Gender differences have led to acts of prejudice just about as long as there have been people on the planet. The tragedies of the Trojan War, for example, stemmed from the Greek king Menelaus’ idea that his wife, Helen, was an object to be taken back through combat, instead of a woman who had chosen a new partner. The power structures that have informed gender relations throughout history have, without a doubt, taken a toll on the quality and the choices in health care that women receive, in comparison to men. In addition to such areas as reproductive rights and physical or sexual abuse, other topics in health care, such as obesity, use of harmful substances such as tobacco, and even mental health come into play when the discussion centers on gender issues in health care.
Indeed, even basic access to control over one’s own health care varies widely by gender, depending on where you live. According to the World Health Organization’s Commission on Social Determinants on Health (2008, p. 153), only about one in four women in Burkina Faso have the final vote in their own health care decisions; in Jordan, that number comes to almost nine out of ten – but why isn’t it ten out of ten? There are other countries where gender relations are more equitable, there are matters of literacy and education that also play a powerful role.
When it comes to general health, education is a powerful determinant in both life span and quality of health throughout life – but particularly for women. For women who have had 13 or more years of education by age 20, the average life span is 72. For women in Chile who have eight or fewer years of education, though, life span averages 60. Five additional years of education can add 12 years to your life (van Rossum, et. al., 2000). The reasons for this connection have to do with choice in vocation: those with only a basic education are stuck doing menial jobs that have a great deal of manual labor, whereas careers requiring college and postgraduate studies involve far less hard work. While the stress with these careers can be higher, the physical toll is far less, leading to a higher average life span.
While the AIDS epidemic in Africa is horrific on many different levels, the toll it has had on women is especially tragic. In the vast majority of the countries on the continent, the women of Africa are forced into marriages without their consent, at an age when they are still considered children in most of the world. Instead of receiving an education, like their male counterparts, they are expected to start bearing children and tending to the home. As a result, they enter adulthood with basically zero earning power, because they have only negligible economic worth (Lewis, 2005). If this weren’t enough, the property laws in Africa mirror the old British common law that was in place when colonies were established in Africa, Asia and the Americas. According to the statutes, married women have no right to inherit property from their husbands – ownership in their own right of any property is extremely complicated.
Where AIDS comes into the picture has to do with the dynamics of marital relationships in many African cultures. Not only are many marriages polygamous, but adultery is a condoned practice for men – who often bring home the HIV virus to their wives, who are forced to submit to sex – and end up infected with AIDS. With no power to effect their own escape from their marriage, and no power to live independently, many of these wives are AIDS patients just waiting for infection.
Heart disease is also a major killer, particularly in more developed countries. While the medical establishments in the West and many countries in Asia have, by and large, conquered epidemic-based diseases, lifestyle choices have led to a high incidence of coronary disease in these societies. Poor diet and lack of exercise, combined with high stress, can lead to coronary disease and related fatalities. As a result, affective factors become important in determining health.
In many workplaces, women feel a lack of control. In many households, women also feel a lack of control. At work, women can feel bullied by their male co-workers and superiors, and they may not feel like they have much control over their own advancement. At home, women may feel dominated and controlled by their partners, and may not feel like they have any recourse, should the situation in their home turn abusive or harmful. Women who feel like they have less control, both at home and in the workplace, are more susceptible to heart disease (Griffin, J., et. al., 2002). Studies of women in the former Soviet bloc, findings of feelings of low control in the workplace for women were connected to increased incidences of heart attack. Studies in Poland, Russia and the Czech Republic showed connections between feelings of low control at work and clinical depression (Marmot, 2006). In a study comparing mortality rates and perceived level of control in seven countries from Central and Eastern Europe, a perceived lack of control over the crucial circumstances of one’s life contributed to a higher rate of mortality at earlier ages (Pikhart, 2002).
Another area in which a feeling of control can be important, for both men and women, is in the area of social interaction. Several studies have shown the importance of engagement in social networks for long-term health (Marmot, 2006). One institution that provides not only intimate interpersonal networking but the opportunity to join in larger groups of social connections is marriage. A study of unmarried men in Hungary and the Czech Republic showed that, when the region was under Communist hegemony, unmarried men died at a significantly faster rate than their married counterparts; no analogous change was observed in unmarried women as opposed to wives (Blazek and Dzurova, 2000; Hajdu, McKee and Bojan, 1995). While it would be difficult to make specific assertions about the quality of the marriages in those countries, based on those findings, it would not be difficult to infer that marriage appears to benefit men far more than women in those countries (Marmot, 2006).
Two behaviors that affect women in countries in which basic survival and subsistence are not a part of their daily life are obesity and smoking. Obesity is a double-edged sword for women; girls who are obese tend to do more poorly in school and are less likely to be involved with extracurricular activities – both of the athletic and academic variety. On the other end, obese women then tend to pursue lower levels of education – when a country’s GNP (gross national product) gets above $2990 per capita, obesity decreases with education level (Marmot, 2006). Obesity tends to harm women’s socioeconomic positions far more often than it does those positions for men (English Longitudinal Study of Aging). Whether this increased harm comes from the objectification of women, as opposed to men, when it comes to physical appearance, or whether it comes from the increased chance of disease and health problems that occur with obesity, or both, is an excellent subject for further study.
Smoking is another lifestyle choice that affects both men and women. While obesity can stem from genetic causes in many instances, smoking is a choice that becomes addictive over time. While there is no evidence that smoking is more harmful to women than to men, if one accepts that women have more barriers, when it comes to social and economic independence, or even very much in the way of personal satisfaction, it makes sense that more women would be likely to turn towards smoking as a way to gain a temporary feeling of pleasure – and would be less likely to refrain from potentially harmful behaviors, out of a fatalistic sense that there is little reason to drag out their lifetime further by making healthy choices (Graham, 1993).
One of the more intriguing differences in health care as it affects men and women has to do with mental health diagnoses. It was not that many centuries ago that, when women reported psychological symptoms – or just an excess of emotional symptoms – they were diagnosed with “hysteria,” a vague umbrella term that covered everything from the venting that might take place at the end of a stressful month to legitimate psychological disorders. However, there were no men diagnosed with “hysteria” – which was seen as a purely female phenomenon.
Now that we have entered the twenty-first century, though, the diagnosis of many disorders has advanced tremendously. However, there are differences in terms of gender that have to do with the way that various diagnoses are handled. For example, men diagnosed with schizophrenia, in an Australian study, were twice as likely to be committed to a mental facility as their female counterparts. However, twice as many women who were diagnosed with specific personality disorders or recurrent depressive disorders were committed to facilities as men who were diagnosed (Australian Institute of Health and Welfare). The significance of this has to do with the perceptions of the seriousness of those conditions by medical professional staff – women are showing up with a disproportionate number of cases of personality disorders. As long as gender inequity is a problem in mainstream society, this is likely to persist as a health threat for women.
It may be impossible to render society fully equitable in terms of gender. There are those who argue that the physiological differences between men and women, specifically focusing on the decisions that some women make to have families, will keep such issues as salary and access to promotions stilted towards those who can maintain their focus on the priorities of their employers. However, when it comes to raising children with a sense that women and men both contribute equally to progress in society, and when it comes to designing government policy so that every person has access to the same resources in the areas of education, self-expression, autonomy and property, this is a matter that governments can handle – and educate their citizens to embrace. In the area of health care, every day that passes without every woman having the same access to quality care as every man – or, better said, without every person having the same access to quality care – is a day too many.
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