Denton Margaret, Prus Steven, Walters Vivienne
McMaster University, W Hamilton, Ont., Canada.
Soc Sci Med. 2004 Jun;58(12):2585-600. doi: 10.1016/j.socscimed.2003.09.008.
Gender-based inequalities in health have been frequently documented. This paper examines the extent to which these inequalities reflect the different social experiences and conditions of men's and women's lives. We address four specific questions. Are there gender differences in mental and physical health? What is the relative importance of the structural, behavioural and psychosocial determinants of health? Are the gender differences in health attributable to the differing structural (socio-economic, age, social support, family arrangement) context in which women and men live, and to their differential exposure to lifestyle (smoking, drinking, exercise, diet) and psychosocial (critical life events, stress, psychological resources) factors? Are gender differences in health also attributable to gender differences in vulnerability to these structural, behavioural and psychosocial determinants of health? Multivariate analyses of Canadian National Population Health Survey data show gender differences in health (measured by self-rated health, functional health, chronic illness and distress). Social structural and psychosocial determinants of health are generally more important for women and behavioural determinants are generally more important for men. Gender differences in exposure to these forces contribute to inequalities in health between men and women, however, statistically significant inequalities remain after controlling for exposure. Gender-based health inequalities are further explained by differential vulnerabilities to social forces between men and women. Our findings suggest the value of models that include a wide range of health and health-determinant variables, and affirm the importance of looking more closely at gender differences in health.
基于性别的健康不平等现象已有诸多记载。本文探讨了这些不平等在多大程度上反映了男性和女性不同的社会经历及生活状况。我们提出四个具体问题。在身心健康方面是否存在性别差异?健康的结构、行为和心理社会决定因素的相对重要性是什么?健康方面的性别差异是否归因于男性和女性所处的不同结构(社会经济、年龄、社会支持、家庭安排)背景,以及他们在生活方式(吸烟、饮酒、锻炼、饮食)和心理社会(重大生活事件、压力、心理资源)因素方面的不同接触情况?健康方面的性别差异是否也归因于男性和女性在易受这些健康的结构、行为和心理社会决定因素影响方面的性别差异?对加拿大全国人口健康调查数据的多变量分析显示了健康方面的性别差异(通过自评健康、功能健康、慢性病和痛苦程度来衡量)。健康的社会结构和心理社会决定因素对女性通常更为重要,而行为决定因素对男性通常更为重要。在接触这些因素方面的性别差异导致了男女之间的健康不平等,然而,在控制了接触情况后,仍存在具有统计学意义的不平等。男女在对社会因素的易感性方面的差异进一步解释了基于性别的健康不平等。我们的研究结果表明包含广泛健康及健康决定因素变量的模型的价值,并肯定了更密切关注健康方面性别差异的重要性。