Gender and Health

Question 1

Describe the patterns of morbidity and mortality related to gender and understand the probable causes suggested.

Answer 1

Within the UK, women have a lower levels of mortality, but higher levels of morbidity (health expectancy) i.e. they can expect to live longer in poor health than men (10.7 years).

Question 2

What can the difference between life expectancy and health expectancy be regarded as?

Answer 2

An estimate of the number of years a person can expect to live in poor health or with a limiting illness or disability.

Question 3

The rate of premature death has fallen by around 1/5 over the last decade. Is it higher in men or women? By how many times?

Answer 3

Men by 1.5 times

Question 4

What ethnic group has the highest expected years of life lost per 100,000 per year?

Answer 4

African American

Question 5

What are the three leading causes of premature death among men?

Answer 5

IHD
HIV/AIDS
Lung, broncus and trachea cancers

Question 6

What are the three leading causes of premature death among women?

Answer 6

IHD
Cerebrovascular disease
Lung, bronchus and trachea cancers

Question 7

What was the Whitehall study of British civil servants and what did it show?
What about Whitehall II study?

Answer 7

Begun in 1967
It showed a steep inverse association between social class and mortality from a wide range of diseases. 

Between 1985 and 1988 the degree and causes of the social gradient in morbidity in a new cohort was studied. 
In the 20 years separating the two studies there has been no diminution in social class difference in morbidity.

Question 8

What was worse in subjects in lower status jobs? (3)

Answer 8

Self-perceived health status
Worse symptoms
Differences in health-risk behaviours (smoking, diet, exercise)

Question 9

What gender differences did the Whitehall II study find?

Answer 9

Mortality was lower among women than among men, but morbidity was not consistently higher. This discrepancy between morbidity and mortality in gender is called the ‘gender paradox’.

In older ages, there are minimal gender differences in self-assessed health but significantly higher levels of disability in women.

Question 10

What is meant by the gender paradox mechanism?

Answer 10

There is greater stoicism amongst men and a greater willingness among women to use health services, report health problems, factor in less serious ailments when assessing their own health. This assumes a woman’s illness is less likely to kill her.

If women over report minor health problems or report them earlier, then association between morbidity and mortality should be smaller among women than men.

A wide range of genetic, hormonal, social and cultural factors play a role in shaping male and female patterns of morbidity & mortality.

Question 11

When is the health disadvantage among women known to be largest?

Answer 11

At younger ages

Question 12

What is the Bem Sex Role Inventory psychological measure?

What was it used for?

Answer 12

The BSRI does not assume that sex and gender (the biological and the social) are coincidental. It requires participants to endorse a series of characteristics which have been judged to be stereotypical of men (masculine) or women (feminine). From this, it becomes possible to derive two separate masculinity and femininity scores for each individual participant.

It was used to explore whether observed male and female differences in health status might mask an association of a ‘feminine’ gender role orientation with relatively poor health, and a ‘masculine’ gender role orientation with relatively good health - for both men and women.

Question 13

What were the results of the BSRI study?

Answer 13

When measures of masculinity and femininity were included in the analysis, the significance of ‘sex’ difference disappeared.
High ‘masculinity’ scores were associated with better health, and conversely, high ‘femininity’ scores with poorer health, for both men and women.

Question 14

What is the queer theory?

Why are binaries dangerous?

Answer 14

All sexualities are pluralistic, fragmented and frequently reconstructed.
The danger lies in the recognition that the binaries of male/female, masculine/feminine, heterosexual/homosexual are normal. By taking these categories as givens, we do not fully consider the ways that inequalities are constructed by the categories in the first place. These categories exert power over individuals, especially for those who do not fit neatly.
Queer theory deconstructs these binaries.

Question 15

What four distinct social scientific theoretical traditions have developed to explain gender?

Answer 15

• Focuses on how individual sex differences originate, whether biological or social in origin.
• Emerged as a reaction to the first and focuses on how the social structure creates gendered behaviour. Portrayed best in Epstein’s (1988) Deceptive Distinctions.
• Also a reaction to the individualist thinking of the first, emphasizes social interaction and accountability to others’ expectations, with a focus on how “doing gender” creates and reproduces inequality.
• Gender performed in every social interaction; it seems naive to ignore the gendered selves and cognitive schemas that children develop as they become cultural natives in a patriarchal world. The more recent integrative approaches treat gender as a socially constructed stratification system.

Question 16

Explain gender as a social construction.

Answer 16

Gender is an institution that is embedded in all the social processes of everyday life and social organizations.
Gender difference is primarily a means to justify sexual stratification and to justify inequality, but it is socially constructed.

Question 17

What are the criteria for a social institution? (12)

Answer 17

Characteristic of groups
Persists over time and space
Includes distinct social practices
Constrains and facilitates behaviour/action
Includes expectations/rule/norms
Constituted and reconstituted by embodied agents
Internalised as identities and selves
Includes a legitimating ideology
Contradictory, rife with conflict
Changes continuously
Organised by and permeated with power
Mutually constituted at different levels of analysis

Question 18

What is the term ‘gender’ utilised for?

Answer 18

To distinguish between the biological fact of ‘sex’, and the social and cultural characteristics associated with being male or female.

Question 19

Define biological sex.

Answer 19

Refers to biological and physical anatomy and is used to assign gender at birth.
Traditionally, biological sex and gender are aligned.

Question 20

Define gender identity.

Answer 20

A person’s innate, deeply felt sense of being male or female (sometimes both or neither).
Some feminists argue that there is no essential identity and that all is constructed.

Question 21

What is gender expression?

Answer 21

Everything that communicates our gender to others – clothing, hairstyles, body language, mannerisms, how we speak, how we play, and our social interactions and roles.
External, based on individual and societal expectations and conceptions and dependent on context.

Question 22

Define sexual orientation.

Answer 22

The romantic or sexual attraction to people of a specific gender. Sexual orientation and gender identity are separate distinct parts apparently.

Question 23

Define gender variance/gender non-conformity.

Answer 23

Refers to behaviours and interests that fit outside what is considered ‘normal’ for a child or adult’s assigned biological sex e.g. tom boy.

Question 24

What is meant by transgender?

Answer 24

Gender identity does not match their assigned birth sex. It does not imply any specific sexual orientation.
Anyone whose identity or behaviour falls outside stereotypical gender norms.

Question 25

What is gender fluidity?

Answer 25

Conveys a wider, more flexible range of gender expressions, with interests and behaviours that may even change from day to day.
These people do not feel confined be restrictive boundaries of stereotypical expectations of men and women. For some, gender fluidity extends beyond behaviour and interests, and serves to specifically define their gender identity.

Question 26

What is meant by genderqueer?

Answer 26

Blurring of lines surrounding society’s rigid views of both gender and sexual orientation.
Genderqueer people embrace a fluidity of gender expression that is not limiting.

Question 27

What are gendered social practices?

Answer 27

Those which shape women’s and men’s bodies in ways that reinforce particular cultural images of ‘femininity’ and ‘masculinity’.

Question 28

How are gender identities imposed?

Answer 28

Starts with assignment to a sex category on the basis of what the genitalia look like at birth. Then reinforced through naming, dress, and the use of other gender markers (e.g. sex-typing of clothes). Once a child’s gender is socially ascribed, they are treated differently from children ascribed to the other gender. Children respond to this by feeling different/behaving differently.
As soon as they can talk, children start referring to themselves as members of their gender.

Parenting is gendered, with different expectations for mothers and for fathers, as are work roles.

Question 29

What does transcendence mean?

Answer 29

The ways in which biology can be transformed by gendered social practices.
Gender differences are constructed by exaggerating bodily DIFFERENCES and suppressing similarities and converting average differences into absolute differences.

Question 30

How are these socially constructed differences seen in terms of physical activity in boys/girls.

Answer 30

Boys are more active than girls, with the difference increasing with age group. As the decline in activity levels with age starts earlier in girls. However, the gender difference does not appear until the 8-10 group. This gender difference in activity levels cuts across social class (as measured by household income).

Among boys aged 11-15 who met the recommended levels this pattern reflected fathers but not mothers activity levels. For boys (in both age groups) more were in the less active category if their parents were also in this group. In contrast, among girls (of both age groups), the activity level of parents made relatively little difference to the proportion meeting recommendations.

This probably reflects the wider influence of socio-cultural factors on the physical activity levels of girls that go beyond individual parental influence and social class difference.

Amongst young adults a much higher proportion of men than young women met the recommended levels of exercise.

Question 31

Gender influences the way women and men relate to their health through differences in power, opportunities and personal and social expectations.
Give examples of gender differences in health. (5)

Answer 31

• Paid and unpaid work (more women work part time)
• Health behaviours and risks (e.g. occupational hazards)
• Inpatient experience (women have generally less positive experiences)
• Help-seeking behaviour (men consult their GP less often)
• Perceptions of personal health (men are more likely to assess their health as being good or very good)

Question 32

Describe key health concerns for men and women. (8)

Answer 32

Life expectancy
Coronary heart disease
Mental health and emotional issues
Overweight and obesity
Cancer
STIs
Auto-immune illnesses (diabetes and MS)
For women - pregnancy/maternity care

Question 33

Outline implications for healthcare.

Answer 33

Increasing diversity rarely recognised
Denial of difference – homogenisation
Silence used as a strategy to manage and contain gender issues, may also be due to embarrassment, lack of knowledge and experience, not feeling responsible, and lack of resources to provide support if required.
Silence forms a covert practice. Covert practices are more powerful and more difficult to dismantle in their contribution to the invisibility of gender issues.
Gendered privilege - widens the gap in health.