THE SOCIOLOGY OF THE SOCIOLOGY OF GENDER AND HEALTH: AN GENDER AND HEALTH: AN

OVERVIEWOVERVIEW

Lyn GardnerLyn Gardner

DEFINITIONSDEFINITIONS

• Sex – Sex – biological or genetic differences biological or genetic differences between men and women. Largely universal.between men and women. Largely universal.

• Gender – Gender – socially/culturally constructed socially/culturally constructed differences between men and women. differences between men and women. Variable.Variable.

• Sexism – Sexism – the personal and institutional the personal and institutional differentiation of power and status between differentiation of power and status between the sexes which limit opportunities for girls the sexes which limit opportunities for girls and women. and women.

• Gender/sex role – Gender/sex role – pattern of behaviour a pattern of behaviour a particular society expects from individuals of particular society expects from individuals of either sex. Learned through either sex. Learned through socialisation.socialisation.

Recognising the Social Recognising the Social Construction of GenderConstruction of Gender

‘‘Gender refers to women’s and men’s Gender refers to women’s and men’s roles and responsibilities that are roles and responsibilities that are socially determinedsocially determined. Gender is related . Gender is related to how we are to how we are perceived and perceived and expectedexpected to think and act as women to think and act as women and men because of and men because of the way society the way society is organisedis organised, not because of our , not because of our biological differences’.biological differences’.

Gender and Health, WHO (1998:5)Gender and Health, WHO (1998:5)

THE SECOND SEXTHE SECOND SEX

‘‘In truth, to go for a walk with one’s eye open In truth, to go for a walk with one’s eye open is enough to demonstrate that humanity is is enough to demonstrate that humanity is divided into two classes of individuals whose divided into two classes of individuals whose clothes, faces, bodies, smiles, gaits, interests clothes, faces, bodies, smiles, gaits, interests and occupations are manifestly different.and occupations are manifestly different.

Perhaps these differences are superficial, Perhaps these differences are superficial, perhaps they are destined to disappear.perhaps they are destined to disappear.

What is most certain is that they do most What is most certain is that they do most obviously exist.’obviously exist.’

Simone De Beauvoir – 1953Simone De Beauvoir – 1953

SOCIAL EXPLANATIONS OF SOCIAL EXPLANATIONS OF GENDER DIFFERENCESGENDER DIFFERENCES

• Feminine traits are de-valued and Feminine traits are de-valued and under-valued by society.under-valued by society.

• Women as relative beings – ‘woman Women as relative beings – ‘woman as other’.as other’.

In a very important sense, it is normal In a very important sense, it is normal to be a man and abnormal to be a to be a man and abnormal to be a womanwoman

Explanations Cont.Explanations Cont.

• The process of socialisation places The process of socialisation places menmen in a in a different position to women: a different position to women: a masculine masculine archetypearchetype

• Traditional notions of Traditional notions of masculinity masculinity position men position men as ‘breadwinners’, as ‘breadwinners’, risk takersrisk takers (in terms of (in terms of hazardous work – industrial accidents, contact hazardous work – industrial accidents, contact with harmful substances, and other pursuits such with harmful substances, and other pursuits such as sport, sex, violence and health damaging as sport, sex, violence and health damaging behaviours – smoking and excessive alcohol behaviours – smoking and excessive alcohol intake) intake)

See Doyal, L. (2002) in Bendelow, G. et al (eds) See Doyal, L. (2002) in Bendelow, G. et al (eds) Gender, Health and Healing. Gender, Health and Healing. London:Routledge.London:Routledge.

GENDER SOCIALISATIONGENDER SOCIALISATION

TAKES PLACE IN:TAKES PLACE IN:

the familythe family

school/educationschool/education

mediamedia

wider societywider society

FAMILYFAMILY

• Do parental/family expectations of boys and girls Do parental/family expectations of boys and girls push them into particular gender roles?push them into particular gender roles?

• Gender stereotypes: girl babies are quiet, clean Gender stereotypes: girl babies are quiet, clean and restrained. Boys are noisy and adventurous.and restrained. Boys are noisy and adventurous.

• Research into reactions to a crying baby: told it Research into reactions to a crying baby: told it was a boy – interpret as anger. Told it was a girl – was a boy – interpret as anger. Told it was a girl – interpret as fear.interpret as fear.

• Promotion of emotional inhibition (‘big boys don’t Promotion of emotional inhibition (‘big boys don’t cry’), positive sanctions (‘what a brave boy’) and cry’), positive sanctions (‘what a brave boy’) and prohibition of feminine behaviour (‘don’t be a prohibition of feminine behaviour (‘don’t be a woos’) See Stillion (1995) woos’) See Stillion (1995)

• Or are parents/families responding to initial Or are parents/families responding to initial differences in behaviour?differences in behaviour?

SCHOOLSCHOOL• Teacher expectations may be different.Teacher expectations may be different.• ‘‘Hidden curriculum’ – guides pupils’ expectations Hidden curriculum’ – guides pupils’ expectations

and behaviour.and behaviour.• Evidence to suggest that boys get more attention Evidence to suggest that boys get more attention

from teachers.from teachers.• Peer pressure to conform to particular gender Peer pressure to conform to particular gender

roles or stereotypes. roles or stereotypes. • Recent challenges to traditional male role = Recent challenges to traditional male role =

uncertainty for boys/young men uncertainty for boys/young men • Role models (or lack of) may influence Role models (or lack of) may influence

subject/course choice subject/course choice

MASS MEDIA INFLUENCESMASS MEDIA INFLUENCES

• Portrayal of women as either ‘sexual Portrayal of women as either ‘sexual objects’ or caring/nurturing.objects’ or caring/nurturing.

• Emphasis on women’s appearance.Emphasis on women’s appearance.

• ‘‘You’re only a feminist because you’re You’re only a feminist because you’re ugly!’….ugly!’….

• Treatment of women who commit Treatment of women who commit violent crimes – ‘doubly deviant’ – a violent crimes – ‘doubly deviant’ – a crime against your sex (gender?). crime against your sex (gender?).

Health Surveillance: a Health Surveillance: a Foucauldian PerspectiveFoucauldian Perspective

• The medical The medical gazegaze – societal – societal gazegaze• The process of observation, or The process of observation, or surveillancesurveillance, by , by

both the medical profession and wider society – both the medical profession and wider society – whereby individuals are whereby individuals are measuredmeasured against a against a given masculine or feminine given masculine or feminine benchmarkbenchmark

• Individuals assess their performance in a process Individuals assess their performance in a process of of self-surveillanceself-surveillance

• Yet men have an Yet men have an uneasy relationshipuneasy relationship with their with their bodies and health (see White, A.K. and Johnson, bodies and health (see White, A.K. and Johnson, M. (2000) M. (2000) Men making sense of chest pain in J. of Men making sense of chest pain in J. of Clinical Nursing, 9:534-541.Clinical Nursing, 9:534-541.

• ‘‘The maintenance of the male body becomes The maintenance of the male body becomes problematic’ (White and Johnson, p.535)problematic’ (White and Johnson, p.535)

Social or Biological?Social or Biological?

‘‘Men’s health is not a medical issue, it Men’s health is not a medical issue, it is societal’ argues White (2001:3)is societal’ argues White (2001:3)

Yet equally, argues Doyal (2002), this Yet equally, argues Doyal (2002), this is the case for women also – both is the case for women also – both nationally and globally.nationally and globally.

DIFFERENCE/SAMENESS DIFFERENCE/SAMENESS DEBATEDEBATE

• Why should any difference – if it exists, or Why should any difference – if it exists, or we believe it to – be constructed as we believe it to – be constructed as disadvantage, particularly for women?disadvantage, particularly for women?

• If we are the same – the problem of If we are the same – the problem of women's relative disadvantage and lack women's relative disadvantage and lack of power remains unresolved.of power remains unresolved.

• What needs to be addressed is not are we What needs to be addressed is not are we the same or different, but what structures the same or different, but what structures exist which convert this into exist which convert this into disadvantage?disadvantage?

LEGISLATION TO ADDRESS LEGISLATION TO ADDRESS SEXUAL INEQUALITYSEXUAL INEQUALITY

• 18821882 Married Women’s Property ActMarried Women’s Property Act• 19191919 Votes for Women over 30Votes for Women over 30• 19231923 Equality in grounds for divorceEquality in grounds for divorce• 19281928 Votes for women over 21 Votes for women over 21• 19701970 Equal Pay Act Equal Pay Act• 19751975 Sex Discrimination Act Sex Discrimination Act• 19921992 Church of England Synod Church of England Synod

votes to votes to allow women priests allow women priests

Contemporary Social Changes Contemporary Social Changes in the Lives of Men and Womenin the Lives of Men and Women

• Changes in work and employment:Changes in work and employment: ‘Women are almost as likely as men to be ‘Women are almost as likely as men to be employed; but almost all of this increase is in employed; but almost all of this increase is in part-time work. There has been a significant part-time work. There has been a significant narrowing of the wages gap between women narrowing of the wages gap between women and men who work full-time, but this does and men who work full-time, but this does not extend to women who work part-time. not extend to women who work part-time. There has been a major increase in the There has been a major increase in the proportion of women in top jobs, but proportion of women in top jobs, but significant sex segregation in employment significant sex segregation in employment still remains’. Walby, 1997:36-7).still remains’. Walby, 1997:36-7).

Cont.Cont.

• Changes in educational achievement:Changes in educational achievement: there is evidence that women have made there is evidence that women have made (and continue to make) rapid gains in (and continue to make) rapid gains in educational terms since the mid-1980s, in educational terms since the mid-1980s, in comparison to their male counterparts. A comparison to their male counterparts. A larger increase in admissions to HE (115% larger increase in admissions to HE (115% over a 10 year period, compared to only over a 10 year period, compared to only 35% increase for men), improvements for 35% increase for men), improvements for girls in GCSE and A level achievements.girls in GCSE and A level achievements.

Cont.Cont.

• Changes in family and household: Changes in family and household: fertility fertility rates (falling birth rate), rise in single-parent rates (falling birth rate), rise in single-parent households (estimates suggest 90% of these households (estimates suggest 90% of these are women-headed), increase in divorce rate.are women-headed), increase in divorce rate.

• Yet women still maintain the majority share of Yet women still maintain the majority share of household tasks and childcare (and other household tasks and childcare (and other care) responsibilitiescare) responsibilities

• Increase in older, single/widowed households Increase in older, single/widowed households (risk of poverty – feminisation of poverty) (risk of poverty – feminisation of poverty)

GENDER & HEALTH GENDER & HEALTH INEQUALITIESINEQUALITIES

‘‘Women get sicker but men die quicker’Women get sicker but men die quicker’

(Miers, 2000)(Miers, 2000)

MorbidityMorbidity rates are higher for rates are higher for womenwomen

MortalityMortality rates are higher for rates are higher for menmen

Statistically Speaking…Statistically Speaking…

• Life expectancy is higher for women Life expectancy is higher for women than men: in 2001 life expectancy at than men: in 2001 life expectancy at birth for women was 80.4 years birth for women was 80.4 years compared with 75.7 for men.compared with 75.7 for men.

• Life expectancy for men has been Life expectancy for men has been increasing faster than for women: an increasing faster than for women: an increase of 4.8 years for men, and 3.6 increase of 4.8 years for men, and 3.6 years for women between 1981 and years for women between 1981 and 2001.2001.

More stats…More stats…

• In 2001 obesity levels were similar for both In 2001 obesity levels were similar for both sexes: nearly sexes: nearly half of menhalf of men were considered were considered overweight, compared with a overweight, compared with a thirdthird of women of women

• Underweight: men 4%, women 6%Underweight: men 4%, women 6%• Men twice as likely to exceed recommended Men twice as likely to exceed recommended

daily benchmarks for alcohol consumption (3-4 daily benchmarks for alcohol consumption (3-4 units daily for men, 2-3 for women)units daily for men, 2-3 for women)

• Young men more likely to binge drinkYoung men more likely to binge drink• Student drinking levels/behaviours revealed no Student drinking levels/behaviours revealed no

significant differences between the sexes!significant differences between the sexes!

CRITIQUECRITIQUE

• THE PICTURE IS MORE COMPLEXTHE PICTURE IS MORE COMPLEX• Gender differences are less significant in Gender differences are less significant in

middle years of life – age ranges are middle years of life – age ranges are significant.significant.

• Men have higher rates of serious illness Men have higher rates of serious illness than womenthan women

• Women have higher consultancy rates Women have higher consultancy rates than men – particularly GP contactthan men – particularly GP contact

• When consultations for When consultations for pregnancy/childbirth and GU are removed, pregnancy/childbirth and GU are removed, gender differences are less significantgender differences are less significant

The New Woman – The New Woman – Emancipation ThesisEmancipation Thesis

• Women are increasingly consuming alcohol in Women are increasingly consuming alcohol in larger quantities – and drinking more larger quantities – and drinking more frequentlyfrequently

• Women are smoking in greater numbers than Women are smoking in greater numbers than beforebefore

• Women are more at risk from injuries at work Women are more at risk from injuries at work (in addition to higher risk of injury in the home)(in addition to higher risk of injury in the home)

• Increasingly more likely to indulge in ‘risk-Increasingly more likely to indulge in ‘risk-taking behaviours’ which may be damaging to taking behaviours’ which may be damaging to healthhealth

• Increasingly more likely to be injured or killed Increasingly more likely to be injured or killed in road and car accidentsin road and car accidents

WHY ARE WOMEN THE MAIN WHY ARE WOMEN THE MAIN CONSUMERS OF HEALTH CONSUMERS OF HEALTH CARE?CARE?• WOMEN ASSUME MAIN RESPONSIBILITY FOR WOMEN ASSUME MAIN RESPONSIBILITY FOR

CONTRACEPTIONCONTRACEPTION• WOMEN ENCOUNTER MEDICAL PROFESSION DURING WOMEN ENCOUNTER MEDICAL PROFESSION DURING

PREGNANCY AND CHILDBIRTHPREGNANCY AND CHILDBIRTH• WOMEN ASSUME PRIME RESPONSIBILITY FOR WELL AND WOMEN ASSUME PRIME RESPONSIBILITY FOR WELL AND

SICK CHILDRENSICK CHILDREN• WOMEN’S ANATOMY IS SEEN TO BE MORE COMPLEX THAN WOMEN’S ANATOMY IS SEEN TO BE MORE COMPLEX THAN

MEN’S AND APPEARS TO BE MORE LIKELY TO SUCCUMB TO MEN’S AND APPEARS TO BE MORE LIKELY TO SUCCUMB TO HELATH PROBLEMS AND ILLNESSHELATH PROBLEMS AND ILLNESS

• TRADITIONALLY WOMEN HAVE BEEN SEEN TO BE FRAIL – TRADITIONALLY WOMEN HAVE BEEN SEEN TO BE FRAIL – MEDICINE HAS CAPITALISED ON WOMEN’S PERCIEVED MEDICINE HAS CAPITALISED ON WOMEN’S PERCIEVED WEAKNESSES ( FROM THE VAPOURS TO PMS)WEAKNESSES ( FROM THE VAPOURS TO PMS)

• WOMEN SEE THEMSELVES AS ILL MORE OFTEN THAN MENWOMEN SEE THEMSELVES AS ILL MORE OFTEN THAN MEN

WOMEN AND MENTAL WOMEN AND MENTAL ILLNESSILLNESSHistorically women have been admitted to psychiatric Historically women have been admitted to psychiatric

hospital at a higher rate than men – in 1999 468 per hospital at a higher rate than men – in 1999 468 per 100,000 – men 364 per 100,000100,000 – men 364 per 100,000

Women are twice as likely to be taking tranquillisersWomen are twice as likely to be taking tranquillisersTwo-thirds of people taking anti-depressants are womenTwo-thirds of people taking anti-depressants are womenWomen are the majority recipients of ECT (approx 70%)Women are the majority recipients of ECT (approx 70%)But the picture is changing as the psychiatric services But the picture is changing as the psychiatric services

focus resources on the people experiencing the so-focus resources on the people experiencing the so-called serious and enduring mental illnesses e.g. called serious and enduring mental illnesses e.g. Schizophrenia, Bi-polar DisorderSchizophrenia, Bi-polar Disorder

Why should this impact on care provision for women?Why should this impact on care provision for women?

Impact on HealthImpact on Health

Women may still (just) have some Women may still (just) have some advantage over men in life expectancy, advantage over men in life expectancy, may seem to get ‘sicker’ (higher rates of may seem to get ‘sicker’ (higher rates of morbidity), may be protected to some morbidity), may be protected to some extent from CHD due to oestrogen levels extent from CHD due to oestrogen levels – but their changing patterns of – but their changing patterns of behaviour are giving cause for interest behaviour are giving cause for interest and concern: women are becoming more and concern: women are becoming more like men, and thus experiencing similar like men, and thus experiencing similar health problems.health problems.

Suggested ReadingSuggested Reading

• Annandale, E. & Hunt, K. (2000) Gender Inequalities in Health. Annandale, E. & Hunt, K. (2000) Gender Inequalities in Health. OUP: Buckingham. OUP: Buckingham.

• Busfield, J. (1996) Men, Women and Madness. Macmillan: Busfield, J. (1996) Men, Women and Madness. Macmillan: Basingstoke.Basingstoke.

• Doyal, L. (1995) What Makes Women Sick? Macmillan: Doyal, L. (1995) What Makes Women Sick? Macmillan: Basingstoke.Basingstoke.

• Miers, M. (2000) Gender Issues and Nursing Practice. Macmillan: Miers, M. (2000) Gender Issues and Nursing Practice. Macmillan: Basingstoke.Basingstoke.

• Wilkinson, S. & Kitzinger, C. (eds) (1994) Women and Health: Wilkinson, S. & Kitzinger, C. (eds) (1994) Women and Health: Feminist Perspectives. London: Taylor and Francis.Feminist Perspectives. London: Taylor and Francis.

• National statistics onlineNational statistics online• Davidson, N. and Lloyd, T. (eds) (2001) Promoting Men’s Health. Davidson, N. and Lloyd, T. (eds) (2001) Promoting Men’s Health.

London: Bailliere Tindall.London: Bailliere Tindall.• www.menshealthforum.org.ukwww.menshealthforum.org.uk• Social Science and Medicine (1999, 4, 1) special issue on gender Social Science and Medicine (1999, 4, 1) special issue on gender

and health.and health.