Embed Size (px)
DESCRIPTION
“Constrained Choice: A Framework for Understanding the Intersectionality of Social Disparities and Health Outcomes” American Sociological Association Annual Meeting, Atlanta. August 16.
Citation preview
Constrained Choice: a Gendered Framework for
Understanding Health Disparities Chloe E. Bird, PhD
RAND Corporation
Martha E. Lang, PhDGuilford College
Patricia P. Rieker, PhDBoston University
Overview Summary of gendered health
disparities Current knowledge gaps in
understanding causes of gendered health disparities
The uses of the constrained choice model to address these knowledge gaps
Ways that the constrained choice model can inform our understanding of health disparities stemming from the intersections of gender, race/ethnicity and sexual orientation
50
55
60
65
70
75
80
85
U.S. Life Expectancy at Birth, 1970-2005Years of life
SOURCE: Hoyert, DL, Kung HC, Smith BL, Deaths: Preliminary Data for 2003, National Vital Statistics Report, Volume 53, No. 15, National Center for Health Statistics, Hyattsville MD, February 28, 2005 and Kochanek, KD, Murphy, SL, and Anderson, RN, Deaths: Final Data for 2002, National Vital Statistics Report, Volume 53, No. 5, National Center for Health Statistics, Hyattsville, MD, October 12, 2004.
More information on life expectancy is available at: http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm
1970
1980
1990 200
0
0
White female
Black female
White male
Black male
2005
W orld Map of Gender Gap in Life Expectancies, 2000-2005 Average
Source: U N D P 2005
N um ber of Years W om en L ive Longer
-1.7 - 1
1 - 3
3 - 6
6 - 9
9 - 13.1
World Map of Gender Gap in Life Expectancies, 2000-2005 Average
Source:: UNDP 2005
Number of Years Women Live Longer
than Men
Explanations of Gendered Life Expectancy Gap
Biomedical Explanations Hormonal differences Immune function Sex-specific and sex-linked diseases Biological evolution
Social Explanations Emphasize Context and Mediating Factors SES affects exposure/risk and
vulnerability/resilience Age, education, race/ethnicity, marital status
Social relationships Social support Social isolation
Personality traits and coping responses
What’s Missing?
Neither social or biological explanations alone are sufficient
Inequality models do not explain paradox
Lack of knowledge of pathways and processes
Disciplines proceed separately Many questions about gender and
little certainty
What’s Needed to Gain a Better Understanding of
Gender Differences? A comprehensive social
framework that incorporates: contextual effects on health individual choice and agency interaction between biological and
social processes
Decisions and Actions by Families, Communities and
Governments Shape men’s and women’s
choices and opportunities Impact their stress levels and
exposure to risks Create incentives and
disincentives for engaging in health behaviors
Schematic Framework of Constrained Choice
Individual Choices (e.g. Health Behaviors)
Health OutcomesMorbidity Mortality
Work
Community Settings
Government Social Policies
Family
Biological Processes(e.g. Stress Responses)
Further Questions for Consideration
How are does gender intersect with other social statuses in compounding health disparities?
How do these intersected statuses result in unique health disparity experiences for specific populations?
How do we frame the role of normative expectations and social policies in shaping intersectional health disparities?
Constrained Choice Schematic with
Intersection TheoryClass
Race
Gender
Sexual Orientation
Individual Choices (e.g. Health Behaviors)
Health OutcomesMorbidity Mortality
Work
Community Settings
Government Social Policies
Family
Biological Processes(e.g. Stress Responses)
Female HIV/AIDS Cases by Race/Ethnicity U.S. 1981-
2002
SOURCE: CDC 2008
0%10%20%30%40%50%60%70%
American Indian /Alaskan Native Asian / Pacific Islander
Black (not Hispanic) Hispanic
White (not Hispanic)
Male HIV/AIDS Cases by Race/Ethnicity U.S. 1981-
2002
0%10%20%30%40%50%60%70%
American Indian /Alaskan Native Asian / Pacific Islander
Black (not Hispanic) Hispanic
White (not Hispanic)SOURCE: CDC 2008
0%10%20%30%40%50%60%70%
American Indian /Alaskan Native Asian / Pacific Islander
Black (not Hispanic) Hispanic
White (not Hispanic)
Crude Death Rates for Diseases of the Circulatory System by Age, Gender and
Race/Ethnicity in the United States 1999-2005
SOURCE: CDC/NCHS 2008
45-5455-64
65-74
Black
0
200
400
600
800
1000
1200
1400
1600
Women Men
AgeWhite
Dea
ths
per
100
,00
0 A
du
lts
Women
Men
Questions to Ponder
Are there gender differences in opportunities to choose health?
Does understanding constrained choice make a difference for how we intervene?
How do further marginalized statuses shape opportunities to pursue health?
Related Publications Bird and Rieker. 2008. Gender and
Health: The Effects of Constrained Choice and Social Policies. Cambridge University Press.
Bird, Lang, and Rieker. 2010. “Changing Gendered Patterns of Morbidity and Mortality” in Handbook for Gender and Health Care edited by Ellen Kuhlmann and Ellen Annandale. London: Palgrave.
Rieker, Bird, and Lang. In Press. “New Directions in Understanding Gender and Health” in The Handbook of Medical Sociology edited by Bird, Conrad, Fremont, and Timmermans. Sixth Edition. Nashville, TN: Vanderbilt University Press.
