Gender, Age and Health

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Gender, Age and Health

• Steve Brindle

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Inequalities and Health

• Last week we addressed socio-economic and ethnic
  inequalities and health.
• This week we look at differences between men and
  women, and different age groups.

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Aims and Objectives

• To look at the various trends in health and
  illness as related to gender and age (focusing
  mainly on the UK).
• To unpack the causes of these trends by
  considering the various biological, social and
  behavioral explanatory factors.

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Sex or gender

• Sex - a biological given.
• Gender - socially acquired, and includes social,
  psychological, and cultural characteristics.

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Sex

• Hormonal difference
• Childbirth
• Performance in sport (??)
• Different brains? For example women are better
  readers around the world, but sex differences
  vary markedly across countries.

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Sex, fitness sport injuries

• Study of US Army recruits female Army recruits
  were less fit than men--lower aerobic capacity
  lower endurance, higher BMI, and less muscular
  strength.
• Women 2 ½ times more likely to suffer a serious
  injury.
• But within each fitness group, women were no more
  likely to get hurt than men. Matching men and
  women by fitness level, gender did not predict
  injury-risk.
• Am J Prev Med 2000, 18(3) Suppl. 1 141-46

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Gender

• What factor help us
• define gender?

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Gender and health

• Men are more likely to die whilst women are more
  likely to be ill at any one time
• Life expectancy of women in the developed world
  is roughly 6.5 years longer than men (United
  Nations, 1991)
• This is true in most places apart from some areas
  in South Asia (in particular Bangladesh, Bhutan,
  Nepal and the Maldives) where men outlive women

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Gender and Health

• Women constitute the majority of NHS patients
  including GPs, psychiatric, geriatric and most
  preventative services.
• Women consult GPs more often than men do, not
  only for themselves but also for their children
  and elderly relatives for whom they are carers
• Pregnancy

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Gender and Health

• Approximately two-thirds of disabled population
  of 4 million in the UK are women.
• A large proportion of that inequality is due to
  age difference (i.e. women live longer, and old
  people are more likely to fall ill).
• 12-17 of women suffer depression compared to 7
  of men

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Gender and Health

• Women appear to have higher levels of morbidity,
  but the illnesses are less likely to be fatal

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Gender and Health

• Why are women sicker than men. Three explanations
• Biological
• Artefact
• Social Causation

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Gender and Health

• Biological
• - Greater resistance to killer diseases (e.g.
  heart disease due to hormones)

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Gender and Health

• Artefact
• Women viewed by some as closer to nature, and
  consequently women are considered more in tune
  with (and at the mercy of) their bodies.
• Evidence suggests that what men and women mean by
  health is patterned by gender. Men functional
  women holistic.
• Women more likely to report illness, go to the
  doctors, therefore health statistics not a true
  reflection of morbidity rates

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Gender and Health

• Social causation
• Women more likely to be in a position of poverty,
  so more likely to be ill
• Pressure of living in a patriarchal, or male
  dominated society, might result in more illness
• Womens roles give less control and are not
  valued by society (Popay and Bartley (1989))

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Mental illness- differences between men and women.

• Women are disproportionate users of mental health
  services. There is a greater degree in minor
  than in serious mental illness. No real
  biological explanations?
• However

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Mental illness- differences between men and women.

• Social causation explanations
• Mental illness as a gendered social product
  oppression of living in a male dominated society
  makes women more susceptible to mental illness.
• 2. Mental illness as a gendered social
  construct mental illness is a label applied by
  medicine which does not necessarily reflect any
  kind of biological reality. i.e., Women are more
  likely to be labelled mentally ill.

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Mental illness- differences between men and women.

• However, a considerable amount of illness is
  never reported, and significantly here, mental
  illness amongst the male population may be less
  likely to be reported to official channels.

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Gender and Death

• Why do men at all ages have a higher risk of
  death than women?
• Biological
• Social Causation

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Gender and Death

• Biological
• Males have greater susceptibility to fatal
  diseases (e.g. heart disease)

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Gender and Death

• Social Causation
• Women in most Western societies (including the
  U.K) have traditionally engaged in fewer risky
  behaviours (though this may be changing).

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Gender and Smoking Prevalence adult cigarette
smoking, GB
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Smoking, Gender and Class
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Smoking, Gender and Ethnicity

• While smoking rates for men and women in the UK
  on the whole are converging, amongst minority
  ethnic groups there are still marked gender
  differences in smoking, e.g rates are low in
  particular among South Asian women.
• Office for National Statistics (2001). Living in
  Britain Results from the 2000 General Household
  Survey Chapter 8 Smoking, The Stationery Office
  London www.statistics.gov.uk/lib2001/resources/fil
  eAttachments/GHS2001.pdf

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Gender and Health (wider issues)

• Complications of pregnancy and childbirth
  constitute a major cause of death and disability
  among women of reproductive age in LDCs. Of all
  human development indicators for adults, the
  maternal mortality ratio shows greatest
  discrepancy between developed and developing
  countries.

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Gender and Health (wider issues)
  Malnutrition affects 450 million women in
developing countries, especially pregnant and
lactating women. Iron, iodine, and vitamin A
deficiency are widespread. Domestic violence,
rape, and sexual abuse occur in all regions,
classes and agesaffecting about 30 of women
worldwide.
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Gender and Health (wider issues)
Female genital mutilation (FGM) is both a health
and human rights issueit affects two million
girls p/a, mainly in Africa. Women represent a
disproportionate share of the poor and have
limited access to health services. Furthermore,
often the gap is greater between rich and poor in
access to skilled delivery than access to other
basic health services.
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• Family and Health
• The (changing?) role of women in relation to
  health care in society

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Family and healthRole of women in relation to
health care in society.

• FAMILY LIFE in Britain, family life is
  considered to be private, but, society impinges
  on family life
• i it influences responsibility between the
  sexes
• ii it influences distribution of resources
  between the sexes
• iii it influences expectations with regard to
  responsibilities within the family unit.
• Iv family often takes responsibility for many of
  the functions required by society- e.g. health
  and care

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Care in the family

• Health care is shared between professionals and
  families.
• Within the family, the caring role, normally a
  female role, will be highly influential in terms
  of health.
• Who does health and care is a society wide issue.

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Nursing in the family

• Sickness places responsibility on family
• - especially the wife/mother.
• Normal duties continue and nursing is added on
  top.
• This can mean the carer having,
• normal (work/household) activities
• nursing duties
• increased financial costs to budget

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Rise of Neo-liberalism and nursing in the family

• Neo-liberialism and the decline of the welfare
  state.
• Increased participation by middle class women in
  the labour market.
• All western countries are seeing an increase in
  paid domestic labour (within the private sphere).

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Rise of Neo-liberalism and nursing in the family

• Often this labour (overwhelmingly female) is
  coming from abroad, both as legal and illegal
  transnational migration.
• From the Philippines alone there are 700,000
  women working abroad as domestic helpers.
• I in 3 of all women migrating for economic
  reasons end as domestic employees

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Rise of Neo-liberalism and nursing in the family

• Conclusions
• Health care roles and responsibilities appear to
  be changing (at least in middle class families)
• yet another facet of the decline of the welfare
  state?
• Economic polarisation of national economies in
  the world system and increases in
  transnationalism are driving migration (supply
  and demand).

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Health and Gender Conclusions

• Society places different expectations and role on
  men and women, and this can effect health outcome
• Women are more likely to live longer, but are
  also more likely to be ill.
• Male dominance in society can be detrimental to
  womens health.

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Health and Gender Conclusions

• This is largely due to differences in the way men
  and women live their lives and how they are
  treated by society
• The family is an important site for health care
  and health behaviour. Roles are strongly
  associated with gender.
• Social class and ethnicity still matter

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Age chronological or social?

• For categorical purposes wow do we define age?

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Age Stages of Life

• Humans move sequentially through the life stages,
  and for this reason, age is a unique bases of
  differentiation.
• Demographic trends mean that the proportion of
• elderly in society is increasing.
• The present trends are a rise in the proportion
  of
• old elderly and a fall in the proportion of
  young
• elderly.

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Age-related disease/illnesses

• Patterns of illness vary by age
• Age and gender are related as majority of older
  people are women.

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Our ageing population

• Demographic changes over the past century have
  been enormous!
• Capitalism, modernity, and general social change
  impact the population structure.

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The dependency ratio

• Refers to the proportion of economically active
  to the economically inactive in society.
• Anxiety over the present trends with regard to
  the dependency ratio stem from the assumptions
  that
• elderly are a burden
• needs of the elderly impose a strain on the
  economy
• health, housing and social services are being
  stretched by number of elderly in the population.

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Old age and poverty

• 1 in 5 people in the UK are over pension age
• They comprise almost a third of those living
  living on incomes on or below the income support
  level.
• Risk of suffering poverty is nearly x3 for those
  over retirement age

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Attitudes to ageing.

• In traditional societies, the old are revered for
  their experience.
• In modern societies, rapid technological advance
  make the old a less useful source of information.
• Prejudice towards the elderly is apparent in all
  our societys main institutions including the
  NHS.
• These attitudes reflect a general negative
  approach to ageing which is endemic in UK.
• Examples of this can be found in - language
• 
  - stereotyping of the ol
• 
  - ageism

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Social construction of old age

• How is age socially constructed in ones society?

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Behaviour

• Behavioural factors have an influence on age
  and health status
• For example, taking exercise, smoking, alcohol
  use, etc.

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Health costs

• Health care needs increase markedly at 75
• the 75s use 50 of all hospital beds.
• The health care of the elderly is improving.
• Care of the elderly is a low cost speciality.

• Many of the elderly occupying hospital
• beds do not require medical care.

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Patterns of medical use (different patterns among
the elderly).

• There is a correlation between age and physical
  disability.
• Mortality morbidity rates among the elderly are
  stable or falling.
• Although people are living longer, they are
  remaining well for longer.
• Of the elderly, it is the old elderly who are the
  high users of the NHS, and it is this group that
  are increasing.

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Ageism/Rationing

• Although not explicit, rationing does take
  place within the NHS. There is evidence ageism
  exists in the allocation of resources within the
  NHS at
• practice level
• planning and policy level (breast screening over
  64s)
• the institutional level
• an individual level.

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Age and health conclusions

• Obviously, age is related to health
• People live longer and are healthier for longer
  now
• While ageing is a biological process of
  degradation, it also socially determined.
  Different things are expected of different age
  groups.

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Age and health conclusions

• The number of dependents is on the increase in
  society, partly due to the relative increase in
  older people
• Age is an interesting health determining factor
  because everyone ages.

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Conclusion

• Always think about the way all factors interact
  (social class, gender, ethnicity, age).
• Also, how does the family relate to all this?
  What if members of the same family have different
  social class backgrounds, or are of different
  ethnicities?

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Conclusion

• When looking at inequalities many of the same
  arguments exist biological/cultural/ material
  factors. Gender/sex, age/life cycle,
  ethnicity/race.
• Finally, when considering official statistics
  think about how they were created, and what they
  mean (women and consultation rates, for
  instance).

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Some useful references

• Brown C (2004) Tobacco and Ethnicity a Lit.
  Review, Edinburgh ASH Scotland
• Bytheway, B. (1995) Ageism. Buckingham Open
  University Press.
• Doyal, L. (1995). What makes women sick.
  Macmillan, London.
• Coleman, et al. (1993) Ageing in the twentieth
  century, in J.Bond, et al.(eds) Ageing in
  Society An Introduction to Social Gerontology.
  (2nd Ed), London Sage.
• Scot. Exec. (2003) Improving Health in Scotland
  The Challenge Edinburgh The Stationery Office
  www.scotland.gov.uk/library5/health/ihis-00.asp
• Scot. Exec (2002) The Health and Well-being of
  Older People in Scotland Edinburgh ISD.