Sex and gender in health and health care

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Sex and gender in health and health care

• Lesley Doyal

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Introduction

• Gender receiving increasing attention in
  health/medical field but what does it mean?
• Is it just an updated term for sex?
• Much confusion with two terms often used
  interchangeably
• Often discussed in context of equity but also
  central to effectiveness and to good science
• Not just about women but about men too

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Key issues for today

• defining sex and gender
• sex and gender as determinants of health
• impact of sex and gender on health care

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Defining sex and gender

• Sex differences between women and men biological
  and unchangeable
• Gender differences socially constructed and vary
  over space and time
• Sex and gender differences are interlinked and
  constantly influence each other
• Both major factors shaping morbidity and
  mortality of women and men
• http//www.genderandhealth.ca/en/modules/introduct
  ion/introduction-whatsthedifference-Shayna.jsp?

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• Reproduced from MRC Policy brief No. 1, March
  2003. Initial estimates from the South African
  National Burden of Disease study, 2000. Bradshaw
  D et al.

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Womens Health
Reproduced fromDraft MRC document on causes of
death and premature mortality in Cape Town,
2001-2004, Bradshaw D et al.
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Mens Health
Reproduced from Draft MRC document on causes of
death and premature mortality in Cape Town,
2001-2004, Bradshaw D et al.
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Biology , sex and health

• Biological differences usual starting point for
  biomedical understanding of being male and
  being female
• Reproductive potential key to womens survival
  and wellbeing
• Differences in reproductive organs mean some
  health problems specific to women or men (eg ca
  cervix and prostate)
• But other biological differences between sexes
  receiving increasing attention

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Beyond reproductive biology

• Range of genetic, hormonal and metabolic
  differences affect male and female patterns of
  morbidity and mortality
• Eg men more susceptible than women to range of
  infectious diseases
• And women more likely than men to develop
  auto-immune problems
• Men as a group develop heart disease earlier
  than women
• So biology is important

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But gender also important what do we mean by
gender?

• all societies divided by gender
• reflected in duties and entitlements allocated to
  individuals
• not just differences but inequalities that take
  different forms according to time and place

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Gender inequality global problem
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How does gender influence health of women and
men?

• affects exposure to health risks and
  vulnerability to physical and mental disorders
• influences access to resources (including income,
  power and time) for promoting health
• influences perception of symptoms and health
  seeking behaviour
• impacts on access to care and quality of care
  received

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Gender influences on health of poor women global
perspective

• double burden
• lack of access to education
• poverty and lack of entitlement
• lack of power/status in relationships at
  household

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Double burden

• Central to fault line of gender that women
  responsible for domestic labour
• Can lead to double burden of work that
  increases vulnerability to a range of health
  problems
• Variety of health hazards associated with
  domestic work
• Low status of work combined with lack of autonomy
  can contribute to mental health problems

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Gender and education

• Major improvements in female enrolment in schools
  but girls still less likely to attend than boys
  and more likely to drop out
• Of the 150 million children not in school over 90
  million are girls and 2/3 of worlds illiterates
  are women
• Lack of education increases female poverty and
  economic dependency and heightens risk of range
  of health problems including HIV infection

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Poverty and gender

• Women more likely than men to be poor because of
  cultural beliefs and also structural
  discrimination
• Lower wages and lack of access to many social
  benefits
• More likely than men to be in single headed
  households (at all ages)

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Impact of poverty on womens health intersections

• Clear links in community studies between gender,
  poverty and depression
• Gendered poverty major factor in feminisation
  of AIDS pandemic
• Food insecurity especially serious for women and
  often reinforced by gender bias in allocation of
  household resources
• Poverty makes it especially difficult for women
  to get health care in reproductive years and old
  age

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Gender bias can damage poor womens health at all
ages
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Gendered risks to health of poor women in South
African context

• Rural Black women are poorest group in population
  
• Highest rate of unemployment found among African
  women ( 2005 37)
• Depression/anxiety almost twice as common in
  women as in men
• HIV also more common among women especially in
  younger age groups (2005 20-24 age group 23.9
  females and 6.0 males)
• Incidence of gender based violence very high and
  linked to low status of women especially in
  economically stressed communities
• for excellent discussion of connections
  between these different factors see
  http//www.hst.org.za/uploads/files/chap21_06.pdf

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question

• What do you think are the advantages of female
  gender for the health of women?
• And what about gender and men? Is maleness an
  advantage or a disadvantage?

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Key health hazards of male gender

• dangers associated with waged work
• masculinities and risk taking behaviour
  (especially motor vehicle injuries)
• participation in required violence
• maleness and emotional health

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Gender paradox?

• Women live longer than men in most countries of
  the world (WHY?)
• But women in many communities also tend to report
  more sickness and distress than men do (WHY?)

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Gender differences in life expectancy at birth in
selected countries 1992 (UN Data)
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Gender and health care women

• evidence that much of womens need for
  reproductive health care still unmet
• Eg 120 million couples' without contraception45
  million terminations each year of which 19
  million unsafe
• gendered obstacles to access
• male bias in medical research
• women often receive less respect and poorer
  quality of care

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Gender and health care men

• fewer practical obstacles than women because less
  care of dependents
• but does work interfere?
• often reluctant to admit weakness
• difficult to reconcile masculinity with illness?

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Sex/gender/ health and diversity conclusion

• Biological sex and social gender both major
  determinants of health
• Interact in influencing morbidity and mortality
  of women and men
• Do this in a variety of ways shaped by specific
  economic, social and geographical contexts
• Need to be included in research designs , service
  planning and individual medical encounters.

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Remember.
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A small exercise to endchoose your own health
problem