Gender and Health - April 20, 2005
Health – Sex and gender relationships affect health status and they interact with other factors – social class, race and ethnicity, age, sexual orientation – to shape not only health status, but also the physician-patient relationship and treatment by the health care system.
”Men and Women: Health and Illness” – Mary K. Zimmerman & Lisa Cox Hall
Medical knowledge, medical institutions, and the profession of medicine itself- as well as many other ways society responds to illnesses- are socially constructed, part of an ongoing process through which people create their culture.
It is widely recognized that health is heavily influenced by social factors such as poverty, violence, and mental distress. The most fundamental consequences are poverty and a lack of individual autonomy; in addition, women’s inequality brings a multitude of health-related ramifications, including the hazards connected with women’s paid and unpaid work, with the way societies respond to and control women’s sexuality, and fertility, and with violence and various forms of abuse directed specifically toward women. Women’s mental health is also lined to subordinated socials status and lack of self-determination.
Statistics:
Mortality:
Gender gap in life expectancy. In 1996 79.4 (females)vs. 74 (males). This is modified by race.
Heart disease is the leading cause of death and cancer the second leading cause for both women and men, together accounting for approximately 55 percent of all deaths for both sexes. In women, the third leading cause of death is stroke; in men it is homicide and legal intervention. Suicides and accident-related deaths are also several times higher in men than women.
Some changes in behavioral patterns between the sexes such as increased smoking among women have narrowed the gap between men’s formerly higher mortality rates from lung cancer, chronic obstructive pulmonary disease and ischemic heart disease.
Gender differences in morbidity – Women report higher rates than men of most acute (short-term) conditions, for example, respiratory conditions, infections, digestive system disorders, urinary tract problems, and headaches. Men report higher rates of wounds and lacerations, fractures and dislocations.
There is more similarity in men’s and women’s rates of chronic diseases. Among the notable gender differences in chronic diseases, women have higher rates of arthritis and migraine headaches.
Females are generally more likely than males to experience chronic conditions such as anemia, chronic enteritis and colitis, migraine headaches, arthritis, diabetes, and thyroid disease. However, males are more prone to develop chronic illnesses such as coronary heart disease, emphysema and gout. Although chronic conditions do not ordinarily cause death, they often limit activity or cause disability.
Women and AIDS According to the Centers for Disease Control and Prevention, the proportion of all AIDS cases reported among adolescent and adult women in the United States has more than tripled since 1986. AIDS is the fourth-leading cause of death among women in this country between the ages of 25 and 44, and is the leading cause of death among African American women ages 25 to 34. Black women represent about two-thirds of all new HIV infections among adult and adolescent females.
Factors that intersect with gender to influence morbity and mortality
Harrison – Traditional constructions of gender are hazardous to our health.
With regard to physical health, traditional masculinity appears to put men at greater risk for a variety of physical conditions, such as heart disease and stroke, various forms of cancer, and chronic liver disease. Their greater likelihood to smoke, drink alcohol, and engage in violence renders them more susceptible not only to these diseases, but also to accidents, homicide, successful suicide, and alcohol and illicit drug abuse. In fact, it seems that the more a man conforms to traditional masculinity, the greater is the risk to his health
Men sustain higher injury rates that are partly owed to gender difference socialization and lifestyle, such as learning to prove manhood through recklessness, involvement in contact sports, and working in risky blue-collar occupations. Traditional Femininity seems to be negatively related to health, particularly mental health:
Heart Disease – While employed women face the doubly stressful burden of job responsibilities couples with home and family care, they do not appear to more likely than full-time homemakers to develop coronary heart disease. In fact, some studies indicate that just the opposite may be the case. In general, women employed outside the home appear to be healthier than nonemployed women, even when employed women must fulfill multiple roles. “The employment role is the strongest correlate of good health for women.” (LaCroix and Haynes)
Some researchers have argued that far less is known about heart disease in women because, until quite recently studies of heart disease focused exclusively on male subjects. Cardiology is male-dominated in terms of both physicians and patients. Recent studies show that most physicians do not respond as quickly to female patients’ symptoms of heart disease as they do to male patients’ symptoms. – For example, high cholesterol monitoring, heart attack or congestive heart failure. In ED women with complaints about chest pains wait twice as long as men to see a doctor and twice as long for an EKG and they are 50% less likely to be given medications that inhibit further damage to the heart and other parts of the body following a heart attack.
Mental Health - Women who embrace the traditional feminine role are more prone to depression and other psychological problems.
Depression, histrionic personality, and agoraphobia. Higher rates in women than men. Race and ethnicity is a factor. Women of color and poor women who head households have the highest rates of depression of any group.
Other researchers have found that married women are more susceptible to depression than both never-married women and married men.
The frequency of mental illnesses also varies by gender. Women have been found to have higher rates of depression, anxiety disorders, and eating problems, whereas men have more problems with alcoholism and drug abuse and antisocial personality.
Males are more likely than females to commit suicide from middle childhood until old age. Compared to females, males typically deploy more violent means of attempting suicide (for example guns or hanging) and are more likely to complete the act. Suicide data show that men attempt suicide less often than women but are more likely to die than women. Elderly males in North America commit suicide significantly more often than elderly females. Whereas white women’s lethal suicide rate peaks at age 50, white men age 60 and older have the highest rate of lethal suicide, even surpassing the rate for young males.
Eating Disorders – women 90 to 95% of anorectics are women. 4 to 20% of college students are bulimic.
However, recently researchers are questioning whether is has gone unrecognized in women of color or gay men, etc.
Marital Status – related to life expectancy for men. This relationship did not hold for women; women were more negatively affected by low income than by lack of a spouse.
Most studies report that men rely almost totally on their spouses for social support. Women have wider social support networks than men. When a woman’s husband dies, she retains the social support of relatives and friends.
Behavioral and cultural factors that are contributors for men.
Cigarette smoking higher for men.
Type A personality (Coronary Prone Behavior Pattern) Characteristics of Type A individuals are more than twice as likely as laid-back Type B personalities to suffer heart attacks, regardless of whether or not they smoke. Characteristics of type A closely parallel those typical of traditional masculinity: competitive, inpatient, ambitious, aggressive, and unemotional.
Type D – strong, silent type. Also, a characteristic of traditional masculinity. The research indicates that Type D personalities have an increased risk of hear attacks and have poorer recovery rates following a heart attack.
Occupational Hazards– asbestos, exposure to toxic fumes, and chemicals. Men are more likely to experience toxic workplace exposures – another byproduct of occupational sex segregation.
Although men make up 54% of the labor force, they account for 93% of workers who die from job-related injuries.
Certain female-dominated jobs – micro-chip and electronic component assembly involve extensive exposure to toxic chemicals.
Historically women have been prohibited from employment in certain occupations (for example in battery production, type-setting in printing) in that there is concern that the work environment was potentially hazardous to the fetus.
Problems – Pregnancy Discrimination Act of 1981 forbids employment discrimination against women workers solely on the basis of pregnancy. This type of discrimination looked only at women’s reproductive health but not at men’s.
Most exclusionary policies were common in male-dominated industries but not in equally hazardous female-dominated occupations. Protective legislation has had two major effects: 1. Legitimation of employment discrimination against women and 2 neglect of the potential risks posed by workplace hazards to male workers' health, including their reproductive health. However, women's exclusion from the workplace does not necessarily protect women or children from exposure to toxins. Homes can be contaminated.
Major cause of work-related death for women is homicide. (30% of women who die on the job are murder victims)
These deaths are largely a result of women being concentrated in retail trade and food services, which showed increases in job-related homicides in recent years, most of which were associated with robberies or robbery attempts.
Drugs and Alcohol– chronic liver disease and cirrhosis of the liver are frequently caused by excessive alcohol consumption and related malnutrition. Men are more than four times more likely than women to drink heavily are. Contributes to higher accidental death rate.
Men have significantly higher rates of alcoholism and use of drugs. Problem drinking is also a problem in the gay community (both lesbians and gay men). Women suffer greater impairment than men who are heavy drinkers because they have less of an ability to digest alcohol. Female alcoholics have difficulty in getting the treatment that they need. They often lose their support system. For example, only one women in ten leaves her addicted male partner, whereas, nine out of ten men leave addicted female partners.
About half of all American women use psychotropic drugs; they are 70 percent of habitual tranquilizer uses and 72 percent of antidepressant drug users. Women are more likely than men to suffer cross-addictions.
Aggressiveness – higher suicide rate and their higher death rate due to homicide. Men are four times more likely than women to be murdered or to die from "legal interventions."
Fatal vehicular accident rate for women is 17.5 per 100,000 licensed drivers, compared with the male rate of 53.2 per 100,000 license drivers. Men are involved in nearly twice as many fatal car accidents in which the driver was intoxicated.
Don Sabo points out, ”There is no such thing as masculinity; there are only masculinities.” He looks at several masculinities: adolescent males, men of color, gay and bisexual men, prison inmates, and male athletes. There are substantial differences between health options for these groups and differences in how they act out their masculinity.
Adolescent males: He says that traditionally masculine attitudes are associated with being suspended from school, drinking and use of street drugs, frequency of being picked up by the police, being sexually active, the number of heterosexual partners in the last year and tricking or forcing someone to have sex. They behaviors elevate boys’ risk for sexually transmitted disease.
Males form a majority of the estimated 1.3 million teenagers who run away from home each year in the United States. For both boys and girls, living on the streets raises the risk of poor nutrition, homicide, alcoholism, drug abuse and AIDS. Homicide is the second leading cause of death among 15 to 19 year old males.
Men of Color. Generally, because African Americans, Hispanics, and Native Americans are disproportionately poor, they are more apt to work in low-paying and dangerous occupations, reside in polluted environments, be exposed to toxic substances, experience crime. To illustrate homicide is the leading cause of death among young African American males. More than 36% of urban African American males are drug and alcohol abusers. In 1993 the rate of contracting AIDS for African American males aged 13 and older was almost 5 times higher than the rate for white males.
42 percent of Native American male adolescent are problem drinkers.
Native American youth exhibit more serious problems in the areas of depression, suicide, anxiety, substance abuse, and general health status. The rates of morbidity, mortality from injury and contracting AIDs are also higher.
Gay and Bisexual Men. – Whether they are straight or gay, men tend to have more sexual contacts than women do, which heightens men’s risk for contracting sexually transmitted diseases. Traditional masculinity in gays acts as a barrier to safer sexual behavior among men (for example, refusal to wear a condom). Gays have high rates of alcoholism and suicide, as well. Again, these men do not operate in a vacuum.
Athletes – The powerful male athlete, a symbol of strength and health, has often sacrificed his health in pursuit of ideal masculinity (Messner and Sabo) – through the use of steroids, extreme dietary practices, over training, inflicting injury on others, playing while hurt.
Prison Inmates – 1.3 million men imprisoned in American jails and prisons (1993 statistic) High risk for AIDS infection, (202 per 100,00 to 14.65 in 100,000 in the general population) tuberculosis, and hepatitis. Inmates return to their communities after having served an average of 18 months inside. Within three years, 62.5 percent will be rearrested and jailed. They move in and out of the community and thus, present potential risk to the community.
Illness Rates as Social Constructions – the fact that women report more illnesses than men may reflect a myriad of social factors as well as actual instances of disease. The literature suggests that men and women respond to illness in different ways that may affect official illness statistics.
Are women really sicker than men? Much of our knowledge of illness rates is based on self-reported information or the report of a close relative. Most studies indicate that women report more symptoms more readily than men do.
A second source for disease rates is information reported by physicians. Diagnostic decisions too are filtered through perceptions, both the awareness of patients and their ability to articulate, and the interpretive orientation and reporting accuracy of physicians.
A third source for disease rates is hospital discharge data. Zimmerman and Hill did an analysis – when deliveries were excluded, American men had more short-stay hospital days than women did at all ages.
Do men and women perceive their own health differently?
It is commonly health that women are taught to monitor their health and the health of others. There is evidence that men are raised to be more stoic than women and are encouraged more than women to ignore or endure physical pain and discomfort. …. In self-ratings of health, women report slightly poorer health than men, but the difference disappears in those over age 65.
Do others perceive the health of women differently from the health of men? If men and women view their own health differently, then it has been hypothesized that they also view each other differently in terms of health.
Women are more easily placed in the “sick” role, meaning that they are relieved from their normal responsibilities and expected to take action to get well. This also seems to support the stereotypic idea that women are the “weaker” sex. Women, by contrast, have sometimes accused doctors of not taking their complaints seriously enough.
Closely related to the gendered perceptions of others it’s the question of whether physicians’ perceptions of male and female patients are gender biased. In other words, are patients with similar conditions perceived and treated differently?
Some studies on response time to cardiac symptoms seem to reflect the gendered or raced perceptions of others.
Is the response of women to their symptoms different from the response of men? Studies of reported symptoms and self-ratings of health suggest that women perceive more health problems than men and demonstrate greater willingness to acknowledge them to other. Studies show that women use health-care services more frequently than men, suggesting that no only do they perceive more need, but that they seek health care as a result.
Do men and women differ in their willingness to visit a physician?
Women make more physician visits than men. It may be that women have more actual illness and require more visits, or it may be that men are just as sick, or even more frequently sick, but are failing to visit physicians in accordance with their true levels of illness. Women are thought to enter the sick role more easily compared to men. They also appear to be more able to perceive and report symptoms.
There is at least some reason to believe that rates of acute illness in men may, in fact, be higher than are reported and that women’s rates in some disease categories may be inflated because of gender bias in medical diagnoses.
Do women and men have different patterns in following medical treatment? – studies unclear
Medicine and the Construction of Illness
Recent studies in medicine have repeatedly documented that women are treated less aggressively in cases of coronary heat disease, the leading cause of death for both men and women – for example being less likely to be referred for catheterization or bypass surgery. A similar trend has been observed for blacks compared to whites, with the result that black women seem to be at a particular disadvantage in terms of receiving high-tech cardiac care (1999)
Medicalization – the way nonmedical problems become defined and treated as medical ones, usually in terms of illnesses or disorder. For women, many non-medical issues have become medicalized:
Life difficulties and unhappiness – examples: Examples – childbirth, premenstrual syndrome, co-dependency, weight control, beauty,
Reproductive Processes – examples – childbirth, menopause,
Domestic responsibilities – Child development, parenting,
Accordingly women are more likely to be labeled with psychiatric disorders than are men and they are more likely to be prescribe psychotropic drugs, hormones, etc.
Medicalization can also be seen as a merging of capitalism and medicine, i.e., there has been an expansion of medical definitions which allows for an expansion of markets.
Medicine as an Institution of Gender Control – Dominance of the biomedical model of disease as an example of how the cultural authority of medicine shapes people’s lives and identities. It supports the gender stratification that permeates all of contemporary society.
When women take medications or have surgical procedures in the pursuit of their appearance, it raises the question of whether or not these uses of medical services are properly viewed as part of women’s health care.
Patriarchal Hierarchy of Health Care Work
Poor women and men and women/men of color have been used for research.
Sterilization has been directed to the poor and to women of color. As recently as 1972, 100,000 to 200,00 sterilizations took place under the auspices of federal programs.
People of color, gay men and lesbians, and the poor, both historically and currently.
Tuskeggee Study of Untreated Syphilis in the Negro Male 1932-1972, more than 400 Black men diagnosed with syphilis were denied treatment for the disease so that researchers from the U.S. Public Health Service could observe the disease’s effects on Black men over the course of their lifetimes
Many researchers argue that far less is known about heart disease in women than men- For example, syndrome X which seems to be evident in women (insulin resistance) is difficult to identify and is overlooked. When we look at race, we see that there are significant differences in how people are treated. For example, black patient who had had a heart attack were 60 percent less likely than white heat attack patients to undergo a potentially life-saving procedure called cardiac catheterization.
“Gender Hierarchies in the Health Professions” Judith Lorber , Renzetti and Curran
Increasing number of women providing health care, but as in many other occupations, the fields women enter in significant numbers become gender stratified.
There are differences in the careers of women and men physicians – where they work, their specialties, and their professional power.
Numbers of women increasing – 41.6% of physicians are women. The reason for the rise in women doctors is the changing structure of medical practice. As Medicine has become more regulated and paid for by governments and the expanding insurance industry. As doctors’ authority has been diluted and their income decreased, fewer white men have applied to medical school, leaving an occupation niche for women and nonwhite men, similar to what has happened in other desegregating occupations.
Different specialists are considered appropriate for women and for men. Women medical students are encouraged to go into pediatrics and family medical or into one of today’s growing fields for women – obstetrics and gynecology, ophthalmology and dermatology. The women’s specialties are less prestigious and have a lower income than the men’s specialties. Even in the same specialty, however; women’s pay tends to be less because they are more likely to work in managed care and in clinics and because they may have to cut back on their work time if they have small children at home.
Nursing is considered a woman’s profession.
Men nurses are encouraged by their mentors to move into positions of authority. For them not to move up to supervisory and administrative positions is considered inappropriate for a man. As a result, they are on a “glass escalator,” upwardly mobile whether they are ambitious or not. But they face a glass ceiling at the highest levels. Women heads of nursing care too visible for them to re replaced by men.
Dentistry in the United States is still a man’s profession, unlike in many European countries, where it is considered women’s work. Women are 12.5% of all dentists. Despite their similarities, there are substantial gender differences in income. A comparison of women and men dentists in full-time general practice showed that men earn about $26,000 more per year than women dentists.
Pharmacists - more than half are women – gender segregated by the settings of the practice – women pharmacists mainly work in as salaried employees in hospitals or in chain stores; men are owners or managers of drugstores.
Have women doctors transformed medicine? Women are not in positions of power, and until they are, they are not likely to make deep-seated changes in medical practice. When they teach in medical schools, they are not promoted at the same rate as men faculty, nor are they sponsored for becoming chiefs of departments or directors of hospitals and research centers. As a result, men still dominate positions of authority and the production of medical knowledge. Women are less likely than men to have high-level administrative positions or to be professors and deans of medical schools. The persistence of the glass ceiling means that women do not attain the more prestigious and powerful positions in the system.
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