Addressing Essential Structural Dimensions of Gender Inequality
POLICY BRIEF #1 First Published: October 2011
How do structural dimensions of gender inequality affect women and men´s health?
All over the world, women as a group have less power and resources in comparison to men as a group. This structural dimension of gender inequality has a tremendous impact on both women’s and men’s health and longevity.
Structural gender inequality
The structural dimension of gender inequality refers to the unequal division of power and resources between women and men. These inequalities are assigned through other gendered mechanisms, which are reproduced and maintained at the individual as well as societal level (Okin, 1989).
Norms, values and practices give rise to clear distinctions between the sexes and to allocating women as subordinated to men in most important spheres of life, for example, type of education, labour market position, and unpaid duties (Wamala & Lynch, 2002).
In many parts of the world, men and boys exercise power over women and girls, making decisions on their behalf, constraining their access to resources and personal agency, and
policing their behaviour through socially condoned violence or threat of violence.
Even in countries where extreme gender inequality is not evident; women continue to have less influence in economic, political, and other influential institutions than men (Schultz & Mullings, 2006; WGEKN, 2007).
Global fact
The male versus female dominance in the structural gender aspects of power and resources is a global fact. The Gender Empowerment Measure presented by the United Nations’ Development Programme is an index measuring differences between women and men in three basic dimensions:
- economic participation and decision-making,
- political participation and decision-making, and
- power over economic resources,
with 1.0 referring to absolute gender equality.
Among the countries from which values are reported, about ten exceed a score of 0.8 while more than one-third falls below 0.5 (UNDP, 2010). An illustration from the EU setting is that the average female versus male salary during the last decade has been around 80% (Eurofond, 2010).
Longevity
There is a rich body of studies which indicate that high degree of influence and participation as well as access to resources improves people’s lifetime health (WHO 2010). One gender paradox in health is therefore that women live longer than men despite being subordinated in society (Annandale and Hunt,2000). The caring role, typically assigned to women, may protect more
against life threating attitudes and behaviours than the bread winning role, usually assigned to men (Månsdotter et al. 2006).
Furthermore, the various norms and structures of gender are intimately interwoven (Harding 1986).
A man who does not achieve the masculinity norm of intellectual and monetary resources may, for example, need to compensate his loss of prestige with the masculinity codes of heavy alcohol drinking and other risk taking behaviours (Connell, 1995). According to Courtenay:
“Confronting this [masculinity coded behaviour to retain societal status] may well improve [men´s] physical well-being, but it will necessarily undermine their privileged position and threaten their power and authority in relation to women”
Courtenay 2000, p 1397
Health measures
In general women report to a larger extent mental ill-health and have less health- related quality of life than men (WHO, 2001). Obviously, women´s relative lack of power, influence and resources affects health negatively.
Further, femininity codes such as caring and cautiousness suit feelings of worries and inferiority, depression and anxiety (Connell, 1995; Hammarström, 2002). The typically female multiple role combination of paid and unpaid labour may also be stressing enough to trigger a variety of adverse health outcomes (Härenstam et al., 2001).
Existing EU-Level Policy
Roadmap for Equality Between Men and Women, 2006
Gender equality regarding structural dimensions such as education and income is widely recognized goal within the EU institutions. A recent illustration is the “European Commission’s Roadmap for equality between men and women (2006)”, which outlines six priority areas for EU action on gender equality for the period 2006-2010, including equal economic independence for women and men, equal representation in decision making, and eradication of all forms of gender based violence.
Together for Health: A Strategic Approach for the EU 2008-2013 (White
paper)
The reduction of health inequalities is one of the priorities for the overall Health Strategy 2008- 2013. A statement on common values and principles in EU healthcare systems, listing the overarching values of universality,
access to good quality care, equity and solidarity, was adopted.
COMMUNICATION FROM THE COMMISSION, EUROPE 2020
A strategy for smart, sustainable and inclusive growth
The Strategy is promoting gender equality to increase labour force participation, as a consequence this will increase growth and social cohesion. The Strategy reinforces the importance of promoting new forms of work-life balance, active ageing policies and increasing gender equality as an action for EU to increase the growth smart and sustainable
Fathers who took paternity leave had a decreased death risk of 16%, and the cost-effectiveness ratio was EUR 8000 per gained QALY. The conclusion was that the right to paternity leave is a desirable reform based on gender equality, public health and economic goals”
Månsdotter et al, (2007)
Good Practice: Example 1:
Discussing homosexuality among Dutch Moroccans, the Netherlands
This GP aims to increase acceptance of sexual diversity and homosexuality among the Dutch-Moroccan community in five cities giving information, and organizing dialogues with local Lesbian, Gay, Bisexual and Transgender organisations. The taboo regarding homosexuality concerns a number of gendered issues including the proper male and female behaviours and works, religion, social control, and family honour. Consequently, managing change is likely to increase approval of homosexuality as well as of structural gender equality.
Good Practice Example 2:
Paternity leave: costs, savings and health gains, Sweden
This GP examined the reform that permitted Swedish fathers to take parental leave in 1974. It was shown that fathers who took paternity leave had a decreased death risk of 16%, and that the cost-effectiveness of the reform was 8,00 EUR per gained QALY (quality-adjusted life-year). The conclusion was that the right to paternity leave is a desirable reform based on gender equality, public health and economic goals.
Good Practice Example 3:
The RoSa Library, Belgium
The current visions and practices of gender equality in all aspects of life are undoubtedly helped by old and new empowerment initiatives of women (Kiss, 1998). This GP contains more than 22 000 books and works on gender and feminism, and a number of extensive archives from the pioneering women’s movement.
Good Practice Example 4:
The Men’s Health and Well-being Programme, Ireland
This GP was established by the Larkin Unemployment Centre in partnership with the Glasgow Celtic Football Club, in Dublin’s North inner city. The objectives included assisting men to take control of their own health, providing information in a gender sensitive way, acting as a catalyst to effect positive change, providing new opportunities to engage in recreation and sporting, and building capacity in the community.
Good Practice Example 5:
Resolution on the 2009-2014 National Programme on Prevention of Family Violence, Slovenia
This GP represents a strategic document that stipulates the objectives, measures and key policy makers for the prevention and reduction of family violence in the Republic of Slovenia. The fundamental objectives are to connect the measures of various sectors and to ensure efficient activities to reduce family violence at the level of identification and prevention. Definite tasks and activities for the implementation of methods and their deadlines will be translated into action plans, created every two years.
Steps for Policy Action
1) Address both private (family) and public (labour market) aspects of life in policy and programmes to enhance gender equality in society and gender equity in health.
This refers to continued EU and member state efforts on topics such as equalising the number of women and men in educational programs at upper secondary as well as university level, and equal pay policies in public as well as private bodies. A key aspect is gender‐neutral parental leave entitlements.
The right for both mothers and fathers to care for their child, and for the child to be cared for by both parents, should be guaranteed by changed legislation in member states that continue to make a difference between maternity and paternity leave, by considering economic incentives such as “daddy quotas” in member states that have not reached gender equal parental leave, and by widely disseminating information on the consequences from gender equality in parenthood on societal gender equality in the long run.
2) Design programmes and policies that take into account discrimination based on (class, ethnicity, age, sexuality, etc.) in order to more effectively reduce health inequities between women and men.
There is an interaction between gender inequalities and other social inequalities on health and longevity. This is referred to as intersectionality, which comes from feminist sociological theory, and aims to explain how various socially, economically, and culturally constructed categories such as gender, ethnicity, class, sexual orientation, and disability interact and jointly contribute to oppression and discrimination. The reduction of gender inequities in health are therefore helped by identifying and addressing multiple social vulnerabilities for reverse health outcomes at the EU level as well as at the national, regional, and local levels in the member states
3) Support existing efforts and the development of future actions to promote empowerment incentives for women
The vision of gender equality in all aspects of life is founded on the pioneering women who did not accept being subordinated to men. However, the unequal division of power, influence, and resources between the sexes still exists, why continued and developed empowerment efforts by and for women will be highly motivated in the future.
4) Design programmes and policies, which prevent risky behaviours serving as masculinity codes – for improving men´s health, and for diminishing the global male versus female dominance
When preventing and treating sickness, injuries and premature death related to alcohol, traffic, violence, etc., public health decision-makers and practitioners must consider that these behaviours are codes of certain masculinities (seldom of femininities), i.e. resistance to change may be strong among certain men. However, the resources invested for changing these behaviours are essential for improving gender equity in health, for cost-effectiveness in the long-run, and ultimately, for reaching a society in which men do not dominate over women. In this context should also be considered the risk of making normative assumptions about women´s and men´s readiness for various lifestyles, and suitability for various life tasks, based on the current empirical situation. This note regards everyone working with gender and health issues.
5)Work towards eradication of men’s violence against women, since it constitutes a mean to maintain gender inequality and compromises risks for women’s health, dignity and independence
Men’s violence against women deserves special attention. It represents a mean to maintain gender inequality on both the individual and societal level, by threats as well as completed violent acts. It represents also a great risk factor for immediate injury and death, and for future ill health among women. Efforts at EU and member state levels must guarantee the goal of eradication, not simply reduction, and then continue to implement existing and develop new strategies for prevention, identification and response in all relevant sectors of society.
Contributors
Anna Månsdotter,PhD, Karolinska Institutet, Sweden
Isis Marie Aimée Nyampame,MPH, Swedish National Institute of Public Health, Sweden
Charlotte Deogan,MPH, Karolinska Institutet, Sweden
Hanna Wallin,MPH, Karolinska Institutet, Sweden
Ineke Klinge,PhD, Maastricht University, the Netherlands
Carina A. Furnée,PhD, Maastricht University, the Netherlands
María Cristina Quevedo‐Gómez,MD,MPH, Maastricht University, the Netherlands
Petra Verdonk,PhD, Maastricht University, the Netherlands
Peggy Maguire, European Institute of Women’s Health, Ireland
Kristin Semancik, European Institute of Women’s Health, Ireland
Expert Reviewer
Aagje Ieven, PhD, EuroHealthNet
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