Sex and gender in Sex and gender in health and health health and health

carecare

Lesley DoyalLesley Doyal

IntroductionIntroduction

► ‘‘Gender’ receiving increasing attention in Gender’ receiving increasing attention in health/medical field but what does it health/medical field but what does it mean?mean?

► Is it just an updated term for sex?Is it just an updated term for sex?►Much confusion with two terms often used Much confusion with two terms often used

interchangeablyinterchangeably►Often discussed in context of equity but Often discussed in context of equity but

also central to effectiveness and to ‘good also central to effectiveness and to ‘good science’ science’

►Not just about women but about men tooNot just about women but about men too

Key issues for todayKey issues for today

►defining sex and genderdefining sex and gender

►sex and gender as determinants of sex and gender as determinants of

healthhealth

► impact of sex and gender on health impact of sex and gender on health

carecare

Defining sex and gender Defining sex and gender

► Sex differences between women and men Sex differences between women and men biological and unchangeable biological and unchangeable

► Gender differences socially constructed and Gender differences socially constructed and vary over space and timevary over space and time

► Sex and gender differences are interlinked Sex and gender differences are interlinked and constantly influence each otherand constantly influence each other

► Both major factors shaping morbidity and Both major factors shaping morbidity and mortality of women and menmortality of women and men

► http://www.genderandhealth.ca/en/modules/introduction/introduction-whatsthedifference-Shayna.jsp?

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.

Reproduced from:Draft MRC document on causes of death and premature mortality in Cape Town, 2001-2004, Bradshaw D et al.

Women’s Health

Females 15+ years

Inf and para3%

Resp infections3%

Maternal0%

TB9%

HIV26%

Breast Ca3%

Lung Ca3%

Cervix Ca1%

Other CA7%

Diabetes7%

IHD4%

Stroke5%

Hypertension4%

Other CVD4%

Other non communicable10%

Unintentional 6%

Intentional5%

Reproduced from: Draft MRC document on causes of death and premature mortality in Cape Town, 2001-2004, Bradshaw D et al.

Men’s Health

Males 15+ years

Inf and para2%

Resp infections2%

TB10%

HIV13%

Lung Ca3%

Oesophagus Ca1%

Stomach Ca1%

Prostate Ca1%

Other Ca5%

Diabetes3%

IHD4%

Stroke4%

Hypertension2%

Other CVD3%

COPD3%

Other non communicable7%

Road traffic8%

Other unint7%

Homicide22%

Biology , sex and healthBiology , sex and health

► Biological differences usual starting point Biological differences usual starting point for biomedical understanding of ‘being for biomedical understanding of ‘being male’ and ‘being female’ male’ and ‘being female’

► Reproductive potential key to women’s Reproductive potential key to women’s survival and wellbeing survival and wellbeing

► Differences in reproductive organs mean Differences in reproductive organs mean some health problems specific to women some health problems specific to women or men (eg ca cervix and prostate)or men (eg ca cervix and prostate)

► But other biological differences between But other biological differences between sexes receiving increasing attention sexes receiving increasing attention

Beyond reproductive biologyBeyond reproductive biology

► Range of genetic, hormonal and metabolic Range of genetic, hormonal and metabolic differences affect male and female patterns differences affect male and female patterns of morbidity and mortalityof morbidity and mortality

► Eg men more susceptible than women to Eg men more susceptible than women to range of infectious diseases range of infectious diseases

► And women more likely than men to develop And women more likely than men to develop auto-immune problemsauto-immune problems

► Men as a group develop heart disease Men as a group develop heart disease earlier than women earlier than women

► So biology is important…………So biology is important…………

But gender also important : But gender also important : what do we mean by gender?what do we mean by gender?

►all societies divided by gender all societies divided by gender

►reflected in duties and entitlements reflected in duties and entitlements allocated to individuals allocated to individuals

►not just differences but inequalities not just differences but inequalities

that take different forms according to that take different forms according to time and placetime and place

Gender inequality global Gender inequality global problemproblem

How does gender influence How does gender influence health of women and men?health of women and men?

► affects exposure to health risks and affects exposure to health risks and vulnerability to physical and mental disordersvulnerability to physical and mental disorders

► influences access to resources (including influences access to resources (including income, power and time) for promoting healthincome, power and time) for promoting health

► influences perception of symptoms and health influences perception of symptoms and health seeking behaviour seeking behaviour

► impacts on access to care and quality of care impacts on access to care and quality of care receivedreceived

Gender influences on health Gender influences on health of poor women: global of poor women: global

perspective perspective

►double burdendouble burden► lack of access to education lack of access to education ►poverty and lack of entitlementpoverty and lack of entitlement► lack of power/status in relationships at lack of power/status in relationships at

household household

Double burdenDouble burden

► Central to ‘fault line’ of gender that women Central to ‘fault line’ of gender that women responsible for domestic labourresponsible for domestic labour

► Can lead to ‘double burden ‘ of work that Can lead to ‘double burden ‘ of work that increases vulnerability to a range of health increases vulnerability to a range of health problemsproblems

► Variety of health hazards associated with Variety of health hazards associated with domestic work domestic work

► Low status of work combined with lack of Low status of work combined with lack of autonomy can contribute to mental health autonomy can contribute to mental health problems problems

Gender and education Gender and education

► Major improvements in female enrolment in Major improvements in female enrolment in schools but girls still less likely to attend than schools but girls still less likely to attend than boys and more likely to drop outboys and more likely to drop out

► Of the 150 million children not in school over 90 Of the 150 million children not in school over 90 million are girls and 2/3 of world’s illiterates are million are girls and 2/3 of world’s illiterates are women women

► Lack of education increases female poverty and Lack of education increases female poverty and economic dependency and heightens risk of economic dependency and heightens risk of range of health problems including HIV infection range of health problems including HIV infection

Poverty and gender Poverty and gender

►Women more likely than men to be Women more likely than men to be poor because of cultural beliefs and poor because of cultural beliefs and also structural discriminationalso structural discrimination

►Lower wages and lack of access to Lower wages and lack of access to many social benefitsmany social benefits

►More likely than men to be in single More likely than men to be in single headed households (at all ages)headed households (at all ages)

Impact of poverty on women’s Impact of poverty on women’s health: intersectionshealth: intersections

► Clear links in community studies between Clear links in community studies between gender, poverty and depression gender, poverty and depression

► Gendered poverty major factor in Gendered poverty major factor in ‘feminisation’ of AIDS pandemic‘feminisation’ of AIDS pandemic

► Food insecurity especially serious for women Food insecurity especially serious for women and often reinforced by gender bias in and often reinforced by gender bias in allocation of household resourcesallocation of household resources

► Poverty makes it especially difficult for Poverty makes it especially difficult for women to get health care in reproductive women to get health care in reproductive years and old ageyears and old age

Gender bias can damage poor Gender bias can damage poor women’s health at all ageswomen’s health at all ages

Gendered risks to health of poor Gendered risks to health of poor women in South African contextwomen in South African context

► Rural Black women are poorest group in population Rural Black women are poorest group in population ► Highest rate of unemployment found among African Highest rate of unemployment found among African

women ( 2005: 37%)women ( 2005: 37%)► Depression/anxiety almost twice as common in Depression/anxiety almost twice as common in

women as in men women as in men ► HIV also more common among women especially in HIV also more common among women especially in

younger age groups (2005: 20-24 age group 23.9% younger age groups (2005: 20-24 age group 23.9% females and 6.0% males)females and 6.0% males)

► Incidence of gender based violence very high and Incidence of gender based violence very high and linked to low status of women especially in linked to low status of women especially in economically stressed communities economically stressed communities

for excellent discussion of connections between these different factors for excellent discussion of connections between these different factors see see http://www.hst.org.za/uploads/files/chap21_06.pdf

►

questionquestion

►What do you think are the advantages What do you think are the advantages of female gender for the health of of female gender for the health of women?women?

►And what about gender and men? Is And what about gender and men? Is ‘maleness’ an advantage or a ‘maleness’ an advantage or a disadvantage?disadvantage?

Key health hazards of male Key health hazards of male gender gender

►dangers associated with waged work dangers associated with waged work ►masculinities and risk taking masculinities and risk taking

behaviour (especially motor vehicle behaviour (especially motor vehicle injuries)injuries)

►participation in ‘required’ violenceparticipation in ‘required’ violence►maleness and emotional healthmaleness and emotional health

Gender paradox? Gender paradox?

►Women live longer than men in most Women live longer than men in most countries of the world (WHY?) countries of the world (WHY?)

►But women in many communities also But women in many communities also tend to report more sickness and tend to report more sickness and distress than men do (WHY?)distress than men do (WHY?)

Gender differences in life Gender differences in life expectancy at birth in selected expectancy at birth in selected

countries 1992 (UN Data) countries 1992 (UN Data)

Gender and health care: Gender and health care: womenwomen

►evidence that much of women’s need evidence that much of women’s need for reproductive health care still unmetfor reproductive health care still unmet

►Eg 120 million ‘couples' without Eg 120 million ‘couples' without contraception:45 million terminations contraception:45 million terminations each year of which 19 million ‘unsafe’each year of which 19 million ‘unsafe’

►gendered obstacles to access gendered obstacles to access ►male bias in medical researchmale bias in medical research►women often receive less respect and women often receive less respect and

poorer quality of carepoorer quality of care

Gender and health care: menGender and health care: men

►fewer practical obstacles than women fewer practical obstacles than women because less care of dependents because less care of dependents

►but does work interfere?but does work interfere?►often reluctant to admit weaknessoften reluctant to admit weakness►difficult to reconcile masculinity with difficult to reconcile masculinity with

illness?illness?

Sex/gender/ health and Sex/gender/ health and diversity: conclusion diversity: conclusion

► Biological sex and social gender both major Biological sex and social gender both major determinants of health determinants of health

► Interact in influencing morbidity and Interact in influencing morbidity and mortality of women and menmortality of women and men

► Do this in a variety of ways shaped by Do this in a variety of ways shaped by specific economic, social and geographical specific economic, social and geographical contexts contexts

► Need to be included in research designs , Need to be included in research designs , service planning and individual medical service planning and individual medical encounters. encounters.

Remember….Remember….

A small exercise to end…choose A small exercise to end…choose your own health problemyour own health problem