Gender and Health Inequality

Author(s): Jen'nan Ghazal Read and Bridget K. Gorman

Source: Annual Review of Sociology , 2010, Vol. 36 (2010), pp. 371-386
Published by: Annual Reviews

Stable URL: http://www.jstor.com/stable/25735083

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 Gender and Health Inequality
Jen'nan Ghazal Read1 and Bridget K. Gorman2
1 Department of Sociology and Duke Global Health Institute, Duke University, Durham,
North Carolina 27708; email: [email protected]
2 Department of Sociology, Rice University, Houston, Texas 77005;
email: [email protected]

Annu. Rev. Sociol. 2010.36:371-86

Key Words
First published online as a Review in Advance on
morbidity, mortality, health disparities
April 20,2010

The Annual Review of Sociology is online at

Abstract
soc.annualreviews.org
This review synthesizes gender differences in U.S. health and systemat
This article's doi:
ically examines the attention that gender has received in the sociological
10.n46/annurev.soc.012809.102535
literature on health disparities over the past three decades. Its goal is
Copyright (c) 2010 by Annual Reviews. to map where we have been in order to identify new directions for
All rights reserved
sociological research. We begin by summarizing major differences in
0360-0572/10/0811-0371$20.00 U.S. men's and women's health and by reviewing explanations for ob
served differences. We then assess the basis for this knowledge, namely
publications in major sociology journals and funding by major granting
agencies, focusing on both the quantity and substantive content of this
work. We couch the discussion in the broader framework of the analysis
of gender in sociology and conclude with promising avenues for future
work.

57'

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 INTRODUCTION disparities literature and to estimate whether
and how the treatment of gender has changed
The early to mid-1980s marked a watershed era
over the past three decades. Our primary goal
in research and policy on gender and health.
is to map where we have been in order to iden
Verbrugge (1985) published a seminal piece in
tify new directions in which to go. To that
the Journal of Health and Social Behavior that
end, we begin by summarizing the major pat
outlined the major patterns, hypotheses, and ex
terns and explanations for gender differences in
planations for gender differences in U.S. health.
U.S. health. We then focus on the foundation
Nathanson (1984) published an article in the
of our knowledge to date: published research
Annual Review of Sociology that examined sex
and funded grants. The final section looks to
differences in mortality, and a Public Health
ward future research studies and identifies two
Service task force of the U.S. Department of
Health and Human Services (HSS) issued arelated areas that look particularly promising
for pushing our knowledge regarding gendered
widely discussed report urging more scientific
data on women's health (Public Health Serv. patterns of health forward: specifically, con
textual assessments of health and multimethod
1985). At the same time, Stacey & Thorne
approaches.
(1985) published an influential piece in So
For the purposes of this review, we made
cial Problems arguing that sociology had been
several difficult choices in order to work within
less successful than other disciplines in placing
space constraints and to keep the article focused
women's experiences at the center of analysis
on the relationship between gender and health.
or, put differently, in treating gender as an or
First, we limited our discussion to the U.S.
ganizing category of social life.
context, owing to a lack of comparability in
We take these publications as our point of
data and publishing/funding practices abroad.
departure to ask, "What is the quantity and
Second, we focused on two broad dimensions
quality of attention that gender has received in
of U.S. adult health?mortality (death) and
the sociological literature on health disparities
since that time?" We take a two-pronged ap morbidity (physical illness)?and included any
article that addressed these topics. We included
proach to answer this question. First, we look
articles on mental health when they related
at changes in research activities and funding to
to physical health outcomes and/or mortality
determine the degree of support for research
and acknowledge that gender differences in
on gender and health?funding that supports
mental health could serve as the basis of an
publications on this topic. Second, we exam
entirely separate review. Finally, we focused on
ine the coverage of gender and health in four
general patterns rather than specific differences
major sociology journals {American Journal of
across population subgroups (e.g., younger
Sociology, American Sociological Review, Journal
versus older adults, whites versus blacks, etc.),
of Health and Social Behavior, and Social Forces,
hereafter AJS, ASR, JHSB, and SF) in additionalthough we recognize that these differences
are important and have reviewed these trends
to Demography, the flagship population studies
elsewhere (Gorman & Read 2006; Read &
journal and an important outlet for sociolog
Gorman 2006, 2010).
ical research on morbidity and mortality. We
tally the number of articles published in each
journal since 1980 and discuss the substantive
PATTERNS
content of those articles. We distinguish the ar AND EXPLANATIONS
OF
ticles along three dimensions: (a) comparative GENDERED HEALTH
(women relative to men) versus those focused DISPARITIES
on one gender (women or men), (b) quantitative
Patterns
versus qualitative, and (c) major thematic focus.
Together, these approaches allow us to asThe historical and contemporary motivation
sess the prominence of gender in the health for sociological interest in gendered health

372 Read Gorman

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disparities is rooted in the indisputable fact that well-being and increase their risk of death
men and women differ in their physical health via accidental injuries and homicide. These
profiles, regardless of how health is defined. behaviors also have a cumulative impact
In broadest terms, women have longer life ex that negatively affects men's health at later
pectancies than men but suffer from more ill stages of life by elevating their likelihood
ness. This finding is well documented in the of premature death from life-threatening
health disparities literature, and several reviews conditions (e.g., heart disease, cancer). In
provide detailed descriptions of the size and contrast, women are more likely to suffer from
scope of gender differences in health (e.g., Bird nonfatal, chronic conditions such as arthritis
& Rieker 2008, Read & Gorman 2010, Rieker and disability that do not necessarily result
& Bird 2000). Rather than replicate those re in their death but do depress their quality of
views, we briefly summarize the major patterns life. These health patterns are directly related
and explanations for contemporary differences to the differential life expectancy of men and
in men's and women's health in terms of mor women. Although women live more years than
tality and morbidity and then move to an as men without disease and disability, studies
sessment of trends in research and funding on show that the elevated female morbidity
gender and health. rate is related to their longer length of life
Gender differences in health are most (Crimmins et al. 1996, 2002). As a result,
obvious with respect to mortality: Women live diseases that show a weaker relationship with
longer than men in every developed country age (e.g., asthma, bronchitis/emphysema) vary
in the world. The most recent data for the less by gender than do those with stronger age
United States show that life expectancy at gradients (e.g., heart disease, hypertension,
birth for women is 80.4 years, compared with arthritis).
75.2 years for men?meaning that, on average,
women live 5.2 years longer than men (Natl.
Cent. Health Stat. 2009). While large, the size Explanations
of the gap has been steadily declining since Why do women live longer than men but
the mid-1970s, when women, at the peak, spend more years in poor health? Research
held a 7.8-year advantage over men. The most has advanced several explanations for this
frequently cited explanation for the dimin relationship, and they typically reference a
ishing mortality gap is changes in men's and combination of biological, social-structural,
women's smoking patterns, as men have been psychosocial, and behavioral characteristics and
reducing their smoking at a more rapid pace conditions that differentiate the lives of men
than women (see review by Gorman & Read and women (Verbrugge 1985, Read & Gorman
2007). It is also important to note that men and 2010). These explanatory categories are not
women are susceptible to the same diseases, mutually exclusive and are often framed in
even though women outlive men; for example, terms of differential exposure (men and women
the top two leading causes of death for both have different levels of exposure to the con
men and women are heart disease and cancer. ditions that foster good health) or differential
Gender differences in morbidity are not as vulnerability (men and women react differently
straightforward as those for mortality, with to these health conditions), with both perspec
the gap between men and women varying by tives receiving empirical support (see reviews
specific disease outcome and stage of the life by Denton et al. 2004, Rieker & Bird 2000).
cycle (Crimmins et al. 2002, Gorman & Read Biologically, women are more robust than men.
2006). At younger ages men tend to engage in For example, estrogen helps to reduce women's
more health-damaging behaviors than women risk of heart disease by lowering the circulation
(like heavy drinking, illegal drug use, and until of harmful cholesterol, whereas testosterone
recently smoking) that adversely affect their puts men more at risk of life-threatening

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 conditions by causing immunosuppression stressors than men, in addition to lower levels of
(Owens 2002). However, because biological self-esteem and personal control (Denton et al.
explanations fail to explain why the gender gap 2004, Forthofer et al. 2001, Nazroo et al. 1998,
in health differs over time and by social group, Rieker & Bird 2000, Thoits 1995). Depression
they are rarely discussed prominently in soci also increases as socioeconomic standing
ological studies of gender disparities in health. declines, and studies consistently report higher
More commonly, sociological studies focus levels of depression among women (Kessler &
on social and contextual factors that shape Zhao 1999). This is harmful to physical health
men's and women's behaviors, social posi in that there are numerous longitudinal studies
tions, and well-being. The most widely and showing that depression is linked to a plethora
frequently cited factor shaping contemporary of physical health problems, particularly heart
differences in men's and women's health is so disease (see review by Rugulies 2002). On the
cioeconomic status (SES). In general, persons more positive side, women do have stronger
of higher social standing have better health support networks than do men, and these
because they have greater access to resources networks appear to enhance their well-being
needed to prevent and cure disease and typically (Denton et al. 2004, Shye et al. 1995). Some
can better cope with stressful events over their studies indicate that women benefit more from
lifetimes (Marmot 2004). Yet women remain social support than do men (Denton et al.
economically disadvantaged in U.S. society 2004, Denton & Walters 1999, Forthofer et al.
relative to men, despite advances in recent 2001, Umberson et al. 1996). However, the
decades (Milgrom & Petersen 2006, Rose & evidence on this point is not conclusive (see
Hartman 2004, Valian 1998). These and other Elliott 2001, Neff & Karney 2005), as women
studies show that women occupy fewer posi are more involved in the health needs and
tions of power in most occupational categories, behaviors of family, friends, and other social
especially prestigious occupations, and are less network members, and this higher involvement
likely to hold key leadership positions in their can result in additional strains and stresses that
local, state, or federal governments. They are are harmful to health (Shye et al. 1995).
also more likely to work part-time, engage in A large body of research also examines how
domestic and unpaid labor, and receive less men and women differentially participate in
pay than men for similar work. For example, behaviors that are either beneficial or harmful
using 15 years of data from the Panel Study to health. With few exceptions, men are
of Income Dynamics, Rose & Hartman (2004) exposed to more harmful behavior, which is
show that even among adults with the strongest why adjusting for behavioral measures tends to
attachment to the labor force, only 9.6% of narrow the gap in mortality for men relative to
women earned more than $50,000 annually, women. Men receive fewer preventive health
compared with 44.5% of men. care visits than do women, and they drink more
When compared with men, it is clear that frequently and more heavily than women,
the socioeconomic profile of women places especially during young adulthood (Johnson
greater limits on their access to health-related et al. 1998, Crimmins et al. 2002). Smoking
resources (Phelan et al. 2004, Ross & Bird 1994, rates are also higher among men, and men may
Walters et al. 2002). In addition to this direct be more vulnerable than women to the health
pathway, SES also has a large indirect influence effects of cigarettes and alcohol (Denton et al.
on health through psychosocial characteristics 2004, Denton & Walters 1999). Furthermore,
(Denton et al. 2004, McDonough & Walters across a wide array of risky behaviors (including
2001). Studies show that poor SES increases illegal drug use, drunk driving, and lack of
stress and decreases feelings of personal control seatbelt and helmet use), men participate at
and self-esteem, and not surprisingly, women higher levels than women (e.g., Everett et al.
report more stressful life events and chronic 2001, Subst. Abus. Ment. Health Serv. Admin.

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2006). As a result, they experience more publishing on this topic, particularly since the
unintentional injuries than women, con mid-1980s. Indeed, the mid-1980s marked a
tributing to their elevated rate of premature time of important change regarding the place
mortality (Cent. Dis. Control Prev. 2005). of women and gender issues more generally
That said, the gender pattern is more mixed within the medical research community. As
for behaviors related to diet/exercise and vi detailed by Epstein (2007), a long history of
olence. Men engage in slighdy higher lev women's health activism coupled with the
els of regular exercise (Natl. Cent. Health broader feminist movements of the 1970s and
Serv. 2009), and they appear to benefit more 1980s provided an important motivational
from exercise than do women (Denton et al. backdrop for reformers who argued that health
2004). However, they eat a less healthy diet knowledge was incomplete and health practices
than women (Cent. Dis. Control Prev. 2007), unjust because of inadequate representation
and rates of overweight are higher for men? and attention to women and racial minorities
although obesity levels are slightly higher in medical research. Those pushing for more
among women (Nad. Cent. Health Serv. 2009). attention to gender had statistical support on
In addition, although violence plays an impor their side: Women make up more than half
tant role in shaping the health profiles of men of the U.S. population and comprise 58% of
and women, they differ by the types of violence seniors aged 65 and older (U.S. Census Bur.
they are exposed to. Women experience much 2007), the implications of which are striking
higher rates of sexual and intimate partner vio in terms of the dynamics of health care. As
lence than men, with women comprising over an example, hypertension afflicts two-thirds
three-quarters of victims of sexual assault and of adults aged 60 and over (Ostchega et al.
rape (Tjaden & Thoennes 2000). Intimate part 2007). Yet because of differential mortality and
ner violence makes up 20% of all nonfatal vi morbidity rates, after the age of 65 women
olence against women but only 3 % of nonfa spend about twice the amount of time living
tal violence against men (Rennison 2003). In with hypertension than do men, which implies
terms of fatal violence, however, rates of sui that the costs to treat this condition will be
cide and homicide are more than twice as high greater for women than for men (Crimmins
among men than women (Cent. Dis. Control et al. 2002). Beyond the financial burden, this
Prev. 2005). is worrisome for women given that adverse
In sum, for women their biological advan drug reactions affect women at 1.5-1.7 times
tage and generally more positive behavioral the rate of men (see review by Anderson 2005).
profile result in a longer life expectancy than These factors, coupled with increasing in
men, but their disadvantaged economic status ternal and external pressure by critics and med
and elevated exposure to social stressors in ical reformers, led HSS in the early 1980s to
crease their likelihood of experiencing acute create the Public Health Service Task Force
and chronic nonfatal illnesses that elevate their on Women's Health Issues. In 1985, the task
morbidity levels in relation to men. force issued a report that highlighted the lack
of scientific data on women's health and called
COVERAGE OF GENDER for, among other things, increased attention to
AND HEALTH: RESEARCH how gender shapes health conditions and dis
AND PUBLISHING eases in biomedical and behavioral research. As
discussed by Auerbach & Figert (1995), this re
Research
port was used by women's health activists, pro
Thus far, our review shows that quite a bit fessionals, politicians, and scientists to push for
is known about gender differences in health. reform, and it laid the groundwork for change
This knowledge has been gained by an influx to come. Over the next decade, several poli
of funding that has invigorated research and cies, guidelines, and federal laws were enacted

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 that sought to include women in medical stud most important funding source for health re
ies, thereby permitting the study of gender search in the United States. Analyzing 2000
based difference in medical research (see 2003 NIH data, Simon et al. (2005) calculated
Epstein 2007 for review). These changes re the percentage of funded proposals for which at
moved formal barriers to women's inclusion in least one specific study aim was to examine male
medical research (e.g., repeal of a 1977 FDA and female differences in health status. The au
rule excluding fertile women from a large por thors found an average yearly percentage of just
3% of the total proposals awarded NIH-wide.
tion of clinical drug trials) and sought to remove
more informal preferences for male subjects be Furthermore, even though the total number
cause of concerns surrounding how fluctuat of grants awarded at NIH increased by nearly
ing hormone levels in women might complicate 20%, the number awarded to study sex/gender
medical studies. The changes reflected the view differences in health dropped by 16%. Overall,
of critics and reformers alike that "[g]enuine Simon et al. (2005, p. 8) concluded that "for the
equality between the sexes should be based not most part, the NIH institutes with the largest
on a false assertion of sameness, but rather?at budgets, and hence the most impact on the
least sometimes?on a proper acknowledgment conduct of biomedical research in the United
of difference" (Epstein 2007, p. 67). States, have provided relatively little support for
Together, these transformations have sex differences research in their areas."
helped contribute to a research environment Additionally, a recent analysis of clinical tri
that is more supportive of research on gender als for heart disease found that since 1965 the
differences in health and mortality than ever overall enrollment rate of women has increased
before. Indeed, a 2001 review by the Institute of significantly, reaching 54% in 1998 (Harris &
Medicine came to the overarching conclusion Douglas 2000). However, more than half of the
that sex "is an important basic variable that women were enrolled in one of just two very
should be considered when designing and large, all-women trials: the Women's Health
analyzing studies in all areas and at all levels Study (designed to explore the efficacy of as
of biomedical and health-related research" pirin use for women) and the Women's Health
(Wizemann & Pardue 2001, p. 2). Direct Initiative (a study of cardiovascular disease, can
assessments of funding do provide positive cer, and osteoporosis in women). If these types
evidence regarding the inclusion of women of single-sex studies are excluded, female partic
and attention to gender-based disparities in ipation drops to 38%, which is not a significant
medical research investigations (Epstein 2007). increase from the 1965 rate. That said, although
gender-comparative research designs are cru
For example, part of the mission of the Office of
Research on Women's Health at the National cially important, single-sex studies do make a
Institutes of Health (NIH) is to monitor adher meaningful contribution to the representation
ence to NIH policies regarding the inclusion of women in health research, and these studies
of women in funded clinical research studies. (when considered alongside the findings from
According to the most recent assessment gender-comparative research) are clearly in
(Pinn et al. 2008), NIH is compliant with its creasing our understanding of how men and
policy, importantly with regard to the larger women are similar and different (Buring 2000).
scale Phase 3 efficacy trials in which women We next discuss perhaps the most important av
represent more than half of research subjects.enue for the dissemination of research on gen
But at the same time, barriers to the advance der disparities in health status?publishing.
ment of knowledge about gender differences in
health and illness persist (Wizemann & Pardue
Publications
2001). For example, the continuing neglect of
gender in health research is illustrated in the An exhaustive review of five major journals from
grants that are funded by NIH, the largest and 1980 through 2008 produced 281 articles that

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 Mortality Morbidity Mental Aging Fertility Health Work Race and Marriage
health behaviors and SES ethnicity and family

Figure 1
Number of articles by theme across all journals, 1980-2009. Morbidity includes functional ability, physical
outcomes, and medical conditions; health behaviors include physical activity, drug/alcohol use, smoking,
nutrition, obesity, and sexual behavior; work and SES include employment status, unpaid employment, and
neighborhood; race and ethnicity include immigrant health; marriage and family include parenthood, marital
status, and marital happiness.

dealt explicitly with gender and health. These and topically addressed body image, nutrition,
journals include the top-tier, nonspecialized so and eating disorders.
ciology journals mentioned above: AJS, ASR, Figure 2 illustrates the dispersion of the 281
SF, JHSB, and Demography. Our review strategy articles across time and by journal. As might be
consisted of downloading all article titles and expected, JHSB published the most pieces on
abstracts for each journal issue over the selected gender and health, with a total of 132 over the
time period. The data were then imported into 29-year period, followed by Demography with
Excel, and key word searches allowed us to nar 87 articles. Far fewer articles appeared in the
row the list to articles that examined the re AJS (10), ASR (18), and SF (34). Except for
lationship between gender and health. Of the JHSB, articles on gender and health make up
remaining articles, we reviewed the titles and a very small fraction of all articles published in
abstracts for substantive content, coded them any given year, ranging from an average low
by specific key words, and then grouped the key of about 1% for AJS and ASR to 10% for De
words thematically (see Figure 1 and Table 1). mography and 16% for JHSB (percentages vary
We excluded internationally based journals slighdy from year to year). That said, there has
and/or journals with a strong international and been a general trend upward in the number of
interdisciplinary focus, such as Social Science & articles published on gender and health since
Medicine, owing to lack of comparability in con 1984. The last period (2005-2009) produced
tent and structure with U.S.-based journals. the highest number of articles (63), compared
We also looked at two prominent outlets for with a low of 30 articles between 1985 and 1989.

gender-based sociological research, Gender & Yet these numbers only tell part of the
Society and Sex Roles, to assess how much atten story. Although Figure 2 gives us a sense of the
tion health was receiving in the gender dispar quantity of articles that have been published, it
ities literature since 1980 (a slight reversal of provides no information about the substantive
our primary research question) and found 14 and thematic focus of the articles. To provide
articles in the former and 122 in the latter; a more insight on these issues, we conducted a
significant number of articles employed qual content analysis of the articles to distinguish
itative methods (86% and 10%, respectively) quantitative from qualitative, comparative from

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 Table 1 Key word searches3
Abortion Marriage
Adolescents Medical, medical conditions
Age, age at first birth Men
Aging Mental health
Alcohol, drinking Mental illness
Blood pressure Morbidity
Cancer Mortality
Cardiovascular disease Neighborhood
Children Nutrition
Class, social class Obesity, overweight
Comparative Older adults
Death, dying Parent, parenthood
Depression Prenatal health
Drug use, abuse Physical activity
Economic Physical health
Employment, unemployment Qualitative
Family structure Quantitative
Female(s) Race, ethnicity
Fertility Religion
Functional ability, disability Relationships
Gender Review article
Gender inequality Self-rated health
Genetics Sex ratio
Health, health behaviors Sexual behavior
HIV/AIDS Sexual health
Homicide Single country (non-U.S.)
Hypertension Smoking
Infant mortality Socioeconomic status
Immigrants Suicide
Immunization Treatment differences
International scope Welfare
Male(s) Well-being
Marital happiness Women
Marital status Work

aTerms searched separately, in combination, and in derivatives (e.g., parent, parenting).

single-gender focus, and thematic content. small proportion (12%) focused only on men.
Most articles were quantitative (98%), with The trend since 1995 has been away from
JHSB the only journal to publish studies that male-only studies toward a greater focus on
were primarily qualitative. We also differen comparative pieces and studies on women.
tiated between comparative articles and those In terms of thematic focus, we identi
that only focused on men or women. Most fied 55 recurring key words, which we then
(54%) compared the health profiles of women collapsed into 9 major thematic categories
and men, 34% focused on the health of women that are common in the health disparities
only?typically reproductive health?and a literature. For example, we combined smoking,

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 25

20

.-.* dem
? _*asr
0I_t*-?^-.^^^^^-r~.-.-.t ajs
1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009
Year

Figure 2
Articles on gender and health as a percentage of all published, by journal. The figures for 2005-2009 are
constructed from an average of 2005-2008. Journals: JHSB, Journal of Health and Social Behavior; SF, Social
Fo?xes; DEM, Demography; ASR, American Sociological Review; and AJS, American Journal of Sociology.

alcohol consumption, nutrition, and exercise in the figure, there is a high degree of thematic
into "health behaviors" and specific disease overlap in many of the individual journal arti
outcomes, such as cancer, cardiovascular dis cles. For example, most of the articles dealing
ease, and functional ability, into "morbidity." with morbidity and mortality also focus on
Table 1 provides details on our coding deci health behaviors and socioeconomic position.
sions. Figure 1 illustrates the frequency of the Overall, three findings are particularly note
themes across all journals and all years. Moving worthy from this 29-year publishing review.
from left to right in the figure, we order the First, research on gender and health remains
themes into three major groups: major health firmly grounded in the purview of demogra
outcomes (mortality, morbidity, and mental phers and quantitative sociologists (Figures 1
health), health processes (aging, fertility, and and 2). Nathanson (1984) accurately noted that
health behaviors), and social and contextual this was the case 20 years ago, especially with
factors that influence health (work and SES, respect to studies of mortality, and we find
race and ethnicity, and marriage and family). this remains the case with most publications
Importantly, most articles deal with a com appearing in Demography and JHSB. For all
bination of themes (e.g., mortality and SES); other major sociological journals, attention to
thus, the themes should not be interpreted as gender and health has remained relatively small
representing individual articles. Rather, they and flat. Second, we have seen a slight increase
provide insight into the most common and in coverage of this topic in sheer number of
popular topics covered in research on gender articles published since 1985, although not in
and health. In terms of health outcomes, the proportion, except for Demography, where
Figure 1 shows a strong focus on mortality, there has been an overall increase in both. And
followed by mental health and morbidity. across the board, we have seen a movement
For health processes, reproductive health has away from single-gender studies to more com
received the most attention, which is not parative works, partly reflecting a shift toward
surprising given its centrality in research on more inclusive studies of both women and
men.
women's health. Although not readily apparent

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 Third, and importantly in terms of future and whites (e.g., Manton & Stallard 1980, Keith
& Smith 1988, Berkman et al. 1989, Guest et al.
directions, our analysis shows that quantitative
research clearly dominates the field in terms of 1998). However, in recent years we have seen
methodological approaches, and this is largely growing attention to how gender differences in
due to the type of data that is available and mortality differ across a broader array of eth
the type of funding that supports the collec nic groups beyond blacks and whites, particu
tion of new data. More than two decades ago, larly Hispanics (e.g., Elo et al. 2004, Pampel &
Stacey & Thorne (1985) noted that when gen Rogers 2004). This is a significant trend that
der was incorporated into sociological studies, will continue in order to fit the ever-changing
it was mostly as a variable in a quantitative demographic makeup of the U.S. population.
analysis. In Williams's (2006) reassessment, al In addition, a growing number of studies
though quantitative methods continue to domi are exploring whether the gender-health pat
nate in journals such as ASR and AJS, qualitative tern seen in developed contexts, such as the
work is more typical in gender-focused journals United States, applies in poorer contexts as
such as Gender & Society. Our examination sup well?and findings suggest that both similar
ports these assessments, with the composition ities and differences exist. For example, Fuller
of health-related articles in the gender journals and colleagues (1993) examined morbidity rates
we reviewed (i.e., significantly more qualitative among Thai men and women, concluding that
studies, with a strong focus on issues related to although gender patterns in morbidity and
diet and body image) indicating a substantial mortality mimic U.S. patterns, explanations for
disconnect with the nonspecialized, health, and these patterns differ from U.S. studies, with
demography journals included in our review. problems relating to reproductive health and
This methodological and topical split is unfor psychological distress accounting for most of
tunate, as it represents a missed opportunity for the gender difference in morbidity. Other work
qualitative and quantitative sociologists to work has also examined how gender patterns in mor
in a more collaborative fashion and to publish tality, disability, health behaviors, and spe
this work in outlets that are widely read by users cific health conditions operate both within and
of both methodological disciplines. across nations (e.g., McKinlay 1996; Pampel
Beyond these general trends, our 29-year re 1998, 2001; Timseus & Jasseh 2004; Yount &
view also reveals important substantive shifts in Agree 2005), suggesting that we still have much
research on gender and health that we believe to learn about how social conditions shape the
lay the foundation for future research in this health experience of men and women in an in
area. Notably, there has been a clear movement creasingly global society.
toward greater specificity in the conditions that
shape men's and women's health. Research in
the early and mid-1980s was dominated by
NEW DIRECTIONS
language such as "sex differences," "minority In the course of conducting this review, we
groups," and "social structure." Today, the fo made a conscious effort to pay close attention
cus is more on "women's and men's positions," to the nature and content of research on gender
"health of (insert specific ethnic group) and and health over the past three decades, partic
(insert specific disease outcome)," and "educa ularly with respect to how it has evolved and
tion, occupation, and income." The common where it should be heading now and into the
thread is an attempt to situate and contextual future. Two areas stood out in terms of their po
ize individuals' lives without losing the ability tential for moving forward theory and evidence
to generalize to different population subgroups.on gender and health: contextual/multilevel ap
For example, until recently, research on gender proaches and mixed-methods research. These
and racial differences in mortality and life ex two areas are not mutually exclusive; rather,
pectancy focused almost exclusively on blacks they have the potential to work in tandem to

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 improve our understanding of the mechanisms the physical environment, and economic indi
that differentially (and sometimes similarly) cators, are more strongly related to self-rated
affect the health of men and women. health status for adult women than for men
and that overall self-rated health status varied
more across neighborhoods for women. The
Contextualizing Gender and Health authors attribute these differences to unequal
Research on the gender-health relationship exposure to neighborhood conditions; specifi
has typically revolved around identifying cally, women as a group spend more time in
individual-level factors that differentially shape their neighborhoods than do men because of
health outcomes for men and women, particu lower employment rates. Other studies have
larly socioeconomic position (e.g., poverty sta also put forth an exposure argument to explain
tus, educational level, health insurance status)
the stronger relationship between context and
and health-related behaviors (e.g., body mass health seen among women, although height
index, smoking, alcohol consumption). This at ened perceptions of fear and feeling unsafe in
tention is appropriate, as research has repeat one's neighborhood may also contribute to this
edly demonstrated strong connections between difference (Roman & Chalfin 2008, Wang &
these factors and physical health status. The Beydoun 2007).
problem with such a focus is that individuals are There are several promising directions for
situated within broader social, cultural, and po future research that emerge from this relatively
litical contexts that also condition their health new literature on contextual effects. First, we
status (Dodoo & Frost 2008). As discussed by need more studies that examine gender differ
Macintyre & Ellaway (2003), the neighbor ences in health using multilevel methods across
hoods that people occupy can have direct as well a diverse set of outcomes, particularly because
as indirect effects on health status (through cog attention to gender in contextual health studies
nitive and emotional processes), although there has been limited to date, and not all studies are
is no reason to assume that these effects are consistent in finding bigger effects for women.
similar across health outcomes or population Second, more attention should be directed to
groups. In terms of gender differences, contex ward investigating why these gender differences
tual influences may operate differently because exist?is it greater exposure or vulnerability to
men and women perceive their environment contextual circumstances among women, or is
differently or because of different levels of expo it that men and women view their contexts dif
sure and/or vulnerability to aspects of the local ferently, with discordant health outcomes as a
environment (Stafford et al. 2005). result? As is, our understanding of this emerg
Findings to date are mixed with regard to the ing pattern is incomplete. Third, we need more
differential importance of neighborhood con studies that examine contextual effects in a lon
text for the health of men and women (see gitudinal framework not only to account for se
discussion by Stafford et al. 2005), although lection effects (i.e., how long have people lived
many studies do find that neighborhood con in these neighborhoods), but also to consider
ditions have a larger influence on the health how health unfolds across the life course and
of women. For example, in a study of obesity, how this might complicate our understanding
Robert & Reither (2004) find that although no of contextual influences. For example, recent
measures of community SES are related to body work by Hamil-Luker & O'Rand (2007) indi
mass index among adult men, there is a strong, cates that childhood SES has a stronger impact
significant relationship among women. Simi on adult women's health than on adult men's,
larly, Stafford et al. (2005) find that multiple and the same might be true for the long-term
aspects of neighborhood characteristics, includ
effects of neighborhood SES (and other contex
ing sociopolitical environment, amenities and tual factors).

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 Mixed-Methods Research inequality because it allows for a wider dis
cussion of subtle biases sometimes missed in
How can we do a better job contextualizing quantitative approaches alone. To date, the
gender inequalities in health? One promising benefit of this approach has been demonstrated
avenue is the use of mixed methods that get at in several sociological research veins, perhaps
contextually and individually based risk factors. most prominently in recent studies of race and
As discussed in this review, research on gen racial attitudes, where survey data document a
der and health (and health more generally) is precipitous decline in overtly racist principles
largely quantitative, in part because of the na among Americans (Bobo 2001)?even though
ture of population studies that are interested in interview data find that while whites are less
documenting broad-based inequalities as pre apt to report racism directly, racial bias is
cisely as possible. There is a definite split be persistent, with minorities continuing to bear
tween the types of questions addressed in quan the brunt of these perspectives (Feagin & Sykes
titatively based research on gender and health 1994, Bonilla-Silva 2006). With respect to gen
(often focused on individual-level characteris der and health, Popay & Groves (2000) note
tics) and those addressed in qualitatively based that the body of qualitative research available
studies (often focused on more contextual-level is very limited, although evidence is mounting
factors). This disconnect is further evidenced by that mixed-method projects offer a more
the methodological break between gender jour accurate picture of how various social factors
nals (more qualitative) and mainstream/health and relationships shape the health profile of
sociology and demography journals (almost men and women. One illustrative example they
completely quantitative). discuss involves gender differences in pain, with
Our understanding of gender differences in epidemiological survey data consistently find
health is hampered by this split. Numerous ing that women report higher levels of chronic
studies demonstrate that combining quantita and intermittent pain than men. However,
tive and qualitative approaches provides greater interview data from Bendelow (1993) show
explanatory power than a single approach be that both men and women express beliefs that
cause it captures both objective, numerical pat pain is more "normal" for women because of
terns and subjective, qualitative experiences the experience of childbirth and because social
(Beatty et al. 2004, Rubin & Rubin 2005). ization processes actively discourage men from
Specifically, in-depth interviews that follow up expressing pain. Interview respondents felt that
on survey findings (a) allow participants to give men take longer to admit to pain than women
narrative responses that elucidate the question do, suggesting that the prevalence of pain doc
answer processes and provide meaning to the umented in epidemiological studies overesti
quantitative patterns (Beatty et al. 2004, Greene mates the extent of gender difference that exists
et al. 1989); (b) allow interviewers to probe spe among adults. As this example demonstrates,
cific responses, which helps increase the validity the ability of qualitative research to explore the
of the survey findings (Denzin & Lincoln 2000);
tangled relationship between identity, agency,
(c) initiate new understandings of the survey and social structure for men and women makes
data by explaining quantitative patterns that ap it an important tool in research on gender
pear counterfactual or surprising (Greene et al. inequalities in health, particularly when used
1989); and (d) provide researchers the oppor in tandem with quantitative techniques.
tunity to capture subtle biases and subjective The use of mixed-method approaches might
experiences that can be missed with quantita also help bridge the publication divide between
tive data (Rubin & Rubin 2005; see Dufur & gender-specialized journals and more main
Feinberg 2009 for example). stream health journals, which in turn would
The use of mixed-method approaches is allow research on gender and health to reach
particularly important in research on gender a wider audience. The use of mixed-method

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 approaches is certainly easier in theory than in an individual attribute rather than as a system
practice, especially for junior scholars who of of inequality, a sentiment that echoes Stacey
ten have the creativity and energy to tackle such & Thome's (1985) claim made some 25 years
tasks but who are also bound by the tenure clock ago. How might future research move past this
and the need to publish from readily available seeming impasse to integrate gender theory
data. Thus, it is incumbent on more established more fully into studies of gender and health?
scholars, funding agencies, and policy makers One promising avenue discussed in this re
to advocate for more data collection efforts that view is the use of multilevel and mixed meth

include both quantitative and qualitative tech ods that would allow for a more comprehensive
niques. Similar advocacy efforts in the 1980s framework to deal with gender as an organizing
had a clear and lasting impact on the field of principle of life that structures opportunities
gender and health inequalities, and we must and resources at the individual and contextual
continue to push for progress in this arena. levels.
Although progress on the methodological
front is one promising possibility, additional
CONCLUSION research attention is also needed on the inter
The past three decades have witnessed numer
sectionality that characterizes (and differenti
ates) the experiences of men and women. As
ous changes with respect to the treatment of
gender in sociological research on health indiscussed above, generalizations about women's
equalities. Feminist activists, scholars, public
health based on data from men no longer serve
health officials, and researchers have helped as the normative research model, and recent
move policies and research in a more inclu years have seen movement away from strictly
sive direction that focuses on the experiences broad-based
of comparisons between men and
women as well as men. As a result, our knowl
women toward more fine-tuned analyses of dif
ference based on a variety of individual and
edge and understanding of differences in men's
and women's health have grown enormously, structural characteristics (e.g., specific health
with studies demonstrating that although, onoutcome, life cycle stage, racial/ethnic group
average, women live longer than men because membership,
of neighborhood location) that dif
ferentiate the lives of men and women (e.g.,
biological advantage and engagement in health
Bird
ier behaviors, they suffer from elevated morbid & Rieker 2008, Gorman & Read 2006,
Stafford
ity rates across a range of conditions because et al. 2005). We expect that such
of their depressed SES and greater exposure detailed
to comparisons will continue and that,
social stressors. when combined with more sophisticated multi
That said, progress in the field has been method and multilevel analytic techniques, the
somewhat slow and localized in the realm of de
coming decades of sociological research on gen
der difference in health will advance our under
mographers and quantitatively based research.
As Dodoo & Frost (2008) recently argued, this
standing of this relationship in substantial and
perhaps unexpected ways.
isolation results in the treatment of gender as

DISCLOSURE STATEMENT
The authors are not aware of any affiliations, memberships, funding, or financial holdings that
might be perceived as affecting the objectivity of this review.

ACKNOWLEDGMENTS
We thank David Eagle for his invaluable help during the writing of this paper, especially his
assistance with collating and evaluating data for the publishing review and with producing the
figures.

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