Ch. 12 – Gender and Health
Robert Wonser
Some Stats on Health
• About 15% of the uninsured are children 18 or under,
majority of which live with an unemployed parent or a
parent who is working part time or full time in a job that
doesn’t provide benefits.
• 9 out of 10 medically uninsured children lives with at
least one working parent.
• 35% of the uninsured how family incomes of less than
25k per year
• 50% of the uninsured are women and men of color
• “health club set” is predominantly white, middle-class or
higher incomes between the ages of 25-44
Some More About Health
• Although research has established direct links between
diet and lifestyle and health, what we eat and how we live
is less of a choice for some people than for others.
• Even if America’s poor get more exercise, improve eating
habits, and cut down on smoking and drinking their health
will not improve substantially since these factors only
account for 13% of the difference between them and the
affluent.
• Health status of the poor is most affected by lack of
medical care, the stress of poverty, working at dangerous
jobs, and living in substandard homes and polluted
neighborhoods.
• Health is more than simply the absence of illness,
according to the WHO, health is multidimensional, a
“complete state of physical, mental, and social wellbeing.”
Gender and Mortality
• Women on average live longer than men.
• Life Expectancy – average number of years an
individual my be expected to live from a given
age or from birth.
• Book stats: U.S. ranks tied with New Zealand
and Puerto Rico for 19th place for females and
25th for male life expectancy.
• Life expectancy has increased.
• Whites enjoy almost a seven year advantage
over Blacks in terms of life expectancy.
Genetics’ Role
• X chromosome carries more genetic info than
the Y, including some defects that can lead to
physical abnormalities, but instead of making
them more vulnerable to X-linked disorders, it
gives them a genetic advantage. females need
two defective X chromosomes for genetically
linked disorders to manifest, otherwise one
healthy one can override the abnormal X.
• Males only need one defective X.
• Estrogens appear to give women protection
against heart disease.
• Marital status improves the life expectancy, for men.
• Women are more negatively influenced by lack of
income rather than lack of spouse.
• Married men  higher level of well-being
• No contentment differences for women.
• Most likely due to social support; women already have it
and men don’t.
• Men are significantly more likely to divorce seriously ill
spouses.
• Major component of gender gap in life expectancy:
behavior differences between the sexes, specifically, a
relationship between life expectancy and conformity to
traditional gender stereotypes.
• Mortality rate – simply the number of deaths in a
proportion to a given population.
Heart Disease
• Male death rate for heart disease is about 84% higher than females
death rate.
• More men than women smoke and more likely to be heavy smokers.
• About ⅓ of the sex differences in heart disease mortality are
accounted for by smoking.
• Men are more likely to adopt the Coronary Prone Behavior Pattern,
or the Prone Behavior Pattern, or the Type A personality. Type A
more than twice as likely as laid-back type B personalities to suffer
heart attacks, regardless of whether or not they smoke.
• Type A closely parallels typical traditional masculinity; competitive,
impatient, ambitious, aggressive, and unemotional.
• Higher anger prone (men or women), higher heart attack risks.
• Type D personality “strong silent type” has difficulty expressing
emotions  increase heart attack and poorer recovery rates.
• Adherence to traditional masculinity = negative health effect
More on Heart Attacks
• Strong correlation between living in neighborhoods with high
concentrations of female-headed households and heart disease
mortality for women.
– Poverty may be underlying factor…
• In general, women employed outside the home tend to be healthier.
– Even when employed women must fulfill multiple roles, such as worker,
parent, spouse, homemaker.
• Role quality may be more important for well-being than role
occupancy per se.
• Heart attacks are rare for premenopausal women under fifty, heart
attack rate for postmenopausal women increases quickly, soon
equaling male rates for men over fifty.
• Race? Elevated blood pressure in African Americans has been
linked to dealing with racial discrimination stress  as much of an
impact (or more) on blood pressure as smoking, lack of exercise,
and a high-fat, high sodium diet.
Cancer
• Men’s death rate due to cancer is 40%
higher than women’s cancer death rate.
• Men are more likely to experience toxic
workplace exposures—another byproduct
of occupational sex segregation.
Occupational Hazards to Male and
Female Workers
• Historically designed to protect women who were not only “the
weaker sex” but also to preserve future generations’ health and
viability.
• In practice, “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.
• Fyi – reproductive disorders are among the ten most frequent workrelated injuries and illnesses in the U.S.
• Employers have typically addressed the problem of harm to women’s
reproductive capabilities by simply removing them from the job,
instead of making the workplace safer for both men and women.
• Take home contamination documented in about 40 industries
(including construction and medical research).
• Second, exclusionary policies were common in
male-dominated industries, but not in equally
hazardous female-dominated occupations.
• Men make up 54% of labor force yet account for
93%of workers who die from job-related injuries
(many accidentally).
• Women: less likely, the cause? Vehicle
accidents and homicide (30% of women who die
on the job)! Of those, 17% murdered by
husbands, ex-husbands, boyfriends and exboyfriends, end result of history of domestic
violence.
Other Causes of Death
• Men involved in nearly twice as many fatal car
accidents in which the driver was intoxicated.
• Men more likely to excessively drink than women.
• Fatal car accident rate for women: 17.5/100,000.
Men, 53.2/100,000.
• Socialization strikes again: women socialized to
act safely, men to take risks.
• Homicide? Higher for men. Suicide? higher for
men (highest for Black men… how come?)
Acquired Immune Deficiency
Syndrome (AIDS)
• As many as 50% of Americans infected with HIV
either do not know it or seek care (180,000280,000 people that is).
• About 66% of those who have contracted HIV
through heterosexual sex are women, the
majority through unprotected vaginal sex with an
infected partner.
• Risk is higher for poor women,
disproportionately higher number of women of
color.
• 2nd most common cause for women: injection
drug use (30.1%).
AIDS Prevention
• Research shows that providing
comprehensive sex education and
increasing the availability of condoms do
not encourage sexual experimentation or
promiscuity, but rather discourage it.
• See page 375 for the rest.
Women, Men, and Morbidity
• On average, women outlive men 6 or 7 years. Despite
this, women have higher Morbidity (illness) rates than
men.
• Higher rates of illness for women for nonfatal chronic
conditions and acute conditions. Make more physicians
visits a year, have twice the number of surgical
procedures as men do.
• Higher morbidity rate may be due to living longer.
• There is a direct relationship between poverty and ill
health.
• Almost 75% of nursing home residents are female.
• 2nd explanation: women use medical
services more than men do.
• Men experience as many or more
symptoms than women do but ignore them
• Behavior is compatible with gender norms.
Sexism in Health Care
• Medical practitioners tend to subscribe to a functionalist model of
health, which sees the human body as analogous to a machine.
• “Women were more easily defined as sick when they were not seen
as functional social members.”
• The “nonfunctional” woman was a status symbol as well as a symbol
of femininity. Only middle and upper-middle class White women
(physicians’ best paying customers) were viewed as delicate and
frail.
• Poor, working-class women, immigrant women and women of color
were seen as more robust; their less civilized nature made them
strong and able to withstand pain!
• Women’s specialties (that is in medicine; obstetrics and gynecology)
medicalized the natural biological events in women’s lives:
menstruation, pregnancy and childbirth, lactation, and menopause.
• Prior to 19th century, child birth was a family event, not a medical
one.
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Studies show doctors may intervene in pregnancy for the sake of
convenience—their own and the other’s—as well as to reduce malpractice
claims against them.
Caesarian deliveries has doubled since 1975 (10.4 to 20.8/100; CDC
maintains 15/100 is more medically appropriate)!
C-sections are twice as expensive as vaginal births; most performed in forprofit hospitals on women covered by private medical insurance!
Menopause? Natural life change, or a hormone deficiency? (increased risk
of breast cancer with synthetic estrogens)
Researchers have also documented widespread sterilization abuse of poor
women and women of color because of racial, ethnic and social class
discrimination.
Many underwent procedure “voluntarily” (i.e. mislead or coerced). Virtual
elimination of federal funding for abortions, but they pay for 90% of
sterilizations. The result? Population control aimed at poor people and
people of color.
Male doctors communicate better with male than female patients.
Females more than twice as likely to have been misunderstood by doctors.
Symptoms of heart disease? Women more likely to be ignored. They must
prove there is a genuine problem (e.g. heart attack, congestive heart failure)
in order to be effectively treated by their physician. How come?
Resulting in… women less likely to survive heart bypass surgery than men.
Heterosexist Health Care
• Lesbians have higher rates of breast cancer
than heterosexual women.
• Not sure why…
• Childless women have higher rates of breast
cancer than women who have had children;
lesbians less likely to have had children?
• Also, about 40% of physicians are
uncomfortable caring for gay, lesbian, bisexual,
and transgendered patients!
The Patriarchal Hierarchy of Health
Care Work
• Did you ever notice the similarity?
• Traditional medical practice in the U.S. parallels
the patriarchal relations of the traditional family?
• “The doctor/father runs a family composed of the
nurse (wife and mother) and the patient (the
child). The doctor possesses the scientific and
technical skills and the nurse performs the
caring and comforting duties.”
• Recent research indicates that female
physicians tend to care for female patients better
than male physicians do. Shocking right?
Feminist Health Care
• Two distinct feature of feminist clinics:
• 1) “the bulk of a patient’s encounter, from the
initial intake to the final counseling, is with
women like herself”;
• 2) “the woman is not the object of care but rather
an active participant.”
• A quick Google search turns up:
• http://www.fpamg.net/
• And
• http://www.fwhc.org/selfhelp.htm
Gender, Sport, and Fitness
• Sports as a masculine domain
• “Women athletes are seen as something less than ‘real women’
because they do not exemplify traditional female qualities (e.g.
dependency, weakness, passivity).”
• Search for ‘female athlete’ and see what kind of results you get…
• Compare salaries for WNBA and NBA players. Veteran players in the
WNBA receive 35k for th entire season, NBA more than that starting
out, a game!
• Men produce greater revenue so they should get paid more, right?
• Doesn’t our culture trivialize female sports and promote sport as the
epitome of masculinity and proof of the physical basis for gender?
• Media reports of sports:
– 1) women's’ are underreported (except Olympics)
– 2) media’s coverage emphasizes “orthodox masculinity” (particularly
toughness and courage in physical task)
– 3) when women are highlighted it is often as sex objects or as victims (see
picture above!)
The Politics of Mental Health and
Mental Illness
• Research shows that physicians often see women’s use of
medical services as a way to cope with psychological
problems.
• Consequently they prescribe psychotropic drugs for women
who complain of physical ailments.
• Women receive about 66% of psychoactive drug
prescriptions!
• Mental illness and health: problems of definition,
identification and appropriate treatment.
• Rosenhan and his colleagues 1973 study: 8 people
complained of ‘hearing voices’ and were institutionalized for
an average of 19 days with all but one diagnosed as
schizophrenic!
• What is defined as mental illness “may be in the culturally
filtered eye of the beholder rather than in the malfunction of
the physiology or psyche of the person whose behavior is
being judged.”
The Double Standard of Mental
Health
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Survey of mental health professionals asked to describe “a healthy, mature,
socially competent (a) adult, sex unspecified, (b) a man, © a woman”.
Guess what they discovered…
Characteristics of mental health differed according to the sex of the person
being described.
Traits considered important for a healthy person were almost identical to
those for men.
Healthy Men – independence, a sense of adventure, and assertiveness.
Healthy women – submissive, dependent, excitable in minor crises, and
conceited about her appearance!
A stereotypical masculine behavior is assumed by many clinicians to be a
norm or the ideal standard of mental health.
Men who don’t conform? Risk being labeled mentally ill…
Mental health professionals were more likely to diagnose Blacks than
Whites as violent, even though the cases were identical in other respects.
Remember, definitions change over time as well. The Diagnostic and
Statistical Manual for Mental Disorders voted in 1980 to delete
homosexuality from it.
Sexism and Mental Health Services
• Clinical depression entails persistent feelings of
discontent or displeasure accompanied by at least four
of eight symptoms (poor appetite or weight loss,
insomnia or increased sleep, psychomotor agitation or
retardation, loss of interest in usual activities, loss of
energy or fatigue, feelings of worthlessness, diminished
concentration, and suicidal ideation) that are present
daily for at least two weeks without evidence of any other
disorder.
• 15% of men, 24% of women experience it
• One study: single best predictor of women’s depressive
symptoms was personal experiences o sex
discrimination.
Histrionic Personality (or hysteria)
• Histrionic personality commonly described as
demanding, dependent, manipulative, melodramatic,
scatterbrained, and seductive but frigid.
• Ancient times thought to be caused by movement in the
uterus, thus, all hysterics were women.
• May also exhibit a conversion reaction, that is they
exhibit a physical illness or disorder that has no apparent
organic cause.
• Women are socialized to be hysterics? Or, hysteria as a
response to highly stressful situation.
Beauty Norms
• A beautiful young woman many years younger than her male partner
increases his prestige in the eyes of others. Ex: “trophy brides”
• Body image is strongly linked to self-esteem  rigid unattainable
beauty norms cultivate in women and girls anxiety about and
dissatisfaction with their appearance starting at an early age.
• Breast augmentation surgery is the 2nd most common type of
cosmetic surgery in the U.S. (75-85% for nonmedical reasons).
Most common procedure? Liposuction.
• Women’s motivations? Approval and admiration from men.
• Men are catching up, in 1980 – 10% of cosmetic surgery patients, by
1994 26%.
• The difference? Few men die to be handsome, more than 70,000
women are thought to be seriously ill with infections, autoimmune
reactions, and cancer from leaky breast implants alone.
Feminist Therapy
• Gender-aware or nonsexist counseling “which seeks to
treat clients as human beings and actively refute sex
ascription in theory and in practice, that is, in options
offered to the clients and in the values espoused by the
therapist.”
• 1) feminist therapists establish egalitarian relationships
with their clients.
• 2) assumes that external conditions not individual
interpersonal ones, generate most psychological
difficulties, particularly those experienced by women and
other marginalized groups.
• 3) committed to working for broader social changes that
benefit not only their individual clients,, but all women
and oppressed groups.
Toward a Healthy Future
• In sum, traditional constructions of gender are
hazardous to our health.
• Regarding physical health, traditional
masculinity puts men at greater risk for a variety
of physical conditions such as heart disease and
stroke, various forms of cancer and chronic liver
disease.
• Women too, but mostly mental health concerns.
• With few exceptions, people of color and
economically disadvantaged people have poorer
health than White, middle- and upper-class men
and women.