1. Gender and Ethnicity Sarah and Susan

2. Gender and Health

3. Sex and Gender ‘Sex’ refers to those characteristics between males and females that are biologically determined ‘Gender’ refers to the social and cultural meanings assigned to being male or female

4. Health Patterns: Men vs Women MenWomen Shorter life expectancyLonger life expectancy More likely to die in all stages of life (foetus to old age) Report higher rates of illness and disability Use health services more frequently Higher rates of anxiety and depression than men Higher rates of self-reported illness Women are sicker. Men die quicker.

5. CHD: Why more men? Biological factors Women have lower neuro-endocrine and cardiovascular reactivity to stressors (men have greater reaction to stress) Oestrogen protects women from CHD prior to the menopause Men: more commonly android – central obesity Women: more commonly gynoid – peripheral obesity

6. Gendered patterns for smoking More men smoke than women (Historically men have smoked more cigarettes but now the difference is narrower) More women taking up smoking than men

7. Gendered patterns of alcohol consumption Men are almost twice as likely as women to exceed the RDA for alcohol consumption (men drink more) Men are also more likely to ‘binge drink’ It is estimated that more men have an alcohol use disorder Strong association between heavy drinking, depression and suicide in men

8. Gender Patterns for Obesity More men than women are overweight Similar proportions of women and men are obese Obesity rates are higher among older age groups for both men and women The peak of obesity among women occurs around ten years later than that for men (post-menopause)

9. Gendered Patterns of Accidental Death Rates of accidental death among men exceed those in women at all ages, except towards the end of the life course Younger men (16 – 34) are particularly at risk; involved in car crashes with speed and alcohol involved Men take more risks

10. Gendered Patterns of Self- harm and Suicide Men are more likely to commit suicide Men tend to use more violent and lethal methods (44% of male suicides involve ‘hanging, strangulation and suffocation’ compared to 27% of female suicides) Women more likely to self-harm

11. Gender and access to health care Women go to the GP more. Men are more willing to use locums and A+E services Well-person checks in GP surgeries are less well attended by men Men are 50% more likely than women to die from skin cancers despite a 50% lower incidence of the disease among men

12. What are the reasons for male health behaviours? Higher male mortality – partly from occupational accidents and diseases Men’s health-related behaviours now viewed as a means by which men demonstrate their masculinity; how men gain status as men Men often use ‘masculine-sanctioned’ coping behaviour to relieve stress E.g. by smoking, heavy drinking, drugs (which have their own associated risks) Less likely to talk about problems

13. Why do men engage less with health services? Men perceive themselves to be less vulnerable or susceptible to illness than women Men tend to ‘normalise’ their symptoms and fear wasting doctors time Men are less likely to accept emotional pain as valid More difficult to access health services e.g. appointment times, leaflets at GPs more aimed at women

14. Gendered explanations for patterns of women’s health Women tend to be characterised by different duties and responsibilities; most notably within the home Women are more vulnerable to poverty and bear the brunt of low income within households Maintaining the material and psychosocial environment of the home increases social isolation and denial of self Link with higher rates of anxiety and depression

15. Ethnicity and Health

16. Race ‘Race’ as a concept concentrates on assumed biological or genetic differences between groups of people No scientific basis for the notion that different ‘races’ share biological or genetic features significant for health

17. Ethnicity 2 main characteristics separating ethnic groups: 1.A long shared history, of which the group is conscious as distinguishing it from other groups, and the memory of which it keeps alive 2.A cultural tradition of its own, including family and social customs and manners, often but not necessarily associated with religious observance. No reference to biological or genetic traits

18. Culture Concentrates on shared experiences, beliefs and values Members of particular ethnic groups may not share the same cultural experiences, beliefs and values

19. 5 explanations for ethnic inequalities in health

20. 1.Genetic/Biological Explanation Some congenital anomalies and haemoglobinopathies strongly influenced by genetic factors, e.g. sickle cell disease, diabetes BUT Genetic differences cannot explain ethnic inequalities in health e.g. access to healthcare i.e. people from different ethnic groups are genetically predisposed to certain conditions

21. 2. Cultural Explanations Concentrate on health beliefs and behaviours of ethnic minority groups e.g. More rickets in Asia due to deficient South Asian diet BUT Neglect the fact that the major health problems experienced by ethnic groups are the same as for the general population i.e. cultural elements e.g. diet, environmental exposures are responsible for greater risk of certain diseases

22. 3. Migratory Explanation Migrants usually have better health among population of origin Health of migrants tends to revert to the mean standard of the population of origin – produces a relative decline in health compared to health in country of destination The ‘Salmon Bias’ phenomenon – people returning home when ill -> artificially reduced mortality rate of migrant populations. Migrants have poorer health respective to population of destination country but lower mortality rate as tend to return home when ill

23. 4. Social Deprivation Socio-economic factors make a major contribution to ethnic differences in health Socio-economic factors appear more important than other more factors (genetic & cultural) Ethnic groups more likely to be of a lower socio- economic status which may link with poorer health

24. 5. Racism and Health Direct experiences of racism and racial harassment result in health differences Indirect experiences of racism also have an effect on health, e.g. a fear of racism creates worry and stress which can damage health Racism can impact directly (e.g. assault) or indirectly (e.g. feelings of fear/stress/low self- esteem) to create more health problems within ethnic groups

25. Definitions within racism Direct racism - people are treated less favourably because of their ethnicity or religion. Indirect racism - people unaware their actions are undermining the position of people from ethnic minority groups. ‘Institutional racism’ - ‘the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin.’

26. SAQ Briefly describe 4 reasons why men’s illness patterns and health behaviours may differ from women’s

27. SAQ Briefly describe 4 reasons why, on average, women may be more likely to use GP services in a GP practice than men

28. SAQ Social variations such as class, ethnicity and gender have a significant influence on the incidence of and death rates from cancer i) Give 2 reasons why lung cancer has been more common among men in the UK ii)Rates of all cancers have often been lower in migrant groups to the UK. Give 3 possible reasons for this

29. SAQ In most countries the life expectancy of women is greater than the life expectancy of men. Give 5 reasons why this might be