Gender Inequalities In Health Research Articles

Biomedical Science’s Embodiments in Contemporary Laos. Informal Caregivers and Children Living with HIV

Who provides informal care? What help informal caregivers do provide it and at what costs? This contribution examines the Biomedical Science’s Embodiments in Contemporary Laos in looking at the materiality of its technologies in the everyday and the ordinary. We aim to tackle this issue in approaching the daily lives of children living with HIV from the point of view of the people who are taking care of them, the so-called informal caregivers. The paper highlights the constraints created by caregiving responsibilities, and the emerging issues related to HIV disclosure, stigma and discrimination and conflicting feelings. The informal caregivers’ narratives underline how families, institutions and local, national and transnational institutions are assigning care work. Informal care offers a lens to explore the social and gender health inequalities, both interrelated with, and too often disregard by the biomedical science.

Solving gender gaps in health, what else is missing?

In recent years, a great deal of attention has been paid to gender inequities in health. However, while we have a good body of evidence on the impact of gender on the health and vulnerability of women and men, we have not yet been able to generate sufficient evidence on effective interventions that can transform this situation or can influence public health policy making. Only a limited number of educational interventions on gender-sensitivity, gender bias in clinical practice and policies to tackle gender inequalities in health have been formulated, implemented and evaluated. Even in the current pandemic situation caused by SARS-CoV2, we have seen the lack of gender mainstreaming reflected in the global response. This happens even when we have tools that facilitate the formulation and implementation of actions to reduce gender inequities in health. We consider that the current initiatives organized to carry out advocacy activities on gender inequity in health to be very positive. In the same line of these initiatives, we propose that while academic and institutional research on gender and health remains essential, we need to shift the focus towards action. In order to move forward, we need public health researchers questioning what public health practice need to do to address gender inequities and shake structural and social power inequities in order to increase the gender equity in health.

Gender Inequalities in Health, Education and Economic Opportunities in the Union Territory of Jammu and Kashmir, India

This paper is an attempt to analyze the various indicators of gender inequality in education, health and economic services in Jammu and Kashmir, one of the union territories of India. This study utilized Gender Inequality index and revealed that after taking education as a starting point, the literacy rate and education of the women of Jammu and Kashmir is far lower than their male counterparts and also lower than women at national level. The male-female gap in literacy rate has increased from 12.71 per cent in 1961 to 20.25 per cent in 2011.There is nearly 21% gap between males and females in case of literacy rate. One of the greatest concerns, as far as gender discrimination is concerned is that of male-female sex ratio. The sex ratio has declined from 892 in 2001 to 889 in 2011. The child sex ratio has also declined steeply from 941 in 2001 to 859 in 2011 losing 80 points. The Infant Mortality Rate has fallen from 51 in 2007 to 23 in 2017, however, it is higher for female child than in male child in India as well as in Jammu and Kashmir. The study also found that, only 18 percent of all women age 15-49 were employed in the 12 months preceding the survey; 75 percent of all men aged 15-49 were employed. Thirty-three percent of women and 81 percent of men age 15-49 own a house alone or jointly with someone else, and 27 percent of women and 73 percent of men own land alone or jointly with someone else

The “Double Burden of Malnutrition” in the Amazon: dietary change and drastic increases in obesity and anemia over 40 years among the Awajún

ABSTRACT Undernutrition and overnutrition are interconnected. Yet few studies have examined the “double burden of malnutrition” (DBM) over time in indigenous communities. We investigated changes in the food systems and nutritional health of Awajún communities in the Peruvian Amazon in the 1970s and in 2013. Methods included ethnography, 24 hr food recalls, and biological measures. In 2013, the number of traditional foods consumed decreased to 10% of levels in the 1970s and the number of market foods consumed increased 40-fold. Rates of anemia and obesity were also substantially higher in 2013 compared to the 1970s (23% vs 6% for anemia and 30% vs. 0% for obesity) indicating a DBM has emerged. Examining the predictors of hemoglobin levels and body mass indices in the 2013 sample reveals that this DBM is differentially impacting women and that risk for obesity among the Awajún is associated with multiple proxies of market integration beyond just the consumption of market foods. These findings highlight the complex pathways by which rapid lifestyle changes are creating gendered health inequalities within indigenous communities over time.

Influence of Gender Determinants on Informal Care and Health Service Utilization in Spain: Ten Years after the Approval of the Equality Law

The existence of gender inequalities in health, in the use of health services, and in the development of informal care has been demonstrated throughout scientific literature. In Spain, a law was passed in 2007 to promote effective equality between men and women. Despite this, different studies have shown that the previous gender inequalities are still present in Spanish society. For all these reasons, the objective of this paper is to study the differences by sex in informal care and in the use of emergency care, and to identify the existence of gender inequalities in Spain 10 years after the adoption of the aforementioned equality law. In this case, we development a cross-sectional study based on the 2017 Spanish National Health Survey of the Spanish population aged 16 and over. To analyze the influence of gender determinants on informal care and emergency care utilization, logistic regressions were performed, model 1 was adjusted for age, and model 2 was further adjusted too by the variables of the Andersen care demand model. The results showed that informal care and the use of the emergency care continues to be higher in women than in men. Informal care in women was related to a higher level of education. In emergency care, the older the age, the lower the probability of utilization, and living in a rural municipality was related to a higher probability of utilization for both sexes. Finally, we concluded that there is still a need for studies that analyze gender inequalities in different contexts, such as the informal care and the use of health services. This is especially relevant in Spain, where economic changes have led to a change in roles, mainly for women, and new management strategies are needed to achieve equity in care and effective equality between men and women.

Aging and Gender Health Gap: A Multilevel Analysis for 17 European Countries

The European population is aging and their declining capacity makes older Europeans more dependent on the availability of care. Male and female health needs at older ages are different, yet there are contradictory results on the study of gender inequalities in health among the older European population. The aim of this article is twofold: first, we study whether there is a general gender health gap at older ages across Europe. Secondly, we analyze the existence of an increasing or decreasing universal association between the gender health gap and age among the older European population or whether, by contrast, this depends on the type of welfare state. To achieve these goals, we use data from the Survey on Health, Ageing and Retirement in Europe (SHARE) for respondents aged 50 and over in 2015, and we carry out several multilevel random intercept logistic regressions for European countries. Our results show that when we split European countries into groups according to the type of welfare state, we only find a significant gender health gap in older people in Southern and Social Democratic countries. Some differences have been found in the links between the gender health gap and age among European countries. Old women report worse health than men at all ages in Southern countries while in Social Democratic states it is only true for women aged 80 and over. In Bismarckian states there are barely any gender differences, while the gender health gap has no clearly defined bias. Between the ages of 60 and 79, men from Eastern European countries report poorer health, while after 80 it is women who report poorer health. In general, we found the widest gender inequalities in health for the oldest population group, especially in Southern and Eastern European countries.

Have Policies Tackled Gender Inequalities in Health? A Scoping Review.

Gender is recognized as one of the most relevant determinants of health inequalities. This scoping review sought to identify and analyse policies, either implemented or formulated as proposals, which aimed to reduce gender inequalities in health. We searched Medline, Web of Science, and Scielo. Of 2895 records, 91 full text articles were analysed, and 33 papers were included. Of these papers, 22 described the process of formulation, implementation, or evaluation of policies whose aim was to reduce gender inequalities in health; six focused on recommendations, and the remaining five dealt with both issues. Our review showed that the policies aimed at reducing gender inequalities in health, either implemented or formulated as proposals, are scarce. Moreover, despite some success, overall progress has been slow. The studies show failures in design and particularly in the implementation process. We found a lack of awareness and capacity in the policy-making progress, under-financing, bureaucratization, shortage of relevant data, and absence of women’s participation in decision-making. Therefore, an emphasis on the design and implementation of gender-sensitive policies seems essential to advance gender equality in health. This scoping review gathers evidence to support the design of such policies and recommendations that can facilitate their implementation.

Gender-sensitive health and social policy and programs: fundamental mechanisms for sustainable gender-equitable access to health and social services

Current data on mortality, morbidity, and the use of health and social services show significant differences in health experiences between men and women worldwide. For instance, research reports indicate that men experience higher mortality and lower life expectancy than women. Across lifespan, women may experience more ill-health than men. This paper posits that these gender-based differences in health status are due to the pervasive gender-inequity in health and social care access. We argue that the overwhelming reason for the differences in health experiences between women and men is the poorly managed structural determinants of health. Therefore, we propose a gender-sensitive health and social policy model as a fundamental mechanism that may promote sustainable gender-equitable access to health and social services. We make this recommendation based on the outcomes of our systematic review of eight projects that encouraged gender-sensitivity, self-empowerment, the four-cardinal ethical principles, and sustainability.

Gender health inequalities and economic productivity in OECD countries

The presented study deals with the relations between the economic life of developed countries and the health of women and men. The primary objective of the presented study was to assess the relations between gender health inequalities and economic productivity in a sample of OECD countries, with a focus on the classification of their health care systems. Analyses included selected causes of mortality as health variables, each in a specification of men and women, and economic productivity represented by Gross Domestic Product (GDP) per person employed (in USD at current prices). The health care systems were represented by multiple insurance model (MI), national health system (NHS) and single payer model (SPM). The analysed data were collected from OECD databases for the period from 2011 to 2016. The analytical processing was carried out by applying descriptive analysis, regression analysis examining the effects of gender inequalities in health on economic productivity, and relationship analysis. Based on the findings, it can be stated that the vast majority of gender inequalities in health is significant. Also, it has been confirmed that gender inequalities in health have an effect on economic productivity. In general (with a few exceptions), it can be concluded that if gender inequalities in health are reduced, economic productivity is expected to increase. From the point of view of the analysed relations, the NHS health care system can be considered the most positive.

‘There is a secret in love’: gender, care and HIV management in South Africa

Research within geography and cognate disciplines have worked to demonstrate the important ways care(ing) informs the emotive, bodily and obligatory nature of gendered health. Although acts of care shape gendered health inequalities and possibilities for reconfiguration, scholarly research tends to focus on individual caregiving and receiving relationships within the domestic sphere, eliding more complicated, contradictory and uncomfortable questions of care that emerge in and through the wider social context. South Africa’s HIV/AIDS epidemic provides important opportunities to engage contradictions in care since expanded access to antiretroviral therapy allows women to care for their health with increased confidence. Drawing on qualitative research with women in South Africa, we argue that while new HIV management regimes rework opportunities for women to care for and enhance bodily health and wellbeing, they paradoxically conflict with women’s ability to care for and maintain their gendered selves, generating possibilities for harm, conflict and abuse. New biomedical modes of care mean women are often forced to make contradictory decisions between caring for their health but losing idealized notions of the gendered self, or caring for their gendered self, but undermining their possibilities for health. This article concludes that future geographic research on gender-health-place interactions should extend the practice and politics of care by illuminating how constructions, experiences and enactments of gender, health and disease mediate encounters with care and the institutions that attempt to manage them.

Everyday Political Economy of Human Rights to Health: Dignity and Respect as an Approach to Gendered Inequalities and Accountability

ABSTRACT Sexual and reproductive health needs and rights are one of the bleakest examples of (racialised) gender health inequalities in Brazil. This is so despite legal and constitutional specificity recognising the right to health as right of citizenship. In this paper we argue that a ‘performance gap’ is revealed in contradictions between what the right to health as a normative framework encourages states to do, and institutional arrangements and power relations that underpin everyday gendered inequalities in health delivery. The contribution of this article is two-fold. First, it contributes to feminist political economy accounts of the neglect of sexual and reproductive rights by adding a perspective of human dignity as an approach to gender inequalities. Second, it explores ways in which health inequalities manifest in everyday practices, and how divergent expectations of what the right to health means for professionals and for disadvantaged black women limit the capacity of healthcare to make a difference to their well-being. The article also underlines the importance of complementing legal accountability in health with mechanisms that account for prerogatives of gender justice, equality and dignity.

Gender equality and health equity: strategic lessons from country experiences of gender mainstreaming in health.

ABSTRACTObjectives.To analyze progress in organizational structures, mechanisms, strategies, and enabling factors and barriers towards gender mainstreaming (GM) in health in Guatemala, Guyana, and Peru, given GM’s role in addressing gender inequalities in health as a key structural driver of health equity.Methods.Data was obtained through a grey literature review of laws, policies, and/or program documents and semi-structured qualitative interviews with 37 informants. Analysis was based on a theoretical framework including 7 categories considered essential to advance GM in the health sector.Results.Despite significant efforts and accumulated experiences of GM in health, structural barriers include: wider societal challenges of transforming gender unequal power relations; health system complexity combined with the low technical, political, and financial capacity of institutional structures tasked with GM; and limited coordination with (often weak) National Women’s Machineries (NWMs). In some contexts, barriers are compounded by limited understanding of basic concepts underlying GM (at times exacerbated by misunderstandings related to intersectionality and/or engagement with men) and the absence of indicators to measure GM’s concrete results and impact.Conclusions.Successful GM requires a more strategic and transformational agenda, developed and implemented in coordination with NWMs and civil society and with reference to external bodies (e.g. Committee on the Elimination of Discrimination against Women) to go beyond process, with clearer distinction between gender sensitivity and gender transformation, and definition of expected results and indicators to measure advances. These then could be better documented and systematized, enabling GM to be more broadly understood and operationalized as a concrete instrument towards health equity.

Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region

By adulthood, gender inequalities in health and wellbeing are apparent. Yet, the timing and nature of gender inequalities during childhood and adolescence are less clear. We describe the emergence of gender inequalities in health and wellbeing across the first two decades of life. We focused on the 40 low-income and middle-income countries in Asia and the Pacific. A measurement framework was developed around four key domains of wellbeing across the first two decades: health, education and transition to employment, protection, and a safe environment. Specific measurement constructs were then defined by considering gender indicator frameworks, the Sustainable Development Goals, indicator frameworks for child and adolescent health and wellbeing, and key stakeholder input. Available data were then mapped to define 87 indicators, subsequently populated using databases (UN agencies and the Global Burden of Diseases, Injuries, and Risk Factors Study) and nationally representative surveys. Where possible, estimates in girls were compared with boys to report relative risks. Although son preference is evident in some settings-as shown by higher than expected male-to-female sex ratios at birth in India, Vietnam, and China (all >1·10 compared with an expected ratio of 1·05) and excess mortality of girl children in some South Asian and Pacific nations-it is during early adolescence where marked gender inequalities consistently emerged. Adolescent girls face considerable disadvantage in relation to sexual and reproductive health (notably in South Asia and the Pacific), with high rates of child marriage (≥30% of women aged 20-24 years married before 18 years in Bangladesh, Nepal, and Afghanistan), fertility (≥65 livebirths per 1000 girls in Nauru, Laos, Afghanistan, Nepal, Marshall Islands, Bangladesh, Vanuatu, and Papua New Guinea), and intimate partner violence (>20% in Timor Leste, Afghanistan, Pakistan, and Myanmar). Despite educational parity in many countries, females aged 15-24 years were less likely than males to be in education, employment, or training in 17 of 19 countries for which data were available. Compared with girls, adolescent boys experienced excess all-cause mortality and substantially higher mortality due to unintentional injury, interpersonal violence, alcohol and other drugs, and suicide, and higher prevalence of harmful drinking and tobacco smoking. These findings call for a focus on gender policy and programming in later childhood and early adolescence before gender inequalities become embedded. UNICEF.

Gender Equality and Gender Inequalities in Self-Reported Health: A Longitudinal Study of 27 European Countries 2004 to 2016.

Significant gender-based health inequalities have been observed across Europe, with women reporting worse health than men. Still, there has been little examination of how the gender–health gap has changed over time, and how it has been shaped by societal gender equality. We used data from the Statistics on Income and Living Conditions Eurostat database (EU-SILC), involving 2,931,081 participants aged 25–64, for 27 European countries. Logistic regressions were performed to model the association between self-reported bad health and gender, in general and over time. Analyses were stratified by employment, education, and clusters of countries according to levels of Gender Equality Index (GEI). Adjusting for age, year, and country, bad health was 17% more likely among women, but this disadvantage ceased after accounting for education and employment. Gender–health inequalities were larger among countries with higher GEI scores and among low-educated groups. The gender–health gap did not reduce significantly between 2004 and 2016, in general and within subgroups. Although societies are becoming more equal, persistent inequalities in employment and income still lead to sustained health differences between men and women.

Self-perceived general health among community-dwelling Portuguese older adults: do men and women differ?

AbstractEvidence on how gender intersects with relevant social constructs in later phases of life is scarce. This investigation examined gender inequalities in perceived health status (self-perceived general health; SPGH) by Portuguese elderly community-dwellers while considering psycho-social and socio-demographic determinants. This study used data from a representative sample of community-dwellers aged ≥65 years (N = 920), who were enrolled in the Portuguese Elderly Nutritional Status Surveillance System (PEN-3S) project. Associations between SPGH and socio-demographic and psycho-social variables, functionality and self-reported morbidity were tested; indirect effects of relevant predictors on SPGH were also tested using a bootstrap method. Gender inequalities in health were found: women significantly rated their health worse than men; overall, participants rated their health as fair. Education, functional status, depression symptoms and self-reported morbidity significantly predicted SPGH among women, whereas only the latter two were associated with SPGH among men. For both genders, depression was the strongest predictor of SPGH. Mediation analyses detected indirect effects of cognitive function and loneliness feelings on SPGH among older adults. Results herein provide insights on the predictive role of psycho-social variables on SPGH and support the need for considering the context when addressing the correlates of SPGH among Portuguese older adults. Altogether, these findings might support cost-effective interventions targeting the most vulnerable groups of the population to inequalities in health and its predictors.

Gender equality and global health: intersecting political challenges.

BackgroundWomen’s and men’s health outcomes are different. Some differences are biological, related to male and female sex, while others are related to their gender. Sex- and gender-related issues require different solutions, but policy makers lack straightforward heuristic strategies to identify gender-related health inequities.MethodsUsing 169 causes of disability-adjusted life years (DALYs) from the 2017 Global Burden of Disease, we calculated the female-to-male (f:m) and male-to-female (m:f) ratios of global DALYs, rank-ordered the ratios by size and calculated the proportion of all-cause DALYs that each cause explained, separately for males and females 15-49 years old. Gender-related vs sex-related causes were categorised using literature on the drivers for the 15 causes with highest f:m and m:f ratios.ResultsCauses of DALYs with high m:f ratios appear to be gendered and include: road injuries, interpersonal violence, and drowning – totaling 12.4% of men’s (15-49 years) all-cause DALYs. However, causes of DALYs with high f:m ratios are more likely a mix of sex-related and gender-related factors – including headache disorders, depressive disorders, and dietary iron deficiency – totaling 13.4% of women’s (15-49 years) all-cause DALYs. Ratios vary by age, geography and Socio-demographic Index.ConclusionsGender-related vs sex-related causes were categorised using available literature on the drivers for selected causes, illustrating that sex-disaggregated data represents a mix of social and biological influences. This analysis offers a model that policy makers can use to uncover potential gender inequalities in health, including intersections with other social factors. From it, new challenges emerge for global health policy makers and practitioners willing to address them. Global health actors will need to achieve a balance between the two agendas of global health and gender equality.

Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries-Empirical Study.

The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people.

Gender inequalities in poor self-rated health: Cross-national comparison of South Korea and Japan.

Japan and South Korea represent "outliers" among rich nations with regard to having achieved high life expectancy but also ranking near the bottom on United Nations indices of gender equality. In the present study, we compared gender inequalities in self-rated health (SRH) across the life course captured in nationally representative surveys from South Korea and Japan. Our comparative analysis focused on the following questions, (1) Do Japan and South Korea exhibit similar patterns of gender inequalities in health as found in western settings (e.g. the "gender paradox" whereby women enjoy longer life expectancy, but worseself-rated health compared to men)? (2) Can gender differences in educational attainment and income account for gender differences in health in Japan & Korea? (3) Do gender inequalities in self-rated health differ over the life-course in Japan compared to South Korea? Cross-sectional data were drawn from nationally representative surveys in South Korea and Japan. We analyzed data for 239,076 participants aged 20 years or older (226,105 in South Korea and 12,971 in Japan). We evaluated the gender gap in poor SRH between two countries using logistic regression models controlling for covariates sequentially. (1) The absolute female/male gap in prevalence of poor SRH was much narrower in Japan compared to South Korea; (2) the prevalence ratios of poor SRH (women relative to men) were significantly higher in South Korea than in Japan after retirement age; (3) but the difference in the prevalence ratios of poor SRH by gender between two countries largely disappeared after adjusting for educational attainment & comorbidity. Each country needs to analyze their specific situations to understand what determines their population health status. In addition, there must exist other reasons for the"gender paradox" - i.e. why Japan & Korea have managed to achieve high longevity without gender equality.

Age and cohort trajectories of gender inequality in health among elderly people in China

ABSTRACT Using a multistate model, this article examines gender gap and its trend in health transition, life expectancy (LE), and active life expectancy (ALE) in different age groups and birth cohorts. The transition rate from life independence/disability to death for elderly women is lower than for elderly men. However, their disability rate is higher. The gender gap in LE, ALE, and DLE (disabled life expectancy) declines as age increases. In successive birth cohorts, men’s LE increases more, and gender gaps in LE and ALE decrease over time. In the future, gender issues should be considered for health-care policy to provide nursing care for elderly women in China.

Educational level, marital status and sex as social gender discharge determinants in chronic obstructive pulmonary disease exacerbations: a time-to-event analysis.

The aim of this study is to evaluate, in patients hospitalized for COPD exacerbation, how educational level, marital status and sex (social gender indicators) affect the prognosis (main effects) and how interact with each other in affecting prognosis (effect modification). Data for all patients discharged with a principal diagnosis of COPD with exacerbation (ICD-9 491.21) by Apulian facilities between 2013 and 2017 were retrieved from the National Hospital Discharge Register Database. A multivariable multi-stratified frailty cox proportional-hazard regression with interaction terms was fitted in order to assess the effect of sex, educational level and marital status on the time-to-event for home discharge through the estimation of hazard ratios. Adjusting for several hospitalization characteristics and for healthcare facilities, low educational level (<8 years of schooling) seems to be a risk factor in both sexes and in all marital status categories (HR 0.92, 95%CI 0.87-0.97, p=0.0020). Female sex seems to be a risk factor only in married patients (HR 0.83, 95%CI 0.78-0.88, p<0.0001). Marital status different from married seems to be a risk factor only in male patients, in particular single patients (HR 0.82, 95%CI 0.74-0.92, p=0.0009), separated or divorced patients (HR 0.71, 95%CI 0.58-0.86, p=0.0005) and widowed patients (HR 0.87, 95%CI 0.80-0.95, p=0.0018). Differently from findings about protective effect of education, the evidence of different effects of sex among civil statuses and of different effect of civil status among sexes is supposed to be a proxy for social gender health and healthcare inequalities.