Week 7: Gender and Health

AIMS: The student will understand the concept of ‘gender’ from biological, behavioural and social
perspectives, and gain insight into how gender is associated with health.
KEY TERMS: Gender, sex, gender roles, gender identity, social norms, social roles, socialization.
KEY CONCEPTS: Inequities in gender and health in Canada and the Association between Gender and Health,
Lesbian, Gay, Bisexual, Transgender or Queer (LGBTQ)

Required Readings:
Benoit,C. & Shumka, I. (2009). Gendering the health determinants framework: Why Girls’ and women’s health
matters. Vancouver: Women’s Health Research Network. (pages 1-28)
http://bccewh.bc.ca/wp-
content/uploads/2012/05/2009_GenderingtheHealthDeterminantsFrameworkWhyGirlsandWomensHealthMa
tters.pdf

Biological and Social Factors that Influence Health

-Girls and women face disadvantage due to structural inequities (i.e., differences among societal groups that
are avoidable and unfair) that limit their access to, and control over, material and symbolic resources, and over
their bodies and lives.
-Compared to males, females utilize health-care services more frequently
-Because their social positions vary by socioeconomic position, ethnicity, race, and migrant status, some girls
and women are especially vulnerable to social disparities and deserve special consideration.
-There are not only significant gender differences in morbidity and mortality worldwide but also in how health-
related risks are diagnosed and treated.
-The best evidence on the fundamental factors affecting women’s health will do little to change health
inequities unless there is the political will to carry through necessary policy recommendations.

Identifying “Health Determinants”

-Barbara Starfield has defined the interaction among the different health determinants as “the wide variety of
interacting proximate and distal influences on the health of individuals/ populations”
-Link and Phelan also recognize that some health determinants are “fundamental” and others “proximate.”
-They emphasize that access to key resources is crucial for health, including access to knowledge, money,
power, prestige, and social connections that determine the extent to which people are able to avoid a range of
risks for morbidity and mortality.
-Health determinants that operate at the middle/meso-level of society, such as public health care, housing,
and transportation, also influence individual health.
-At the “proximal” or micro-level, Link and Phelan locate risk factors that have been the focus of classical and
social epidemiological studies over the last 150 years. These risk factors include poor individual health,
including overcrowding and poor sanitation and, more recently, smoking, unhealthy diets, and lack of exercise.
-In their recent work, they urge us to pay more attention to more fundamental issues affecting equity — most
importantly, socioeconomic status — if health reform is to have its maximum effect in the coming decades
-Gender inequalities in politics, employment, and income opportunities result in health concerns that burden
girls and women in particular ways. It is important to understand the link between these gendered inequalities
and health in order to develop appropriate policies to help reduce these biases
-Historically, females have been and continue to be more likely to be poor, to live in inadequate housing, and to
exert less control over their bodies and lives which is the case in high-income/wealthier countries as well as
middle- and low-income/less wealthy countries.
-Gender inequalities in politics, employment, and income opportunities result in health concerns that burden
girls and women in particular ways.
-Because gender inequalities are often based on sex-based differences, sex should always remain a primary
concern in health research, policy, and practice.

Sex and Gender as Health Determinants: How Do They Differ?

-Feminist health researchers have focused attention in recent decades on bringing sex and gender, especially
the unique health concerns of girls and women, to the forefront of research.
-This began with the North American women’s health movement in the 1970s and ’80s. Until then,
explorations of women’s health were largely concerned with either reproductive or mental health.
-By comparison, studies of men’s health were more likely to incorporate physical health and ignore mental and
reproductive health issues altogether.
-In response, the women’s health movement took women’s bodies back from the institutions of medicine and
reframe their knowledge and experience of their bodies in ways not configured by sexism and androcentrism
-Women activists sought to take control of health knowledge production in order to shed light on their unique
health concerns and, in the process, transform health care and policy.
-Activists and feminist scholars also joined together to change the male-dominated medical care system by
marrying research with action around issues ranging from the legalization of midwives and home birth to
women-centred care more generally

Clarifying Sex
-It is generally agreed that sex is a biological construct based on one’s sex chromosomes (XX = female, XY =
male) and manifested in one’s anatomy, physiology, and hormones
-While it is assumed that there are only two sexes, in reality there are asymptomatic people with sex
chromosome anomalies (e.g., Turner’s syndrome [XO] and Klinefelter Syndrome [XXY], etc)
-Also secondary sex characteristics (facial hair, breast size, and hormone levels) vary among individuals.
-For instance, although testosterone is a hormone usually associated with males, it is found to greater/lesser in
both males and females, depending on their age, health status, and use of pharmaceutical drugs.
-Sex can influence how female and male bodies “respond differently to alcohol, drugs, and therapeutics due to
differences in body composition and metabolism, as well as differences in hormones”
-Research in the addictions field has shown how gender roles can influence interpretations of and patterns in
substance use, whereas complementary research in the area of sex has revealed how biological factors
influence the impact of substances on the body

Clarifying Gender
-Gender is a social construct that goes beyond the biologically defined categories of sex to include social
mediated roles and norms typically given to women, men and other gender groups (transgender, queer)
-Gender refers to the roles and expectations of the groups in a given society which vary historically and cross-
culturally (roles change over time, place and stage in life)
-Gender is a dimension of social organization, shaping our access to material and symbolic resources, how we
interact with others, and even how we think about ourselves.
-Examples include gender pay gape and the male:female ratio in the parliament, role of child caregiver
-Gender stratification — the unequal distribution of wealth, power, and privilege between men and women
shaping the opportunities and limitations each of us faces throughout our lives
-Gendered norms also shape experiences of illness, what health care problems come to the attention of
researchers (so what gets researched), what health services are made available through the public purse and
the norms and values influencing patient care

Impact of Gender Stereotypes on Men’s and Women’s Health

-Gender stereotypes negatively affect men's health especially in high-income countries (Canada) where
females have a biological advantage such as a lower risk of developing cancer, tend to live longer
-Gender roles also play a part in health outcomes
-Men in high-income countries are expected by society to display masculinity by avoiding emotional expression
and to be physical prowess
-They are therefore employed in potentially physically dangerous jobs such as military, mining, logging, fishing
and they participate more in aggressive activities such as contact sports
-This results in higher rates of morbidity and mortality due to accidents, suicide and violence
-Despite women's biological advantage, they typically report poorer overall mental health than men and seek
more health services
-Diagnostic processes and criteria for some mental health conditions may be gender biased allowing women to
more readily identify mental health concerns than men causing women to be more medicalized despite the
fact that the causes of a women's depression often is elsewhere
-Research also has a clinical bias in favour of males in the diagnosis of chronic diseases that are common to
both genders (such as research of symptoms of heart attack)

Intersections of Girls’ and Women’s Health

Gender and Social Class

-Inequalities in health are associated with social class/socioeconomic status-measured by education,
occupation and income
-Opportunity structure is a phenomenon where people who are privileged gain access to health-enhancing
physical environments (such as clean water, quality food and shelter), access to local resources (good schools,
recreation centres) and social environments that provide support and community participation
-There is a difference in opportunity structure between males and females also within groups of women
-Social Class, Work, and Health: lower-income women are more likely to work in socially vulnerable
occupations where: poor compensation, little to no health benefits, unsafe working conditions, unregulated
hours (forced to work too much or too little), and discrimination. These jobs usually involve "caring" or
providing services to others (home-care workers)
-80% of home-care workers are women and are usually racial and ethnic minorities and immigrants
-Compensation is low (close to minimum) also the workers must be flexible in terms of when/where they work
and be willing to accept part-time arrangements.
-The physical strain is high as well when transporting/manoeuvring frail/immobile clients
-The emotional impact is high- this can lead to unpaid overtime work to care for their lonely client or may
perform duties beyond their skill level/training
-SES and disease: Metabolic syndrome: clustering of risk factors for cardiovascular disease and diabetes
including elevated blood pressure, abdominal obesity and insulin resistance
-Women are at higher risk than men and low-income women are at greater risk than high-income women
-The way women look and obesity also a stronger effect on the upward social mobility of women than men
-Globalization and Health Inequality: Developogenic diseases are prevalent in poor areas where they are
caused by development projects such as hydro-electric dam due to rapid urbanization and deforestation
-The result is the spread of diseases like malaria, tuberculosis, cholera, malnutrition, and venereal syphilis,
especially among those who lack the resources and power to change their circumstances
-Social class has also been known to determine who receives health care and the quality of care received

Gender and Race, Ethnicity, and Migrant Status

-Race, ethnicity and migrant status are closely linked to access to education, money, power, and social
connectedness, and implicitly to health inequalities
-Race is a socially constructed category that categorizes people based on biologically shared traits such as skin
colour, facial features, hair texture, and body shape, and can determine the incidence of certain forms of
diseases such as sickle cell anaemia. At the same time, race is closely related to a person’s ethnicity — a
group’s shared cultural heritage based on common ancestry, language, music, food, and religion.
-Both can lead to vulnerabilities to certain SDOH such as poverty, stigma and/or marginalization
-Immigrants/ethic people may also face specific health problems related to the stress, anxiety, and physical
hardships associated with transitioning from culturally familiar “home” to uncharted “foreign” environments.
-Breast Cancer and the Relationship Between Ethnicity and migrant Status: women who are white and
Japanese had earlier diagnoses, smaller tumours and less malignant (lower grade) while Hispanic and black
women had larger tumour with greater malignancy (higher grade) due to socioeconomic factors such as being
less educated, living below poverty line, single parents which contributed to: delayed detection and diagnosis
-Also they tended to live close to areas that are polluted/contaminated with toxic wastes and have less access
to nutritious food
-Marital status was also correlated with breast cancer because married women have greater social support to
invest in their health and higher income home=greater access to health care services
-Cultural practices and beliefs also contributed due to their understanding of the epidemiology of breast
cancer and can shape detection practices
-Healthy immigrant effect is a phenomenon that involves new immigrants experiencing a health advantage
when they first immigrate, but losing that advantage over time as they adapt new lifestyle changes and
behaviours such as smoking, dietary changes, increased alcohol consumption
-Gender roles also play a part because women neglect their own health to fulfill their home responsibilities
-Cultural barriers include self-exams due to not wanting to be touched by a doctor of the same or opposite sex
-Aboriginal Status and Health Disadvantage: Aboriginal women (their population in general) face systematic
discrimination which contributes to them having bad work (sex workers) so low income so poorer health

Gender and Geographic Location

-Urban versus rural: Those living in more isolated geographic areas face greater disadvantage due to lack of
economic and social resources so their health decreases
-Rural women have higher mortality rates than urban women due to lower educational achievement and lower
labour force participation.
-Rural women also have higher fertility rates and report greater stress, anxiety, depression, domestic violence
due to their isolation, limited economic opportunities and access to health and social services
-Place, Race, and Risk of Violence and STIs: Rural women are at risk to HIV and STIs due to lack of career
opportunities and support resources in rural locations forced them to stay in the abusive relationships
(physical, emotional, sexual). Also being separated from friends and family, loss of language and culture caused
Aboriginal women to turn to substance abuse (can’t improve lives without services and resources)
-Place and Childbirth: In addition to limited social services available to women in rural/remote regions of
Canada, the government has down-sized on health care services so the amount of hospitals that provide
maternity care in the area are decreasing which causes the pregnant women to leave their homes and travel to
a major urban centre to give birth which means paying out-of-pocket costs for travel, food, lodging
-Plus women don't know when they will go into labour which may cause them to be away from home for
several weeks so it is financially stressful and emotional distressing if they have other children at home
-Going too late can cause going into labour en route and having an unassisted birth at home can cause
problems if there is a health emergency

Gender and Age

-Sexual health and adolescents: risky sexual behaviour is one of six health behaviours most associated with
mortality, morbidity, and social problems among youth
-Girls are more likely to be the victims of sex exploitation and abuse at the hands of adults and/or experience
dating violence, unprotected sex, STIs, and unwanted pregnancies compared to same aged males
-Adolescence and Early Adulthood: Dating violence is a concern for girls because they become involved in
romantic relationships at an earlier age and tend to have boyfriends who are older
-This can cause self-esteem, body image and emotional health issues
-Girls who are lower social classes are more likely to report being in an abusive relationship and difficulty
leaving the relationship
-Self-harming behaviour is another age-related health concern
-3/4 of youth who reported harming themselves were female
-Youth who came from families that had difficulty affording basic necessities were most likely to report this
-Vulnerability in Mid- and Late Life: Older women who have home care often keep out of the hospital.
However, men don't usually benefit from home care nor have strong social supports which mean both genders
require targeted interventions/programs as they age
-Older men and women have different types of health problems: men suffer from acute health problems while
women have more co-morbidities which causes men to be served better since countries health care are
organized around care of acute problems
-Older women are also more likely to live below the poverty line so lack resources (screening) that men have

Summary and Policy Implications

-Maintenance and promotion of a population’s health is only partly achieved by public investment in health
services such as hospitals, physicians, and advanced medical technology.
-More effective in the long run is the ability to reach out to society’s most vulnerable members and provide
them with the basic necessities of living that promote health and well-being which includes high-quality
education, safe and secure housing, meaningful employment, and good nutrition
-For this to happen, an equitable distribution of resources is crucial.
-This could be achieved with gender equality in paid and unpaid work, social rights such as parental leave and
benefits, public child and elder care, ethno-culturally appropriate health care aimed at our Aboriginal, visible
minority, immigrant, and refugee communities, and social inclusion of all citizens in our country’s political,
educational, and symbolic institutions.
-According to the Public Health Agency of Canada, the ultimate challenge is: “the health sector has been
reluctant to champion policies that improve social conditions because areas of social and economic policy
largely fall outside of the health department’s jurisdiction”
-Inaction causes worsening of the health of vulnerable girls and women and other disadvantaged groups and
affects the health of all Canadians and the communities in which they reside.

REQUIRED MEDIA FILES:

TedX: Sex, Gender and Health- One Size Does Not Fit All (10.03min)
https://www.youtube.com/watch?v=cjIqNduu1qU
-The women in med school didn’t feel the information they were learning resonated with who they were as
women which caused them to start a consciousness raising group to share what they knew and ask questions
-Women and men are different but we treat them the same when it comes to health care
-Women have reproductive chromosomes and XX chromosomes while men have XY which they are found in
every single cell of your body (every cell of your body has a sex) which affects how your body reacts to certain
things such as medication or symptoms for the same diseases may be different or tests used to diagnosis
illnesses need to be different
-80% of drugs withdrawn from the market are because of the side effects of women because researchers
didn’t test them on women (only on men) in trials
-Girls suffer knee injuries 2-3 times more than men because of their ligaments are more stretchy especially
during menstrual cycle (requiring different techniques than men) and their thigh muscles contract at different
times while men contract together while stabilizes their knee
-Gender roles affect women: cooking because it requires standing over gas stoves or open fire and the fumes
cause more lung disease
-Gender roles affect men: more likely to fall off a roof due to occupational role
-To speed up process of research for women: be aware of the information, share it with family and friends, and
ask gender specific related questions about care (has this medication been tested for both genders? Is this the
best diagnostic test for women?)

LGBT: “To Treat Me You Have to Know Me” (10.18min)

https://www.youtube.com/watch?v=NUhvJgxgAac
-LGBT people have higher rates of tobacco use, alcohol use and STD's so they require screening/testing
-They also experience more discrimination so they avoid getting care
-Ask open questions, don’t assume they are heterosexual

Indian ad with transgender mom stirs debate -- and tears (2 videos)

https://www.cnn.com/2017/04/19/health/transgender-india-mom-vicks-advert/index.html
1) Transgender identity, in their words
-Slurs people hear: tranny, heman, heshe
-They worry about their safety because they know people aren’t educated

2) Vicks – Generations of Care #TouchOfCare

-A little girl doesn't have parents (her birth mom died of AIDS when she was 6 years old due to being a sex
worker)
-A lady raises her by herself
-The girl is on a train to boarding school to become a doctor (her “adopted” mom thinks that) but she's really
going to become a lawyer to help her mom
-Her mom can’t adopt her legally because it’s not legal for transgender women to adopt children
Progress in India:
-In a landmark vote in 2014, India's Supreme Court granted the country's "hijra," or transgender people, and
those classified as third-gender the right to self-identify without sex reassignment surgery.
-The ruling in India enabled transgender people equal access to education, health care and employment, as
well as protection from discrimination
-Transgender people – along with same-sex couples – still cannot legally adopt children in India.