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Gender and Ethnic health inequalities. Lydia J enkins. Gender:. Sex v Gender. Define Sex: Characteristics between men and women that are biologically determined Define Gender: Social and cultural meanings assigned to being male or female, not singular or fixed. Male v. F emale. - PowerPoint PPT Presentation
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Gender and Ethnic health inequalities
Lydia Jenkins
Gender:
Sex v Gender
Define Sex:Characteristics between men and women that are biologically determinedDefine Gender:Social and cultural meanings assigned to being male or female, not singular or fixed
Male v. Female
Men are more likely to…….• Die at every stage from foetus to old age
(especially pronounced in youth and early adulthood)
Women have higher……..• Rates of illness and disability• Uptake of health services• Rates of anxiety and depression
Alcohol
Men:• Almost twice as likely to exceed recommended daily
limit• Estimated twice as many have an alcohol use disorder
Obesity
Men:• More men are overweight than women
Similar proportions of men and women are obese
Accidental death
Men:• 16-34 especially at risk• Rates of accidental death
higher in every age group (except towards end of life-more women than men alive)
• 4x more likely to commit suicide (use more violent and lethal methods than women)
Women:• 3-4 times more likely to
commit self harm (including attempted suicide)
Access to health care
Men:• More willing to use a
Locum doctor or A and E as alternatives to GP
Women:• More likely to see GP• Assigned the ‘family
health role’ – including children’s health
Gendered explanations of men’s health
• Male mortality partly reflects men’s exposure to occupational accidents and disease
• Male health related behaviours – means for a man to demonstrate his masculinity
• ‘Masculine-sanctioned’ coping behaviour – just man up etc.• Men taught to be self sufficient, not complain and be strong• Men perceive health to be primarily a women domain• Men perceive themselves to be less at vulnerable/ suseptable
to illness• Tend to ‘normalise’ symptoms and fear wasting the doctors
time
How can we improve men’s health?
• Extend surgery hours• Outreach activities• Well man clinics• Pharmacy services• Address gay men's health• Improve GP training in relation to young men• Increase awareness of confidential and
anonymous sources of health information
Gendered explanations of women’s health
• Tend to be characterised by different roles/duties
• More vulnerable to poverty and bear the brunt of low income households
• Maintain the material and psychological environment of the home – increased isolation and self denial (a women’s work is never done, can lead to stress, anxiety etc)
Gender influences on health care provision - CHD
Women: • Appear to have decreased neuroendocrine and cardiovascular
reactivity to stressors• Oestrogen protects women prior to menopause• Peripheral obesity• less likely to receive a preliminary diagnosis of CHD, and
decreased likelihood of further investigation• less likely to have been prescribed aspirin and lipid lowering
drugs• less likely to be hospitalised, and receive less invasive
treatment
Gender influences on health care provision - CHD
Men:• Appear to have life long sensitivity to certain
damaging metabolites• Central obesity• Twice as likely to have surgery for CHD than
women
Gender influences on health care provision – Mental health
Women:• Prescribed twice as many psychotropic drugs per head
than men – despite equal prevalence between the sexesExplanations:• Drs more likely to perceive a physical illness as
psychological in females• Medical advertising reinforces this perception• This type of medication is more acceptable for women
than men
Breast Ca
• No social patterning in terms of prevalence• 5 year survival rate is 6% higher on women in
more affluent areas
Prostate Ca
• Rates tripled over the last 30 years – men living longer and better testing
• Men lack knowledge re: prostate cancer
Smoking
Men:• Historically
more men smoke than women
• Coping strategy• Affirms status
and place in social network
• Rates decreasing
Women:• Closely associated with disadvantage
and psychological stress• Those who carry a heavier burden tend
to be heavier smokers• Coping Strategy• Aware it plays a contradictory role in
their life• In lower income groups, can be the only
personal expenditure, leisure activity• Rates increasing
Ethnicity
Definitions:
Race:• A concept concentrating on assumed
biological or genetic differences between groups of people
• Used to support racist views• No scientific basis for the notion that different
races share biological or genetic features significant for health
Definitions:
Racism:Idea that one race is superior to anotherRacialisation:Social process which creates the conditions for groups to be recognised as races and which makes racism possible.Involves negative evaluation of particular somatic features and assignment of these individuals to a general category which is seen to reproduce itself biologically.
Definitions:
Ethnicity:• A long shared history, of which the group is
conscious as distinguishing it from other groups and the memory of it keeps it alive
• A cultural tradition of its own – including family and social customs and manners. Often but not necessarily associated with religious observances
No reference to biological or genetic traits.
Large scale migration is dictated by:• Needs of local economy• Patronage of friends and familyTend to be largely concentrated in urban areas
Why describe ethnicity?
• Provides useful national figures
Scrutinises certain ‘exotic’ or ‘deviant’ groups while ignoring the white majorityAccused of assuming or exaggerating a groups homogeneity, and focusing on contrast between groups rather than similarities
Ethnicity and health:
Describe the relationship between ethnicity and health:On the whole ethnic minority groups have poorer health that white majority populationsCan be described in terms of:• Genetic and biological• Cultural• Migratory• Social deprivation• Racism
Genetic/biological:
Based on notion of ‘genetic homogeneity’ • Some congenital abnormalities and
haemoglobinopathies are strongly influenced by genetic factors (e.g. sickle cell)
BUT this can’t fully explain the health inequalities observed
Cultural:
Seeks to locate the poorer health of ethnic minorities in the nature of what it is to be a member of that specific group.• Concentrates on health behaviours and beleifs• Assumes other features of specific cultures also
harmful or the harmful factor is somehow inherent to those people
BUT neglect social character of ethnicity and detach health experiences from social content ‘culture blaming’
Migratory:
Migrants selected by health characteristics – usually have better health among population of origin.• Health of migrants reverts to the standard mean
of origin population, giving them a relative decrease in health compared to health in country of destination
HOWEVER – ‘salmon bias’ phenomenon – people return home when ill, could artifically decrease the mortality rate if migrant populations
Difference between 1st and 2nd generation migrants:
• Childhood experience• Migration occurs along side social and economic
upheaval which might have a direct impact on health
• Contemporary social and economic experiences might be different between migrant and non migrant generations
• Generational differences driven by particular political and historical events
Social deprivation:
Ethnic patterning mirrors the broad patterning of socio-economic inequality among ethnic groups
MAJOR contribution to health inequalities experiences and appear more important that the other factors
Racism:
Conduct, words or practises which disadvantage people because of their colour, culture or ethnic origin• Direct – health differences• Indirect – worried re:possible discrimination, this
can impact on their health• Institutional – collective failure of an organisation to
provide approprate and professional service to people because of their colour, culture or ethnic origin
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