Student Nurse

Sex and Gender


Sex and gender are the foundations of what we are; the biological and the social. We are male or female but society also deems that we should be masculine or feminine dependent on our sex; the behaviour that is expected of us (Jones, 1994). Florence Nightingale, one of the most famous nurses in history wrote this in April 1888:

"…because they are women, and should be recalled to a sense of their duty as women, and because this is women's' work, and that is men's and these are things which women should not do…"

This highlights the inequalities between men and women in the 19th century, yet these inequalities especially in relation to health still occur to this day. Men and women's pattern of mortality and morbidity are different to an extent that men are dying younger than women. However, women are living with increased prevalence of chronic and limiting illnesses (Curtis, 2004). This essay will look at the difference between gender in relation to health and what are the possible explanations for this with reference to the biological and socio-cultural aspects of gender.

Sex and gender are two different concepts whose definitions are sometimes confused. Sex is a term relating to a biological categorisation of a person; whereas gender refers to the social characteristics we acquire which society associates with being male or female; their masculinity or femininity (Jones, 1994). In terms of biology, people are usually classified as male or female. However, with gender, the classification is rather more subjective, where society attributes certain psychological and social characteristics to people on the basis of their biological sex (Livesey, 2001). Masculinity and femininity are cultural categories; the way in which society deems appropriate behaviour for a particular sex; the 'norms' and 'values' of society. The way society produces different expectations for members whether they are male or female. From being born to dying, gender influences the thoughts, actions and emotions of people and by about three years old, children begin to acknowledge their gender through their social experiences (Macionis, 2005). Parents, other adults and even children impart their gender identities on young children, yet are often unaware of the fact. Almost from the moment of birth, children are treated differently, for example, pink clothes for a girl and blue for a boy (Jones, 1994).

Will, Self and Datan's study: 'Maternal behaviour and perceived sex of infant' (1976), showed that gender socialisation takes place from an early age. In this study, five young mothers were observed interacting with a six month old baby girl, Beth and a six month old boy, Adam. Beth was seen as "sweet" or had a "soft cry", was smiled at more and she was given dolls to play with. The reaction to Adam on the other hand, was noticeably different; he was offered train sets to play with, was bounced upon the knee and was a "strong boy". Beth and Adam were actually the same child but dressed in different clothing and illustrates that both consciously and unconsciously gender socialisation takes place (Giddens, 2001). Gender socialisation not only happens at birth but throughout the life-cycle and especially with regards to the health status of men and women in modern society.

In Britain, the health between men and women differs in terms of morbidity and mortality (Jones, 1994). It is generally accepted, from research into gender patterns and health status that women live longer than men but experience greater levels of morbidity and disability. These may be explained by biology but most likely by the social, economic and structural differences between men and women and the way in which they perceive their health status in terms of their socially constructed gender (Curtis, 2004). The average life expectancy for men in Scotland in 2003 was 73.5 years while for women it was 78.8 years (General Register Office for Scotland, 2003). Although life expectancy continues to increase for men and women; the rate of increase for women is faster than that for men. The reason for the marked differences in mortality is that men are more likely than women to die prematurely. The first biggest cause of death in Scotland for both sexes is heart disease; the same numerical rank, i.e. first, although there is hugely different numbers of individuals affected between men and women. The next biggest cause for men is motor vehicle/traffic accidents, whereas for women the second most common cause of death is breast cancer (GRO-S, 2003). However, while women live longer than men, they have higher rates of morbidity.

The differences between male and female patterns of morbidity are more difficult to quantify. It has been suggested that women lead a longer life than men but are hampered by a greater susceptibility to long-term illness and disability (Jones, 1994). This may be because the number of women reporting illness is higher than men or that women use health services more than men due to their lifetime involvement with medicine and their social attitudes to seeking help (White, 2002).

There are many different reasons as to why men and women report illness. The biological explanation is one because women throughout their lifetime are in constant contact with health services. From pregnancy and childbirth and therefore may be over-represented in the morbidity statistics (Curtis, 2001). Some scientists argue that women also have less of a predisposition to certain types of chronic disease due to their genetic differences from men (Nettleton, 2000). These points are valid but do not give the whole picture as there are socio-cultural reasons as to the reasons of the differences in mortality and morbidity between genders.

The cultural/behavioural aspects also give an explanation (or indeed part of it) as to why there are differences. Men and women act differently in relation to their health due to the way society expects them to behave with regards to their gender (Matthews, Manor and Power, 1999). For women, they are more likely to be responsible for the caring and domestic tasks and as a result they put the needs of the family and household before themselves. This has a negative impact on not only their physical but psychological health also (Jones, 1994). Due to their caring role, they will undoubtedly come into contact with health services as mothers usually take their children to appointments, especially first vaccinations. These can be explained as mothers are more likely not to have a full-time job, if one at all and therefore are able to take their children whereas men are usually the 'breadwinners', and usually working full-time hours (White, 2002). Also, when their partners are ill, women tend to care for them, therefore, reducing the likelihood that the man would attend a medical service (Artazcoz, Borrell and Benach, 2001). Men also have a cultural and behavioural role with regards to their increased mortality as they are more likely to indulge in dangerous behaviour; fast driving; a greater number partaking in alcohol and smoking and also experimenting with illegal drugs (Curtis, 2004). Men also have the premise that they cannot be seen as weak or to look as though their masculinity will be threatened. Men in general have difficulty showing their emotions especially to other men in case of being seen as 'less of a man' (Macionis, 2005). These attitudes result in men not getting help when they require it or holding it off so long that the original minor problem is now something more serious (Jones, 1994). Along with the cultural and behavioural factors there are more practical matters with regards to the explanation of the differences between mortality and morbidity.

There are structural and material factors that contribute to the inequalities in health between men and women. In the case of women, they are usually at a disadvantage due to their economic status in terms of the capacity to earn money (White, 2002). They usually receive less earnings in pensions and other benefits due to insufficient National Insurance contributions during the time that they were able to work. Also due to the fact that health care has changed into the public rather than private arena has meant that approximately 15% of women are caring for someone who is elderly, disabled or chronically ill (Jones, 1994). This puts incredible strain and pressure on the women, and often is a detriment to her health especially her mental well-being. Because they are the primary carers to ill individuals also means that they are in contact with the health service indirectly (Jones, 1994). Along with these are the social roles that women are forced into; they have lower status than men; receive less money; work longer hours; work for nothing; have greater social and economic commitments, get less time to sleep or undertake leisure activities out with family life (White, 2002). These are all detrimental to health and as a result increase the morbidity and chronic illness women endure.

In terms of men, the economic and material factors as an explanation highlight that traditional "men's" jobs in society means that men are more likely to die from industrial accidents, occupational diseases and illnesses than women. This is also true as men in low socio-economic classes are trying to survive in poverty; as they are unlikely to receive occupational benefits and the capacity to take time off work (Bird and Rieker, 1999). This may explain why men die almost universally younger than women.

Along with the economic and material factors, is the structural factor; in particular the medicalisation of women's health. During the child-bearing age, women are in constant contact with health services; from contraception and family planning advice through pregnancy and the menopause (Nettleton, 1995). Also, women have the opportunity to attend for the regular screening of cervical and breast cancer. All these opportunities allow health problems to be discussed and as a result the statistics show that women get sicker. Men do not have regular contact with health services; they are more likely to be reactive rather than proactive, and even at that are reluctant as discussed before. They have no regular screening programmes and therefore the statistics show the morbidity is less and mortality greater than women (Jones, 1994).

In conclusion, sex is the biological determination of a person; whether they are male or female. Gender on the other hand is the social, psychological and cultural "norms" and "values" that are imparted onto us by society in relation to our sex. This masculinity and femininity is consciously and unconsciously taught to us by the individuals around us and this gender socialisation allows society to accept who we are. Sex and gender has huge impact on our lives especially the inequalities within the health-care system. Gender has a part to play in the mortality and morbidity of the population; where men are more likely to die younger than women who are at an increased chance of morbidity by developing chronic and limiting disabilities. The life expectancy continues to rise but at a much faster rate for women than men. There are many biological, cultural, economic, behavioural, structural and material reasons as to why this is so. Gender will always play a part in our lives and especially in relation to the health of men and women.


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last updated 18/06/05

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