Gender, ethnicity and health

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Gender, ethnicity and health

• Sarah Earthy
• Sociology of Contemporary Societies

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Key questions

• How do patterns of illness (and health) differ
  between men and women?
• What is the effect of gender on these patterns?
• i.e. the social position, roles and cultural
  norms ascribed to men and women at a particular
  time in a particular society.
• How we can separate out the effects of ethnicity
  from socio-economic position?
• e.g. migration cultural factors social
  exclusion experiences of racism.

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Explanatory models

• Social patterning of health and illness may be
  due to
• artefacts of measurement
• social selection (direct / indirect)
• behaviour / cultural factors
• materialist or structural factors
• psycho-social mechanisms
• disadvantage accumulated across the life course
• the broader structural and political context
• social policies and institutions
• social and environmental conditions created by
  advanced capitalism.

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Stages in illness

• Causes of illness.
• Seeking medical help.
• Response of health services - diagnosis and
  treatment.
• Compliance with medical advice / convalescence.
• Outcome.
• Residual health problems / recurrence of illness.

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Measuring morbidity

• Surveys
• self-reported general health
• self-reported long-standing illness
• self-reported limiting long-standing illness.
• small size of some sub-groups.
• Other data on
• hospital admissions
• contacts with GPs
• community surveys.

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Age-standardised mortality rates per 100,000
population for men and women aged 35-64,England
Wales, 1986-92. Source Acheson 1998
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Main patterns in health and illness by sex/gender

• Mortality men fare worse than women.
• Morbidity women report more illness than men.
• Effects of social class less marked in data on
  womens illness BUT measurement problems.
• Gender includes...
• ... biological factors
• ... behavioural factors
• ... socio-economic position
• ... socially ascribed roles.
• Heterogeneous populations and varied experiences.

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Higher rates of male mortality

• Average life expectancy (UK)
• Men 77 years Women 82 years.
• Gap closing.
• BUT... specific to a certain time period and some
  countries.
• Higher life expectancy for women may be due to...
• Improvements in womens health.
• Excess male mortality.

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Improvements in womens health due to...

• Reduced fertility and better obstetric care.
• Changing position within patriarchal society.
• Education and involvement in paid employment.
• Reduction in socio-economic disadvantage.
• Improved health care.

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Excess male mortality

• Higher rates of survival among female babies
  compared with males.
• Higher male rates of coronary heart disease.
• Occupational hazards / bread winner role.
• Risk-taking behaviours.
• How men respond to symptoms of ill health
  (Cameron Bernardes 1998 OBrien et al 2005)
• the only time I have (gone) to hospital or seen
  a doctor...was when I had been punched in the
  face (and)...I needed stitches...or a relative
  tells you that youve got to go... even then Ive
  been reluctant to go, its other people...tells
  you youve got to go and get that seen to
• (male student, quoted in OBrien et al 2005 507)

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Evidence for a closing gap in male-female
mortality?

• Greater improvements in middle aged mens health.
• Decline in smoking among men increase among
  women.
• Legislation and car design to promote driving
  safety.
• Changing nature of male employment.
• BUT...
• Increasing male deaths from suicide and
  self-harm.
• Different patterns among different cohorts.
• Convergence, not reversal.

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Gender and morbidity

• Some differences in self-reported health but
  mainly for malaise rather than physical
  symptoms.
• Women visit GPs more often for mental disorders,
  osteoarthritis, migraine, obesity and anaemia.
• Men visit GPs more often for angina and heart
  problems.
• Do men and women suffer from different kinds of
  health problems?
• Do men and women respond differently to milder
  forms of ill health? (Davis 1981 Macintyre 1993)

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Summary Gender and health

• Good evidence for differences in patterns of
  illness between men and women.
• Explanatory mechanisms less clear, especially in
  relation to morbidity.
• Gender, socio-economic position and social roles
  often combine to make comparisons between sexes
  difficult.
• Problems measuring womens social class.
• Varied effects of paid employment and role
  combination on womens health.
• As patients, women encounter presumptions about
  their physical and psychological weakness.

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Ethnicity and healthSources of data

• Stand-alone reports (e.g. Engels 1845 Glasgow
  1992).
• Death certificates - migrants.
• Fourth National Survey of Ethnic Minorities
  (Nazroo 1997)
• Davey-Smith, G. et al (2000) Ethnic inequalities
  in health a review of UK epidemiological
  evidence, Critical Public Health, 10(4) 375-408.

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Migration and mental illness

• Admission rates to psychiatric hospitals higher
  among ethnic minority population as a whole but
  variations between groups.
• Highest rates of hospital admissions among Irish
  migrants followed by people born in Caribbean.
• Rate of mental illness among South Asian
  population lower than UK-born white population.
• Higher rates of mental illness for women than men
  in all groups except Caribbean-born.
• Higher admission rates for schizophrenia and
  paranoia among Caribbean-born men and women.

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Treatment by psychiatric services

• Independent Inquiry into death of David Bennett,
  1998 ? Census of inpatients, 31st March 2005
• 9 of in-patients were black or mixed black-white
  ethnicity (3 of national pop)
• black patients were 44 more likely to have been
  sectioned and 50 more likely to have been put in
  seclusion
• black Caribbean men were 29 more likely to have
  been subject to control and restraint.
• South Asian groups healthy migrants? Barriers
  to obtaining help? Expression of emotional
  distress through physical symptoms?

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Variations in health by ethnicity

• Problems classifying ethnicity- contested
  categories, inadequate categories, stereotypes of
  cultural behaviours.
• Dearth of good quality data for many groups.
• Younger age structure of most minority ethnic
  groups.
• Specificity of migration history and relationship
  with material disadvantage (accumulated and
  current).
• Disentangling ethnicity and social class.

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Variations in health by ethnicity (continued)

• Differences in genetic risk?
• Lifestyle / cultural factors.
• Access to and use of health services.
• Social exclusion and health.
• Ecological effects of community.
• Racism and health.
• Fragmented identities.

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Social patterns in health bysocial class, gender
ethnicity

• Good evidence for impact of social factors.
• Overlapping categories.
• Complexity of measuring social position and
  effects on health.
• Structure plus agency.