Chapter 9 Health and Illness

Women and men differ on many measures of health and illness. These differences are a result of both biological and social factors. Health and illness are part of a broad social context that includes social inequalities. These inequalities by gender, race ethnicity, and social class shape our health status.

Health and Illness as Social Issues

The causes of disease and injury and the experience of illness, its treatment, and resolution take shape in a social context. How does gender inequality affect women’s health? How does men’s dominance contribute to men’s diseases? What about the health status of marginal, poor, and working-class men? How does the intersection of race ethnicity, class, and sexuality with gender affect health? How should we envision health? Is health a human right? How can we treat health as feature of communities, nations, and the global world, and not as simply a feature of individual lives?

Nation and Life Expectancy

Where a person is born has a powerful impact on her or his health and life expectancy.

Gender and Life Expectancy

In most nations, life expectancy is longer for women than men. This is a fairly recent phenomenon as men used to live longer than women. Improvements in reproductive health helped women extend their life expectancy. Today, however, reversals are occurring as the incidence of what was previously “men’s diseases” increases among women.

Race ethnicity, social class, and other inequalities intersect with gender to create variation among different social groups.

Sex, Gender, and Health: The Gendered Division of Labor

Higher mortality rates for men may be associated with workplace factors as well as gender expectations for men that include suppression of some emotions. Women’s unpaid work may contribute to illness for women.

The Health Risks and Benefits of Women’s Employment in the West

Employed women are generally mentally healthier than are women who are not in the labor force, but women’s dual responsibility for paid and unpaid work is stressful and may be creating health problems for women. Social class increases the work burden and the stress, leading to greater health problems among poor women.

Poor Women’s Health Risks on the Job in the Global South

In a globalized workplace, people in poor nations work in stressful, illness-producing situations and have little access to medical care. Housework is also more strenuous and dangerous in these areas of the world. The neoliberal free-trade system that eliminates trade barriers and allows corporations to travel the world in search of the cheapest labor with minimal regulation has disrupted local economies, forced massive migrations of working people, and accelerated their impoverishment and insecurity. Sweatshops are increasingly a part of the globalized work world, especially for women.

Sexual and Reproductive Health

Heterosexual women have less control over sex and sexual health than do men. Lack of access to medical care increases their health problems. Despite recent health care legislation, 20 million people are still left without access to affordable care. In that context, it may not be surprising that the maternal mortality rate in the U.S. increased in 2006. Particularly vulnerable are black women, First Nations women, poor women, and immigrants.

Women’s chronic ailments in poor countries or among poor women in rich countries are a result of poverty, hunger, lack of access to clean water, and exposure to communicable diseases, which exacerbates their problems. 

Toxins and Reproductive Risk

The different challenges faced by women and by men regarding their health are a result of the sexual division of labor. Men and women are differentially exposed to chemical agents that threaten their future children. Agent Orange, liberally used by Americans in Vietnam, is suspected of causing such serious fetal harms as spina bifida, childhood leukemia, cleft palate, and tumors to the babies of returning veterans. Depleted uranium, a weapon of the Gulf and Iraq wars, is suspected of causing birth defects in the babies of soldiers exposed in those wars. These findings suggest that it is imperative that workplaces provide safe, nontoxic environments for all workers and that states give up war-making.

Gendered Illness: Believing is Seeing

Medical discourses have constructed gendered maladies as metaphors that build on actual physical and mental ills to capture the political conflicts and social anxieties of their historical period. The text describes the medicalization of women’s conflicts and anxieties as hysteria among middle-class women at the turn of the 20th century, frigidity in the 1950s, and eating disorders today.

Men’s Body Crises

Men’s dissatisfaction with their bodies, and specifically bodily dysmorphia surrounding muscles (sometimes called bigorexia), is growing. Twenty-nine percent of gay men report dissatisfaction with bodily appearance – a rate much higher than heterosexual men (21%) and slightly higher than heterosexual women (27%). Lesbian women are most likely to report dissatisfaction with their bodies at 30%.

Masculinity as a Health Risk

The links between masculinity and risk taking, such as drinking, drug use, and multiple sex partners, are key feature of men’s health problems. Young women have joined men in risky pursuits, such as aggressive driving. Steroids provide another example of how men’s quest to be masculine creates health problems. Steroid users often express insecurity that they will not be “manly” enough without drugs and bodybuilding.

Masculinity and Heart Disease

“Extreme” masculinity is linked to heart disease: type A behaviors (behavior that is competitive, impatient, hurried, angry, and hostile), impoverished social networks, and inability or unwillingness to seek help for health problems. These factors are shaped further by social class and race ethnicity.

Stratification and Inequality in the Health Care System

The health care system in the U.S. is structured along gender, racial ethnic, and class lines. Women and racial minorities have increased their numbers among physicians, but change is slow and the hierarchy of the industry remains highly stratified by gender and race ethnicity. The health care system in the U.S. is currently in profound crisis: it is expensive, inaccessible to many, and ineffective, resulting in high rates of illness and death. When the new health reform bill passed Congress in 2010, there was hope that the U.S., the last developed nation in the world without a national health care program, would at last provide its citizens with needed care. The bill has been under attack by Republicans.

Care Work: the Paid or Unpaid, but Often Invisible, Foundation of Health Care

Much health care in the U.S. is done by women and racial ethnic minorities for no or low wages. Unpaid health care in private homes is increasing as insurance companies shift away from hospital care. Because of women’s entry into the labor force, the rise of single parenting, and the increase in people living alone, a growing proportion of children, the disabled, and the elderly are being cared for by paid care workers. When the paid work of medical workers is redistributed to unpaid family members who are overwhelmingly women, a “work transfer” has taken place, putting additional burdens of labor on women in families. Paid care workers also juggle stressful work for low pay. They now do what used to be the work of trained nurses in hospitals, but with heavy workloads and unpaid overtime.

Women’s Health Movements

The Women’s Health Movement emerged in the U.S. in the late 1960s as women activists identified the gendered, class-based, and racialized character of women’s health care. There were multiple local beginnings of the movement. The publication of the first edition of Our Bodies, Ourselves in 1969 was one milestone in the burgeoning movement, as was the publication that same year of Barbara Seaman’s book, The Doctor’s Case Against the Pill, which raised serious questions about the safety of the contraceptive pill. Around the country, feminists organized health clinics and birthing centers, encouraged women to learn about their bodies, and promoted alternatives to formal medicine, such as midwifery and acupuncture.

Abortion in the United States

Abortion was legal in the U.S. until the late 1880s. In the 1960s, an underground movement helped women obtain safe abortions, and in 1973 the federal law Roe v. Wade was passed, making abortion legal. Anti-abortionists, who called themselves pro-life activists, began to mobilize to change the law. The result of their campaign has been the murder of eight abortion providers, clinic bombings, “wanted posters” of abortion providers on the Internet, and a decline in abortion services.

Beyond Roe v. Wade: The Struggle Continues

Since 1973 a number of restrictions have been debated or implemented on legal access to abortion in the U.S. The Hyde Amendment prohibited federal funding of abortion. Between 1980 and 2008, the Supreme Court upheld the law in the face of challenges. Currently, Congress and state legislatures are moving to tighten restrictions on legal abortion. Funding of abortion is forbidden in the health exchanges set up by H.R. 3590, the Patient Protection and Affordable Care Act signed into law by President Obama on March 23, 2010. Some pro-choice organizations believe the reform bill was achieved at the expense of the pro-choice movement and poor women. Others focus on the new benefits of the legislation: access to health care for millions, no denial of health care for pre-existing conditions, and increased access to obstetric, gynecological, and midwife care.

Women of Color and Sterilization Abuse

The U.S. has a long history of coercive sterilization practiced on poor women and women of color. Today sterilization abuse has taken a new form in the promotion of long-term contraceptives aggressively marketed to young African American, Latina, and Native American women. Black and Latina feminists influenced the abortion movement by broadening the demands to encompass reproductive rights (including the right to bear children) rather than narrowly focusing on legal abortion rights alone.

The Racism and Classism of Sterilization. The U.S. has a long, racist history of forced sterilization of poor women and women of color without their knowledge or consent. Until 1973, between 100,000 and 200,000 poor, black, Mexican, and First Nations women had been sterilized annually under government programs, often “to save taxpayers money.” Sterilization and testing of the birth control pill in Puerto Rico was pursued as the “solution” to the problem of unemployment on the island. Simultaneously, white, middle-class women had difficulty finding doctors willing to perform the operation on them. By fighting for the rights of the most vulnerable women to be free of forced sterilization and to bear as many children as they chose, women of color broadened the women’s rights agenda to include freedom from sterilization. Moreover, the goal of making a woman free to have as many children as she chooses must include the economic means to support her children and equality in her home and community. Otherwise, how is she free to choose?

Globalizing Sterilization

Forced sterilization was part of Nazi strategy and was based on the practices of the eugenics movement in the U.S. More recently, in countries such as Peru and Japan, poverty reduction programs have included forced sterilization. In addition, U.S. policy has introduced sterilization into programs in other nations.

Gender and the Global AIDS Pandemic

Millions of people have died from AIDS and millions more are infected with HIV. The majority of people who are HIV-positive are men, but women are quickly catching up, and among some populations the majority of new cases are women. Those most at risk are poor women of color with little control over their lives and health.

Behavioral and Educational Approaches

The ABC program promotes the three behaviors to curtail HIV/AIDS: abstain, be faithful, and use condoms. The ABC programs have failed because they ignore gender. The ABCs are all pretty much out of the control of women.

Structural Violence and the Women’s Epidemic

The ABCs ignore the fact that women who do not have access to power and resources will not be able to abide by the ABCs. Women who lack power and resources in patriarchal societies and relationships or in war-torn regions of the world cannot refrain from sexual encounters, especially if they are married. Women may be faithful but they cannot make their partners monogamous. Women cannot force men to wear a condom. The resulting exposure and subsequent infection with HIV is a form of structural violence. Women’s lack of economic equality and social rights sets the stage for “structural violence,” forms of extreme suffering (hunger, rape, torture, AIDS) visited on the poor and the powerless. The concept of structural violence focuses attention on the broader social determinants of risk.

Reflections on Gender and Health: Fighting Back Around the World

The concept of structural violence suggests that poor women must achieve economic security, political power, and cultural respect to defeat the HIV/AIDS epidemic and other threats to women’s reproductive and general health. In many places, instead of making gains in these areas, women have in fact been losing ground.

Women’s organizations have created transnational coalitions to fight for control of their own reproduction and their health. Their strategy has been to place reproductive rights in the framework of human rights. Women in the global South have developed this revolutionary framework by linking sexual and reproductive health to housing, education, employment, property rights, legal equality, and freedom from gender violence.

Gender Matters

This chapter shows that health is a collective good. Job hazards, the chemical dangers of household work, the inadequacies of health care, and the lack of access to care are risks that cannot be offset by individual precautions or actions. Only action at the level of communities and societies can ensure healthy lives. Women and men have organized to change health systems and priorities. Women’s transnational movements are successfully linking health to a wide range of human rights.

Short-Answer Essay Questions 

1. What is an epidemiologist?

2. What are some of the key pieces of information provided by Table 9-1?

3. What is care work?

4. What is Roe v. Wade? 

5. Briefly outline the current status of legal abortion in the U.S. and the political debate surrounding it.

6. What is sterilization abuse?

7. What is the global gag rule?

Long-Answer Essay Questions

1. How has the gendered division of labor in families and in paid employment created different health problems for women and men? How are these problems exacerbated for women and men in poor nations compared to those in wealthier nations?

2. What is the ABC approach to HIV/AIDS? Why is it difficult or impossible for many women to follow the ABCs? How does the social construction of femininity conflict with the ABCs? What would need to change about women’s position in society in order for them to avoid HIV? Why is it difficult or impossible for many men to follow the ABCs? How does the social construction of masculinity conflict with the ABCs? What would need to change about our expectations about men in order for them to avoid HIV?

3. The text tells you that health is strongly linked with wealth. Cuba, however, is an unusual country because it is poor but its citizens appear to be quite healthy, with longer lifespans than people from many rich nations. Look at clips from the film Sicko by Michael Moore on YouTube (http://www.youtube.com/user/SickoTheMovie). What does the film show about the health care system that makes it so effective? Why might women, especially, benefit from greater access to free health care?

4. Find a website on the Internet that provides information on how to avoid heart disease. How does the advice conflict with the social construction of masculinity? What advice might be easier for women to follow than men? 

5. Do some research on various attempts to impose restrictions on women’s reproductive rights. Go to http://en.wikipedia.org/wiki/Mexico_City_Policy to read about the history of the Global Gag Rule. Go to http://www.facebook.com/topic.php?uid=97968897553&topic=15317 to learn about L’Operacion in Puerto Rico. Find out about sterilization abuse of African American women at http://www.publiceye.org/magazine/v14n1/ReproPatriarch-12.html and of Mexican American women at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449330/. Write a paper on what you have learned.