Gender Inequalities In Health Research Articles

Health Inequalities among Older Adults in Spain: The Importance of Gender, the Socioeconomic Development of the Region of Residence, and Social Support

BackgroundThis study analyzes health inequalities among older adults in Spain by adopting a conceptual framework that globally considers two dimensions of health determinants (gender and the socioeconomic development of the region of residence) and the mediating influence of social support, taking into account individual socioeconomic position. MethodsData came from the 2006 Spanish National Health Interview Survey. A subsample of people aged 65 to 85 years with no paid work living in two socioeconomically developed regions situated in the north of Spain and in two less developed ones situated in the south was selected. The health outcomes analyzed were self-rated health status and poor mental health status. Multiple logistic regression models were fitted and covariates (age, socioeconomic position, household type, and social support) were added in subsequent steps. FindingsSelf-rated health status among older adults was poorer in the less socioeconomically developed regions, but especially among women, whereas the poorest mental health status was found in one of the most socioeconomically developed regions, especially for men. Social support was an important determinant of health status, regardless of the socioeconomic development of the region. Gender inequalities in health did not differ by regional socioeconomic development with one exception regarding poor self-rated health. ConclusionThese results show the importance of implementing stronger gender equity policies, as well as reducing socioeconomic inequalities among regions and strengthen social support among older adults.

Embedded gender and social changes underpinning inequalities in health: An ethnographic insight into a local Spanish context

Despite growing interest in the social determinants of health and contributions from studies focussing on the analysis of explanations to enhance our understanding of the interactions between gender identities, embodied experiences and structural inequalities between men and women, few research papers have devoted attention to this perspective in the Spanish context. This study is an empirical exploration of lay knowledge, for an enhanced understanding of health inequalities in this context, from an ethnographic standpoint based on a phenomenological approach. Specifically, our aim is to study the lay perceptions of men and women regarding their gender identity and living conditions as health determinants within different "contexts" of their everyday lives, namely: the personal context; the home context; and the neighbourhood context. Fifty eight in-depth interviews and three focus groups were held between January 2005 and January 2007, and analysed using a hermeneutic method. Our findings show how disease-coping strategies or the perceived loss of social cohesion are linked to the gender system. They also point to how the dynamics of social change have developed around a strong division between the productive and reproductive arenas. Approaching these issues from different "contexts" provides insights into the explanations for the gendered patterning of mortality and morbidity, as well as furthering our understanding of the basis for social embodiment of gender differences and health inequalities in the context studied. In the discussion of our findings, we place emphasis on the implications that informal caring has for these processes and also take into account contributions of the "lay approach" to study and understand social determinants and health inequalities.

Exhausted women, tough men: a qualitative study on gender differences in health, vulnerability and coping with illness in Spain

This study analyses different perceptions by women and men, from different social backgrounds and ages, regarding their health, vulnerability and coping with illness, and describes the main models provided by both sexes to explain determinants for gender inequalities in health. The qualitative study involved in-depth interviews with women and men resident in Granada (Spain). The women rated their health worse than men, associating it with feelings of exhaustion. However, men tended to overrate their health, hiding their problems behind the 'tough guy' stereotype associated with masculinity. Both women and men shared the belief that women are more vulnerable, while men are weaker at coping with illness. The explanatory models offered for this paradox of 'weak but strong women' and 'tough but weak men' were different for each sex. Men used biological arguments more than women, centred on the female reproductive cycle. Women used more cultural models and identified determinants relating to social stratification, gender roles and power imbalances. In conclusion, gender constructions affect the health perceptions of both women and men at any social level or age. 'Exhausted' women and 'tough' men should form preferential target groups for intervention to reduce gender inequalities in health.

Mapping the awareness of inequalities in health programs in Spanish communities: moving forward together

The aim of this study is to map the awareness of gender, socioeconomic, immigrant and ethnic health inequalities in health at schools, maternal health and traffic injury health prevention programs. The study was conducted in the 19 health descentralized areas in Spain, 17 autonomous community (ACs) and the 2 autonomous cities (ACities). The data were collected from May 2008 to January 2009. The unit of analysis was the collection of policy documents setting out the programs mentioned above and the related support material in each AC. A reading guide was used to analyze the awareness of inequalities. With regard to health at schools, 2 of 10 programs show a high awareness of inequalities and include many specific proposals to be implemented at the local level. Regarding maternal health, 13 ACs have prepared support material with high awareness of inequalities to be implemented. A traffic injury program has been created in two ACs. We map the whole situation in Spain regarding the health programs that we have used as examples and their awareness of inequalities. We can conclude that there are differences between the regions studied in Spain and in general, the awareness of inequalities is low.

The invisible man – Development of a national men’s health training programme for public health practitioners: Challenges and successes

To develop a national men's health training programme for healthcare and social care practitioners to address gender health inequalities and facilitate the effective delivery of health services to men. A 1-day training course, that combined epidemiological data with the social and behavioural context of men's health behaviour and attitudes, was developed and delivered to 38 public health practitioners working in primary care trusts, local authorities and charities. A post-training questionnaire was completed by all participants to evaluate the efficacy of the training, levels of satisfaction and impact on future work practice. The training was well received and met participants' requirements in terms of content and delivery. The combination of clinical information, practical examples of men's health initiatives and interactive scenario-based tasks increased knowledge and assisted reflective practice. Following the training, all participants intended to adopt a male-gendered approach into their work practice, and stated that they would recommend the course to other public health colleagues. The evaluation highlights the potential of delivering men's health training to increase public health practitioners' knowledge of men's health inequalities, and to promote the development of gender-sensitive services. Future development could incorporate a 'train the trainer' element to maximize capacity building and enhance sustainability. Longer-term follow-up may be required to determine the continuing impact on public health practice.

Gender relations and health research: a review of current practices

IntroductionThe importance of gender in understanding health practices and illness experiences is increasingly recognized, and key to this work is a better understanding of the application of gender relations. The influence of masculinities and femininities, and the interplay within and between them manifests within relations and interactions among couples, family members and peers to influence health behaviours and outcomes.MethodsTo explore how conceptualizations of gender relations have been integrated in health research a scoping review of the existing literature was conducted. The key terms gender relations, gender interactions, relations gender, partner communication, femininities and masculinities were used to search online databases.ResultsThrough analysis of this literature we identified two main ways gender relations were integrated in health research: a) as emergent findings; and b) as a basis for research design. In the latter, gender relations are included in conceptual frameworks, guide data collection and are used to direct data analysis.ConclusionsCurrent uses of gender relations are typically positioned within intimate heterosexual couples whereby single narratives (i.e., either men or women) are used to explore the influence and/or impact of intimate partner gender relations on health and illness issues. Recommendations for advancing gender relations and health research are discussed. This research has the potential to reduce gender inequities in health.

Monitoring Gender Equity in Health Using Gender-Sensitive Indicators: A Cross-National Study

As gender is known to be a major determinant of health, monitoring gender equity in health systems remains a vital public health priority. Focusing on a low-income (Peru), middle-income (Colombia), and high-income (Canada) country in the Americas, this study aimed to (1) identify and select gender-sensitive health indicators and (2) assess the feasibility of measuring and comparing gender-sensitive health indicators among countries. Gender-sensitive health indicators were selected by a multidisciplinary group of experts from each country. The most recent gender-sensitive health measures corresponding to selected indicators were identified through electronic databases (CINAHL, PsycINFO, MEDLINE, Embase, LILACS, LIPECS, Latindex, and BIREME) and expert consultation. Data from population-based studies were analyzed when indicator information was unavailable from reports. Twelve of the 17 selected gender-sensitive health indicators were feasible to measure in at least two countries, and 9 of these were comparable among all countries. Indicators that were available were not stratified or adjusted by age, education, marital status, or wealth. The largest between-country difference was maternal mortality, and the largest gender inequity was mortality from homicides. This study shows that gender inequities in health exist in all countries, regardless of income level. Economic development seemed to confer advantages in the availability of such indicators; however, this finding was not consistent and needs to be further explored. Future initiatives should include identifying health system factors and risk factors associated with disparities as well as assessing the cost-effectiveness of including the routine monitoring of gender inequities in health.

Self‐Perceived Health among Migrant and Native Populations in Madrid: A Gender Perspective

This paper describes the level of self‐perceived health (SPH) in immigrant and native populations resident in Madrid and the demographic and socioeconomic factors associated with negative self‐perceived health status, from a gender perspective. A population‐based home survey (2005 Madrid Health Survey) was carried out. Subjects were selected by random sampling of bistage clusters. The study was limited to 5704 adults (16 to 64 years). SPH was considered the dependent variable. The independent variables included migration status, social class, age, sex, marital status, level of education, area of residence, work precariousness, family burden and perception of environmental quality. The association was assessed by odds ratios and their 95% confidence intervals obtained by multivariate logistic regression models disaggregated by gender and migration status. Results showed that poor/fair health status was perceived more by natives and by women. The variables associated with fair/poor SPH in immigrant men were the influence of working conditions perceived as negative and perception of the quality of the environment as poor, and in immigrant women, older age, low educational level and the influence of working conditions perceived as negative. Gender inequalities in self‐perceived health exist, and different factors are associated with immigrant and native populations. The results of the study support the need for a health intervention that would diminish gender inequalities in health, which are more accentuated in immigrants.

Latin America and the Caribbean: assessment of the advances in public health for the achievement of the Millennium Development Goals.

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC.

Specific comments on gender inequalities in health and quality of life in the informal caregiver

Specific comments on gender inequalities in health and quality of life in the informal caregiver

Review Paper: Gender Competencies in the Medical Curriculum: Addressing Gender Bias in Medicine

Gender inequalities in health and gender bias in medicine are interrelated challenges facing health care providers and educators. Women and girls are disadvantaged in accessing health care because of their low social status and unequal treatment in medical care. Gender bias has long been inherent in clinical practice, medical research, and education. This can be traced to the medical curriculum that shapes the perceptions, attitudes, and behavior of the future doctor. The author advocates medical curricula change to address gender inequalities in health and gender bias in medicine. She analyses the reasons for integration of gender competencies in the medical curriculum, discusses what gender competencies are, and reviews ways to in-build gender competencies and their assessment. Efforts to change and gender sensitize medical curricula in developed and developing countries are also reviewed. The review hopes to contribute to strategic medical curriculum reform, which would lead to gender-sensitive health services and equity in health.

‘Should you turn this into a complete gender matter?’ Gender mainstreaming in medical education

The incorporation of a gender perspective in medical education aims toward better health, gender equity, and a better health care for both men and women. In this article, participants’ responses to a Dutch gender awareness‐raising project in medical education are discussed. Eighteen semi‐structured interviews were held with education directors and change agents. Resistance towards and obstacles for gender mainstreaming in medical education were implicit in four themes: (1) biomedical knowledge was perceived to be gender neutral, to which knowledge about women could be added to the body of knowledge either with or without framing them as gender issues; (2) the relevance of gender was unofficially denied by downplaying it, particularly in comparison with culture/ethnicity; (3) medical education’s social accountability was hardly mentioned and gender inequalities in health were framed as feminist political issues and not medical issues; and (4) we were urged to communicate carefully to increase acceptance and avoid overt resistance which situated gender inequalities outside the medical domain. Recommendations to change educational material were widely discussed; but specific features of gender were easily lost. This was especially true for power differences between men and women. Nevertheless, dominant systems of thought were challenged.

Gender inequality in health among elderly people in a combined framework of socioeconomic position, family characteristics and social support

ABSTRACTThis study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants: socio-economic position, family characteristics and social support. Data came from the 2006Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.

Gender and Health Inequalities: What Are They and What Can We Do About Them?

The subject of gender and health inequalities is contested territory in health policy, research and practice. Yet there is a dominant approach which I describe as a form of technocratic rationality. Its application imposes significant limitations because it represents the problem of gender and health in terms of measurable sex differences in relation to health service access and health outcomes. In doing so, it fails to address and explain the social dynamics that generate the problem. I propose an alternative approach that originates in Australian women's health policies of the 1980s. These emphasised the inequalities between men's and women's participation in mainstream health policy, planning, management and delivery of services, and women's concomitant marginalisation. Recent sociological study offers support for this perspective suggesting that the endogenous organisational dynamics (or logics) within public health institutions provide a better way of understanding what the problem of gender inequalities in health is, and how we might fix it.

Pakistan's health policy: Appropriateness and relevance to women's health needs

The interface between national health policy and women's health needs is complex in developing countries like Pakistan. This paper aims to assess if Pakistan's national health policy 2001 is relevant and appropriate to women's health needs. Through review of existing data on women, a profile of women's health needs was developed which was transformed into framework of analysis. This framework indicates that Pakistani women's health needs are determined by gender disparities in health and health-related sectors. Comparison of national health policy with women's health needs framework reveals that although policy focuses on women's health through prioritization of gender equity, it is however addressed as an isolated theme without acknowledging the vital role gender inequalities in health and health-related sectors play in defining women's health needs. Moreover, gender equity is translated as provision of reproductive health services to married mothers, ignoring various critical overarching issues of women's life such as sexual abuse, violence, induced abortion, etc. Health systems strengthening strategies are though suggested but these fails to recognize main obstacles of utilization of healthcare services by women including non-availability of female healthcare providers and gender-based obstacles to healthcare utilization such as illiteracy, lack of empowerment to make decisions related to health, etc. In order to be relevant and appropriate to women's health needs the policy should: (1) use gender equity in health and health-related sectors as an approach to develop a healthy policy (2) expand the focus from reproductive health to life cycle approach to address all issues around women's life (3) strengthen health systems through creation of gender equity among all cadres of health providers (4) tailoring health interventions to counter gender-based obstacles to utilization of healthcare services and (5) dissemination interventions for behavior change.

The Health of Men and Women ‐ by Payne, S.

Payne, S. The Health of Men and Women 2006 Cambridge : Policy £15.99 ISBN 10 0-7456-3454-0 (pbk) The paradox that women live longer than men but that they experience a greater burden of ill health is resolved in this meticulous exploration of women's and men's health. Recent discussions of gender inequalities in health have recognised that the nature of these inequalities and whether they disadvantage women or men depends upon the aspect of health and illness that is under investigation. In this book Sarah Payne documents the differences and similarities in women's and men's health, showing that they arise not only from the structural and cultural dimensions of gender but also from biological factors and the operation of health services. The six chapters of the book focus on different aspects of health beginning with a general and wide ranging discussion of how sex and gender affect health and illness and moving through discussions of mental health, reproductive health and death and dying. Each chapter presents a wealth of data on women's and men's health, covering the developing as well as the developed world and paying attention to the ways in which class, ethnicity and sexuality influence women's and men's health. Each chapter concludes with one or more case studies which focus on a particular aspect of health in order to illustrate how the different dimensions of gender interact with biological factors as well as class, ethnicity and sexuality to explain the health status and experiences of women and men. The rich data on women's and men's health which are presented in the main body of the book are structured by a particular way of conceptualising and explaining the health differences between women and men. As well as biological differences between the sexes having an impact on women's and men's health it is argued that there are three aspects of gender relations which are significant. These are resources, health behaviour and health care. Payne argues that access to resources is a major influence on health with poor health being associated with poverty and social exclusion. Similarly, structural factors such as occupation affect health and occupational differences between women and men can explain many gender differences in health and illness. Thus while manual labour, usually undertaken by men, is likely to involve risk of accident and injury, much of the work done by women involves stress which can affect mental rather than physical health. The second factor is health-related behaviour. Payne points out that men are more likely than women to engage in risky behaviours such as smoking, drinking, eating unwisely and not exercising enough and that these differences also contribute to an explanation of differences in health. Health care and women's and men's use of it also have an effect on health with men being less likely to use health care than women. But the delivery of health care services may also be gendered. Thus in the case of heart disease, women are treated ‘less aggressively’ than men which, amongst other things, is related to a poorer understanding of heart disease in women and a lack of research. Conversely men who have depression may not be diagnosed because of the association of depression with women and the stigma attached to men admitting that they are suffering from depression. After discussing in careful detail all the different aspects of health and illness covered in the main body of the book, Payne uses the final chapter to put forward a model of the relationship between sex, gender and health. It includes biological factors, structural/material factors, gender discourses, and treatment and resources. This model makes it abundantly clear that gender is multi-faceted and affects women's and men's health in a variety of ways, all of which have to be taken into account when discussing gender inequalities in health. Payne shows that the gender paradox is far too simple a way to understand gender differences in health and that, although men's annual risk of mortality is higher than women's, whether women's health is better or worse than men's depends on a multitude of factors. What is impressive about this book is that it brings together discussions of women's and men's health which often take place separately from each other, and looks at both through a gendered lens. Payne succeeds in showing the complexity of the relation between sex, gender and health and the rich data she presents, together with her clear conceptual model, will make this book immensely useful for teaching as well as an invaluable resource for research.

Strengthening accountability to citizens on gender and health

Accountability refers to the processes by which those with power in the health sector engage with, and are answerable to, those who make demands on it, and enforce disciplinary action on those in the health sector who do not perform effectively. This paper reviews the practice of accountability to citizens on gender and health, assesses gaps, and recommends strategies. Four kinds of accountability mechanisms have been used by citizens to press for accountability on gender and health. These include international human rights instruments, legislation, governance structures, and other tools, some of which are relevant to all public sector services, some to the health sector alone, some to gender issues alone, and some to gender-specific health concerns of women. However, there are few instances wherein private health sector and donors have been held accountable. Rarely have accountability processes reduced gender inequalities in health, or addressed ‘low priority’ gender-specific health needs of women. Accountability with respect to implementation and to marginalized groups has remained weak. This paper recommends that: (1) the four kinds of accountability mechanisms be extended to the private health sector and donors; (2) health accountability mechanisms be engendered, and gender accountability mechanisms be made health-specific; (3) resources be earmarked to enable government to respond to gender-specific health demands; (4) mechanisms for enforcement of such policies be improved; and (5) democratic spaces and participation of marginalized groups be strengthened.

The intersections of gender and class in health status and health care

It is increasingly recognized that different axes of social power relations, such as gender and class, are interrelated, not as additive but as intersecting processes. This paper has reviewed existing research on the intersections between gender and class, and their impacts on health status and access to health care. The review suggests that intersecting stratification processes can significantly alter the impacts of any one dimension of inequality taken by itself. Studies confirm that socio-economic status measures cannot fully account for gender inequalities in health. A number of studies show that both gender and class affect the way in which risk factors are translated into health outcomes, but their intersections can be complex. Other studies indicate that responses to unaffordable health care often vary by the gender and class location of sick individuals and their households. They strongly suggest that economic class should not be analysed by itself, and that apparent class differences can be misinterpreted without gender analysis. Insufficient attention to intersectionality in much of the health literature has significant human costs, because those affected most negatively tend to be those who are poorest and most oppressed by gender and other forms of social inequality. The programme and policy costs are also likely to be high in terms of poorly functioning programmes, and ineffective poverty alleviation and social and health policies.

Occupational epidemiology and work related inequalities in health: a gender perspective for two complementary approaches to work and health research

Objectives:To provide a framework for epidemiological research on work and health that combines classic occupational epidemiology and the consideration of work in a structural perspective focused on gender inequalities in...

How might we understand men's health better? Integrating explanations from critical studies on men and inequalities in health

For researchers interested in understanding men's health, there are two main literatures to harvest. The first is research on men's health arising from the study of men and masculinities. The second is the broader study of inequalities in health, including gender inequalities in health. However, these literatures have remained distinct. This paper seeks to develop a model of understanding men's health from both of these literatures. In order to achieve this integration, this paper argues that studies of men's health should be based on ‘critical studies on men’ which emerges from feminist theory. Critical studies on men's health is then integrated into the broader explanatory options identified in the health inequality literature in order to provide a more fulsome account of variance within men's health and between the health status of men and women. Given the amenability of men's health issues to interrogation within this resulting framework, it is argued that the inequalities literature should start to include men's health issues in its work.