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Why do we need an Institute of Gender and Health? Bird, Chloe 2010

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Why Do We Need an Institute of Gender and Health? Chloe E. Bird, PhD RAND Corporation Funded by a Grant from the National Library of  Medicine (5G13LM007584-03) and a Residency at the Rockefeller Foundation Center in Bellagio, ItalyOverview  Summary of gender differences in health  Current knowledge gaps in understanding causes of gendered health disparities  Framework of Constrained Choice  Implications for understanding and addressing gender differences in health50 55 60 65 70 75 80 85 U.S. Life Expectancy at Birth, 1970-2005 Years of life SOURCE:  Hoyert, DL, Kung HC, Smith BL, Deaths: Preliminary Data for 2003, National Vital Statistics Report, Volume 53, No. 15, National Center for Health Statistics, Hyattsville MD, February 28, 2005 and Kochanek, KD, Murphy, SL, and Anderson, RN, Deaths:  Final Data for 2002, National Vital Statistics Report, Volume 53, No. 5, National Center for Health Statistics, Hyattsville, MD, October 12, 2004. More information on life expectancy is available at: http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm 1970 1980 1990 2000 0 White female Black female White male Black male 2005Gender Gap in Longevity Varies Cross-Nationally  Highest LE Gap  Japan 83 7  Andorra 82 7  Monaco 82 7  San Marino 82 3  Switzerland 82 5  Australia 82 5  Source:  World Health Organization, 2006  Lowest LE Gap  Sierra L. 40 3  Angola 41 3  Afghanistan  42 1  Swaziland 42 2  Niger 42 1  Lesotho 42             4    World Map of Gender Gap in Life Expectancies, 2000-2005 Average Source: UNDP 2005 Number of Years Women Live Longer -1.7 - 1 1 - 3 3 - 6 6 - 9 9 - 13.1Gender Differences in Cardiovascular Disease  Leading cause of death and contributes to differences in life expectancy  Prevalence and age-adjusted death rate greater for men compared to women. Since 1984 more women than men have died of cardiovascular disease  Women spend more years living with CVD disease than do men 350 400 450 500 550 1979 1984 1989 1994 1999 2004 Years De at hs  in  T ho us an ds Women Men Gender Gap in CVD Mortality Has Widened SOURSE: CDC/NCHSGender Differences in Immune Function and Disorders  Immunologic diseases female/male ratios:  thyroid disease  15:1  rheumatoid arthritis  3:1  systemic lupus  9:1  systemic sclerosis  4:1    *Much  of women’s disability in middle and older ages due to autoimmune diseases Main Mental Health Differences  Overall rates of psychological disorder are similar for men and for women  But most common disorders differ by gender  Women have higher rates of depression and anxiety  Men have higher rates of alcohol/drug dependence and antisocial behavior disorders Interactions between Physical Health and Emotional States Emotions affect cells of immune system and can regulate cytokine production, contribute to infections and wound healing*  Depression  Anxiety  Acute and Chronic Stress  Hostility and anger   *Kiecolt-Glaser et, 2002aBiomedical Explanations Emphasize Health Advantages  Which accrue from physiological systems  Hormonal differences  Immune function  Sex-specific and sex-linked diseases  Biological evolutionSocial Explanations Emphasize Context and Mediating Factors  Absolute and relative SES and its impact on both exposure/risk and vulnerability/resilience  Social relationships  Social support  Social isolation  Personality traits and coping responsesWhat’s Missing?  Neither social or biological explanations alone are sufficient  Inequality models do not explain paradoxical differences  Lack of knowledge of pathways and processes  Disciplines proceed separately  Many questions about sex and gender differences and relatively little certainty What’s Needed to Address Gendered Differences in Health?  Interdisciplinary research that incorporates:  an understanding of differences in men’s and women’s biology and in their lives  contextual effects on health  interaction between biological and social processes  individual choice and responsibilityConstrained Choice and Rational Actions  People construct choices from priorities and values  Choices are constrained by context(s) and meanings  Rational people make choices that don’t always maximize their health Constrained Choices Have Cumulative Health Effects Broader social context and sex/gender constrain choices  Jobs and Careers  Marriage, Family, Children  Neighborhood and Housing  Amount and Use of Income  Intergenerational SupportSchematic Framework of Constrained Choice SOCIAL POLICY COMMUNITY ACTIONS WORK & FAMILY BIOLOGICAL PROCESSES (e.g., Stress Responses) HEALTH OUTCOMES MORBIDITY MORTALITY INDIVIDUAL CHOICES  (e.g., Health Behaviors)Decisions and Actions by Families, Employers, Communities and Governments  Shape men’s and women’s choices and opportunities  Impact their stress levels and exposure to risks  Create incentives and disincentives for engaging in health behaviorsDecision Contexts as Targets for Interventions  Policy Regime Level  Social provisions  Regulations  Community Level  Planning and urban design  Housing and transportation  Work and Family  Work environment policies  Health conscious decisionsWhy Understanding Gendered Differences Matters  Knowledge gap hampers prevention and treatment  Clarify multifaceted connections between biological and social processes  To intervene, we need to understand why rational people are ineffective in making health a priority in their everyday livesHow the IGH Addresses these Gaps  Supporting  cross-disciplinary research that:  directly assesses sex and gender differences in health  examines the contributions of both social and biologic factors, and their interactions to health  identifies points for intervention to improve men’s and women’s health and reduce gendered disparities  produces actionable findings that are disseminated to the appropriate audiencesRelated Publications  Bird and Rieker. 2008. Gender and Health: The Effects of  Constrained Choice and Social Policies.  Cambridge University Press.  Bird, Lang, and Rieker.  2010. “Changing Gendered Patterns of Morbidity and Mortality” in Handbook for Gender and Health Care edited by Ellen Kuhlmann and Ellen Annandale.  London: Palgrave.  Rieker, Bird, and Lang.  2010. “New Directions in Understanding Gender and Health” in The Handbook of Medical Sociology edited by Bird, Conrad, Fremont, and Timmermans.  Sixth Edition. Nashville, TN: Vanderbilt University Press.

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