Gender inequality in health and wellbeing
By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech
(International Men’s Day, November 19)
Gender powerfully shapes all aspects of health and wellbeing. Socially and culturally construct gender norms determines roles and opportunities for all people, affecting social and structural determinants of health, health risk behaviors, and access to and quality of health and social services. As a result, restrictive and harmful gender norms, values, and expectations result in inequalities in health and wellbeing that extend across the life course and across generations. The fight for equal political, social, and economic entitlements for women is rightfully front-and-center in the public consciousness, after centuries of injustices experienced by women, particularly those in marginalized groups.
International Men’s Day, celebrated on Nov. 19, encourages us to consider all we still need to do to improve men’s health and wellbeing. The event seems especially pertinent this year, given findings that about 1.5 times more men than women die from COVID-19, despite an apparently equal infection risk.
And, beyond COVID-19, there is a lot left to do. A recent issue of The Global Health analyze gender inequalities in the first 20 years of life, in 40 countries in the Asia-Pacific region. Girls faced considerable disadvantages relative to boys in many aspects of health and wellbeing. However, beginning around puberty, boys showed higher all-cause mortality, and higher mortality associated with injury, interpersonal violence, alcohol and drug use, and suicide. It notes that, during puberty, physical changes are accompanied by intensified gender socialization that can lead to the negative health and wellbeing of oneself or others.
Continuation of these behaviors and their long-term outcomes can be seen in the ‘Global Burden of Disease (GBD)” Study by the United Nations in 2019. In 2019, tobacco was the leading risk factor in males for attributable deaths globally, accounted for 6.56 million deaths, versus 2.15 million female deaths. A similar disparity was seen in deaths attributable to alcohol use: 2.07 million deaths in men versus 0.37 million deaths in women. Differential use of these substances continues throughout the life course, leading to the greater burden of associated cardiovascular diseases, cancers, and several other morbidities borne by men.
GBD 2019 also found that 524,000 men died by suicide, which was more than twice the number of deaths by suicide in women. The difference in interpersonal violence is even starker, at 344,000 deaths in males versus 71,000 in females.
These behaviors often intersect with mental ill health. Drug use, for instance, can be a coping strategy for many men experiencing depression or anxiety, but can lead to job loss and social exclusion, increasing the risk of suicide. As discussed in a UNAID report on male HIV testing and treatment, men are less likely to seek or to be able to access health care, increasing their likelihood of poorer disease outcomes. Vulnerable groups mostly comprising men, such as migrants, homeless people, and prisoners, are particularly susceptible to exclusion from care, often due to social marginalization and poverty. Because women have more contact with health services during their reproductive years, and due to the existence of a specific specialty dedicated to those with a uterus – obstetrics and gynecology- -with no male equivalent, women are potentially more likely to view primary health-care attendance as normal. Taken with a perceived gender expectation prizing male physical resilience and avoidance of showing weakness, thereby stigmatizing care seeking, it is unsurprising but tragic that this disparity persists.
What can be done? First, reporting sex-disaggregated data is key in assessing the situation and tracking change. One important step will be in normalizing use of primary health care. For instance, voluntary male circumcision services could represent an excellent opportunity to engage men in health services, and workplace or community testing efforts help to destigmatize service use. Finally, we must actively undermine gender norms (such as concepts of male self-reliance) during childhood, before they take hold. Many health risks mostly affecting men are modifiable and relate to normalization or promotion of unhealthy behaviors as masculine, with profound long-term impacts on individuals and society.
So, as per the 2030 Agenda for Sustainable Development, everyone should pledge that “no one will be left behind”. As progress on issues mostly affecting women speeds ahead, we must ensure that men are also on board.