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The following discussion will concentrate on social inequalities in health which have lead to the unequal distribution of resources in the society. Health inequalities refers to the differences in the prevalence of incidence of health outcomes between population groups and range by socio-economic groups and geographical area (Graham 2000). Gender which has socially constructed roles of female and male identity, can therefore compound health inequalities which generate the underlying socio-economic inequalities thereby affecting some social groups badly.
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Research on gender inequalities have developed but the rapid social change in the lives of men and women and an increased questioning of an oversimplified established wisdom about gender and health makes a critical retrospective timely development in social theory which raise new questions about gender inequalities (Fried, 2007).
Gender inequalities in society lead to inequalities in health. Most societies give greater status and power to men and this has adverse impact on the health of women. Domestic abuse occurs mostly against women. Thus, women’s health is profoundly affected by the ways they are treated and the status they are given in society (NHS Lothian, 2004).
Distinct roles and behaviours of men and women in a given culture are dictated by their culture, gender, norms and values which gives rise to gender differences. Gender differences and gender inequalities can therefore give rise to inequalities between men and women in health status and the access to health care (World Health Organization, 2009).
Apart from the internalized ideologies of gender that are acquired, all societies are structured around hierarchical systems whereby sex together with age form the vital organizing features. Gender differences in access to and control over key material and social resources result not only in inequalities of health and wellbeing, but also inequalities in power, knowledge, making independent decisions relating to sexual and reproductive decisions and to act on them in health seeking behaviour (Oakley, 1998). So, if biological predispositions form one basis for inequalities in reproductive health and cultural difference (Graham, 2000), then the distribution of resources within the household, family and community forms an additional layer of differences reflecting inequalities of gender.
According to Walby (1997), gender norms and values and the resulting behaviours are affecting health in a negative way. Gender can be one of the major obstacles standing between men and women and the achievement of well-being. Women have lower incomes and make seventy-five percent of single pensioner households and are likely to bear inequality in health related to poverty (Scottish Executive, 2003).Walby (2000) writes that the actions of the European Union are limited by its primary concern with standard employment whereas women are often employed in non-standard forms such as part-time and temporary employment and thus many women do not benefit from its regulations. She went on to explain the extent to which the family form involves women as housewives or workers. This is therefore more complex than the use of gender norms because the different types not only by different types of values but also by the form of the welfare state.
“Gender as well as socio-economic position mediates exposure to material, psychosocial and behavioral risks “(Annandale and Hunt 2000: 1996) Men have traditionally been exposed to the industrial injuries associated with skilled manual work yet women experience the disadvantages of contributing to affective disorder, poor home environment with heavy childcare responsibilities as well as low levels of social support since most women if they are employed, they are on low pay. Women bear extensive caring and nurturing responsibilities and a higher prevalence of poverty. According to Wobbe (2003) stress of making ends meet impacts the health of women leading to mental health illnesses. He explains that enforced childbearing, overwork and poorer access to food compared to men meant that women’s life expectance in society was affected more than men’s.
According to Graham (2000) ,only females are exposed to problems relating to menstruation, pregnancy, abortion, miscarriage, childbirth and lactation. It is only women who experience breast or cervical cancer or pelvic inflammatory disease. (Lorber ,2000) says only men are at risk of prostate cancer, impotence or problems related to vacectomies. But, both sexes can experience infertility. Girls and women are at risk of more varied and serious sexual reproductive health problems than boys and men (Connell 2002).
Gender based inequalities in health cut across and interact with class inequalities (Scott 1988)Thus, health problems such as iron deficiency, anaemia which is common among women, among the poor and in rural areas can result in highly class-specific patterns of reproductive morbidity and mortality among women. However males do have an excess mortality persisting through to later life. They are at risk of dying in childhood and adulthood from diseases such as heart attacks and strokes. Townsend and Davidson (1982:48) writes: “The gap in life expectancy between men and women is the most distinctive feature of human health in the advanced society.” The death of men in different social classes is in most cases double that of women leading to the cumulative health inequalities between the sexes. Gender and class therefore exert highly significant but different influences on the quality and duration of life in modern society. Connell (1987, 1995, 2002) analyses gender and health and writes that men was often reactive to feminism. Men was socialized into the sex-role system in ways which even though they were oppressive to women, they developed men in distorted ways as emotionally repressed and power oriented thus put men at greater risk of early death through suicide and heart disease. Feminist ideologies expressed through by rights and health oriented women’s organizations aim at promoting the sexual and reproductive health services and restrictions on contraception methods that are thought to violate religious norms. Inequalities in access result from the denial of family planning services to the unmarried especially in the African culture and from requirements that married women must obtain their husbands’ consent among other restrictions.
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Annandale and Hunt (2000) say “It is hard to argue that male-female mortality difference are statistical artifact.” They suggest that female excess morbidity is socially constructed. Intense social pressure to conform to accepted ideals of ‘masculinity’ therefore leads men to deny illness out of fear that it displays weakness and are less prepared to report symptoms or use health services compared to women.
Health care professionals are faced with challenging social attitude to prevent and manage risk factors to ensure they do not lead to chronic health problems later in life. So professionals have a role in the prevention of abuse by taking challenging actions and condone violence and abusive behaviour that reinforce the gender stereotypes and underpin domestic abuse in women. Women need to be provided with appropriate response which is part of the high quality care that should be delivered. Professionals should feel confident, have access to training, support and adequate information to enable them to support women experiencing domestic abuse. (NHS Lothian, 2000) Professionals should be aware and able to recognize signs of potential abuse in women. They should respond to women in a supportive way and listen to them. The World Health Organisation (2000) say the goals of Gender and Women’s Health Department are to increase health professionals awareness of the role of gender and inequality in perpetuating abuse, disease and death with the view to eliminate gender as a barrier to good health. The Department of Health (2000) aims to develop an approach to take into account performance management between health authorities about key health issues so as to make targets based on gender specific principles. Females and males think and act differently as a consequences of their socialization and of the gendered society (Walby 2004). The challenge still stands that healthy communities which recognize inequalities should be built and achieved by understanding social issues, changing they way things are done and accepting that the needs of people must be at the heart of everything a professional does.
Working with individuals is vital on the part of health professionals and it is their duty to make service users welcome and comfortable especially the one-to-one support which should be client centred. Since women experience child birth, it is the health professionals duty to held the pregnant woman focusing on her individual needs and interest making her understand more about her health care and be able to make decisions about childbirth and caring for her baby. Women often approach health care professionals for help because they need up-to date advice on breastfeeding, solid foods, because the decisions made at the start of a baby’s life require sensitivity and understanding, thus mothers need reassurance and hence the need for health professionals to work with individuals. Even those women who might have suffered domestic abuse, it is essential to work closely with them individually reflecting on what happened and how best they can be assisted. When working with men as individuals, it should not only allow themselves to talk more openly about their problems, but helps the health professional to find out more about men’s psychological ill health. Since most of them will be clinically depressed and the sense of isolation will be profound as they will not be talking to anyone about their concerns or feelings. Thus, health care should be accessible, approachable and achievable for everyone (Department of Health 2000).
Working with group as stated by Drummomd (2000), it is essential to work with and understand the views of men and women of the local community for health promotions. The professionals should think laterally and work in small companies where men are under pressure. Services according to Drummond should be in youth centres, unemployment centres and many small groups in the community. The development of local strategic partnership offers opportunities or health authorities and local authority to discuss health issues. “To build healthy communities, professionals need to work with local men and women by bringing them into partnership within the locality in which services are placed, working within a context of dialogue that leads to action.” Young men are an especially different group to reach because they are not interested in the long-term results of an unhealthy lifestyle but can be persuaded to consider the immediate impact of current ill-health hence the need to change the way health is marketed. (Deville-Almond 2008) it is vital to work with peer support groups such as the prostate cancer a charity which offers men the opportunity to talk to other men to reduce embarrassment when discussing symptom thereby promoting autonomy.
Townsend and Davidson(1988) states “Inequalities exist also in the utilization of health services, particularly and most worryingly of the preventive services.” According to the Health Promotion, women access health services more regularly and it is much easier for health professionals to consult women. Robinson, a community learning consultant explains that if health professionals are to work with men, they must go where they are thereby being flexible I delivering services. She further says that if one is a female professional she should not hesitate to go and work in a working men’s club and talk about health issues as this would improve the younger men’s health. The Department of Health (2000) argues that services should be sensitive to men’s concerns and attitudes. The Health Department Agency (2001) says there should be more men’s health clinics, telephone and online services should be developed since most men prefer the anonymity of such services. Opening hours should take into account the commitment of people who work full-time. The role of occupational health services should be strengthened. Men’s health needs should be taken into account by the local authority community thus providing the opportunity to take an over acting view of inequalities of all kinds.
This essay has shown that women and men share many similar health challenges and the differences are such that the health women deserve particular attention. Even though women live longer men because of biological and behavioural advantages, their longer lives might not be healthy lives because of the biological and social processes they go through which carry health crisis and therefore require health care. Gender inequalities in health are therefore socially governed and thus actionable. Even in health, biology is not destiny, “Sex and society, nature and nurture, chromosomes and environments interact to determine who is well or ill, who is treated or not, who is exposed or vulnerable to ill-health and whose health needs are acknowledged or dismissed” (Equal Opportunities Commission 2002).
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