9.5. Special gender-related issues

9.5.1. Introduction

“Gender” refers to the social construction of what it means to be a man or a woman. In contrast to “sex” which refers to biological and physiological differences between men and women, “gender” describes roles, responsibilities, activities and norms about acceptable behaviour for women and men in a specific culture, all of which may undergo changes in a given context.

Differences in prevalence / incidence, natural history, diagnosis, and treatment of disease between men and women have been frequently documented. Women differ greatly from men in how their bodies are affected by major diseases (Denton, 2004; Iredale, 2007); e.g. risk factors, symptoms and treatment of cardiovascular diseases vary between the genders. Differences in health behaviour (e.g. tobacco use), risk taking, and medical care utilisation are major components contributing to gender differences in health and longevity. Interactions between the social environment, genes and biology are responsible for the observed differences in longevity, health and human development between men and women. Exploration of gene-environment interactions is fundamental to the understanding of gender-specific health.

In general, women experience greater morbidity than men although women’s life expectancy is higher. As the proportion of women in the population increases through lifetime, women are at a higher risk for experiencing age-related morbidity and are less likely to rely on assistance from a spousal partner (Wang et al 2004). The female adult mortality rate is lower than the male adult mortality rate in almost all countries in the world. The expected number of years to be lived by a female newborn is at least 80 in most Western European countries and 75 for males. In Eastern Europe and Romania, this figure may be up to five years less than the European average for females, while in Latvia it is ten years less than the average for males (WHO HFA-DB, 2006). In older ages, women have clear survival advantages compared to men (UN, 2005). Much of women’s health risk is associated not only to biological differences between men and women and to the reproductive role women have, but also to gender inequality in social, educational, cultural and economic status. In addition, women have lower access to healthcare and encounter high risk sexual intercourse and violence more often than men

 As a movement, men’s health is only beginning to gain momentum. Western societies typically ignore the economic and political significance of the processes of socialisation that prepare men to fight in wars or to work in hazardous industries. Little regard is collectively given to the contribution of these factors to the ill-health of men. Research into men’s health is lacking but it is important in order to generate a more comprehensive and less naïve understanding of what engenders or endangers the health of men and of those with whom they live and work.

A reduction has been seen in cardiovascular disease mortality – primarily through medical advancement, and influenced heavily by a decline in smoking in the last quarter of the twentieth century. Smoking has been identified as a primary determinant of the convergence in mortality differentials between men and women in industrialised countries. As women begin to smoke later than men and are slower to quit smoking, women’s smoking rates continue to rise in some European countries (Czech Republic, Hungary, Portugal and Slovenia). As a result, the gap between men’s and women’s life expectancy is low by historical standards (Cutler et al, 2005)

Psychosocial determinants of health are generally more important for women, while behavioural determinants are more important for men. Higher rates of accidents (traffic accidents, work-related accidents) and violence-related mortality in men seem to be due to differences in gender norms about risk-taking and social protection. The described gender differences contribute to inequalities in health between men and women.

Loosening of social norms about women’s work outside of the home in European countries is related to increases in psychosocial stress and poor health in women, who have to balance responsibilities at home and at work (Lorber, 2005). For what concerns women’s health, it is essential to consider a lifespan and multiple role perspective.

Gender-specific health is multi-determined and includes many modifiable factors which need to be identified and considered in appropriate interventions.

There is still a lack of data on gender differences in health and changing gender relations which have profound influence on patterns of health and disease (Walter, 2004).

The significant differences in the way men and women are diagnosed and treated within the various healthcare systems in Europe stem from both biological factors and disease prevalence. An increasing body of evidence suggests that women do not receive as effective treatment or health information as men and that women may respond differently to the treatment they receive. Most research and clinical trials are made on men, with results extrapolated to women. Research on the types of treatment that are best for women remains limited. Furthermore, women and young girls are disproportionately represented among the most vulnerable population groups.

Economic inequalities mean that in many countries women have difficulty in acquiring the basic necessities for a healthy life. The overwhelming majority of single parents are women, and women with children have lower employment rates than those without. Women can be debilitated by unshared domestic work, especially when combined with inadequate resources.

Biologically, women are more susceptible to several medical conditions. More gender disaggregated research is needed to establish the differential life experiences of men and women during the lifespan.