Health, Social Roles, and Life Cycle:
A Gender Approach in the Tropics
Karen Watkins
UPAEP
Gender and Health



Differences in illnesses and drug use between
men and women.
Explanations: Biological, socioeconomic, and
psychological factors.
Biological issues:


Women more likely to have infections and mental
diseases (Bird and Rieker, 1999; Mechanic, 1995;
Bardel et al., 2000; Green and Pope, 1999).
Men possess more chronic disorders; partially
explains their lower life expectancy (Macintyre et al.,
1996).
Gender and Health

Socioeconomic factors:


Multiple roles associated with womens´ poor
health conditions.
More stress-related
diseases (Bird and Rieker,1999; Brooker and
Eakin, 2001) and less leisure time.
Others argue that busy lives imply less
symptoms perceived and better health (van
Wijk et al.,1999; Janzen and Muhajarine,
2003).
Gender and Health

Socioeconomic factors:


Healthy women are the ones who can have
multiple roles.
How do multiple roles relate with health? 1)
Stress hypothesis: An additional role implies
more stress and deteriorates health;
2)
Accumulation hypothesis: Valid only for
complementary roles; an additional role
improves well-being.
Gender and Health

Socioeconomic factors:



Sexual discrimination both at work and at home
are harmful for health (Kawachi et al.,1999;
O’Campo et al.,2004; Strazdins et al.,2004).
Less liberty to leave their houses reduces
exposure to health services (Vlassoff and Garcia,
2002).
Health relates with power; at a micro level, it
depends on household resource allocation.
Gender and Health

Socioeconomic factors:



Studies for developing nations show that paid work
betters vulnerable women's´ health: provides control
of resources, power, and status.
Negative outcomes on health related to badly paid,
sedentary and monotonous jobs, lack of education
and economic autonomy, poor political participation
and protection, and little free time (van Wijk et
al.,1999; Mechanic,1995; Messing et al., 2003).
Status negatively related with mortality (Kawachi et
al.,1999); income positively correlates with health.
Gender and Health

Socioeconomic factors:

Differences in social roles:
Men are expected to be strong and suffer without
complaint (Vlassoff and Garcia, 2002).
 Women
expected to protect their families,
therefore they pay more attention to symptoms
and health (Bardel et al, 2000; Green and Pope,
1999).
 More men compared to women have full time jobs;
less flexibility to attend medical services (van Wijk
et al., 1999).

Gender and Health

Phycological factors:


Women tend to be more pessimistic than
men, which is prejudicial for quality of life and
health (in particular mental): Brooker and
Eakin, 2001.
Women more likely to search for help, follow
medical treatments, and preventive services,
as well as to adopt the sick role (Green and
Pope, 1999).
Objectives


Add a new case study (Costa Rica) to the
literature on gender and health.
Provide further robustness to existing
hypotheses on health, gender, social
roles, quality of life, and life cycle, and add
new ideas for future research.
Outline



Gender
and
health:
Surveys
on
Medication Use 2003, 2004, and 2005.
Female health and multiple roles: Survey
on Medication Use 2004.
Female health, life cycle, and well-being:
Survey on Medication Use 2005.
Data




Surveys on Medication Use in Costa Rica: 2003,
2004, and 2005.
Self-declaration and measurement of health and
medication use.
Administered at the homes of 1000 Costa Rican
adults (505 females, 495 males).
Representative sample of Costa Rican
population, however not panel.
Methodology



Gender and health: a) Descriptive analysis of selfdeclared measurement of health and medication
use. b) Construction of stress index using factor
analysis and score-regression method. c) Linear
and non-linear probit models.
Female health and multiple roles: a) Construction of
physical and mental illnesses index. b) Dummy
variables for social roles and interconnections
among them. c) Linear regressions.
Female health, quality of life, and life cycle: a)
Descriptive analysis.
Gender and Health
Table 1
Socioeconomic frequencies according to gender
2003
Men
(% )
49
Women
(% )
51
2004
Men
(% )
49
Women
(% )
51
2005
Men
(% )
49
Women
(% )
51
Sex
Age
47
46
52
Fecund (18 to 39 years old)
54
55
44
47
Non-fecund (40 to 64 years old)
37
37
9
7
Elderly (65 years old and above)
9
8
Pearson chi-square p-value 2003:
0.39
Pearson chi-square p-value 2004:
0.73
Education
3
2
None
58
59
Low (up to high-school)
21
20
Medium (technical education or
incomplete college)
18
19
High (completed college)
Pearson chi-square p-value 2003:
0.87
Income
53
59
54
Low(less than 500 US$ per
month)
37
35
37
Medium (between 500 and 1250
US$ per month)
10
6
8
High (more than 1250 US$ per
month)
Pearson chi-square p-value 2003:
0.07*
This table shows the distribution of the sample according to gender. The data corresponds to surveys
on medication use, administered in Costa Rica during June 2003, 2004, and 2005.
* The null hypothesis that income distribution is equal for men and women is rejected at a 10%
significance level for 2003 data.
-Mostly young.
-Low income
-Relatively low educational
level
-Differences in age and education
by gender not significant
-Income differs, lower for women
Gender and Health
Table 2
Health frequencies according to gender
Men
(% )
-Women report higher drug
consumption (even controlling for
fertile period). Can be explained with
more incidence of stress-related
symptoms. These decline with age,
partially due to more leisure time.
-Women use relatively more
prescription than over-the-counter
drugs, compared to men.
Health insurance
Yes (insured)
No (not insured)
Pearson chi-square p-value 2003:
0.23
Pearson chi-square p-value 2004:
0.51
Use of medication from social
security system
Yes (uses medicines provided by
this system)
No (does not use medicines
provided by this system)
Pearson chi-square p-value 2003:
0.32
Amount of medicines consumed
(2003: last month; 2004: las t 6
months)
None
One type
Several types
Pearson chi-square p-value 2003:
0.00*
Pearson chi-square p-value 2004:
0.01*
Types of drugs consumed
Prescription
Over-the-counter
Pearson chi-square p-value 2003:
0.01*
Pearson chi-square p-value 2004:
0.15*
Medicine
expenditure
per
month
Low (less than 25 US$ per
month)
Medium (between 25 and 75 US$
per month)
High (more than 75 US$ per
month)
Pearson chi-square p-value 2003:
0.96
Incidence
of
stress -related
symptoms (2003: last month;
2004: last 6 months)**
Low (stress level lower than 18)
Medium (stress level between 31
and 69)
High (stress level higher than 82)
Pearson chi-square p-value 2003:
0.00*
Pearson chi-square p-value 2004:
0.00*
75
25
2003
Women
(% )
78
22
Men
(% )
77
23
2004
Women
(% )
Men
(% )
2005
Women
(% )
79
21
-Stress index: migraine, back pain,
nervousness, sadness, digestive problems,
insomnia.
76
78
24
22
49
23
28
38
26
36
32
29
39
23
31
46
52
48
61
39
59
41
64
36
80
80
15
15
5
5
55
38
7
33
52
15
-Low monthly medicine expenditure.
55
37
8
36
51
13
Gender and Health

Equations (ordinal probit models):
SRI = 0 + 1Gender + X (1),
CD = 0 + 1Gender + X (2),
SRI = stress index;
CD = consumption of drugs;
X= education, income; logarithm of education,
logarithm of income; education, income,
squared education, squared income
Gender and Health

Results:



Probability to report high incidence of stressrelated symptoms and medication use is
greater for females.
Income is not related with stress
symptoms nor drug consumption.
Highly educated people tend to consume
more types of medicines than the rest.
Female Health and Multiple Roles



Physical diseases index: thyroids, arthritis,
infectious
diseases,
cancer,
cardiovascular illnesses.
Low correlation between stress index and
physical diseases index.
Both health instruments are used as
dependent variables.
Female Health and Multiple Roles

Independent variables (social roles):




Employment (ES-1 unemployed, 0 others)
Civil status (CS-1 single, 0 married)
Maternity (MO-1 no children in the home, 0
others)
Interconections: ES*CS, ES*MO, CS*MO,
ES*CS*MO
Female Health and Multiple Roles

Control variables:




Family income (Y)
Free time (L)
Job satisfaction (S)
Pregnancy (P)
Female Health and Multiple Roles
Equations (linear regressions):
SRI  0  1ES   2CS  3MO   4 ES * CS  5 ES * MO  6CS * MO  7 ES * CS * MO  8Y  9 L  10S  11P (3)
PDI   0  1ES   2CS  3MO   4 ES * CS  5 ES * MO   6CS * MO   7 ES * CS * MO  8Y  9 L  10S  11P
(4)
Female Health and Multiple Roles
Table 3
Econometric results for women
Constant
Unemployed
Single
No kids
Unemployed
and Single
Unemployed
and no kids
Single and no
kids
Unemployed,
single, and no
kids
Family
income
Leisure time
Job
satisfaction
Pregnant
Stress-related symptoms
Physical illnesses
0.55
(.00)
0.00
(1.00)
2.92
(.63)
7.77
(.24)
-7.66
(.35)
-7.29
(.43)
-9.62
(.30)
6.00
(.65)
0.38
(.06)
0.16
(.23)
0.16
(.28)
0.57
(.00)
-0.12
(.54)
-0.23
(.29)
-0.70
(.00)
0.39
(.22)
-0.34
(.43)
0.72
(.61)
-3.29
(.00)
1.08
(.90)
-0.01
(.45)
0.03
(.30)
-0.04
(.13)
0.08
(.69)
This table corresponds to the results for equations (3) and (4),
for 2004 survey. P-values are shown in parenthesis.
-In general, not having children at
home is related with poor physical
female health. However, obviously for
single women this is not the case.
-Job satisfaction (relates with power)
is an important explanatory variable
for both dependent variables.
Female Health and Multiple Roles
Table 4
Health results for women according to different role combinations
Role combinations
Stress-related symptoms Physical illnesses
Employed, Married, With Kids
0
0
Unemployed, Married, With Kids
0
0
Unemployed, Single, With Kids
-5
0
Unemployed, Single, No Kids
-8
0
Employed, Single, With Kids
3
0
Employed, Married, No Kids
8
1
Employed, Single, No Kids
1
0
Unemployed, Married, No Kids
0
1
This table refers to the values of equations (3) and (4), for 2004 survey, when
considering all different role combinations.
-Control role combination: employed,
married, with children (R1)
-Compared to R1, not having roles favours
mental health. More leisure time.
-2 roles in general indicate worse physical
and mental health, compared to 3 roles: stress
symptoms are associated with not having
children (for those married and employed
women) and being a single mother.
-Just 1 role: mixed evidence on its impact on
female health.
Female Health, Life Cycle, and Well-being



Life cycle: phase in life (age, maternity,
age of children, labour status, civil status,
etc.).
Health
perception
introduced
as
dependent variable.
Highly correlated with stress index and
physical diseases index.
Female Health, Life Cycle, and Well-being

Results:



Health perception is better for young women without
children than for those with kids: 2.5% report poor
health, compared to 5.0%; 14% report excellent
health compared to 7.5%.
Correlation between health perception and having
children is particularly negative for young women with
kids between 3 and 12 years of age.
For mature and older females, there are no such
differences in health perception and maternity.
Female Health, Life Cycle, and Well-being
Table 5: Distribution of the young female sample, with and without children between three and twelve years old
With children (3-12 years)
Without children (3-12 years)
Characteristic
Area
Rural
Urban
Civil Status*
Married
Divorced
Free Union
Widow
Separate
Single
Education Level*
Low
Medium
High
O cupation*
Unemployed
Housekeeper
Non-qualified Worker
Low-qualified Worker
Medium-qualified Worker
Student
Profesional
Income Level*
Low
Medium
High
Frequency
Percentage
Frequency
Percentage
28
75
27,2
72,8
37
123
23,1
76,9
63
10
13
0
3
14
61,2
9,7
12,6
0,0
2,9
13,6
32
2
8
0
3
113
20,2
1,3
5,1
0,0
1,9
71,5
35
49
19
34,0
47,6
18,4
23
61
76
14,4
38,1
47,5
1
5
7
9
6
7
8
2,3
11,6
16,3
20,9
14,0
16,3
18,6
2
9
4
21
17
57
20
1,5
6,9
3,1
16,2
13,1
43,8
15,4
62
27
3
67,4
29,3
3,3
53
58
18
41,0
45,0
14,0
-Most women with kids between 3and 12
years are married, contrary to the rest
who in general are single.
-Those women with children in this age
interval have comparatively lower
educational and income levels.
-Almost half the women without kids
between 3 and 12 years old are students,
compared to 70% of the rest who work
outside the house..
Female Health, Life Cycle, and Well-being
Table 6: Economic and Life Satisfaction for Young Women (with and without kids between 3 and 12 years old)
Females with children (3-12 years old)
Females without children (3-12 years old)
Satisfaction Level
Economic Satisfaction Life Satisfaction
Economic Satisfaction Life Satisfaction
Very Unsatisfied
8 (7,8%)
3 (2,9%)
4 (2,5%)
2 (1,3%)
Unsatisfied
13 (12,8%)
6 (5,9%)
14 (8,8%)
5 (3,1%)
7 (6,9%)
9 (5,6%)
8 (5,0%)
Not satisfied nor unsatisfied 7 (6,9%)
Weakly satisfied
29 (28,4%)
15 (14,7%)
35 (21,9%)
17 (10,6%)
Satisfied
35 (34,3%)
42 (41,2%)
53 (33,1%)
60 (37,5%)
Very satisfied
6 (5,9%)
24 (23,5%)
32 (20,0%)
43 (26,9%)
Extremely satisfied
4 (3,9%)
5 (4,9%)
13 (8,1%)
25 (15,6%)
Table 6 presents economic and life satisfaction levels, for young women with and without children (3 -12 years old). In parenthesis is
the percentage of women (with and without kids in this age interval) under a particular satisfaction level. Information is based on 2005
survey on medication use.
-Young women, without kids from 3
to 12 years of age, report better
economic and life satisfaction.
Conclusions




Women use more medicines than men,
independently of the life cycle.
Females are more likely to manifest stress
symptoms than men.
Drug expenditure does not differ significantly
according to gender.
Income is not related with health.
Job
satisfaction is important. The key is
empowerment.
Conclusions


Highly educated people consume more types
of medicines than the rest.
In general women with only 1 or 2 roles report
worse health than those with multiple roles. It
seems that being married, with children, and
employed are complementary roles. But lack
of roles is also positive for females´ well-being,
partially due to more leisure time.
Conclusions


Female health differs significantly for
young women with and without kids from 3
to 12 years of age.
This is related to particular socioeconomic
differences: those without children in this
age interval have more education and
better
economic
conditions
(empowerment, job satisfaction).
Acknowledgements
This study was financially supported by an
unrestricted educational grant from the
Merck
Company
Foundation,
the
philanthropic arm of Merck & Company
Inc., White House Station, New Jersey,
USA.
The End
Thank you!
karen.watkins@upaep.mx