Krieger Nancy
Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, Boson, MA 02115, USA.
Int J Epidemiol. 2003 Aug;32(4):652-7. doi: 10.1093/ije/dyg156.
Open up any biomedical or public health journal prior to the 1970s, and one term will be glaringly absent: gender. Open up any recent biomedical or public health journal, and two terms will be used either: (1) interchangeably, or (2) as distinct constructs: gender and sex. Why the change? Why the confusion?-and why does it matter? After briefly reviewing conceptual debates leading to distinctions between 'sex' and 'gender' as biological and social constructs, respectively, the paper draws on ecosocial theory to present 12 case examples in which gender relations and sex-linked biology are singly, neither, or both relevant as independent or synergistic determinants of the selected outcomes. Spanning from birth defects to mortality, these outcomes include: chromosomal disorders, infectious and non-infectious disease, occupational and environmental disease, trauma, pregnancy, menopause, and access to health services. As these examples highlight, not only can gender relations influence expression-and interpretation-of biological traits, but also sex-linked biological characteristics can, in some cases, contribute to or amplify gender differentials in health. Because our science will only be as clear and error-free as our thinking, greater precision about whether and when gender relations, sex-linked biology, both, or neither matter for health is warranted.
翻开20世纪70年代以前的任何一本生物医学或公共卫生期刊，你会发现一个明显缺失的术语：性别。翻开任何一本近期的生物医学或公共卫生期刊，你会看到两个术语被交替使用，或者被当作不同的概念使用：性别和性。为什么会有这种变化？为什么会产生混淆？这又为何重要？在简要回顾了导致 “性” 和 “性别” 分别被视为生物和社会概念的概念性辩论之后，本文借鉴生态社会理论，列举了12个案例，说明性别关系和与性相关的生物学因素，单独、都不或同时作为所选结果的独立或协同决定因素的情况。这些结果涵盖从出生缺陷到死亡率等方面，包括：染色体疾病、传染病和非传染病、职业和环境疾病、创伤、怀孕、更年期以及获得医疗服务的情况。正如这些例子所强调的，性别关系不仅会影响生物特征的表达和解读，而且在某些情况下，与性相关的生物学特征也会导致或放大健康方面的性别差异。由于我们的科学清晰度和准确性取决于我们的思维，因此有必要更精确地了解性别关系、与性相关的生物学因素、两者或两者都不影响健康的情况及时间。
