Factors that influence health: An introduction

2.2 Sex, gender and health

It has long been assumed that sex (the biological differences between men and women), rather than gender (the socially defined differences between men and women), determines health. For example, in most countries, male life expectancy is lower than that of females and this is projected to continue (see Figure 2). However, in recent years this male disadvantage has become far less significant than before. For example, in England and Wales, between 1970 and 2003, male life expectancy increased by four years, but life expectancy for women increased by only three years, with the gap being 6.2 years in 1971 and 4.3 years in 2003 (ONS, 2005c). So while women were assumed to possess a biological advantage, given changes in patterns of life expectancy, this assumption is being challenged.

Thinking point: to what extent do you think that human biology is a major determinant of health?

Sex differences have also been drawn upon to explain patterns of mortality. For example, coronary heart disease (CHD), which is the leading cause of death in developed countries, was once thought to affect men more than women. Differences in CHD include a later age of onset for women, a greater prevalence of co-morbidity and differences in the initial manifestations of the disease (Bello and Mosca, 2004). However, psychosocial differences, and differences in lifestyle and in living and working conditions between men and women, are probably better indicators of susceptibility to CHD and associated co-morbidity than are biological factors (Fodor and Tzerovska, 2004) and, at least in relation to coronary heart disease, male anatomy is not destiny (Weidner and Cain, 2003, p. 769). So gender, rather than sex, is a better indicator of inequalities in health.