21.08.2019 - Safir Şehir Portalı & Firma Rehberi Teması

Biological differences

Biological differences
Reklam

Perhaps the most obvious explanation for the health differences between men
and women is that they are biologically different – being born female brings
with it a natural biological advantage in terms of longevity. Some have suggested
that these differences may be genetically mediated through differences
in male and female immune systems – women, for example, appear to have
greater resistance to infections than men across the lifespan. Other biological
explanations implicate the role of our sex hormones. High levels of oestrogen
in women appears to delay the onset of CHD by reducing the tendency of
blood to clot and keeping blood cholesterol levels low. As oestrogen levels
in women fall following the menopause, their risk for CHD rises, indicating
a lessening of the protective effect of oestrogen. By contrast, high levels of
testosterone in men increase the risk of blood clots, which contribute to the
development of atheroma and can trigger a myocardial infarction (McGill
and Stern 1979).
A second apparently biological cause of higher levels of disease in men
results from their greater physiological response to stress than women. Men
typically have greater increases in stress hormones, blood pressure and
cholesterol in response to stressors than women – all responses that may
make them at more risk for CHD (see Chapter 8). Whether these differences
are the result of innate biological differences or contextual factors, however,
is not always clear. Lundberg, de Chateau, Winberg et al. (1981) found that
women in traditionally male occupations exhibited the same level of stress
myocardial infarction
death of the heart
muscle due to a
stoppage of the blood
supply. More often
known as a heart attack.
Table 2.3 Relative risk for men dying prematurely (before the age of 65) from
various illness in comparison with women
Cause Male/female ratio
Coronary heart disease 1.89
Cancer 1.47
Stroke 1.16
Accidents 2.04
Chronic lung disease 2.04
Pneumonia/flu 1.77
Diabetes 1.11
Suicide 3.90
Liver disease 2.32
Atherosclerosis 1.28
Renal disease 1.54
Homicide/legal intervention 3.22
Septicaemia 1.36
52 CHAPTER 2 • HEALTH INEQUALITIES
hormones as did men in similar jobs. She also found that when women felt
equally or more threatened by a laboratory stressor than men, their physiological
response equalled those of men. It seems that it is not so much the
gender of the individual that drives their physiological reactivity. Rather, it is
the type of stress that the person is exposed to. Accordingly, any differences
in stress reactivity may be more the result of long-term exposure to different
stresses between the genders rather than biologically determined differences.
Behavioural differences
Further evidence that these gender differences in mortality are not purely
biological stems from studies that show clear health-related behavioural differences
between men and women. More men than women engaged in all but
three of fourteen non-gender-specific types of health-risk behaviour examined
by Powell-Griner, Anderson and Murphy (1997), including smoking, drinking
alcohol, drink driving, not using safety belts and not attending health
screening. Men may also encounter adverse working conditions more frequently
than women. About 6–7 percent of men drink alcohol heavily – in
comparison with 2 percent of women. In addition, women are more likely
than men to eat wholemeal bread, fruit and vegetables at least once per day,
and to drink semi-skimmed milk. In addition, although rates of smoking are
higher among adolescent girls than among adolescent boys, this is only a
short-term effect, and more men than women smoke in adulthood.
Not only do men engage in more health-risking behaviour, they are also
less likely than women to seek medical help when necessary. Men visit their
doctor less frequently than do women, even after excluding visits relating
to children and ‘reproductive care’ (Verbrugge and Steiner 1985). Even when
they are ill, men are less likely to consult a doctor than women. Socially disadvantaged
women are twice as likely to consult a doctor than their male
counterparts when they are ill. High-earning men are even less likely to
consult a doctor when ill than their female counterparts (Department of
Health and Human Resources 1998).
The reasons for these behavioural differences may be social in origin.
Courtenay (2000), for example, contended that they arise from different
meanings given to health-related behaviour by the different sexes. They
reflect issues of masculinity, femininity and power. According to Courtenay,
men show their masculinity and power by engaging in health-risking behaviour
and not showing signs of weakness – even when ill. Societal norms
endorse the beliefs that men are independent, self-reliant, strong and tough.
Courtenay suggested, for example, that when men say ‘I haven’t been to a
doctor in years’, they are both reporting a health practice and making a statement
about their masculinity. Similar processes are at work when men refuse
to take sick leave from work or claim that their driving is better when they’ve
had something to drink. By contrast, illness is threatening to masculinity.
Jaffe (1997), for example, noted the advice given to a US senator not to ‘go
public’ about his prostate cancer as some men might think his willingness to go
public with his private struggle a sign of weakness. Charmaz (1994) also noted
several examples of quite extreme behaviour in which men would engage
in order to hide their disabilities. Examples included a wheelchair-bound
diabetic man skipping lunch (and risking a coma) rather than embarrass
WORK AND HEALTH 53
himself by asking for help in the dining area, and a middle-aged man with
CHD declining offers of easier jobs to prove he was still capable of strenuous
work. The one health behaviour that men consistently engage in more than
women is leisure exercise (Reddy, Fleming and Adesso 1992). Interestingly,
this may also act as a marker of masculinity and power and carry a social
message as well as having implications for health.
Gender inequalities may also impact on other people’s behaviour.
Evidence from studies of young people’s intentions whether or not to engage
in safer sex practices suggests that young women are less empowered than
men in the negotiation of sexual practices and are less able to follow their
intentions to engage in safer sex practices than their male partners. Abbott
(1988), for example, found that 40 percent of a sample of Australian women
reported having had sexual intercourse on at least one occasion when they
did not want to do so as a result of the pressure from their sexual partner.
Socio-economic differences
More women than men may be affected by socio-economic factors. In the
UK, for example, nearly 30 percent of women are economically inactive
and those in work are predominantly employed in clerical, personal and
retail sectors in low-paid work. About two-thirds of adults in the poorest
households in the UK are women, and women make up 60 percent of adults
in households dependent on Income Support (a marker of a particularly low
income) (see Acheson 1998). Social isolation is also more frequent among
women than men: women are less likely to drive or to have access to a car
than men, and older women are more likely than older men to be widowed
and to live alone. These factors may also impact adversely on health.
Work and health
Some of the excess mortality among people in lower socio-economic groups
may result from the different work environments experienced by people
across the socio-economic groups. Part of this difference may reflect the
physical risks associated with particular jobs. Although health and safety
legislation has improved the working conditions of most workers, there are
still environments, such as building sites, that carry a significant risk of injury
or disability. Work factors may also influence levels of engagement in healthcompromising
behaviour. Ames and Janes (1987), for example, found that
job alienation, job stress, inconsistent social controls and the evolution of a
drinking culture were particularly associated with heavy drinking among
blue-collar workers. Similarly, Westman, Eden and Shirom (1985) found that
long work hours, lack of control over work and poor social support were
each associated with high levels of smoking among blue-collar workers.
Despite these differences across social groups, most psychological research
has focused on theories that suggest there is something intrinsic to different
work environments that impacts directly on health – work stress.
54 CHAPTER 2 • HEALTH INEQUALITIES
Work stress
One of the first, and certainly the most influential, models to systematically
consider elements of the work environment that contributed to work stress
and illness was the job strain model of Karasek and Theorell (1990). Their
model identified three key factors that contribute to work stress:

  1. the demands of the job;
  2. the degree of freedom to make decisions about how best to cope with these
    demands (job autonomy); and
  3. the degree of available social support.
    These elements interact to predict stress and stress-related risk of disease.
    Karasek and Theorell’s model differed markedly from previous models of
    work stress, which suggested that stress was simply an outcome of the
    demands placed on the person – a model that gave rise to the idea of the
    classic ‘stressed executive’. Instead, it suggests that only when high levels of
    demand are combined with low levels of autonomy, and perhaps low levels
    of social support, will the individual feel stressed and be at risk for disease.
    This high demand–low autonomy combination is called high job strain
    by Karasek and colleagues. Where an individual experiences high levels of
    demand combined with high levels of autonomy (e.g. being able to choose
    when and how to tackle a problem) and good social support, they will experience
    less stress than in the high-strain segment. Measures of each dimension
    of this model suggest that those who are in the highest-strain jobs are often
    blue-collar workers or those in relatively low-level supervisory posts (see
    Figure 2.3).
    Figure 2.3 Some of the occupations that fit into the four quadrants of the Karasek and
    Theorell model.
    WORK AND HEALTH 55
    The majority of studies exploring the health outcomes of differing combinations
    of these work elements support Karasek’s model. Kristensen (1995),
    for example, reviewed sixteen studies measuring the association between job
    strain and mental and physical health outcomes. Fourteen reported significant
    associations between conditions of high job strain and an increased incidence
    of either CHD or poor mental health. More recently, Nordstrom, Dwyer,
    Merz et al. (2001) measured the degree of atheroma in the arteries of 467
    working men and found that levels of atheroma were highest among men
    with the highest job strain scores. No such association was found among
    women. By contrast, there is no evidence that job strain is related to the
    development of cancer (e.g. Achat, Kawachi, Byrne et al. 2000).
    An alternative model of work stress has been proposed by Siegrist,
    Peter, Junge et al. (1990). They suggested that work stress is the result of an
    imbalance between perceived efforts and rewards. High effort with high
    reward is seen as acceptable; high effort with low reward combine to result
    in emotional distress and adverse health effects. This theory has received less
    attention than that of Karasek, and most studies of this model (see de Lange
    et al. 2003) have focused on the impact of imbalance on wellbeing rather
    than physical health. Nevertheless, in a five-year longitudinal study tracking
    over 10,000 British civil servants (the Whitehall Study II, see research focus
    above; Stansfeld et al. 1998), both theories received some support: lack of
    autonomy, low levels of social support in work, and effort–reward imbalance
    each independently predicted poor physical health.
    n Gender differentials
    Reflecting some of the previous discussion, there is consistent evidence that
    working environments have a differing effect on men and women. For men,
    the experience of work stress and its impact on health is generally a function
    of the working environment alone. For women, work stress frequently combines
    with other areas of demand in their lives to influence levels of stress and
    risk for disease. The term ‘work–home spillover’ has been used to describe
    this issue. Women still tend to carry more responsibilities in the home and
    outside work than men. As a consequence, once they have finished paid
    work, women are more likely than men to continue working in the home and
    experience strain. This argument is perhaps exemplified in the physiological
    findings of Lundberg, de Chateau, Winberg et al. (1981), who found that
    female managers’ stress hormone levels remained raised following work,
    while those of male managers typically fell. This effect was particularly
    marked where the female managers had children. It seems that while the men
    they studied relaxed once they went home, the women continued their efforts
    – only the context changed.
    This psychological and physiological strain also appears to influence risk
    for disease. Having a job appears to improve the health of both men and
    women – the so-called ‘healthy worker effect’. This may be because of the
    social contact available at work as well as feelings of control, self-esteem and
    the financial security associated with work. However, there appears to be a
    stress threshold, which differs for men and women, related to work–home
    spillover, above which work may have a detrimental effect on health. Haynes
    and Feinleib (1980), for example, found that working women with three or
    more children were more likely to develop CHD than those with no children.
    56 CHAPTER 2 • HEALTH INEQUALITIES
    Adding to this issue, Alfredsson, Spetz and Theorell (1985) found important
    gender differences in the impact of working overtime. They found, as predicted
    by Karasek’s model, that high levels of job strain were associated with
    high rates of CHD in both sexes. However, working overtime was associated
    with a decreased risk of CHD among men, while it was associated with an
    increased risk in women. For women, working ten hours or more of overtime
    per week was associated with a 30 percent increase in risk of CHD. It appears
    that men may have compensated for their increase in working hours by a
    decrease in demands elsewhere in life. Such compensation may not have been
    possible for the women they studied, and working overtime simply increased
    the total demands made on them and resulted in increased rates of stress and
    ill-health.
Reklam
BU KONUYU SOSYAL MEDYA HESAPLARINDA PAYLAŞ
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