Gender, Health and Healthcare

Women's and Men's Experience of Health and Working in Healthcare Roles

Jacqueline H. Watts

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317129998
• Edition: 1
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

Health status and the experience of working in health care roles are both strongly shaped by gender and, although there have been attempts to incorporate 'gender awareness' in both health and employment policies, the significance of gender in these areas continues to be marginalised within public debates and academic discourses. Taking a social constructionist perspective, Watts considers the ways in which gender impacts upon health in all its elements including access, technology, professionalisation, health promotion and health as an important sector of the labour market. She discusses gender as a developing and diversified category, exploring ideas about masculinity and the fluidity of gender boundaries in determining individual identity. Chapters that follow discuss men's and women's health; ideology of gender and health, specifically exploring different social norms and ideas about male and female health and the dominant ideological association between femaleness and caring; working for health with particular focus on the gendered interplay of caring and curing roles; technology and changes to gender, health and healthcare; health promotion as a gendered activity and, finally, the importance of introducing an intersectional approach beyond gender to articulate a deeper understanding of health in a postmodern context. The concluding chapter draws together these themes to underscore the importance of placing gender at the centre of health and health care delivery to fully take account of both the different life and health experiences of men and women and the gendered dimensions of working in health care.

Chapter 1
Introduction

Gender and the ‘gender order’ (Matthews, 1984) have, for some social commentators, begun to be ‘unfashionable’ topics of enquiry. Gender as a social construct has, in recent times, lost its former conceptual allure to the extent that its ongoing relevance to understanding social organisation and personal behaviour has begun to be questioned, particularly relative to other social categories. Despite this, gender continues to engage many in the academy, and recent work by writers such as Ryle (2012) and Walby (2011) has demonstrated that the gender project, though subject to continuous transformation and interpretation, continues to be integral to the realisation of social democracy achieving its full potential. More specifically, in aligning social democracy with economic democracy and opposing the excesses of capitalism that give rise to inequality, Walby (2011) argues for a stronger articulation of gender within macro-analytical frameworks, citing as an example the full employment of women as necessary for economic growth.

Health status and the experience of working in healthcare roles are both strongly shaped by gender and, although there have been attempts to incorporate gender awareness in both health and employment policies, the significance of gender in these areas continues to be marginalised within public debates and academic discourses that have historically tended towards a gender-neutral perspective. The work of Kuhlmann and Annandale (2010), Gough and Robertson (2010) and Featherstone et al. (2007) has gone some way towards highlighting the ways in which gender materially influences health behaviour and healthcare practice, but this remains an under-theorised area. Focusing more specifically on labour market participation in the health sector, recent empirical work reported by writers such as Karlsen (2012) and Pas et al. (2011) has extended the debate to focus on the importance of gendered norms in culturally shaping clinical careers. Moore’s (2009) critique of intersectionality, as a tool to explore how advantage/disadvantage within specific occupations and sectors is reproduced in terms of gender and race, has added to our understanding of how inequality is both complex and layered. Walby et al. (2012), addressing theoretical issues concerning intersectionality, raise important questions about the conceptual and material relationship between multiple inequalities.

These texts are amongst a number that have made a valuable contribution to knowledge about the impact of gender on the experience of health and illness and also on the gendered experience of being employed as a healthcare worker. However, the approach of much recent writing on these topics has been to focus on gender and health or on gender and work rather than taking an integrated perspective on the impact of gender on the wider health domain. This volume offers an integrated discussion of how the experience of health and illness and healthcare work is gendered, to particularly draw out how gender affects the type of health work undertaken by men and women and the rewards they receive for their labour.

This is a complex area, both conceptually and empirically, because of shifting understandings of the ways in which gender is contested and negotiated and the changing environment of healthcare work that in recent years has had to respond to growing demands arising from an ageing population and more sophisticated treatments for a range of conditions. Added to this, health has long been recognised as more than just the absence of disease and, for example, the importance of healthy lifestyles, as part of health promotion initiatives, draws attention to health both as individual responsibility and public good.

The three concepts that provide the underpinning themes of this volume are: gender, health and work. These concepts have been widely debated in the literature from a number of disciplinary perspectives offering a plethora of meanings rendering each beyond simple or straightforward definition. Whilst space does not allow for an in-depth critique of each of these concepts, the principal aim of this chapter is to introduce each in relation to key debates that draw out their contested nature, as a way of setting the scene for the chapters that follow. Gender, as the overarching construct, is explored in more/greater depth in Chapter 2 deserving, as it is, of further scrutiny to uncover its multiple dimensions and historical development.

Introducing gender

Gender is everywhere around us and is generally taken for granted. We identify a person as a man or a woman and social arrangements of all kinds are organised around this distinction (Connell, 2002; Ryle, 2012). At the level of everyday life, this perceptual and material categorisation that draws on biological sex difference, underpins many practical aspects such as separate toilets in public places for men and women, sporting activities for boys and girls in separate teams and the provision of single-sex schools to name but a few. Gender seems obvious, ‘natural’ and in terms of the way we relate to one another, reasonably certain. Expectations about the roles men and women have in life, both in the home and in the public sphere, have also continued to be shaped by gender norms. Most childcare is the responsibility of women (Chodorow, 1978) and there are many more men than women in senior business and political positions (Crompton, 2006). Gender roles are the activities a culture assigns to each sex or, put another way, culture takes biological differences and associates them with certain activities. The extent to which these gender divisions are ‘natural’ has been at the forefront of sociological thinking in this area, particularly since the 1970s and it is sociology that has led the way in distinguishing between sex and gender. Before then, work on sex roles had been marginal to sociology’s mainstream concerns (Jackson and Scott, 2002). Other disciplines such as anthropology and psychology have also begun to incorporate gender into their analytical thinking, drawing out its wider cultural and social meanings and this is discussed in more detail in the next chapter.

So, gender as social category has become an established feature of the way we see the world, but is this fixed and mainly (or only) dependent on biological and sexual difference? The idea of sex as part of the ‘natural order’ renders it as fixed, non-volitional and determined and, as such, not socially constructed. Writers such as Connell (2002), Evans (2003), Walby (2011), Ryle (2012) and Carrera et al. (2012) counter the position of biological determinism with their argument that gender is acquired rather than given and that femininity and masculinity are produced through a range of practices and behaviours shaped by dichotomous social expectations of what it means to be male and female. Both women and men are required to engage in different forms of sex-marking behaviour (Frye, 1983) involving, for example, aspects of embodiment and appearance including the choice of clothes and hairstyles and items of adornment such as jewellery and fashion accessories. Whilst such matters are subject to cultural norms and the vagaries of fashion, each person is expected to claim their gender by making clear what sex they are in order to engage in normal social interaction. Efforts aimed at continual gender reinforcement feature across the life-course.

This argument positions gender as socially constructed rather than biologically determined such that our social selves are equally as important as our biological selves in shaping our gender. At a simplistic level, attributes seen as masculine are in opposition to those identified as feminine. Masculine notions of power, authority, objectivity and rationality are contrasted with feminine attributes of sensitivity, nurturing and emotion. However, ‘female and male’ and ‘feminine and masculine’ are not necessarily clear and opposite categories. Some people may look and behave in ways that do not neatly fit the labels female/feminine or male/masculine (Holmes, 2009). Bodies as well as affective behaviours also come into play here, particularly given the primacy of bodies in determining gender. An infant being labelled either female or male begins the process of gender socialisation.

Focusing on sexed bodies, Butler (1990) argues that bodies, whilst generally sex-identified at birth through the presence of female/male genitalia, become gendered through the continual performance of gender with this as a process reproducing existing conventions and norms. One thus becomes a girl or a boy with this being not simply a fact of nature or, as Holmes (2009: 14) puts it, “gender is not something we naturally are but something we learn to do”. Issues of dress, play, education and bodily adornment are relevant and these aspects are powerful symbols of what it means to be a girl or a boy child. In the West, for example, the colour pink for girls and blue for boys predominates in many areas of material consumer culture. Girls and boys do different subjects at school, often end up in different jobs, and women and men are portrayed differently in the media (Ryle, 2012: 276). It is important to stress, however, that there are significant cross-cultural variations and studies from anthropology which have much to teach us about how gender is produced differently in some non-Western societies. Because anthropologists study biology, culture and society, they are in a unique position to analyse nature (biological predispositions) and nurture (socialisation) as determinants of human behaviour and the cultural construction of male and female identity (Kottak, 2004). Anthropologists have gathered data about similarities and differences involving gender in many cultural contexts uncovering a wide range of diverse gender patterns. In some cultures, for example, a ‘third gender’ exists and Schmidt (2003) describes how in Samoan Polynesian society some men adopt feminine ways in terms of appearance and social roles and are seen neither as men or women. Two sexes are not sufficient to capture the variety found among human beings, with tension between bodies and identities contributing to gender ambiguity.

Much sociological analysis on gender has its roots in feminist scholarship that has focused attention on men and women as social rather than natural categories, challenging the ‘naturalness’ of differences between men and women and considering ways in which people might resist gender conventions and do things differently (Jackson and Scott, 2002). Central to the contribution of feminist thinking on this topic is the importance placed on exploring the divisions between men and women and the hierarchical relationship between them (Delphy, 1993). Division and hierarchy are the two constitutive elements of gender. The hierarchical relationship, as a form of gender stratification, is characterised by an unequal distribution of rights, resources and power between women and men, with men having the major share. Whilst gender stratification varies across cultures, economies and political systems, a common feature is the distinction between women’s reproductive domestic work and men’s productive economic labour that reinforces a contrast between men as public and valuable with social status and prestige and women as domestic, home-based, less visible and less valued. The seminal contribution made by feminist scholars to increasing awareness and understanding of the impact of gender on all spheres of social and public life is discussed in more detail in the next chapter. Discussion will include reference to the various political standpoints of particular feminist positions. The distinctions of liberal, radical and socialist feminism are identified in respect of the approach of each to the analysis of gender relations. For the current chapter it is helpful to briefly set out some key points that chart the development of feminist ideas about gender as a political site for thinking about the social environment that shapes women’s and men’s lives differently.

Brownmiller (1976) and Firestone (1979), writing in the early years of second-wave feminism, argue that women’s oppression is primarily due to a universal male control of women’s bodies and sexuality, with women’s reproductive role at the core of their inferior status. Writers such as Barrett and McIntosh (1982), however, point to the gendering of social relations in both the domestic and public spheres as the cause of women’s oppression. They argue that only when the sexual division of labour within the family is eradicated, can women take up an equal economic role with men. Pateman (1988), in her seminal work on contract theory, raises feminist questions about the hidden sexual contract that she contends forms a significant part of the subtext of citizenship, employment and marriage all underpinned by the subjection of women in the private sphere within a system of patriarchy, a system largely controlled by men and operated in their interest. However, she identifies patriarchy as not only familial and located in the private sphere, arguing that patriarchy shapes relations between government, labour and capital in the civil realm.

The concept of patriarchy is taken up and developed by Walby (1986; 1990) in her powerful critique of interrelated patriarchal structures that she sees as reinforcing women’s subordination. Her thesis is that patriarchal relations in the home, in the waged labour market, in the operation of the state, in the propensity for male violence against women, in the culture of ‘compulsory’ heterosexuality and lastly in the cultural values found in art, education, science and religion reproduce structured inequalities and the institutional oppression of women. Walby (1986; 1990) emphasises that this oppression does not derive simply from individual actions, but is built into structural and institutional patterns and policies. Even if men are uncomfortable with this and would like to change it, they still benefit from the overall subordination of women within a male-dominated society in terms of monetary benefits, authority, respect and access to institutional power. Connell (1995: 79) terms this as the ‘patriarchal dividend’; he also makes the point that some women participate in the patriarchal dividend by being married to wealthy men. On one level it could be argued that systems that discriminate against women because of their gender have been largely removed through legislation, but as discussion below reveals, dominant gendered expectations about women’s and men’s roles in society endure and related gender stereotypes continue to be strongly held with negative impacts for women through a range of exclusionary practices.

Thinking about health

In exploring the question ‘what is health?’ I will be exploring meanings of health from a variety of perspectives. Drawing on a range of disciplines, the discussion that follows presents contrasting and competing ideas to construct health as individual, familial, social, local and spatial. Health, like gender, is all around us; it is often in the news and is at the centre of public policy in many countries of the West. Whilst most would agree that health is an important issue, there is less agreement on how health is defined and what it means to be healthy. One starting point is the WHO (World Health Organisation) definition: ‘Health is a state of complete physical and mental wellbeing and not merely the absence of disease or infirmity’ (WHO, 1985). Critics of this definition claim that it is idealistic, utopian and unrealistic, particularly given the enormous disparity in terms of wealth and resources both between and within countries across the globe. And, though there is certainly a debate to be had about the utility of the WHO definition, it does establish that health is multi-dimensional and holistic encompassing physical, emotional, psychological, social and mental aspects. Warwick-Booth et al. (2012) augment this holistic stance on defining health arguing that health involves a range of subjectivities and experiences that are socially, historically and culturally located. As an example, the link between poverty and poor health in contemporary society has been well evidenced such that Graham (2009: 1) contends that: “the opportunity to live a long and healthy life remains profoundly unequal”. However, the association between income and mortality, widely accepted today, may be a more recent phenomenon. Bengtsson and van Poppel (2011), analysing mortality data from locations across Europe and North America up to the first part of the twentieth century, argue for a reconsideration of the causal link between income and mortality. Whatever the causal factors, the social distribution of health continues to exercise policy-makers and those working on the frontline delivering a range of healthcare services (Sheaff, 2005).

Further recent thinking has directed attention to other characterisations of health such as quality of life, lifestyle choices and health consumerism positioning health as something that can be chosen and performed and also as a commodity that can be bought and sold like any other in the market place. Health means different things to different people and, with the emergence of more pluralistic notions of ‘being healthy’, health is no longer dominated by more medical and scientific explanations. Taking exercise, eating fresh unprocessed food, watching one’s weight, keeping fit and actively participating in society are all now seen as indicators of health. In former times it was the absence of illness that was seen as the primary health indicator. Concepts of health are changing and being and remaining healthy is a core activity within our society. However, health depends not only on what goes on inside our bodies, but also on the conditions under which we live and work. Individual susceptibilities may play a part, but many of the preconditions for health are beyond the control of any but the privileged few. Health is thus highly political and the politics of health are discussed in Chapter 7 which considers health promotion as a positive concept emphasising social and personal resources of all kinds as well as physical and mental capabilities.

Health is culturally produced with its meaning varying considerably from society to society and from one historical period to another. The cultural construction of health has long been the concern of anthropology that has contributed much to our understanding of health as social construction and cultural practice through production of detailed ethnographies of many types of societies, both indigenous and developed. Medical anthropology has become a thriving branch of the discipline shedding light on the values of indigenous methods in coping with ill-health and on the ways that various human populations respond to ageing and bodily deterioration (Hendry, 2008: 296). Anthropologists have also had an important contribution to make to world health programmes, advising about potential cultural sensitivities to certain medical approaches in local contexts.

Notions of health and illness drawn from ethnographic studies are useful in offering alternative ways of thinking about what it means to be ‘well’ and what it means to be ‘ill’. Davis (2000), for example, writing about illness and therapy among the Tabwa of Central Africa, reports that when asked to define the condition of health, people described it as a state in which one feels nothing and one just goes about ordinary life as usual. This might well resonate with many of us in the West when asked to consider the same question. Health has an invisible and intangible quality and is not something on which we routinely focus, at least not on a day-to-day basis. Davis (2000: 65) comments further that: “a healthy body has a well-balanced relation to its environment, external and internal”. ‘Wellness’ is signified through whole bodily and mental balance as a desired external and inner state of harmony. In health, forces of a potentially pathological nature are kept in abeyance to maintain an overall balance. In illness the situation is reversed with the balance of well-functioning organs thrown into a state of disorder resulting in the breakdown of bodily integrity. Illness, though in opposition to health, is nevertheless accepted as a necessity leading to death as part of the cycle of life. Davis (2000) reports the words of a Tabwa man receiving treatment for tuberculosis; when Davis offered reassurance the man responded with a question: “have you ever seen a thing which did not die?” Despite an innate acceptance of death as natural, tribal societies, in effect, maintain individual and group health by emphasising prevention of morbidity rather than treatment of disease (Baer et al., 2003). The emphasis on prevention has now also become a pivotal aspect of much health promotion in many countries of the West (see Chapter 7).

Ideas about health change, but so also does health itself. HIV/AIDS and significant levels of drug addiction are two diseases of the modern age present in both developed and less developed societies. These are diseases of the global system, affecting people of every age, race, class, ethnicity, gender and sexual orientation. The sudden appearance of AIDS in the early 1980s was unexpected and, in the Western context, challenged the notion that mortality from infectious disease was a thing of the past. AIDS has revealed itself as a disease of social relationship – not merely a social disease (Baer et al., 2003: 230) and, with its rapid spread the term epidemic was thrust back into popular language invoking notions of high-risk personal behaviour and the threat to health from some intimate encounters. The health status associated with these conditions is socially constructed as deviant and subject to social opprobrium and public disparagement evoking a range of responses from tolerance through to empathy and disgust (Campbell and Ettorre, 2011). In the case of AIDS, there is the added stigma that those suffering with the disease are being punished for their deviant behaviour leading Baer et al. (2003: 238) to comment that: “the social damages of stigmatization are equal to if not more painful than the medical consequences of the disease”. The stigma impact of AIDS has only been partially mitigated by the widespread appearance of the disease among some receiving blood transfusions; their position, as one without personal guilt, is attributed victim status.

Other changes in health identified by Taylor and Bury (2007) are an ageing population, better housing, smaller family sizes, increased standards of living, female emancipation and shifts from manual to knowledge-based occupations as shaping overall improvements in health in the West. Malnutrition, as a disease of poverty, has now in affluent societies been overtaken by obesity, a disease of plenty as a major health issue, particularly amongst disadvantaged groups in those societies. Whilst the physical stress associated with hard manual labour is in decline, the psychological stress connected to fast-paced demanding service sector and knowledge-based work is on the increase. Added to this, wider access to information from the internet and the me...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• 1 Introduction
• 2 Constructing and Deconstructing Gender
• 3 Women’s and Men’s Health
• 4 Ideologies of Health, Care and Gender
• 5 Working for Health
• 6 Technology and Health
• 7 Health Promotion
• 8 Caring not Curing
• 9 Intersectionality
• 10 Conclusions
• References
• Index