Relevance: Sociology: Stratification and Mobility :Concepts- equality, inequality, hierarchy, exclusion, poverty and deprivation.
Gender differences in social determinants of health and illness
Social factors, such as the degree to which women are excluded from schooling, or from participation in public life, affect their knowledge about health problems and how to prevent and treat them.
The subordination of women by men, a phenomenon found in most countries, results in a distinction between roles of men and women and their separate assignment to domestic and public spheres.
The degree of this subordination varies by country and geographical or cultural patterns within countries, however, in developing areas, it is most pronounced. In this section, the example of nutrition will demonstrate how gender has an important influence on the social determinants of food-consumption patterns and hence on health outcomes.
Several studies have shown the positive relationship among education of mothers, household autonomy, and the nutritional status of their children.
During the first 10 years of life, the energy and nutrient needs of girls and boys are the same. Yet, in some countries, especially in South Asia, men and boys often receive greater quantities of higher quality, nutritious food such as dairy products, because they will become the breadwinners.
Das Gupta argued that depriving female children of food was an explicit strategy used by parents to achieve a small family size and desired composition . Studies from Latin America also found evidence of gender bias in food allocation in childhood and, correspondingly, in healthcare allocation.
In developing countries, most studies show preferential food allocation to males over females. Nonetheless, some studies have found no sex differences in the nutritional status of girls and boys, and others have described differences only at certain times of the life-cycle.
For example, research in rural Mexico found no nutritional differences between girls and boys in infancy or preschool, but school-going girls consumed less energy than boys. This was explained by the fact that girls are engaged in less physical activity as a result of culturally-prescribed sex roles rather than by sex bias in food allocation.
Studies from developing countries of gender differences in nutrition in adulthood argue that household power relations are closely linked to nutritional outcomes.
In Zimbabwe, for example, when husbands had complete control over all decisions, women had significantly lower nutritional status than men.
Similarly, female household heads had significantly better nutritional status, suggesting that decision-making power is strongly associated with access to and control over food resources.
Access of women to cash-income was a positive determinant of their nutritional status. In rural Haiti, the differences in nutritional status for male and female caregivers were examined for children whose mothers were absent from home during the day.
Those who were looked after by males, such as fathers, uncles, or older brothers, had poorer nutritional status than children who were cared for by females, such as grandmothers or sisters.
Ethnographic research conducted by the authors revealed, however, that, while mothers told the interviewers that the father stayed home with the children, it is probable that the father was, in fact, absent most of the day working and that the children were cared for by the oldest child, sometimes as young as five years of age.
The involvement of both men and women in nutritional information and interventions is key to their successful implementation. Unfortunately, in most developing countries, women are selected for nutritional education because they are responsible for the preparation of meals.
However, they often lack access to nutritional food because men generally make decisions about its production and purchase. Similarly, men may not provide nutritional food for their families because they have not received information about nutrition.
The participation of both men and women is, therefore, fundamental to changing how decisions about food are made and food-consumption patterns and nutrition families.
The study in rural Haiti referred to above also found positive outcomes through the formation of men’s groups which received information on nutrition, health, and childcare. These men, in turn, were resources for education of the whole community.
The gender differences are also found in the social determinants of nutrition in industrialized countries, although their manifestations are different.
For example, gender plays an important role in determining risk factors for eating disorders, which influence nutritional outcomes. The most common of these are anorexia nervosa, bulimia nervosa, and binge eating (BED).
The root causes are only partly understood. Biomedical and psychological theories include hormonal imbalance, malfunctioning of serotonin in the brain, genetic explanations, and emotional problems expressed by abnormal relationships with food.
Sociocultural explanations include the emphasis placed on the ‘ideal’ female body shape in western society. Experts agree that a key factor is the desire to please others.
These characteristics are linked to ‘negative femininity’—behaviours associated with passivity, dependence, unassertiveness, and low self-esteem. Dieting and bingeing may be used for improving body image and self-esteem.
Among men, dieting and bingeing seem to be more common among gay men and sports competitors than in heterosexuals.
Many studies have demonstrated the effect of social support on nutrition in older adults, with a positive impact being seen among those who are married, especially men.
This has been explained by several factors—the greater likelihood to skip meals when living alone, or to eat filling but unhealthy products and snacks.
Women who are alone may not be able to afford an adequate diet, or they may be less motivated to cook for themselves when they are accustomed to providing for others.
The gender differences in nutritional risk were studied among an older sample of black and white community dwelling residents in Alabama, USA .
The study took into account social support, social isolation, and social capital as possible determinants of nutritional risk. Social capital was defined to include neighbourhoods, trust people felt in their security, and religion.
The study found important gender and racial differences between different groups, black men being the most affected by poor nutrition if lacking in social support and capital. White men were in the best overall position, with white women in the second best position, and black women in the third.
The study found that social isolation and lower income contributed most to nutritional risk for all groups, except black men, for whom lack of social support and capital were the most important determinants of nutritional risk.
The studies discussed in this section demonstrate that gender matters in terms of nutritional outcomes, but, at the same time, generalizations as to how gender affects the social determinants of nutrition can be misleading.
The complexity of social, economic and cultural contexts and also demographic and epidemiological indicators must be taken into account to fully understand the additional impact that gender has.