What might be the impact of socio economic status or gender or ethnicity (the social determinants of health) on the ‘experience’ of health and illness, focus particularly on those of older people?
Disparities in health exist in various forms due to age, gender, socio economic status or other lifestyle factors and are often referred to as ‘the causes of the causes’. This short essay focuses on the subject of gender in relation to the older person, and highlights the issue of gender bias within health services.
The biological sex of a person can be described by their physiological characteristics and differences (WHO, 2013), however gender is defined as how we are perceived and expected to behave within society, for example being feminine, wearing heels and lipstick, or being masculine, having a hairy chest or big muscles (Cummings, 1995). There are many explanations that try to describe the shaping of an individual’s health, mind and longevity, such as biological, social and constrained choice models of theory (Kuhlmann & Annandale, 2012).
Patterns of disease highlight that environmental factors can affect the probability of developing an illness; however ‘age’ is more often considered a health problem rather than an illness. Statistics report that women’s life expectancy figures are significantly higher than men’s worldwide, on average by ten years (ONS, 2012), but what is the reason behind this phenomenon? (Payne, 2006). It may be argued that there is a significant lack of knowledge in the area as research into gender and health has been biased, due to the fact that its studies have mainly been centred on men.
Gender ideologies are that women are more susceptible to emotional illnesses such as depression or anorexia nervosa, whereas men are more prone to suffer from cardiovascular disease (CHD) or emphysema.
Goffman (1959) hypothesised that individuals have roles, and that they act out these roles within a ‘social stage’, for example, from a capitalist perspective (Marx, it could be argued that within these roles women have unequal divisions of labour, power and money within the home, resulting in a poorer socio economic status (Moss, 2002). Their experience of health and illness differs significantly, which could suggest that men and women are predisposed to certain sex specific health behaviours such as smoking and drinking for instance.
Patriarchy within the family unit suggests that males have the top role, and that women tend to neglect their own health needs by focusing on the families’ health. This behaviour is known as emotional labour which consequences in some women enduring high levels of stress and illness. The same theory could be applied to single mothers or widowed women who live on their own.
The ideological stoic male within society is often considered less of a man if he seeks help for any illness related problems because social construction adopts the view that he should be masculine and ‘soldier on’, however this can have detrimental negative effects on his health outcomes. Women however could be argued to take more of an active role regarding their health, as they tend to access health services more during their maternal years, which could endure in their later years. When couples are married or co-habiting it is usually the man’s occupation that is used to determine social class.
There is a considerable amount of evidence concerning health and social class, published on what seems to be a weekly basis, but one of the most influential pieces is entitled ‘The Black Report (Townsend and Davidson, 1982). The report highlighted the problems of ill-health and mortality, and how they can be unequally distributed among the British population. It has been argued that inequalities have been rapidly increasing, not shrinking, since the founding of the National Health Service in 1948. The Report also found that the inequalities were not always due to failings in the NHS, but rather to the social determinants that influence health.
To conclude, we are living in an ageing society, therefore it is vital that men and women are equals in regard to their health and treatments. That being said there are gender inequalities within health systems that can have a devastating effect on the mortality of both sexes (WHO, 2008). Public Health Policies need to be reviewed and updated to enable individuals to receive the same outcomes, treatments and rights to access healthcare (WHO, 2008).
Health promotion strategies must endeavour to lessen the gap between the sexes as it is more important to understand the ‘wholeness’ of a person regardless of age or sex, rather than making assumptions based on the initial presenting symptoms of an illness, as there is a real danger of dismissing his or her complaints by relating them to a degenerative aging process.
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