title: Understanding gender and health: systematically comparing the health and health experiences of men and women
Creators: name: Hunt, Kate
Publisher: name: University of Glasgow
Year: 2007
Subjects: subject: Gender, health, health behaviour, masculinity, social constructions of gender

description: Gender differences in health are the product of a complex interaction between biology and the social world. Our ascribed sex and how this is interpreted in the culture within which we live (gender) have life-long consequences for our life chances, including our health. 

For many years the aphorism that ‘men die quicker but women are sicker’ was presumed to encapsulate gender differences in health. The first paper presented in the thesis challenged this dominant paradigm. First, an analysis of morbidity in two British data sets showed more similarity than difference between men and women. Secondly, we highlighted earlier research with similar results which had been overlooked and failed to shake the ‘gender orthodoxy’. Thirdly, we stressed the ahistoric and decontextualised way in which research on gender and health had been conducted or reported. 

The remaining papers in the thesis share two underlying principles; all make systematic comparisons between men and women, and all attempt to also examine diversity within gender. All but one of the papers utilise data from the West of Scotland Twenty-07 Study, a study of the social patterning of health in three age cohorts. 

The second paper examined the impact of paid and unpaid work on symptoms, treating each domain as being relevant in principle to the health of both women and men. The experience of paid work was the predominant influence on malaise symptoms, and unpaid work in the home did not explain any variation in men’s symptom scores. Similar associations were seen between most aspects of paid work and malaise symptom scores in both genders. The paper highlighted the dearth of literature that had compared systematically either the conditions of men’s and women’s paid work, or the health effects of the paid and unpaid work environment for men and women.

Men’s ‘under-usage’ of health care is often constructed as a problem, potentially reinforcing an assumption that women ‘over-use’ health care. On average, women have more consultations with their general practitioner, but this excess is mostly apparent in the reproductive years. The third paper examined whether these gender differences exist when taking account of the underlying nature and perceived severity of illness. Women were no more likely than men to have consulted their GP in the past year amongst those reporting morbidity in any of the five condition groups, and men were more likely to have consulted amongst those who reported digestive conditions. 

The fourth paper takes as its starting point the strong patterning of cigarette smoking by gender (and class) throughout the twentieth century. In it we examined the relationship between ‘masculinity’ and ‘femininity’ scores using the Bem Sex Role Inventory (BSRI, an instrument developed within social psychology in the 1970s). No relationship was seen between either score and smoking in the youngest cohort, nor amongst men in the middle cohort, and in the oldest cohort there was only a suggestion of an association between higher femininity scores and smoking in men. The strongest relationship was seen between ‘femininity’ score and smoking amongst women born in the 1950s who also had a somewhat elevated risk associated with higher ‘masculinity’ scores.

Suicide and suicidal behaviours are strongly patterned by gender, and the dramatic rise in suicides amongst young males in the late 1980s and 1990s in several countries was often attributed to a ‘crisis’ in masculinity. The fifth paper examines the association between serious suicidal thoughts and the same measures of ‘masculinity’ and ‘femininity’ and a measure of gender traditionalism. In both men and women in early and late middle age, we found a negative association between higher ‘masculinity scores’ and serious suicidal thoughts, and a positive association between more traditional gender role attitudes and serious suicidal thoughts at older ages. No such associations were seen in early adulthood, and no relationship was seen between serious suicidal thoughts and ‘femininity’ scores at any age. 

Gender differences in the pattern of coronary heart disease (CHD) mortality have been described as enigmatic and one of the most striking features of cardiovascular mortality in the twentieth century. In an analysis controlling for many of the classic risk factors for CHD (smoking, blood pressure, body mass index, mental health), we found that higher ‘femininity’ scores (using continuous scores from the BSRI) were associated with a decreased risk of CHD mortality in men. No such association was seen in women, and the continuous ‘masculinity’ scores were unrelated to mortality in both women and men. Some advantages and problems with using these measures of ‘masculinity’ and ‘femininity’ in sociological research on gender and health are discussed.

Previous research on one distressing side effect of some cancer treatments, chemotherapy-induced hair loss, has almost exclusively focussed on women. The final paper compares young adults’ experiences of hair loss following chemotherapy. Hair loss was a challenging aspect of the experience of cancer for both women and men which made them acutely aware of their vulnerability and visibility as a ‘cancer patient’. Both recounted negative reactions to their altered image, challenging social norms of interaction. However, there were two notable gender differences: it was only men who discussed the loss of body hair below the eyeline; and only women who spoke of being encouraged to wear wigs or offered ice helmets to delay or disguise hair loss. These differences are discussed in relation to social constructions of hair as a marker social identity, including gender. I argue that the gender-comparative approach taken reveals important commonalities across gender, highlighting a greater need for more support for men with chemotherapy induced alopecia, and makes what is not said in the women’s interviews as revealing as what is said in men’s.

The concluding remarks highlight the challenges in researching gender and health, and discuss the complex ways in which gender can influence health and vice-versa.