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Women, Patriarchy and Health Inequalities: An Unresolved Issue

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (10 September 2020) | Viewed by 56464

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Special Issue Editors

Dr. Anna Matheson

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Guest Editor

Faculty of Health, Victoria University of Wellington, Po Box 600, Wellington 6140, New Zealand
Interests: health inequalities; complex social systems; complexity theory; social action; community intervention; health and community systems; qualitative; case-based and mixed methods

Dr. Heather Came

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Guest Editor

Taupua Waiora Centre for Māori Health Research – Auckland University of Technology, Manukau, Auckland 2025, New Zealand
Interests: institutional racism; critical policy analysis; te Tiriti o Waitangi; health inequities; anti-racism; health activism

Prof. Dr. Jacquie Kidd

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Guest Editor

Auckland University of Technology, Manukau, Auckland 2025, New Zealand
Interests: cancer diagnosis; health and community services; Maori health; mental health

Special Issue Information

Dear Colleagues,

Globally, the evidence of health inequalities between women and men provides a stark picture of the systematic undervaluing of women, including their perspectives, roles and work. Racism worldwide compounds experiences and outcomes for women, with developing countries carrying the burden of health inequities. Many women continue to live in political contexts where they are fighting for their sexual and reproductive rights, their right to education and freedom from violence. The social, economic, commercial and environmental determinants of health are profoundly influenced by gender relationships. Even where there has been progress on equality and life expectancy for women has surpassed that for men, historical and continuing injustice towards women has far-reaching consequences. Men’s economic power and control drive social priorities and values that are often invisible but shape relationships and outcomes for women. Social and political actions at multiple levels are required to achieve ‘whole-system’ change. Potential levers include upholding human-rights; tackling systemic corruption; shifting power to women; and reorienting health systems to better address the determinants of health. Transparency and accountability on who holds power, and who needs to hold power for change, is a key cross-cutting challenge.

This Special Issue seeks research and analysis papers on various aspects of health inequality and the impacts on and opportunities for women. We encourage submission of work that applies critical analysis and focuses on power relationships, capitalism, patriarchy, heterosexism, human rights, the health system and social determinants. We are interested in the submission of both qualitative and quantitative evidence on the existence of health inequalities by gender and we especially encourage work analysing actions to address these inequalities through either specific actions or action on systemic causes. We welcome submissions on disability, gender fluidity, ageism from developing countries, Indigenous peoples and other groups such as refugees whose voices are less heard.

Dr. Anna Matheson
Dr. Heather Came
Prof. Jacquie Kidd
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Women and health inequalities
Addressing systemic causes
Power relationships and patriarchy
Human rights
Reorienting health systems
Health activism
Community empowerment
Indigenous Health
Social determinants
Critical theory
Gender relationships

Published Papers (12 papers)

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Editorial

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4 pages, 259 KiB

Open AccessEditorial

Women, Patriarchy and Health Inequalities: The Urgent Need to Reorient Our Systems

by Anna Matheson, Jacquie Kidd and Heather Came

Int. J. Environ. Res. Public Health 2021, 18(9), 4472; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094472 - 23 Apr 2021

Cited by 5 | Viewed by 5062

Abstract

This Special Issue is entitled “Women, patriarchy, and health inequalities: an unresolved issue” [...] Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

Research

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23 pages, 1185 KiB

Open AccessArticle

New Perspective on Why Women Live Longer Than Men: An Exploration of Power, Gender, Social Determinants, and Capitals

by Fran Baum, Connie Musolino, Hailay Abrha Gesesew and Jennie Popay

Int. J. Environ. Res. Public Health 2021, 18(2), 661; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020661 - 14 Jan 2021

Cited by 24 | Viewed by 8565

Abstract

Background: Women live longer than men, even though many of the recognised social determinants of health are worse for women than men. No existing explanations account fully for these differences in life expectancy, although they do highlight the complexity and interaction of biological, social and health service factors. Methods: this paper is an exploratory explanation of gendered life expectancy difference (GLED) using a novel combination of epidemiological and sociological methods. We present the global picture of GLED. We then utilise a secondary data comparative case analysis offering explanations for GLED in Australia and Ethiopia. We combine a social determinant of health lens with Bourdieu’s concepts of capitals (economic, cultural, symbolic and social). Results: we confirmed continuing GLED in all countries ranging from less than a year to over 11 years. The Australian and Ethiopian cases demonstrated the complex factors underpinning this difference, highlighting similarities and differences in socioeconomic and cultural factors and how they are gendered within and between the countries. Bourdieu’s capitals enabled us to partially explain GLED and to develop a conceptual model of causal pathways. Conclusion: we demonstrate the value of combing a SDH and Bourdieu’s capital lens to investigate GLED. We proposed a theoretical framework to guide future research. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

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16 pages, 324 KiB

Open AccessArticle

“Ashamed, Silent and Stuck in a System”—Applying a Structural Violence Lens to Midwives’ Stories on Social Disadvantage in Pregnancy

by Eva Neely, Briony Raven, Lesley Dixon, Carol Bartle and Carmen Timu-Parata

Int. J. Environ. Res. Public Health 2020, 17(24), 9355; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249355 - 14 Dec 2020

Cited by 5 | Viewed by 3318

Abstract

Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives’ narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

10 pages, 305 KiB

Open AccessArticle

Intersectionality: Social Marginalisation and Self-Reported Health Status in Young People

by Fiona Robards, Melissa Kang, Georgina Luscombe, Catherine Hawke, Lena Sanci, Katharine Steinbeck, Karen Zwi, Susan Towns and Tim Usherwood

Int. J. Environ. Res. Public Health 2020, 17(21), 8104; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218104 - 03 Nov 2020

Cited by 10 | Viewed by 5585

Abstract

Background: The aim of this study was to measure young people’s health status and explore associations between health status and belonging to one or more socio-culturally marginalised group. Methods: part of the Access 3 project, this cross-sectional survey of young people aged 12–24 years living in New South Wales, Australia, oversampled young people from one or more of the following groups: Aboriginal and or Torres Strait Islander; living in rural and remote areas; homeless; refugee; and/or, sexuality and/or gender diverse. This paper reports on findings pertaining to health status, presence of chronic health conditions, psychological distress, and wellbeing measures. Results: 1416 participants completed the survey; 897 (63.3%) belonged to at least one marginalised group; 574 (40.5%) to one, 281 (19.8%) to two and 42 (3.0%) to three or four groups. Belonging to more marginalised groups was significantly associated with having more chronic health conditions (p = 0.001), a greater likelihood of high psychological distress (p = 0.001) and of illness or injury related absence from school or work (p < 0.05). Conclusions: increasing marginalisation is associated with decreasing health status. Using an intersectional lens can to be a useful way to understand disadvantage for young people belonging to multiple marginalised groups. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

12 pages, 548 KiB

Open AccessArticle

by Michal Kozubik, Jitse P. van Dijk and Ivan Rac

Int. J. Environ. Res. Public Health 2020, 17(19), 6992; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17196992 - 24 Sep 2020

Cited by 8 | Viewed by 3678

Abstract

Background: Data on Roma women’s experience of violence from their male partners are very scarce. We explored the process of actual domestic violence against Roma women, the threat of violence and its health consequences. We further focused on barriers in the availability of specialized support services aimed at eliminating domestic violence. Methods: The sample included 20 Roma women living throughout Slovakia: scattered among the majority (45.0%), in crisis centers and sheltered houses (40.0%), and in segregated Roma settlements (15.0%). Data were obtained through qualitative research by means of semi-structured interviews in 20 individual case studies. All 20 women had experienced a combination of violence: physical, psychological and economic, all of them connected with social isolation. Results: Prevailing gender stereotypes are a precondition of domestic violence against women, regardless of their status. Violence against Roma women resulted in several health consequences, and all of the 20 women suffered from these. Most of them reported general psychological problems (75%), among which anxiety and depression (25%), headache (25%), weight loss (10%) and health problems connected with motor activity (5%). The barriers include lack of awareness among Roma women of any specialised support services and the absence of such services for abused women in the region. Conclusions: Domestic violence results in serious psychological and physical health consequences. Violence elimination is generally set up without a specific ethnic or gender approach. Disregard of these specifics can lead to deepening of the uneven position of Roma women within the family, community and society, and the acceptance of violence against Roma women. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

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16 pages, 689 KiB

Open AccessArticle

Cycle of Perpetual Vulnerability for Women Facing Homelessness near an Urban Library in a Major U.S. Metropolitan Area

by Janny S. Li and Lianne A. Urada

Int. J. Environ. Res. Public Health 2020, 17(16), 5985; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165985 - 18 Aug 2020

Cited by 7 | Viewed by 4389

Abstract

Background: Homelessness among women and the multiple vulnerabilities they endure (sexual exploitation/human trafficking, violence, and mental health issues) is a perpetually unresolved issue in the U.S. and globally. Methods: This study is based on qualitative in-depth interviews accompanied by brief socio-demographic surveys conducted among 32 total participants, consisting of cisgender females (n = 17) and cisgender males (n = 15) experiencing homelessness at a large public library. Results: Of the women, 35% were White, 35% Latina, 18% African American/Black, and 18% LGBT. Half of all participants said in qualitative interviews that they witnessed violence against women, and/or experienced unwanted harassment/sexual exploitation; one in three described suspected human trafficking. Of the women interviewed, half struggled with mental health symptoms, feelings of hopelessness, and nearly all reported isolation; approximately one-third had substance use issues. Many described an inadequate number of emergency and long-term shelters Available for women facing homelessness; many had to wait or saw other women waiting to get into shelters and faced abuse on the streets in the meantime. Conclusion: The emergent themes showed that women face a “cycle of perpetual vulnerability” with three relational pathways: iterated trauma from chronic abuse/violence inflicted on them, a state of paralysis due to inadequate availability of supportive services, shelters, and mental health resources to cover all women living on the streets, leaving women susceptible to being a target phenotype for predators. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

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14 pages, 1467 KiB

Open AccessArticle

The “Silent Reserves” of the Patriarchal Chinese Welfare System: Women as “Hidden” Contributors to Chinese Social Policy

by Yingqi Wang and Tao Liu

Int. J. Environ. Res. Public Health 2020, 17(15), 5267; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17155267 - 22 Jul 2020

Cited by 6 | Viewed by 3079

Abstract

Scholars of social inequality in China have commonly concentrated on strata-related social welfare systems that divide the population into urban and rural dwellers, and additionally, into different welfare classes such as civil servants, employees, and migrant workers. Following Esping-Andersen, Siaroff, Sainsbury, and others, this paper brings the perspective of “gendering welfare” into the study of Chinese social policy. Focusing upon two major social policy branches in China—the old age pension insurance system and care services within the household—it discusses the role of Chinese women in these two fields. Through a gender-sensitive analysis, this paper elaborates the social phenomenon of “silent reserves” (namely, women) within the Chinese welfare regime. While women assume a crucial role in intrafamily care services, constituting the chief contributors of long-term care and childcare, their care contributions at home are not recognized as “social achievements” and are not monetarily compensated by the patriarchal Chinese welfare state. In addition, this paper argues that women are systematically disadvantaged by pension insurance arrangements. Furthermore, the individualization of care services in the intrafamily context weakens the pension entitlements of women, since their unpaid care constrains their ability to maintain full-time jobs in the labor market. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

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11 pages, 370 KiB

Open AccessArticle

The Influence of Ideological Variables in the Denial of Violence Against Women: The Role of Sexism and Social Dominance Orientation in the Spanish Context

by Jesús M. Canto, Macarena Vallejo-Martín, Fabiola Perles and Jesús San Martín

Int. J. Environ. Res. Public Health 2020, 17(14), 4934; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17144934 - 08 Jul 2020

Cited by 8 | Viewed by 2984

Abstract

Violence against women in heterosexual intimate relationships is a major social problem with serious physical and psychological consequences for the victims. There is a line of research that seeks to analyze how ideological variables and contextual variables influence the way in which this type of violence is perceived. This study analyzed the relationship between hostile sexism, benevolent sexism and social dominance in the acceptance of the myths about violence against women in intimate relationships. A total of 215 Spanish university students (125 women and 90 men) participated in the research. The results indicate that hostile sexism and social dominance orientation act as factors that influence the acceptance of such myths in men. Benevolent sexism did not act in this way. The data reconfirm the importance of hostile sexism and social dominance orientation in the perception of violence against women, in this case, that which is committed by their partners (or ex-partners) in the area of intimate relationships. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

13 pages, 1704 KiB

Open AccessArticle

Socioeconomic Inequalities in Uptake of Breast Cancer Screening among Saudi Women: A Cross-Sectional Analysis of a National Survey

by Mohammed Khaled Al-Hanawi, Rubayyat Hashmi, Sarh Almubark, Ameerah M. N. Qattan and Mohammad Habibullah Pulok

Int. J. Environ. Res. Public Health 2020, 17(6), 2056; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17062056 - 20 Mar 2020

Cited by 14 | Viewed by 4631

Abstract

Timely and adequate screening for breast cancer could improve health outcomes and reduce health costs. However, the utilization of free breast cancer screening services among Saudi women is very low. This study aims to investigate socioeconomic inequalities in breast cancer screening among Saudi women. The data of this study were extracted from the nationally representative Saudi Health Interview Survey, conducted in 2013; the study included 2786 Saudi women. Multivariate logistic regression, the concentration curve, and the concentration index were used to examine, illustrate, and quantify income- and education-related inequalities in three outcomes: Knowledge about self-breast examination (SBE), clinical breast examination (CBE) received in the last year, and mammography, that has ever been previously carried out. Results showed a marked socioeconomic gradient in breast cancer screening services. The concentration index by income was 0.229 (SBE), 0.171 (CBE), and 0.163 (mammography). The concentration index by education was 0.292 (SBE), 0.149 (CBE), and 0.138 (mammography). Therefore, knowledge about breast cancer screening, and the utilization of screening services, were more concentrated among richer and better-educated women. Poorer and less educated women had less knowledge about self-breast examination, and had considerably less adherence to clinical breast examination and mammography. The findings are helpful for policy makers to devise and implement strategies to promote equity in breast cancer screening among Saudi women. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

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11 pages, 304 KiB

Open AccessArticle

Sex Differences in Factors Affecting Hospital Outpatient Department Visits: Korea Health Panel Survey Data from 2009 to 2016

by Chang Hoon You, Young Dae Kwon and Sungwook Kang

Int. J. Environ. Res. Public Health 2019, 16(24), 5028; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16245028 - 10 Dec 2019

Cited by 4 | Viewed by 3325

Abstract

This study intends to inspect the sex differences in proportion of hospital outpatient department (OPD) visits in overall outpatient (OP) visits using national panel data and to explore factors that influence the proportions by sex. This study analyzed data of the 2009–2016 Korea Health Panel Survey. Fractional logit regression was applied to analyze factors that affect proportion of hospital visits among outpatient visits. Analysis of related factors was carried out first for all analysis subjects and then by sex. The study data were provided by 7470 women (52.2%) and 6846 men (47.8%). The overall average number of OP visits was 13.0, and women showed a much higher frequency of visits (15.8) than men (9.9). The average proportion of hospital OPD visits among overall OP visits was 21.9%, and men showed a higher rate (25.1%) than women (19.5%). The analysis model including sociodemographic factors, economic factors, and health-related factors confirmed that men showed a higher rate of hospital usage than women. Type of medical security, household income, participation in economic activities, disability, and serious illnesses were significant variables for both sexes. Age, education level, marital status, and subscription to voluntary private health insurance were significant only for women, whereas region of residence was significant only for men. This study confirmed that there is a sex difference in proportion of hospital OPD visits and in the factors that affect the proportion of hospital OPD visits. Universal health coverage is provided through social health insurance, but there is a sex difference in hospital OPD visits, and factors related to socioeconomic status have a significant effect, especially on women’s selection of health care institutions. More attention should be given to sex differences in factors affecting health care utilization. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

Review

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19 pages, 1816 KiB

Open AccessReview

‘As Long as It Comes off as a Cigarette Ad, Not a Civil Rights Message’: Gender, Inequality and the Commercial Determinants of Health

by Sarah E. Hill and Sharon Friel

Int. J. Environ. Res. Public Health 2020, 17(21), 7902; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17217902 - 29 Oct 2020

Cited by 12 | Viewed by 5844

Abstract

Scholarship on the commercial determinants of health (CDoH) has sought to understand the multiple ways corporate policies, practices and products affect population health. At the same time, gender is recognised as a key determinant of health and an important axis of health inequalities. To date, there has been limited attention paid to the ways in which the CDoH engage with and impact on gender inequalities and health. This review seeks to address this gap by examining evidence on the practices and strategies of two industries—tobacco and alcohol—and their interaction with gender, with a particular focus on women. We first describe the practices by which these industries engage with women in their marketing and corporate social responsibility activities, reinforcing problematic gender norms and stereotypes that harm women and girls. We then examine how tobacco and alcohol companies contribute to gender inequalities through a range of strategies intended to protect their market freedoms and privileged position in society. By reinforcing gender inequalities at multiple levels, CDoH undermine the health of women and girls and exacerbate global health inequalities. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

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20 pages, 723 KiB

Open AccessReview

Exploring the State of Gender-Centered Health Research in the Context of Refugee Resettlement in Canada: A Scoping Review

by Chloe Zivot, Cate Dewey, Cole Heasley, Sharada Srinivasan and Matthew Little

Int. J. Environ. Res. Public Health 2020, 17(20), 7511; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207511 - 15 Oct 2020

Cited by 6 | Viewed by 3085

Abstract

Interdisciplinary health research that investigates gender as a relational process is necessary to facilitate a safe and healthy resettlement process for refugees in Canada. This scoping review explores the range, nature, and extent of published research examining gender in relation to refugee health during resettlement in Canada. An initial search of six databases yielded 7325 articles published before June 2019. A total of 34 articles published between 1988 and 2019 were included for in-depth review. Articles meeting inclusion criteria primarily focused on refugee women. Categories of focus included maternal health, social and emotional health, health impacts of sexual and gender-based violence and torture, access to health and social services, decision-making and health-seeking behavior, mental health, and sexual and reproductive health. Our thematic analysis identified connections between gender roles, expectations, ideals, and health through interactions and lived experiences within the family, community, and healthcare system. Review findings suggest that many refugee women are influenced by pervasive gender roles and expectations as well as exposed to gendered health systems and practices that may pose risks to health, particularly mental health and access to services. Further efforts should be made to understand processes and experiences of resilience and community building in countering negative impacts of gendered beliefs and practices on health during resettlement. Full article

(This article belongs to the Special Issue Women, Patriarchy and Health Inequalities: An Unresolved Issue)

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