HSS1101E Determinants of Health

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HSS1101E Determinants of Health

• Feb 5, 2009 Gender and Health

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Gender and Health
UK Life Expectancy at Birth
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Gender and Health
UK Death Rates from Alcohol Related Causes
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Gender and Health
Canada
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Gender and Health

• Women are more likely to suffer arthritis and
  rheumatism
• Women cost the health care system more for the
  bulk of their lives, but then men cost more near
  the ends of their lives
• Almost all homicide-suicide victims in Canada are
  wives
• Aboriginal women are most likely to suffer
  spousal abuse
• Women make up 57 of all Canadians 65
• Men are more likely to die of lung cancer than
  women are of either lung or breast cancer but
  female rates of lung cancer are on the rise

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Gender and Health
Canada
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Gender and Health

• Bad jokes
• Why do men die before their wives? Because they
  want to.
• Women love longer because theyve never really
  lived. old Victorian adage
• These are examples of misogyny in medicine we
  must be aware of this tendency and ask ourselves
  why society treats health care for men and women
  differently, and what we can do to address these
  gaps to make everyone healthier

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From the reading (Denton, et al)

• In our society, women have lower rates of
  mortality than men
• Women have higher rates of depression,
  psychological disorders and many chronic
  illnesses
• Direction and magnitude of gender differences
  varies with age

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From the reading (Denton, et al)

• Gender is a measure of both innate biology and
  social differences
• Therefore health differences between men and
  women can be understood as
• Differences in biology
• Differences in social roles/expectations
• Interplay between both of the above

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Gender vs Sex

• Sex
• Male vs female
• Objective, biologically determined or is it?
• X chromosome vs Y chromosome
• Genitalia?
• Gender
• Masculine vs feminine
• Subjective and culturally determined
• Gender is a social construct
• Eg, A genetic male can be feminine

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Gender vs Sex

• Sex Biology
• Gender behaviour, expectations, economics,
  culture, etc (i.e., everything else)

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A Great Resource

• www.genderandhealth.ca

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Gender vs Health

• A recent study found that aspirin reduced the
  risk of death from heart disease in women. This
  finding is a result of
• Gender?
• Sex?

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Gender vs Health

• Men tend to smoke to increase positive feelings,
  while women tend to smoke to hide negative
  feelings
• Gender?
• Sex?

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Gender vs Health

• Lung cancer rates today reflect smoking patterns
  20 years ago.
• Gender?
• Sex?

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Gender and Health

• Differences in health and illness patterns of
  men and women are attributable both to sex, or
  biology, and to gender, that is, social factors
  such as powerlessness, access to resources, and
  constrained roles.
• Susan Phillips, Int J Equity Health. 2005 4 11

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Gender and Health

• Content of womens health is clearly restricted
  to women but both women and men are subject to
  the health effects of gender
• In most countries
• Women have less access to resources
• Women have less control over their bodies and
  lives
• Until recently, health resources have been
  disproportionately focused on men

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Research Gap

• There is a history of generalizing from studies
  on men to therapies for women
• Eg, Gender bias in human anatomy textbook
  illustrations (Psychology of Women Quarterly.
  198610413420)
• In recent years, governments have expended much
  money on womens health research to help address
  this historic gap

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Example Heart Disease

• The leading cause of morbidity and mortality for
  women in Canada and in much of the world is
  coronary heart disease (CHD)
• For many years CHD has been recognized as the
  disease of the middle aged and elderly men, and
  the research has been mainly focused on this
  population. 
• Such views were a reflection of past societal
  values which dictated that the health and
  contribution of men was of primary importance to
  the growth of the economy and the development of
  society.
• Since the life expectancy of women has increased
  over the years, the once uncommon phenomenon of
  CHD in women is now more prevalent and CVD is the
  leading cause of death in women as well.
• However, despite the knowledge that CHD is more
  becoming prevalent, it still continues to be
  underdiagnosed in women by heath care
  professionals.

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Example Heart Disease

•  In 2002, cardiovascular disease accounted
  for 32 of all male deaths and 34 of all female
  deaths
• Despite differences in symptoms between men and
  women, doctors still behave as if symptoms are
  the same for both sexes.
• In fact, women experience more nausea and back
  pain during a heart attack, while men experience
  left arm pain and chest pain, which is thought to
  be the "classic" sign of a heart attack.

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Example Heart Disease

• Studies show that women with suspected heart
  disease have fewer non-invasive and invasive
  diagnostic tests ordered compared to male
  counterparts, while those with proven disease
  have fewer interventional procedures performed.
• www.genderandhealth.ca

It wasnt until 1970 that studies on women and
cardiac surgery began appearing in medical
journals.
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Example Heart Disease

• Why the dearth of studies on women?
• Assumption that women are less important to
  society?
• Assumption that women could not be suffering from
  heart disease because work and stress are the
  domain of men?
• Assumption that the medical study of women is
  undignified for both researcher and patient?
• Assumption that studying men could be generalized
  to women

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Example Heart Disease

• Most agree that psychological support is needed
  for recovery from a heart attack
• But studies suggest that women are less likely to
  be referred by their physicians
• Studies also suggest that women are less likely
  to attend support sessions even when they are
  referred
• Why?
• Something innate about womens behaviour?
• Or having to do with women not having access to
  free time, transportation, child care, etc?

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Example Heart Disease

• Like all determinants of health, there are
  interactions with other determinants
• Eg, ethnicity
• African American women are twice as likely to
  suffer a stroke compared to Caucasian women
• African American women have more strokes and have
  them at a younger age
• Latin and Native American women have lower risk
  of stroke than do White women

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Interactions Bet Gender and Age
Canada
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What about Media and Politics?
Canada