Lifespan, Gender

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Lifespan, Gender CultureWomens Health (1)
P.corcoran_at_city.ac.uk
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Womens Health -Outline

• Womens health in context
• Lifestyle factors and health
• Life threatening illness- Aids
• Responses to life cycle challenges
• Health promotion and disease prevention

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Improvements in Life Expectancy

• 1900 average life expectancy 48
• 1997 average life expectancy 79
• Western society has witnessed enormous changes
  in womens roles, economic and educational
  opportunities and health care status.

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Factors related to improvements in Life Expectancy

• Less deaths in childbirth
• Birth control and medical improvements in general
• More involvement in health care settings and
  decision making
• Political changes.e.g 1975- International Womens
  Year - UN General Assembly
• More research into womens health

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Issues in Womens Health

• Women live longer than men, therefore more
  susceptible to disease in later life
• Women suffer from more ill-health than men
• Under stress combining work and family life
• Certain health problems are more prevalent in
  women (e.g. STDs)
• Certain health problems are more particular to
  women (e.g. Breast cancer)

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• For women, coronary hearth disease, stroke, lung
  cancer, and breast cancer are the leading causes
  of death and disability.
• (Wenger, Speroff and Packard, 1993)
• Many of the risk factors identified for these
  diseases are a function of health behaviours
  acting in concert with genetic and environmental
  factors.
• (Luepker, 1994)

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Women from different ethnic and socio-economic
backgrounds bring different life histories,
cultural and health beliefs and practices, and
concerns to the health care setting.

• Moreover, they bring different experiences of
  situational stress and resources for coping with
  these stressors. For example, results from a
  recent study (Krieger Sidney, 1996) indicated
  that racial discrimination shapes patterns of
  blood pressure among the U.S. Black population
  and differences in Black-White blood pressure.

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Social factor

• Socioeconomic status (SES) and breast cancer.
• breast cancer is higher among higher SES women
• lower SES women are more likely to die from
  breast cancer

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SES and Age

• Wagener and Schatzkin (1994)
• mortality rates dropped for women aged 25-44
  years, declines greater for women in more
  affluent regions
• women aged 45-64 - mortality rates decreased over
  time in affluent regions, increased in poor
  regions
• all women over the age of 65- mortality increased
  , increase sharper for women in poorer regions

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Social Factor

• Violence
• 1985, US Surgeon General stated that the number
  one health problem facing women was violence
• in one community practice in US, 23 of women
  seeking medical care had been assaulted by their
  partner. Neither demographic nor health factors
  could accurately predict who among these females
  had been assaulted (Hamberger et al, 1992)

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Psychosocial factors

• e.g. Social networks
• the relation of social support to health is
  weaker and more complex among women than men
• Shumaker and Hill (1991) noted a mortality
  disadvantge for women with social support

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Psychosocial factors

• e.g. Marriage
• women derive fewer physical and mental health
  benefits from marriage than men
• women recover more quickly and suffer less
  adverse health consequences from widowhood than
  men

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Psychosocial factors

• e.g. religiosity
• Clark, Friedman Martin (99) - women who viewed
  themselves as more religious in adulthood had a
  lower risk of premature mortality than those who
  were less religiously inclined
• Alferi (99) - Catholic women with breast cancer,
  the more religious the more distress they showed
  whereas the opposite was true for evangelical
  women

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Lifestyle factors and health

• Alcohol
• Smoking
• Diet
• Stress
• Physical activity
• Sexual behaviour

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Diet

• 1992- 40 of women were overweight in England
• 55 chose underweight body image as ideal body
• Doll Peto(81) - approx 35 of all cancer
  deaths can be attributed to diet (cf tobacco -
  30)
• Meat consumption and alcohol increases the risk
  of some cancers
• Vegetables and fruit are protective for almost
  all cancers

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Eating disorders- Anorexia Nervosa (AN)

• most life threatening eating disorder
• 90 of cases female
• course and prognosis is poor
• approx 40 recover after treatment
• lack of research into ethnic minorities and AN

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Eating disorders - Bulimia Nervosa

• 90 of cases female
• females born after 1960 have an increased risk
• results of treatment variable, CBT shown good
  results
• recovery ranges from 13 -71
• relapse rates are high
• (Olmsted, Kaplan Rockert, 1994)

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Eating disorders- Binge eating disorder

• new eating disorder (DSM-IV, 1994)
• largest eating disorder group
• recurrent episodes of binge eating without
  purging or fasting
• approx 50 of people with BED - obese
• only slightly more common in women than men
• black and white women are at equal risk

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Factors associated with eating disorders

• depression
• low self-esteem
• anxiety and stress
• problems with expression of negative affect in
  families
• problems with conflict management in the family
• public self-consciousness
• dieting at a young age

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Contextual factor associated with eating disorders

• - media ?
• The media provide particular examples of role
  expectations and images of beauty which may
  influence young peoples perceptions of
  acceptable body imageThe images of slim models
  in the media are a stark contrast to the body
  size and shape of most children and young women
  who are becoming heavier. Research has found
  that most female characters on television are
  thinner than average women.
• BMA, 2000

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Contextual factor associated with eating disorders

• Socialization
• Being female means that how one looks is more
  important than what one does
• Discontent about body is the norm for women.
• p125 C.Lee.

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Eating disorders - barriers to treatment

• feelings of shame and self-loathing
• fear of weight gain
• feeling that the eating disorder will go away on
  its own
• lack of knowledge about appropriate referrals

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Women and Aids

• In the UK, the prevalence of Aids/HIV has nearly
  doubled over the last century
• June 2000- 17,998 Males and 5,063 Females
  reported to be HIV infected
• Leading cause of death for women in certain areas
  of Africa
• 4 times more cases in France

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Women and Aids

• Transmission (Sherr, 1996)
• Risk of transmission after a single unprotected
  act of heterosexual intercourse with an HIV
  positive woman 20 times less likely than is
  transmission from an HIV positive man to a woman
• Second most common transmission category for
  women with AIDS is heterosexual contact (source
  US)
• 19-32 of women whose male partners report
  bisexuality(source UK)

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Women and Aids

• Psychological impact of HIV in women
• very few studies have examined this
  systematically
• most studies looked at the psychological impact
  of gay men
• women may differ from gay men in the nature of
  their social support, their roles within the
  family, their childrearing situation, roles
  within sexual relationships, their goals,
  opportunities, hurdles and aspirations
• contemporary discourse about sexual choice
  implies a freedom which may not be available to
  women

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Women and Aids

• Psychological impact of HIV
• anxiety
• depression
• lowered self image (weight loss, Kaposis
  sarcoma, hair loss)
• loneliness (changes in sexual behaviour lost
  avenue to new relationship formation)
• fear
• dementia

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Women and Aids

• A gender analysis, Sherr, (1996)
• women are less likely to leave their partner if
  he becomes HIV positive
• Alternative explanation This is due to
  commitment
• women are less likely to withhold knowledge of
  their HIV status from their male partner
• Alternative explanation This is due to honesty.

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Women and Aids

• A gender analysis, Sherr, (1996)
• women are less likely to be exposed to
  unprotected sex from an HIV positive male partner
  than the other way around
• Alternative explanation This is due to male
  disregard
• women are less likely to be tested for HIV
  without consent
• Alternative explanation This is due to
  discrimination

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Conclusions

• Despite the many improvements in womens health,
  many are still possible if we are willing to view
  not only the biomedical aspects of health, but
  also the social and psychological
• Lifestyle factors play a big part in womens
  health
• Less women are reported to be HIV infected but
  are more vulnerable to the virus
• A gender analysis of HIV/Aids can reappraise
  findings offer less victimising explanations