CHAPTER 5: SOCIAL INEQUITY, DISEASE AND DEATH IN CANADA
Introduction: social-structural positions and health
Inequity and health
ï Age and gender are important bases of inequality.
o W are more likely to be responsible for the domestic sphere of life, M are more
likely to be engaged in the public sphere (which is more valued).
o W report poorer health.
o When W work full-time in the paid labour force, they earn considerably less.
ï Gender gap in Canada today is 21% and has decreased substantially.
ï Black women earn 10% less than the average of all Canadian women.
ï Female single-parent families have the lowest average total income among families.
ï There are sex differences in the incidence and prognosis for numbers of diseases e.g.,
HIV/AIDS, TB, CVD etc.
o M tend to have shorter LE, while W tend to live longer lives and live them in the
context of chronic illnesses and disabilities.
ï Ethnicity and racialization are an important hierarchal and cultural component of
Canadian social structure.
o People of different ethnic groups can be ranked according to income.
o Can also be differentiated with regard to culturally based views & attitudes
o Visible minority groups are treated in a discriminatory manner in individual
interactions with health-care providers as well as in policy and medical system
Age, gender, and life expectancy
ï In Canada, there is an increase in the aging population (esp in W) and a decrease in
younger population ï trend expected to continue like this until at least 2036.
ï Population pyramid â most basic graphic method used to describe age distribution of a
ï Most important factor in population aging is the overall decline in birth rates.
ï Also due to the increase in LE due to: rapid decline in infant mortality rate.
o LE of W has increased more than that of M (diff greater in the last 25 yrs)
ï§ Due to improved nutrition and other public health measures for
o Different in LE between M and W is partly due to the changing sex-specific
incidence of certain diseases e.g., while rate of heart disease has declined for
both sexes, absolute decline has been faster among M than W.
ï§ Mortality rate decline for accidents has been larger.
ï Why then do M still live shorter lives?
o More M are conceived and yet more fetuses die thus W are genetically superior.
o However, sex-mortality differential canât be due to genetics alone because
genetic structures do not change that quickly.
ï§ Stereotyped machismo masculinities tend to put M at higher risk than
ï§ M are 3X more likely to die from car accidents and suicide.
ï§ M are 3X more likely to be murdered or die from wars.
o Most important contributions to higher M mortality can be argued to be related
to the following causes (all of which relate to the performance of masculinities): ï§ Higher rate of cigarette smoking among men.
ï§ M are more prevalent in the workforces of industries involving work
with carcinogenic substances
ï§ Higher alcohol consumption among M ï accidents and suicide
ï· M drive more than W and less safely.
ï· Liver diseases associated with alcohol consumption are more
than twice as common as causes of death among M.
ï§ Higher-fat diet among M
ï§ M proclivity to engage in violent, aggressive and high-risk activities
o W are more likely to attempt suicide, but because M tend to choose more
violent means, they are more likely to succeed.
Infancy and youth
ï Particularly susceptible to sickness and death, especially if theyâre poor, visible
minorities, single mother families, and experience other negative SDH.
ï Rates of childhood mortality, accidents, and sickness are correlated with social class.
ï Weight of newborn babies is a key predictor of their survival chances ï associated with
physical and mental disabilities and infant death.
o Rate has only declined slightly.
o Mothers younger than 20 or older than 35 are more likely to have low-birth-
ï§ Associated with a number of health outcomes including overweight and
obesity in later years ï diabetes, CVD.
ï§ Astociated with intellectual and cognitive delays ï impedes success
ï§ 1 three years of life are significant to subsequent health ï
development of brain and nervous system, lang acquisition etc.
ï Social status of women has consequences for the health of children.
o Investment in womenâs education has been shown to significantly reduce
mortality rates among children.
o Health and well-being of children was found to be linked to womenâs political,
economic, and social status.
o The health of adult M and W is better in states (in US) where W have higher
ï Young M tend to take more risks and to be more aggressive ad more stoic in the face of
pain and distress ï thus more likely to suffer various injuries associated with binge
drinking, and to take grater risks in regard to frequent and multi-partnered sexual
ï More likely to be hospitalized and be prescribed medication.
ï More likely to be given prescriptions inappropriately.
ï Some of the problems associated with pharmaceutical use among the elderly result
from the fact that the drugs have been tested on much younger people.
o Metabolic and other changes due to aging affect absorption rate of drug.
o Side effects from multi-drug use associated with simultaneous treatment of
several problems are particularly problematic among the elderly.
ï Falls are also a major cause of suffering and hospitalization.
ï Dementia is more common in W, and incidence is expected to increase. o Alzheimerâs is the most common type of dementia (# expected to triple)
ï Have more chronic conditions, more likely to be hospitalized and medicated, and they
are still more likely to self-report excellent or good health and health satisfaction.
o They see and evaluate themselves in relative terms in comparison with others of
the same age.
Gender and morbidity
ï Womenâs disability-free LE is 70.8 years compared to 68.3 years for men.
ï W are more likely to be ill ï incidence of illness is higher in W
ï W are twice as likely to be diagnosed with depression, anxiety and panic attacks, and
appear to be more sensitive to stress.
ï Most non-fatal chronic diseases are generally more prevalent in women.
ï M and W generally suffer from the same sorts of illnesses and disability, but M tend to
experience them more severely.
o Menâs illnesses also proceed more quickly to death.
ï Summary: W have more frequent illness and disability but the problems are typically not
serious ones. In contrast, M suffer more from life-threatening diseases and more
permanent disability, and earlier death from them.
ï Inaccurate morbidity rates are due to: M rates are underreported, stats minimize W
illnesses, preventative and early stage medical care is more freq in W because of visits
to the doctor for pregnancy, childbirth etc.
Gender, poverty, and mortality/morbidity
ï Females are more likely to be ill, die or be killed when they live in impoverished
ï Inequalities in the valuation of M and W in all classes, but particularly among the
poorest people, lead to a higher valuation of boy babies in many cultures.
ï Rape is more common among poor women.
Racialization, ethnicity, and minority status
ï Race â social and political construct that has been used to distinguish people based on
their physical characteristicsï Caucasians, mongoloids, and negroids.
ï Ethnicity - refers to a common cultural background â total way of life of a group of
ï Minority status â numerical distribution of different ethnic categories of people.
ï Racialized groups are more likely to be poor, homeless, and to experience discrimination
and barriers in access to health care.
o W and children in female-led households are more likely to be poor.
ï Poverty is especially endemic among immigrant and refugee groups from Africa, S. Asia,
and SE. Asia.
o Overrepresented in low-wage sectors of economy.
ï Visible minority populations are more likely to go to the general practitioner or medical
specialist, but less likely to be hospitalized or to engage in early detection measures e.g.,
test for prostate, cervical and breast cancer.
ï Cultural competence ï new emphasis in practices of HCPs to overcome behaviours e.g.,
unwillingness of visible minorities to engage in some health-related behavio