Inequalities in Health Gender, Ethnicity & Social Class

Discuss A 2008 study concluded that life expectancy in Glasgow is lower than in Baghdad. Why do you think this might be the case?

This Section… Are some groups in society more/less healthy than others? If so, why is this? Is it evidence of serious inequality in our society? GENDER. ETHNICITY. SOCIAL CLASS For each one, we’ll briefly examine EVIDENCE of inequality/difference. We will then focus on the different types of explanations.

Different Types of Explanations?

Artefact The statistics are flawed…or, the method by which the statistics were gained is flawed. For example, statistics might tell us that one group of people have more ill health than another. However, that group might be more likely to report sickness to their doctor, or more likely to admit they are ill. Only sickness that is reported makes the statistics. Therefore, the statistics are flawed.

Recap What different types of statistics do we use to gain information on health/illness? Where does this data come from, and what problems have we already identified with it? Because we have already identified issues with the statistics, you can also refer to this issues when writing about Artefact explanations. The statistics are ALWAYS flawed.

Biological There are clear genetic/physiological differences between different groups (e.g. males/females; ethnic groups). Therefore, some groups may be more resistant to certain types of illness than others and therefore suffer less illness/live longer (e.g. some claim women may be more resistant to heart disease…).

Cultural/Behavioural The behaviour of individuals causes them better/worse health. Sometimes, this behaviour might be dictated by the culture of the society. Smoking, drinking, dieting, exercise etc. are all behavioural factors…Some behaviours might be more/less common in certain groups (e.g. working-classes have higher smoking rates). Cultural factors look at the types of behaviour expected from different groups. For example, men are expected to act ‘tougher’…

Structural/Material The structure of society and the living/working conditions of people within it are responsible for health inequalities. For example, ethnic minorities, working-classes, males = all more likely to work in dangerous conditions. Women more likely to experience poverty; some ethnic groups more likely to experience homelessness…

Social Selection Refers specifically to SOCIAL CLASS… …Suggests that people do not suffer poor health because they are of a lower social class… …Instead, having poor health makes people move down the social class scale (downward mobility). In other words…PEOPLE ARE NOT SICK BECAUSE THEY’RE POOR : PEOPLE ARE POOR BECAUSE THEY’RE SICK!

DISCRIMINATION Being discriminated against and experiencing things like racism, bullying etc. due to factors beyond your control (e.g. gender, race) creates stress that in turn causes social problems and ill health. The more vulnerable a group is to discrimination, the more ill health they are likely to suffer.

1. Gender

What is the difference between sex and gender? Recap What is the difference between sex and gender?

Difficulties in studying Gender and Health There are a lot of extraneous variables. For example, a person may be a young, rich, middle-class, Chinese woman. Which of these five variables is most important in determining her health chances? Where possible, we must ask additional questions to remove the extraneous variables.

Gender & Mortality

Activity Complete the table on your worksheet Identify which type of explanation best fits each statement. 5 mins

Gender & Mortality Since the end of the C19th, women have had a higher life expectancy than men. At all ages, women’s death rates are lower than men’s. Almost two thirds of deaths before age 65 are male – after that, there are twice as many women than men in the population.

Gender & Mortality

Gender & Mortality Heart diseases are the main causes of death in both sexes... ...Although men are more likely to die from this, as well as from cancer and HIV/AIDS. Men are twice as likely to die in accidents and three times more likely to commit suicide.

Issues with Gender & Mortality Statistics Not all women shared an equally long life-expectancy... ...Social class, for example, seems to have a particularly significant impact on women’s life expectancy (e.g. a rich woman lives significantly longer than a poor woman).

Gender & Morbidity “Men die quicker, but women are sicker!” What does this quote, cited as a general trend in health studies, suggest?

Gender & Morbidity Women live longer than men but... ...Spend more years of their lives in ill health than men.

Gender & Morbidity: Discuss From where do we obtain data on morbidity? Why might this make us question the statement on gender and morbidity?

Explaining Gender Inequalities in Health

In Pairs Consider the different types of explanation. For each, decide on at least two explanations as to why women live longer than men, and why women are more sick than men. ARTEFACT BIOLOGICAL CULTURAL/BEHAVIOURAL STRUCTURAL

Activity On the following slide are a range of explanations. In pairs, decide whether the explanations are biological (B), Cultural/Behavioural (C), Artefact (A) or due to Structural (S). You have five minutes, then pairs will record their answers on the board.

Males are more likely to play violent sports Pregnancy and childbirth impacts women’s health more than men’s. Men drink and smoke more than women Working-class women have difficulties accessing their GPs Women are more likely to report themselves as ‘sick’ than men Women are socialised into being more aware Women have a better resistance to heart disease Women are more likely to suffer from poor/inadequate working conditions Menstruation and menopause impact women’s health, not men’s. Most people in senior positions in healthcare are men Men do not visit GPs as often as women Women’s role of carer causes ill health Some forms of cancer are gender-specific (e.g. prostate, ovarian). Women are less likely than men to take regular physical exercise Women are more likely to live in poverty than men

1. Genetic/Biological Explanations Biological differences mean that women may require more medical advice/help than men: Statistically, this makes it seem like women are more ‘sick’ – but in reality, this is not the case. Discuss: What conditions is this referring to? Because women live longer, they are also more likely to experience degenerative conditions.

2. Genetic/Biological Explanations There is evidence to support the view that women have a better genetic resistance to heart disease (Waldron; 1983)

Genetic/Biological Explanations: Evaluation Points Biological explanations cannot account for all illness – so are somewhat limited. Gender differences also do not necessarily mean inequality. Many biological factors are subject to cultural influences. For example, how do the following issues differ between cultures and societies (and how might they impact health): Contraception? Age at which women have children? Number of children produced? The treatment of women in pregnancy and childbirth?

2. Artefact Explanations The differences in morbidity rates are partially down to self-reporting...women are more likely to report themselves as sick than men. However, Macintyre (1993) found that men are more likely to over-rate their symptoms (meaning women might actually experience more ill-health than statistics show...).

3. Cultural/Behavioural Explanations The norms/roles of hegemonic masculinity may encourage behaviours that pose serious risks to health... What sort of norms/roles might this include?

3. Cultural/Behavioural Explanations Suicide is the most common cause of death among young men – their higher consumption of drugs/alcohol may account for this (Taylor & Field; 2007) A study by Perren et al (2004) found that men are more likely to be socially isolated than women (which might restrict their potential to seek help or advice).

3. Cultural/Behavioural Explanations Women are more aware of their health (as femininity is ‘defined’ by the body) and more likely to follow healthy diets... ...However, females are more likely to suffer from eating disorders than men (possibly due to pressure from the media) http://www.youtube.com/watch?v=5g8ygw0icEQ

3. Cultural/Behavioural Explanations It is more socially acceptable for women than men to define themselves as ill, because they are socialised to be more aware than men of their health problems. Seligman (1990) called this ‘learned helplessness’.

Discuss Do you agree that women have more health awareness and are more likely to seek a doctor’s help? Can you think of anything that may limit a woman’s likelihood of visiting a doctor?

Activity In Pairs: Study the worksheet on Matthew Parris and answer the questions provided.

4. Structural/Material Explanations The role of women as carer (of children, partner, relatives etc) causes ill health. Graham (1985) claimed that 80% of disabled adults who live at home are cared for by mothers. Parker (1980) found that the health of family members was a key reason for women retiring early.

Ext: - How might women’s caring role differ between social classes? Discuss: Pairs How might women’s caring role affect their health chances? Decide on a minimum of three ways. Ext: - How might women’s caring role differ between social classes?

Material/Structural Explanations Women are also more likely to experience poor employment conditions (low pay, no perks etc), which can force them into poorer living conditions and – ultimately – poverty. Pahl (1983) found that members of the same household do not always enjoy the same standard of living...

Material/Structural Explanations Men are more likely to suffer accidents at work than women. Structural changes in the economy have led to an increase in male unemployment: Unemployment is linked to mortality and morbidity.

Activity: Copy and Complete Structural Factors May Cause: How?: Who is most affected (men or women?): Lung Cancer RSI Asbestosis Industrial Accidents Asthma Leukaemia Bronchitis Tuberculosis Depression

Structural/Material Explanations: Evaluation Points Gender roles are changing, which makes many of these explanations outdated (e.g. more women in manual positions than before…) Structural explanations do not take into account individual lifestyles. Some poor people (men or women) suffer more ill health than others, so structure alone cannot explain health inequalities.

Homework Outline and evaluate the view that women experience more ill health than men [33] Due: Next Lesson

Gender & Mental Illness

Which of the explanations covered so far could be applied to this? Evidence More women than men are diagnosed with mental illnesses. Women are more likely to self-report psychological illnesses inc. depression, worry, sleep disturbance, strain (Blaxter, 1990) Which of the explanations covered so far could be applied to this?

Biological Explanations??? Some diagnoses are limited to women (e.g. post-natal depression)… …Although there are other diagnoses which are overwhelmingly male (e.g. anti-social personality disorder). Women live longer than men, therefore have higher rates of conditions such as dementia/depression in old age…

Rogers & Pilgrim (2005) Three explanations for the over-representation of women in mental health statistics: Social causation Artefact Social Labelling

Social Causation Society causes excessive mental illness… Women’s lives are more stressful than men’s because Of their role as carers Of the lack of structure in domestic roles Of their lack of time to reflect over emotional difficulties Of their lack of privacy

Artefact Female over-representation is a social construction. Women are more likely than men to seek professional help… Mental illness among women might actually be under-represented, as women place the needs of their children before their own, thus never enter the sick role.

Social-Labelling Women are more likely to be labelled mentally ill than men. Women who deviate from traditional femininities are easily labelled as ‘mad’ or ‘neurotic’. Women are more likely to be prescribed tranquilisers and anti-depressants than men. This turns social problems into medical ones (see: Iatrogenesis).