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University of Toronto Scarborough
Health Studies
Rhan- Ju Song

HLTC05: Social Determinants of Health Lecture 10 –Gendered Health Disparity (Baer et al. 2003b; Spitzer 2005, and WHO 2008, Chapter 13) Tuesday, November 13, 2012  Gender is a social determinant of health Biological Differences  between men and women can play a role in health outcome  Area that requires more research  Variation in growth and development  Variation in nutritional requirements  Different reproductive changes / health conditions  Maternal requirements as child-bearers: nutrition, health, etc.  Differences with aging (hormonal, menopause, etc.), e.g., later adult bone mineral density (biology & social factors)  Sex differences in treatment success, morbidity (severity, progression, symptom manifestation) and mortality risk Image 1  Major causes of death for US males and females in 2008  Women have higher rate of cardiovascular disease than men  Indicates cardiovascular disease plus congenital cardiovascular disease o Cancer, accidents, chronic respiratory disease, diabetes mettitus, Alzheimer’s disease Image 2  Women mount a stronger inflammatory response than men following infection by the flu Image 3  Women as shore of people living with HIV/AIDS by region 2008  Globally, it’s 50 %  Social conditions discuss why women have higher rates of HIV/AIDS; shows overrepresentation of their gender in this disease Gendered as a Social Determinant of Health  Is interlinked with biological and other social determinants (access to social and economic capital, geopolitical environment, cultural values, racism, ageism) (Spitzer 2005)  Relationship b/w health outcomes and social hierarchy (wealth-health gradient) is more linear in predicting men’s health, while association to women’s health is more complex (Matthews et al. 1999)  “Relationship b/w gender inequities and health is seldom static and intersects with factors such as ethnicity, sexuality, age and disability in dynamic and complex ways” (Spitzer 2005: S78) - gender roles are historically contingent, and the roles and relations can change throughout one’s lifetime and can influence access to health resources o Gender roles changed over time o History of society’s social organization over time  Patriarchy: a social system in which males are the primary authority figure in social organization; power is held by adult men; fathers hold authority over women, children, and all property  It entails female subordination: being in a lower position or social status, with less power and rights  Many patriarchal societies are also patrilineal: property and title are inherited by males only o Huge impact on women whether they can inherit things  Patriarchy is manifest in the social, legal, political, and economic organization of many different cultures o Embedded in all aspects of life Gender Paradox  discrepancy between life expectancy  Females will, on average, live longer than males (by approx. 5 yrs), but females more likely to experience those years as unhealthy ones (Spitzer 2005) o Their life is long, but quality of life is not good as men o They live longer based on their behavioural aspects (men take more risks than women)  11% women vs. 4% men suffer from chronic conditions  Diagnosed more often with conditions like MS, lupus, migraines, hypothyroidism and chronic pain (Spitzer 2005)  Life expectancy disparity is mostly due to higher rates of accidents and injuries leading to excess mortality among men (masculinity, risk-taking, valour) Cultural Factors in Female Health  Unequal access to resources  Less social capital and opportunities, incl. political  Restricted education (64% global illiterate are ♀)  Lack of decision-making power over one’s destiny, property (control of assets) and health care  State regulation of reproduction, population control  Lack of reproductive rights (contraception)  Violence (physical/sexual/emotional, partner/stranger)  Inadequate support resources (state funding is cut)  Restricted activity/differential access to spaces  Child marriage and early pregnancy (higher rates of maternal death)  Sex trade and slavery (trafficking)  Cultural practices re: female genital mutilation (result in great morbidity, loss of fertility)  Discriminatory feeding patterns (cross-cultural, prioritize valued foods for men and boy-children rather than girl children/women; women lack nutrients in later life)  Selective abortion and infanticide (emphasize on having male children; support family, have rights over property, higher proportion of male than women) Reproduction and Inequality women only involved in having children and taking care of them  Female subordination is not a universal circumstance o Not always had women with less access to resources or lower-status positions  Female autonomy in non-State vs. State societies (Baer et al. 2003b)  With social stratification & inequality  reproduction and the health of women’s bodies has increasingly become state controlled (birth control, abortion) o Lead to less access to women with less control of their own bodies o Lack of autonomy for women o Reproduction out of women’s control  “Medicalization of childbirth” (Baer et al. 2003b) o More unequal childbirth o Natural process involved female relative helping to give birth to a child at home o Modern childbirth involves male doctors and nurses all in one room with masks on and ready to deliver the child Female Responsibilities  In most cultures, female roles generally entail responsibility for disproportionate amount of unpaid domestic labour, cultural transmission and socialization of children (besides having children), and kinship obligations (attending to familial social relations) o Double burden/shift  domestic and market-labour responsibilities o Pressure to have a job or a career to bring in money o Women have a harder role with balancing both burdens that they must be responsible for  Leads to more stress, worse health conditions than men  In addition, in many cultures, women are also responsible for subsistence production and/or aspects of the labour market  DOUBLE BURDEN OF UNPAID DOMESTIC AND LABOUR MARKET RESPONSIBILITIES  Women, cross-culturally, are considered the most appropriate caregiver for children, the sick and the elderly, including their role in visiting health centres (taking time off, travel) to get drugs, equipment, services o They give up their own health to take care of other people such as their children, parents, etc.  Health Consequences: (see Spitzer 2005) o Demanding social ties: a strong predictor of stress-related conditions  e.g., depression, coronary heart disease o Greater risk of backaches, insomnia, arthritis with caregiving (women also do more hours of it) – and women often forgo their own health to provide care Household Hazards  Women and girls more likely to spend more time at home, where may be more exposed to hazards such as household cleansers, chemicals, house fires, poor housing (toxic pollutants, e.g., lead paint, dust)  Low income households disproportionately located in industrial areas (pollutants, trace metals, etc.)  Outside home, women exposed to environmental hazards in female-dominated workplaces such as electronic plants, fireworks and brick factories, agriculture, floral industries and laundry operations (Gopalan and Saksena 1999)  Note: greater absorption of toxic chemicals in females (see Spitzer 2005) (cadmium, lead) Feminization of Poverty key factor of health inequality between genders**  Globally, females are at greater risk for poverty than males o Social conditions lead women to be in poverty rather than the biological differences  Marginalization, issue of economic disadvantage and gender are closely related** Image 4/5  Women and poverty statistics  Feminization of poverty is a global problem  Poverty rate for US women grew from 13.9 percent in 2009 to 14.5 percent in 2010; even higher for women of colour: 1 in 4 black and Latina women lived in poverty in 2010 (National Women’s Law Center)  o Much greater poverty in women Image 6  Differences tied to race/ethnicity  This stats is not reflecting innate biological issues  Just that these groups are more impoverished than the other groups Poverty among Women in Canada  On average, 9% of Canada’s population are poor  However, some groups are much more likely to be poor than others: o Aboriginal women (First Nations, Métis, Inuit)—36% o Visible minority women—35% o Women with disabilities—26% o Single parent mothers—21% (7% of single parent fathers are poor) o Single senior women—14% Image 7  Bar graph shows that ethnicity plays a role in poverty (within the UK)  Age standardised “limiting long-term illness” by ethnic group and sex  Overall, female in each ethnicity group more likely to have illness and poverty Interaction of Gender and Ethnicity  Aboriginal women are at higher risk for getting diabetes: o 2-3 x more than other (non-Aboriginal) Canadians and twice the rate of Aboriginal men (see Spitzer 2005) HIV-AIDS and Aboriginal Women in Canada  Canadian First Nations with HIV have risen from 57,000 in 2005 to 65,000 in 2008 (a 14% increase)  First Nations with HIV are over-represented in Canada: comprised 12.5% of all new infections in 2008 (pop. % < 4%) Women: IDU, heterosexual sex  Ultimate factors?  Historical factors? Aboriginal Canadian Women vs. non-Aboriginal Canadian Women  50% of newly diagnosed HIV cases among Aboriginal people vs. 20% of newly diagnosed non-Aboriginal HIV cases (Health
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