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					Health equity as if
gender mattered
      Alex Scott-Samuel

EQUAL - Equity in Health R & D Unit
    Division of Public Health
     University of Liverpool
        Health inequality
    Unfair or unjust differences
in health determinants or outcomes
      within or between defined
             populations

         Health equity
 The absence of health inequality
      Life expectancy at birth




Source: www.who.int
                 Female life expectancy at birth by social class,
                         England and Wales,1972-2005
Years
  85




  80




  75

                                                                      Non-manual
                                                                      Manual




  70
          1972-76        1977-81    1982-86   1987-91   1992-96     1997-2001   2002-2005
   Source: ONS Longitudinal Study




                                                                                            4
The health inequalities / health
 equity discourse - landmarks
• Inverse care law 1971
• Black report 1980
• WHO Health For All strategy
• Acheson report 1999
• WHO Commission on Social
  Determinants of Health 2008 – Closing
  the Gap in a Generation
• Marmot report 2010 Fair Society,
  Healthy Lives
 Dimensions of UK health
equity research and policy

• Social class – SES, not class
  relations - UK ‘tradition’ –
  measurement and
  ‘microscopism.’ Poverty
• Geography - resource allocation
• Race and ethnicity – biology,
  culture and racism
• Sex - biology
Sex, gender and health equity

• Dominated by the (biologised)
  women’s health discourse
• From struggle to ghetto
• Recent advent of (biologised)
  men’s health discourse
• Gendered health discourse and
  reductionism
   Men and gender:
conceptual frameworks

  • male responsibility
  • men as partners
  • men’s health
  • gender relations
               Gender relations
The gender-relations perspective locates the origins
     of inequality between men and women in the
  social organization of relations between them: the
  construction of social groups (gender categories)
  that are made to appear internally homogeneous
  and dichotomous; the allocation of status, power,
    and resources through the positioning of these
      gender categories in the social order.…and
   hierarchical positions carrying gender meanings
        that naturalize and legitimate inequality.

  Ferree and Hall, Am Soc Rev 2000, 65 475-81
 Engendering health equity

• Interpret sex differentials in health
  using gender relations paradigm
   Determinants of health inequality




Krieger N. Proximal, distal, and the politics of causation: What’s
   level got to do with it? Am J Public Health 2008;98:221–230
Refocussing upstream
 Engendering health equity

• Interpret sex differentials in
  health using gender relations
  paradigm
• Adopt lessons of
  intersectionality research
(Intersectional scholarship) arose primarily
  to understand and to address the multiple
    dimensions of social inequality (class,
     race, ethniucity, nation, sexuality and
 gender) manifest at both the macrolevel of
      institutions and the microlevel of the
  individual experiences of women who live
 at the intersections of multiple inequalities.
  Weber L. Reconstructing the landscape of health disparities research.
  Promoting dialogue and collaboration between feminist intersectional and
 biomedical paradigms. In: Schulz AJ, Mullings L, eds. Gender, Race, Class
 and Health: Intersectional Approaches. San Francisco: Jossey Bass, 2006,
                                   21-59
 Guinier L, Torres G. The
 Miner's Canary: Enlisting
  Race, Resisting Power,
 Transforming Democracy.
   Cambridge, Mass. and
London: Harvard University
        Press, 2002
What is to be
  done?
       EQUAL
    Equity in Health
     Research and
   Development Unit

Division of Public Health
 University of Liverpool



alexss@liverpool.ac.uk

				
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