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Week One Forum Sociology of Medicine and Health

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Week One Forum Sociology of Medicine and Health

Introduction to Section 1 This section addresses the fi rst of the three broad themes identifi ed in the factors mentioned in the Introduction as now being recognized key social aspects of health. In the exploration of ‘The relationship between social categories and health’ that takes place in this section, four such social categories are discussed: ■ Gender and health ■ Social class and health ■ Ethnicity and health ■ Ageing and health Each of these topics is dealt with in a separate chapter and hence there are four chapters. The chapters all include relevant key concepts and theoretical perspectives. Although the chapters in this section can be read independently, you are advised to refer to both the Glossary at the end of the book and to the outlines of the theoretical perspectives that inform the study of the social aspects of health in Chapter 1 to enhance your understanding of each topic. social aspects of health.indb 31 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. social aspects of health.indb 32 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 33 Overview Introduction 34 What is gender? 34 Gender differences in health 36 Morbidity rates 36 Mortality rates 37 Infl uences on men and women’s health 38 Work and gender 38 Public sphere 39 Private sphere 40 Poverty and gender 41 Health-related behaviour and gender 41 Smoking 41 Drinking 41 Diet 42 Exercise 42 Weight 42 Substance misuse 43 Healthcare and gender 43 Recipients of healthcare 43 Providers of healthcare 44 Theoretical approaches to gender differences in health 44 Feminist explanations of gender differences in health 45 Criticism of feminist approaches to gender differences 46 Conclusions 46 Key points 46 Discussion points 47 Suggestions for further study 47 Women are sicker but men die quicker. (Quoted in Gatrell 2008: 2) Gender and health 2 social aspects of health.indb 33 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 34 Section 1 The relationship between social categories and health Introduction The relationship between gender and health has been debated since the 1970s and was one of the fi rst topics to be addressed within the sociology of health and illness. During this time, the many contradictory trends that have emerged, such as that in the quote above, have been extensively researched, contested and theoretically explored. As we shall see in the course of this chapter, gender is a major social division in our society and an appreciation of the impact of gender on health is central to the study of the social aspects of health. This chapter aims to capture the main themes in the literature about this important social aspect of health and starts by clarifying the concept of gender. It then looks at the differences in men and women’s physical and mental health. This is followed by an exploration of a range of infl uences on men and women’s health. The chapter ends with a discussion of theoretical explanations that have been developed about the connections and interactions between gender and health. The emphasis throughout is on both men and women’s physical and mental health. Activity 2.1 Using the boxes below, jot down some examples of what is ‘typically’ associated with being male and female in our society. Males Females There are some ideas in the ‘Activity feedback’ chapter on page 225. What is gender? Gender means something different from sex; sex can be distinguished at birth and refers to being biologically male or female. In other words, sex refers to having male or female genitals and to the ways in which we develop anatomically in certain predictable ways. In contrast, gender means the social, as distinct from purely biological, characteristics associated with masculinity or femininity in a particular society (Janes 2002). For example, in the UK, wearing make-up, dresses and high heels, passivity, tenderness and caring roles are associated with being a female. In contrast, masculinity is associated with physical strength, undertaking physically demanding work, aggressiveness, toughness, and being emotionally unexpressive and adventurous. These associations often lead to unwarranted generalizations from sex differences, referred to as gender stereotyping. They also vary over time and between societies and cultures. For instance, Reynolds (1996: 66) describes how up until the late 1800s all young children, irrespective of whether they were boys or girls, were dressed in what would now be described as feminine clothes. Interestingly, their activities were simultaneously portrayed in literature and the arts as gender stereotypical: ‘Well into the last century, infants and young children were effectively genderless. Boys and girls were both dressed in skirts and frocks . . . images of children tended to conform to gender stereotypes, with boys engaging in activities out of social aspects of health.indb 34 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 35 Chapter 2 Gender and health doors while girls busied themselves at home’. In relation to changes in adult gender stereotypes, during the Second World War women successfully undertook all forms of manual work which previously had not been associated with being female (Jones 1994; Abbott 2006). Such changing gender stereotypes show that gender is not linked to biological necessity. Therefore, sociologists argue that gender is socially constructed because of the way it owes so much to social and cultural infl uences. The social process whereby biological differences are given social and cultural signifi cance and used as a basis for the social classifi cation of males and females is called gender differentiation. Another important concept about the social construction of gender in these arguments is gender role. This refers to the social and behavioural characteristics that a society assigns to masculine and feminine roles. These can form the principal categorization within social life and in some societies there are radical divisions between gender roles (O’Donnell 2002; Gatrell 2008). Extreme social constructionists argue that gender differences have no biological or genetic basis (Oakley 1972). Those that refute this view point to a variety of evidence. This includes the fact that although societies do differ in terms of the exact characteristics they assign to males and females, there is evidence that these ‘gendered roles’ are relatively consistent across time and space. Moreover, there are very few societies where gender roles are completely reversed and females are expected to be ‘masculine’ and vice versa. Other evidence cited is that from studies which show preschool children prefer gender stereotyped toys despite being bought gender neutral toys from the age of 1 (Robinson and Morris 1986; Servin et al. 1999). In defi ning gender, reference has already been made to the fact that gender differences can lead to radical divisions in social life between males and females. One of the main areas where this is most apparent is in health. Activity 2.2 See how much you already know about gender differences in health by ticking whether the following statements are true or false! All of these points are covered in the text in Sections 2 and 3, but the answers can also be found in the ‘Activity feedback’ chapter on page 225. Women have a lower number of inpatient hospital stays than men T/F Women are twice as likely to suffer from depression than men T/F Women live around four years longer than men T/F Heart disease and cerebrovascular disease are a major cause of death among women T/F Men tend to fi nd their work more alienating and stressful than women T/F Smoking rates are higher for women T/F Women are more physically active in every age group T/F Men are more likely to be obese than women T/F There is a general reluctance among men to report ill health and access healthcare services T/F social aspects of health.indb 35 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 36 Section 1 The relationship between social categories and health Gender differences in health As mentioned in Chapter 1, morbidity and mortality rates are used to measure differences in health between various groups in society. Analyses based on these rates show that gender has a signifi – cant impact on physical and mental health. Let’s look at some of these gender differences in health by analysing morbidity and mortality rates further. Morbidity rates Studies about gender differences in health traditionally use indicators of health service use, such as visits to GPs and number of inpatient stays in hospital. These indicators show that women get physically and mentally ill more often. Figure 2.1 illustrates this in relation to the frequency with which women visit their GPs. However, such statistics have been questioned for several reasons. Women are more likely to have to visit their GP and experience inpatient stays because of certain biological conditions related to pregnancy and childbirth, contraception, menstruation and the menopause. In addition, as women live longer than men they are likely to use health services for a greater number of years. Indeed, when this fact is taken into account, women only have a slightly higher morbidity rate with the exception of mental health. This is supported by recent statistics that showed the overall difference between the sexes in self-reported rates of ‘not good health’ was just one percentage point (7 per cent and 8 per cent respectively), once the age distribution of the population was taken into account (Busfi eld 2000a; Offi ce for National Statistics 2006a). Irrespective of whether women do have higher morbidity rates than men or not, some common illnesses which are unrelated to physiological sex differences are gendered. For instance, women are more likely to suffer from cancer, arthritis and rheumatism than men, while men have higher rates of circulatory diseases including ischaemic heart disease (i.e. heart attack or angina) and strokes (Offi ce for National Statistics 2006a, 2008a). With reference to mental health specifi cally, while females have higher rates of mental ill health at most stages of their lives, men and women seem to be prone to particular types of mental illness. The following fi gures illustrate this: Figure 2.1 Gender and morbidity rates – percentage of males and females consulting an NHS GP in the 14 days prior to interview, Great Britain, 1971–2002 Source: National Statistics (2004a) social aspects of health.indb 36 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 37 Chapter 2 Gender and health ■ women are twice as likely to suffer from depression; ■ women are 10 times more likely to suffer from bulimia nervosa and anorexia nervosa; ■ men are more likely to receive a diagnosis of schizophrenia and other serious psychoses; ■ men are three times more likely to commit suicide; ■ more men than women are treated for problems with drug and alcohol abuse (Doyal 1995; Allen 2008; McCrone et al. 2008). Although such fi ndings do clearly show there are gender differences in physical and mental illnesses, evidence is starting to emerge of reductions in some of the observed differences. Among the most interesting developments are the increases in numbers of young men with anorexia nervosa and young women with drinking problems (Drummond 2010; Plant et al. 2010). These changes will inevitability impact on illness rates for males and females and will therefore need to be taken into consideration in future discussions of gender and health. Mortality rates Figure 2.2 shows that while there have been improvements in life expectancy at birth in the UK since 1981, there is still a four-year difference in life expectancy between males and females, and this looks set to continue. When considering this difference, it is important to note that not all the years females gain through increased life expectancy are lived in relatively good health and free from a disability or limiting long-term illness. Healthy life expectancy at birth for females in 2004 Source: Government Actuary’s Department (2006), cited in Allen (2008) Figure 2.2 Male and female life expectancy at birth, UK, 1981–2056 social aspects of health.indb 37 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 38 Section 1 The relationship between social categories and health was 70.3 years compared with 67.9 years for males. Disability-free life expectancy for females born in 2004 was 63.9 years and for males 62.3 years. Consequently, while women live longer than men, they are also more likely to spend more years in poor health or with a disability (Offi ce for National Statistics 2006a, 2008a; Allen 2008; Department of Health, 2009a). As with morbidity, causes of death are gendered, with heart disease and cerebrovascular disease being major causes of death among men. Although these diseases also result in the deaths of a substantial number of women, they manifest themselves in lower mortality rates than for men. The most common causes of death among women are breast cancer and cancers of the genito-urinary system (Hayes and Prior 2003). Infl uences on men and women’s health So what factors lead to these gender differences in health? Much research has been carried out into several aspects of men and women’s lives which shows that there are a variety of infl uences. Examples of these are illustrated in the case study below and then discussed in the rest of the section. Where details of their specifi c impacts on health are required, these will either be given or the reader will be referred to the list of ‘Infl uences on health’ on page 27 of Chapter 1, as appropriate. Case example: Peggy and Stuart This middle-aged couple had just celebrated their twenty-fi fth wedding anniversary. Since the last of their three children had reached school age, Peggy had a part-time offi ce job to fi t in with caring for the family and to supplement the family income. Stuart was a warden in their local country park. Peggy had always been careful of the family’s health, paying great attention to the quality of their diet and encouraging the children to take part in sports activities at school. She applied the same care to her own health, swimming twice a week and accessing health screening programmes when invited to do so. Stuart enjoyed his food but because of the nature of his job did not gain weight until his midforties. When the pounds started to pile on, he refused to reduce the amount he ate or undertake any exercise outside work. In his early fi fties he started to have headaches that lasted several days and found that his increasing girth was slowing him down at work. He initially refused to attend a ‘well-man’ clinic at the local GP surgery but did give in to Peggy’s ‘nagging’ when the headaches increased in intensity. He was diagnosed with high blood pressure and was also found to have considerably raised cholesterol levels. Despite medical advice to reduce his salt and fat intake, plus lose two stones in weight, he strongly resisted changing his lifestyle. Work and gender In order to explore the relationship between gender and work, it is necessary to explain how the sociological concept of work is different from the everyday meaning of work. Work for sociologists has two meanings. ■ An activity which brings in money. This is therefore called paid work and is done outside the home in the public domain. social aspects of health.indb 38 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 39 Chapter 2 Gender and health ■ An activity which contributes to the reproduction of society. This means that the activity is necessary for a society to run but it is unpaid work. These activities enable people to go on living and indeed to undertake paid work. They include all forms of domestic labour such as producing the next generation, caring for children, shopping and cooking for a household, washing clothes, and providing a clean and warm place to relax and sleep. Unpaid work is done in the private domain of the home, does not have as much status as paid work and does not receive the public recognition of money. Sociological research has shown that there are differences between the type of ‘work’ that men and women do in both the public and private sphere. Let’s take the public sphere fi rst. Public sphere Women now make up 45 per cent of the workforce in the UK. Even though there is legislation protecting women’s position in the labour market and more women are educated to degree level than in the past, there are considerable differences in the type of work that men and women do. This means that women do not have the same pay, status and power as men because they are more likely to: ■ be concentrated in certain types and areas of employment such as care work, personal service, shop work, cleaning and clerical work; ■ work part-time and/or in temporary jobs; ■ be in the less well-paid and less powerful posts. For instance, only 10 per cent of women in the UK are judges, 8 per cent are in top management positions and 5 per cent are MPs. A trend of lower pay and less power also applies in those occupations where the number of men and women is equal, such as teaching and health. With reference to health occupations, although the fact that the number of women entering medicine now exceeds the number of men (the ratio is 60 women to 40 men) only 5 per cent of surgeons are female and women typically end up in part-time GP work with smaller caseloads and smaller salaries than their male counterparts (Janes 2002; Gatrell 2008). Despite these inequities, the gender pay gap between men and women has been decreasing since the late 1990s. As Table 2.1 shows, the pay gap (as measured by the median hourly pay excluding overtime of full-time employees) narrowed between 2006 and 2007 to its lowest value since records began. However, this trend can be adversely affected by changes in the economy, particularly Table 2.1 Gender pay gap Employees on adult rates, whose pay was unaffected by absence (%) Median Mean Full-time/full-time 12.8 17.1 Part-time/part-time –3.5 13.2 All employees/all employees 22.5 20.9 Note: The data represent the gender pay gap for hourly earnings excluding overtime Source: Hicks and Thomas (2009) social aspects of health.indb 39 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 40 Section 1 The relationship between social categories and health economic downturns and realignments of different employment sectors. An example of the latter is the continuing decline of the manufacturing sector. One of the outcomes of this decline is that men are predicted to take a bigger share of the part-time jobs in the service sector that have to date been mainly undertaken by women (Sunderland 2009; UK Commission for Employment and Skills 2009). There are proven health advantages related to pay, status and power. These include enhanced quality of life and higher rates of self-esteem. It is clear from the preceding discussions that these health advantages are not equally shared between men and women and that this situation may also worsen. Furthermore, there is some evidence that the types of jobs women undertake are hectic with little control over their hours or conditions of employment. As such characteristics have been linked to increased stress levels, it has been argued that women are much more likely to suffer from stress from their employment outside the home. On the other hand, women are less likely to be in dangerous and/or polluting occupations such as the armed forces, agriculture, construction and mining. Men also tend to fi nd their work more alienating and stressful than women because they see their jobs as their key role in life, have higher aspirations and are less likely to be motivated by a desire for sociability and social interaction than women. In fact, being in paid employment has been found to be benefi cial to women’s health in terms of enhancing their self-esteem and extending their social networks (Doyal 1995; Annandale and Hunt 2000; Busfi eld 2000a). Private sphere Regardless of whether they or their partners/husbands are employed, women are primarily responsible for the day-to-day running of the home and carry out the bulk of all domestic and caring work. This includes cooking, cleaning, the washing and ironing, shopping, and caring for both children and elderly/frail relatives. Although men provide some help with such activities, the only area of domestic life where they are likely to make a signifi cant contribution is repairs around the house (Sullivan 2000; Abbott 2006; National Statistics 2007; Gatrell 2008). Thus, even though women are now recognized as being a crucial part of the workforce, and their wages are essential to the economic well-being of the family, they continue to bear substantial domestic responsibilities. The way that working women tend to combine their paid work in the public sphere with their unpaid work in the private domain of the home has led to the development of the concept of the dual role. Fulfi lling a dual role has implications for women’s health. With respect to domestic tasks specifi cally, these have many of the characteristics that occupational psychologists have shown to be most stressful for waged workers. This is because they are of service to others, monotonous, boring and repetitive, and they are not done through choice. The fact that there is also no recognition for this work because housework is rarely noticed unless it is not done can lower self-esteem and promote feelings of worthlessness. The emotional and mental strain of meeting the demands of their roles in the private and public spheres has been shown to lead to exhaustion and depression in women (Oakley 1974; Doyal 1995). These sorts of fi ndings about the different activities and roles that men and women undertake in the private sphere of the home and the public sphere of paid employment are referred to as the sexual division of labour. It is important to note that both men and women are constrained by this sexual division: just as it is diffi cult for a woman to advance in her career in a way she might wish, so it is also diffi cult for a man to participate fully in family life. Each is constrained by the gender expectations of their respective roles and there are fi nancial as well as social penalties for those who do not conform (Janes 2002; Abbott 2006). This is illustrated in the following quotation from Abbott (2006: 67): ‘structural constraints continue to limit the opportunities available to women in a masculine culture. At the same time, although men benefi t from this relationship, the same masculine culture also imposes constraints on men’. social aspects of health.indb 40 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 41 Chapter 2 Gender and health Poverty and gender As we saw in Chapter 1, poverty is an important determinant of physical and mental health. The different positions of men and women in the public and private domains is one of the reasons why women are more vulnerable to poverty than men throughout their lives. Indeed, 20 per cent of women compared to 18 per cent of men in the UK belong to households in poverty (Palmer et al. 2007). Particular groups of women are more vulnerable to poverty than others, such as those who are lone parents (especially teenage lone parents) and older pensioners (see Chapter 5) (Gardiner and Millar 2006; Levitas et al. 2006; Patsios 2006). Women are also more likely to experience poverty at particular stages of their lives – for example, when caring for children and following divorce. With reference to the latter, it has recently been established that women suffer more fi nancially than men after a divorce: men’s incomes rise by a third and women’s incomes (regardless of whether they have children or not) fall by more than a fi fth and remains low for many years. This has important implications for women because almost half of marriages in England and Wales will end in divorce. When they live in poor households, women often bear the brunt of poverty and they are the ones who ‘do without’. Studies have shown that they make sacrifi ces in terms of going without food, clothes and entertainment to provide for their children, in order to manage with scarce resources (Abbott 2006; Jenkins 2008). Women’s increased risk of, and greater vulnerability to, poverty in their lives means that they are therefore at risk of the adverse effects of poverty on their health, as discussed in Chapter 1 (see page 27). Health-related behaviour and gender Men and women’s health-related behaviour varies and while there are some exceptions, men tend to engage in more risky behaviour that is a threat to their health. Some examples are set out below. Smoking Figure 2.3 shows that although smoking prevalence has declined dramatically during the past four decades, men are still more likely to smoke than women across all ages. In 1974, 51 per cent of men and 41 per cent of women smoked whereas in 2007 these fi gures had dropped to 22 per cent and 20 per cent respectively. The gap between men and women therefore fell from 10 per cent to 2 per cent (Offi ce for National Statistics 2006a, 2009). Although the consistently higher smoking rates among men have been attributed to conformity to ideas of masculinity, some of the complexities of the relationship between women and smoking have also been unravelled. For instance, studies have found that certain groups of women, such as young mothers on low incomes, are more likely to smoke than others despite the fact that they acknowledge smoking is irrational from a health and fi nancial point of view (see Chapter 1, page 27). They say they smoke because they feel that it creates space and time out for them from their daily routines of caring for their families and helps them cope (Graham 1993; Graham and Blackburn 1998). Drinking More men than women exceed the recommended daily alcohol intake benchmarks (40 per cent of men compared to 23 per cent of women). Men are also more likely to drink more heavily than women (23 per cent compared to 9 per cent). Death rates for men from alcohol-related causes, including accidents, alcohol-related illnesses and accidental poisoning with alcohol are over double those for women (Busfi eld 2000a; Offi ce for National Statistics 2006a, 2008a). social aspects of health.indb 41 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 42 Section 1 The relationship between social categories and health Diet Although both men and women generally have a good knowledge of what constitutes a ‘healthy diet’ and the ways in which such a diet benefi ts their health, men report greater diffi culties acting upon their knowledge for various reasons. These diffi culties include increasing responsibilities at home and at work. Hence, women have healthier diets and are more likely than men to eat wholemeal bread, fruit and vegetables once a day, drink semi-skimmed milk and eat less ‘unhealthy foods’ like cakes and chips (Offi ce for National Statistics 2006a; Weaver et al. 2008). Exercise Although the percentage of adults who meet the recommended levels of physical activity has declined since 2003, men are more active in every age group (Offi ce for National Statistics 2006a; Weaver et al. 2008). The general reduction in adults taking the recommended levels of exercise is a risk factor in the health of both men and women (see Chapter 1, page 27). The fact that women are less active indicates that they are at greater risk than men. Weight Men are more likely to be overweight but less likely to be obese than women. Body mass index (BMI) is the indicator of healthy and unhealthy weight that is now used and is a measurement of a person’s weight in kilograms divided by their height in metres squared. A BMI of more than 25 is regarded as being overweight and about 65 per cent of men currently have a body mass index of more than 25 compared to 55 per cent of women. Being obese is defi ned as having a BMI of 30 or more. Although the gap between the sexes in terms of obesity has been closing during the past two decades, overall obesity rates have increased and women are still more likely to be obese. As Figure 2.4 shows, in 1993 the obesity rates were 13 per cent and 16 per cent for men and women respectively. In 2005, the equivalent fi gures were 23 per cent and 25 per cent (Offi ce for National Statistics 2006a, 2008a). Figure 2.3 Prevalence of cigarette smoking, Great Britain, 1974–2007 Source: Offi ce for National Statistics (2009) social aspects of health.indb 42 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 43 Chapter 2 Gender and health Therefore, signifi cant numbers of men and women are at risk of the many health problems associated with being an unhealthy weight, and women in particular are more likely to develop the more severe health problems that obesity brings (see Chapter 1, page 27). Substance misuse Both the number of, and the gender difference in, those reporting use of illicit drugs has decreased since 1998. Nonetheless, 9 per cent of men and 7 per cent of women still report such usage which indicates that men are still more likely to experience the negative effects of substance misuse on their health than women (see Chapter 1, page 27) (Offi ce for National Statistics 2008a). Healthcare and gender The ways in which men and women’s experiences as recipients and providers of healthcare vary are yet another set of infl uences on gender differences in health. Although some aspects of the examples discussed in this section are addressed in more detail in other parts of the book, the following overview of the gendering involved in receiving and providing healthcare will give you an appreciation of the relationship between gender and healthcare. Recipients of healthcare We saw earlier in this chapter that medicine plays a greater role in women’s lives because they visit their GPs more frequently than men and have a higher number of inpatient stays in hospital. Feminists have argued that as the senior levels of the medical profession are male dominated, research and therapies are shaped by male interests. As a result, women are subject to control by men within the healthcare system and their medical diagnoses and treatment are adversely affected (Oakley 1993; Doyal 1995, 1998). On the other hand, men’s medical needs are not always met through healthcare services. This is partly because of a general reluctance among men to report ill health and access services that are Figure 2.4 Prevalence of obesity in adults: by gender, 1993–2005 Source: Offi ce for National Statistics (2008a) social aspects of health.indb 43 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 44 Section 1 The relationship between social categories and health available and partly because of inadequate levels of healthcare provision for men, such as less than comprehensive screening for testicular and prostate cancer (Luck et al. 2000). The following quote illustrates this; it is about treatment available through the NHS and how this is ‘more focused and holistic for female health needs but more fragmented for male health needs. The result is that the NHS generally provides health services for males only in indirect and implicit ways’ (Luck et al. 2000: 145). Providers of healthcare Community care policies since the 1970s have led to an increasing reliance on family carers, most of whom are women. Women are also expected to make sure their children are healthy, take appropriate action if they are ill and provide informal healthcare. It is well established that informal caring negatively affects physical and psychological health (Lewis and Meredith 1988; McLaughlin and Ritchie 1994; Brown and Stetz 1999; Hirst 1999; Bond et al. 2003) (see also Chapters 5 and 10). Despite the increase in the number of male nurses, nursing is still a female-dominated profession. Although many fi nd being a nurse a satisfying job, they face several health hazards in the course of their duties. In hospitals, risks include lifting heavy patients, allergic reactions to drugs they have to administer and violence from patients. Nursing, particularly mental health nursing, can be psychologically stressful because of the responsibility involved, workplace culture, understaffi ng and lack of resources (Doyal 1995, 1998; Hayes and Prior 2003; Gabe et al. 2004). Activity 2.3 Now that you have read through the above account of the infl uences on men and women’s health, what do you think are the problems of studying gender differences in health? You may wish to compare your ideas with those presented in the ‘Activity feedback’ chapter on page 225. Theoretical approaches to gender differences in health The nature and the extent of the sort of differences in men and women’s lives that have featured in the discussions of the infl uences on gender and health in this chapter are examples of the evidence used to argue that gender is a major social division. As we have seen, gender structures and organizes our public and private lives and opportunities, leading to inequalities between men and women. There are several theoretical approaches which specifi cally address gender inequalities in health. Although biological factors (such as the way women’s experiences of health are shaped by menstruation, pregnancy and childbirth) are acknowledged, within the study of social aspects of health explanations tend to emphasize socially constructed gender differences. For instance, cultural and behavioural explanations have focused on the extent to which women suffer from ill health because they take on too much responsibility if they accept the role of housewife as well as undertake paid employment and/or do not take regular physical exercise. Another important approach has adopted the concept of hegemonic masculinity. This concept is used to explain how particular versions of masculinity come to be idealized and embedded in culture and in institutions in society. Characteristics of such ideals of masculinity typically include stoicism and invincibility, which in turn are seen as demonstrating manliness. Hegemonic masculinities lead to alternate forms of masculinity being regarded as less legitimate. Explanations which apply the concept of hegemonic masculinity to gender differences in health highlight the ways in which men’s poorer health in social aspects of health.indb 44 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 45 Chapter 2 Gender and health general is due to their health-related behaviour. They link this behaviour to the construction of masculinity in our society which inhibits self-care and healthy lifestyles. These approaches therefore argue that in order to change men’s attitudes to their health and health behaviour, hegemonic masculinity needs to be challenged (Connell 1995; Gough and Robertson 2010). Although the above theoretical approaches are very useful, it is feminism that has had the most impact on the development of theoretical explanations of gender differences in health. Hence the rest of this section will look at these in more detail Feminist explanations of gender differences in health Some of the work of leading feminists in the fi eld of gender and health (most notably Oakley and Doyal) has been mentioned in this chapter already. Despite their differences, feminist perspectives have certain commonalties. For instance, they all acknowledge that differences in patterns between male and female health and illness stem in part from obvious biological differences. In addition, they assume that patriarchy is an important consideration in health and point to the way that women have been excluded from the medical profession because of male domination, and how men have taken over aspects of women’s lives, such as childbirth, and imposed their views about what is regarded as abnormal physical and mental symptoms in women patients. Nonetheless, feminist views on gender and health do vary and the interpretations put forward by Marxist, radical and liberal feminists are outlined below to illustrate some of these variations. ■ Marxist feminism: according to Marxist feminists, women are exploited as reproducers and producers. When analysing gender differences in health, the emphasis in this perspective has been twofold. The fi rst is on the way women’s fertility is exploited because of the need to produce the next generation of workers required by capitalism. The second is women’s exploitation in their role as providers of free childcare and increasingly as informal carers of old and/or disabled family members. ■ Radical feminism: as radical feminists argue that it is men, as opposed to the economic system, that dominate and shape society to meet their own needs rather than the needs of both males and females, they maintain that it is men who control and benefi t from healthcare. ■ Liberal feminism: the emphasis within liberal feminism is on gender equality through campaigning for equal rights. This has led liberal feminists to focus on the inequalities in women’s participation in medicine as a profession. With reference specifi cally to mental health, some feminist writers have argued that the gender differences in mental health are constructed by psychiatry and psychiatrists. The categories and concepts used in psychiatry mean that women and their behaviour are more likely to be defi ned as pathological and hence there is more chance of them being wrongly diagnosed as mentally ill than there is for men. There is also a greater likelihood of discourses from criminology being used to construct men’s behaviour and this is yet another reason why men do not receive psychiatric diagnoses as often as women. With regards to psychiatrists, these feminist writers have focused on the way that gender shapes the encounter in consultations between male professional psychiatrists and female patients; as the psychiatric profession is male dominated, patriarchal power is exercised during consultations. Within patriarchal power, women’s behaviour is typically devalued and pathologized and they are, by defi nition, viewed as being psychiatrically impaired. Thus during social aspects of health.indb 45 17/12/2010 11:42 Larkin, Mary. Social Aspects Of Health, Illness And Healthcare, McGraw-Hill Education, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=681119. Created from apus on 2019-10-09 14:42:45. Copyright © 2011. McGraw-Hill Education. All rights reserved. 46 Section 1 The relationship between social categories and health consultations between male psychiatrists and women, women tend to be labelled as mentally ill (Showalter 1987; Ussher 1991). There is evidence to support such views from studies on the diagnosis of mental illness. One such study is that by Floyd (1997) who found that the diagnosis of depression in women is inaccurate with a misdiagnosis in 30–50 per cent of female patients. This study identifi ed some of the causes of mis diagnosis by psychiatrists, such as a woman’s age, sexual orientation, menstrual, occupational and/parental status. These are therefore potential areas for discrimination against women used within the psychiatric diagnostic process which can lead to them being wrongly diagnosed as depressed. Criticism of feminist approaches to gender differences Critics of the aforementioned feminist approaches highlight how they ignore the way in which healthcare can also harm men – for example, because of lack of screening programmes for men’s diseases (Abbott et al. 2005). They also argue that there is a need to look at the changing social constructions of gender and illness. This can be illustrated by another reference to mental illness: Payne (1998) described how young men have come to be constructed as being more likely to be highly mentally disordered than women. She attributes this to several highly publicized incidents involving mentally disordered young men in the 1990s which led to the construct of the ‘highly disordered male’ being created. This coincided with other representations of young men that were emerging at the same time, such as their increased levels of involvement with the criminal justice system, dramatic increases in suicide and higher rates of youth employment. Thus, fears about the danger of the mentally disordered came to focus on young men and madness was consequently reconstructed in gendered terms as being associated with this group. Conclusions The powerful infl uence of gender on our physical and mental health is clear from the material and information presented in this chapter. Both sociology and the sociology of health and illness have made and continue to make valuable contributions to understandings of gender differences in health. Among the most signifi cant of these is the acknowledgement that the health of men and women is shaped by a multitude of social factors that interact in a variety of ways and change over time. This leads to the conclusion that the study of gender differences in health is dynamic and, furthermore, cannot be studied without due consideration of the other social divisions that impact on our health during our lives (Seale and Charteris-Black 2008). Therefore, the next three chapters will assess the effect of social class, ethnicity and age on health. Key points ■ Gender differences can lead to radical divisions in social life between males and females. ■ In relation to health, gender signifi cantly impacts on both physical and mental health. ■ Factors that lead to gender differences in health include the type of ‘work’ that men and women do

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