exercise as a means of keeping their blood sugar under control, whereas girls were more likely to give themselves more insulin instead.
Gender differences in the economic consequences of illness The gender differences in the economic consequences of illness include how work of men and women is affected by illness, such as availability of substitute labour, opportunity costs of health-related actions, available income, and the impact of economic policies.
When poor women in developing countries are ill, they tend to delay seeking modern treatment until their symptoms are too severe to ignore, meanwhile perhaps visiting a traditional healer or local pharmacy. Thus, they take longer to recover and often return to work before they have completely recuperated Although the ratio of male to female births 1: Male death rates continue to be higher than female death rates through adulthood.
The difference in male and female mortality reaches a peak in late adolescence and early adulthood, owing much to an excess of accidental deaths amongst men. These differences between male and female mortality might signal some important biological differences between men and women, but it would be a mistake to assume that they were an unchangeable feature of the human condition. Indeed, greater female longevity appears to be a relatively recent phenomenon.
It seems that from the Palaeolithic period until the Industrial Revolution it was men that had a longer life expectancy at around 40 years, as compared with around 35 years for women.
During the nineteenth century, women's life expectancy became more similar to men's. Inlife expectancy at birth was 41 years for men and 43 for women. Since that time, life expectancy has improved dramatically, particularly for women. Most of the improvement has occurred in the twentieth century and is attributable to the dramatic decline in infectious disease mortality. It is important to remember that men stil1live longer than women in some less developed countries e.
India, Pakistan, Nepal, Afghanistanwhere infectious disease remains an important threat to health, where potentially harmful environmental and occupational exposures are unregulated, and where women have more children at younger ages in the face of poorer nutrition. But women are sicker?
In north America and western and northern Europe, men's higher mortality is often contrasted with women's greater morbidity. In adulthood, women are often said to rate their health less positively, to report more physical and psycho-social symptoms, to consult health professionals more frequently, to report more days of disability or sickness absence from work, and to have a higher level of conditions which are not life-threatening than do men. It was sometimes suggested that this presented a paradox: More recently, people have argued that this picture has become over-generalised, and that we have drifted too far towards a blanket expectation of difference.
Gender specific symptoms of ill-health Plenty of studies have shown differences in some aspects of health. Certain symptoms such as headaches, tiredness are more often reported by women, and as a group, women have a higher prevalence for some kinds of mental distress. The British Health and Lifestyle Survey showed an excess in women of depression and problems with nerves, of varicose veins, of migraine, and haemorrhoids at most ages, and of arthritis and rheumatism at older ages; but it also suggested a male excess of digestive disorders, asthma and back trouble in younger adulthood, and as expected a male excess in heart disease at older ages.
The proportion reporting that they have a chronic illness is very similar for men and women up until the age of 74 years. This is partly because of the difference in the age distribution in this oldest age group by sex. It also bears witness to the fact that many women may survive longer than men, but that at these later ages their healthy life expectancy may not be that different from men's. Perhaps it is not surprising that the evidence should be so mixed.
There is no doubt that men and women differ biologically in some ways, but any biological differences that do exist are mediated by a complex interplay of exposures which are socially determined.