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52 4 Understanding Gender and Health Old Patterns, New Trends, and Future Directions Patricia P. Rieker, Boston University and Harvard Medical School Chloe E. Bird, RAND Corporation Martha E. Lang, Guilford College the wrong questions. For example, “Which is the weaker sex?” is framed in the binary language of biological advantage of one sex over the other and “Which gender is more advantaged?” assumes social advantage of one gender over the other. Even if there are real circumstances where biological superiority and social inequality can be observed, the framing of such questions implies that biological differences or social positions and roles can be summed up to determine which sex is the fittest or which gender is the most privileged. At best, this approach produces oversimplified models of the complex patterns of gender differences in health with little thought given to similarities. A binary approach has the additional limitation of treating men and women as distinct homogenous groups, whereas gender differences in health vary substantially by age, race/ethnicity, and socioeconomic status. The dichotomy also ignores the wide array of gender identities and sexualities. Although men and women do seem to have on average some unique biological advantages and disadvantages over each other, substantial variation occurs among women and among men, and these differences seem to vary with certain social conditions (Fausto-Sterling 2005, 2008). It is still the case that much of clinical research tends to minimize or ignore the social and A central feature of mortality trends throughout the twentieth century is the sex/gender difference in life expectancy: in the United States, women live on average 5.2 years longer than men do (NCHS 2009). Women have not always held a mortality advantage (Berin, Stolnitz, and Tenenbein 1990) and it may not continue. In fact, the age-adjusted gender gap in longevity appears to widen and narrow due to environmental/behavioral risk and protective factors, as well as genetic, biological, and hormonal processes (Annandale 2009). Biomedical and social science researchers who have pursued the causes of men’s and women’s differential mortality seldom agree on explanations, partly because, as Nathanson (1984, 196) stated in her discussion of the literature on differences in men’s and women’s health, “investigators’ disciplinary orientations are reflected in specification of what is to be explained . . . in their choice of potential explanatory variables, and in the methods they employ; . . . the biologist sees hormones; the epidemiologist , risk factors; and the sociologist, social roles and structural constraints.” Even sociologists’ understanding of the differences and similarities in men’s and women’s physical and mental health has changed dramatically over the past twenty-five years. Reviews of this literature indicate that researchers have often asked Understanding Gender and Health 53 environmental processes that can influence health differentially and to reify biomedical models that portray men’s and women’s health disparities as inherently biological or genetic. In recent years, a growing number of clinical researchers has come to recognize that social and biological factors interact in complex ways, and that this explains not only health or illness at the individual level but also population health and the observed patterns of men’s and women’s health and longevity in general. Yet relatively few biomedical or sociological studies examine both sets of factors (Institute of Medicine 2001a, b), highlighting the need to move beyond the binary in thinking and research, as ultimately integrating them will contribute to better science. Biological “sex” and social “gender” processes can interact and may be confounded . In acknowledgement of this, we use the term “gender” to refer to observed differences in men’s and women’s lives, morbidity, and mortality. In this chapter, we briefly review gender differences in longevity and health in the United States and cross nationally, examine U.S. disease patterns for four specific conditions to illustrate gender disparities, review recent findings on the relationship between mental and physical health and its possible connection to gender differences in health, and consider limitations of current approaches to understanding men’s and women’s health. We suggest that in contrast to prevailing models of inequality, our integrative framework of constrained choice describes how decisions made and actions taken at the levels of family, work, community, and government shape men’s and women’s opportunities to pursue health and contribute to observed disparities. The constrainedchoice model and gender-based analysis provide a new direction for discourse, research, and policy. We close with suggestions of interesting questions and issues for researchers to...

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