Gender and Ethnic health inequalities Lydia Jenkins

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. 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: 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 sexes Explanations: 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 another Racialisation: 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 family  Tend to be largely concentrated in urban areas

Why describe ethnicity? Provides useful national figures Scrutinises certain ‘exotic’ or ‘deviant’ groups while ignoring the white majority Accused 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 populations Can 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 1 st and 2 nd 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