1. Sex and gender in health and health care
Lesley Doyal

2. Introduction
‘Gender’ receiving increasing attention in health/medical field but what does it mean?
Is it just an updated term for sex?
Much confusion with two terms often used interchangeably
Often discussed in context of equity but also central to effectiveness and to ‘good science’
Not just about women but about men too

3. Key issues for today defining sex and gender
sex and gender as determinants of health
impact of sex and gender on health care

4. Defining sex and gender
Sex differences between women and men biological and unchangeable
Gender differences socially constructed and vary over space and time
Sex and gender differences are interlinked and constantly influence each other
Both major factors shaping morbidity and mortality of women and men

5. Reproduced from: MRC Policy brief No. 1, March 2003
Reproduced from: MRC Policy brief No. 1, March Initial estimates from the South African National Burden of Disease study, Bradshaw D et al.

6. Women’s Health
From this more detailed breakdown of cause of death by disease category – shows HIV/AIDS leading cause of death for women and men, but higher for women, also slightly greater number of women dying from CVD than men. These difference are starker when examine causes of death by age.
Reproduced from:Draft MRC document on causes of death and premature mortality in Cape Town, , Bradshaw D et al.

7. Men’s Health
From this more detailed breakdown of cause of death by disease category – shows HIV/AIDS leading cause of death for women and men, but higher for women, also slightly greater number of women dying from CVD than men. These difference are starker when examine causes of death by age.
Reproduced from: Draft MRC document on causes of death and premature mortality in Cape Town, , Bradshaw D et al.

8. Biology , sex and health
Biological differences usual starting point for biomedical understanding of ‘being male’ and ‘being female’
Reproductive potential key to women’s survival and wellbeing
Differences in reproductive organs mean some health problems specific to women or men (eg ca cervix and prostate)
But other biological differences between sexes receiving increasing attention

10. Beyond reproductive biology
Range of genetic, hormonal and metabolic differences affect male and female patterns of morbidity and mortality
Eg men more susceptible than women to range of infectious diseases
And women more likely than men to develop auto-immune problems
Men as a group develop heart disease earlier than women
So biology is important…………

11. But gender also important : what do we mean by gender?
all societies divided by gender
reflected in duties and entitlements allocated to individuals
not just differences but inequalities that take different forms according to time and place

12. Gender inequality global problem

13. How does gender influence health of women and men?
affects exposure to health risks and vulnerability to physical and mental disorders
influences access to resources (including income, power and time) for promoting health
influences perception of symptoms and health seeking behaviour
impacts on access to care and quality of care received

14. Gender influences on health of poor women: global perspective
double burden
lack of access to education
poverty and lack of entitlement
lack of power/status in relationships at household

15. Double burden
Central to ‘fault line’ of gender that women responsible for domestic labour
Can lead to ‘double burden ‘ of work that increases vulnerability to a range of health problems
Variety of health hazards associated with domestic work
Low status of work combined with lack of autonomy can contribute to mental health problems

16. Gender and education
Major improvements in female enrolment in schools but girls still less likely to attend than boys and more likely to drop out
Of the 150 million children not in school over 90 million are girls and 2/3 of world’s illiterates are women
Lack of education increases female poverty and economic dependency and heightens risk of range of health problems including HIV infection

17. Poverty and gender
Women more likely than men to be poor because of cultural beliefs and also structural discrimination
Lower wages and lack of access to many social benefits
More likely than men to be in single headed households (at all ages)

18. Impact of poverty on women’s health: intersections
Clear links in community studies between gender, poverty and depression
Gendered poverty major factor in ‘feminisation’ of AIDS pandemic
Food insecurity especially serious for women and often reinforced by gender bias in allocation of household resources
Poverty makes it especially difficult for women to get health care in reproductive years and old age

19. Gender bias can damage poor women’s health at all ages

20. Gendered risks to health of poor women in South African context
Rural Black women are poorest group in population
Highest rate of unemployment found among African women ( 2005: 37%)
Depression/anxiety almost twice as common in women as in men
HIV also more common among women especially in younger age groups (2005: age group 23.9% females and 6.0% males)
Incidence of gender based violence very high and linked to low status of women especially in economically stressed communities
for excellent discussion of connections between these different factors see

21. question
What do you think are the advantages of female gender for the health of women?
And what about gender and men? Is ‘maleness’ an advantage or a disadvantage?

22. Key health hazards of male gender
dangers associated with waged work
masculinities and risk taking behaviour (especially motor vehicle injuries)
participation in ‘required’ violence
maleness and emotional health

23. Gender paradox?
Women live longer than men in most countries of the world (WHY?)
But women in many communities also tend to report more sickness and distress than men do (WHY?)

24. Gender differences in life expectancy at birth in selected countries 1992 (UN Data)

25. Gender and health care: women
evidence that much of women’s need for reproductive health care still unmet
Eg 120 million ‘couples' without contraception:45 million terminations each year of which 19 million ‘unsafe’
gendered obstacles to access
male bias in medical research
women often receive less respect and poorer quality of care

26. Gender and health care: men
fewer practical obstacles than women because less care of dependents
but does work interfere?
often reluctant to admit weakness
difficult to reconcile masculinity with illness?

27. Sex/gender/ health and diversity: conclusion
Biological sex and social gender both major determinants of health
Interact in influencing morbidity and mortality of women and men
Do this in a variety of ways shaped by specific economic, social and geographical contexts
Need to be included in research designs , service planning and individual medical encounters.

28. Remember….

29. A small exercise to end…choose your own health problem