Napoleon, a typical great man, said to have created the "Napoleonic" era through his military and political genius
The great man theory is an approach to the study of history popularised in the 19th century. According to it, history can be largely explained by the impact of great men, or heroes:
highly influential and unique individuals who, due to their natural
attributes, such as superior intellect, heroic courage, extraordinary
leadership abilities or divine inspiration, have a decisive historical effect. The theory is primarily attributed to the Scottish essayist, historian and philosopher Thomas Carlyle, who gave a series of lectures on heroism in 1840, later published as On Heroes, Hero-Worship, & the Heroic in History, in which he states:
Universal
History, the history of what man has accomplished in this world, is at
bottom the History of the Great Men who have worked here. They were the
leaders of men, these great ones; the modellers, patterns, and in a wide
sense creators, of whatsoever the general mass of men contrived to do
or to attain; all things that we see standing accomplished in the world
are properly the outer material result, the practical realisation and
embodiment, of Thoughts that dwelt in the Great Men sent into the world:
the soul of the whole world's history, it may justly be considered,
were the history of these.
This theory is usually contrasted with people's history,
which emphasises the life of the masses creating overwhelming waves of
smaller events which carry leaders along with them. Another contrasting
school is historical materialism.
Carlyle stated that "The History of the world is but the
Biography of great men", reflecting his belief that heroes shape history
through both their personal attributes and divine inspiration.In his book Heroes and Hero-Worship,
Carlyle saw history as having turned on the decisions, works, ideas and
characters of "heroes", giving detailed analysis of six types: The hero
as divinity (such as Odin), prophet (such as Muhammad), poet (such as William Shakespeare), priest (such as Martin Luther), man of letters (such as Jean-Jacques Rousseau), and king (such as Napoleon).
Carlyle also argued that the study of great men was "profitable" to
one's own heroic side; that by examining the lives led by such heroes,
one could not help but uncover something about one's own true nature.
As Sidney Hook notes, a common misinterpretation of the theory is that "all factors in history, save great men, were inconsequential", whereas Carlyle is instead claiming that great men are the decisive
factor, owing to their unique genius. Hook then goes on to emphasise
this uniqueness to illustrate the point: "Genius
is not the result of compounding talent. How many battalions are the
equivalent of a Napoleon? How many minor poets will give us a
Shakespeare? How many run of the mine scientists will do the work of an Einstein?"
The American scholar Frederick Adams Woods supported the great man theory in his work The Influence of Monarchs: Steps in a New Science of History. Woods investigated 386 rulers in Western Europe from the 12th century until the French Revolution in the late 18th century and their influence on the course of historical events.
The Great Man approach to history was most fashionable with
professional historians in the 19th century; a popular work of this
school is the Encyclopædia Britannica Eleventh Edition
(1911) which contains lengthy and detailed biographies about the great
men of history, but very few general or social histories. For example,
all information on the post-Roman "Migrations Period" of European history is compiled under the biography of Attila the Hun. This heroic view of history was also strongly endorsed by some philosophers, such as Léon Bloy, Søren Kierkegaard, Oswald Spengler and Max Weber.
Georg Wilhelm Friedrich Hegel, proceeding from providentialist
theory, argued that "what is real is reasonable" and that
world-historical individuals are the World-Spirit's agents. Hegel wrote:
"Such are great historical men—whose own particular aims involve those
large issues which are the will of the World-Spirit." Thus, according to Hegel, a great man does not create historical reality himself but only uncovers the inevitable future.
In Untimely Meditations, Friedrich Nietzsche writes that "the goal of humanity lies in its highest specimens". Although Nietzsche's body of work shows some overlap with Carlyle's
line of thought, Nietzsche expressly rejected Carlyle's hero cult in Ecce Homo.
Assumptions
This theory rests on two main assumptions, as pointed out by Villanova University:
Every great leader is born already possessing certain traits that will enable them to rise and lead on instinct.
The need for them has to be great for these traits to then arise, allowing them to lead.
This theory, and history, claims these great leaders as
heroes that were able to rise against the odds to defeat rivals while
inspiring followers along the way. Theorists say that these leaders were
then born with a specific set of traits and attributes that make them
ideal candidates for leadership and roles of authority and power. This
theory relies then heavily on born rather than made, nature rather than
nurture and cultivates the idea that those in power deserve to lead and
shouldn't be questioned because they have the unique traits that make
them suited for the position.
Responses
Herbert Spencer was a contemporary critic of Carlyle's great man theory.
Herbert Spencer's critique
One of the most forceful critics of Carlyle's formulation of the great man theory was Herbert Spencer, who believed that attributing historical events to the decisions of individuals was an unscientific position. He believed that the men Carlyle supposed "great men" are merely products of their social environment:
You must admit that
the genesis of a great man depends on the long series of complex
influences which has produced the race in which he appears, and the
social state into which that race has slowly grown.... Before he can remake his society, his society must make him.
—Herbert Spencer, The Study of Sociology
William James' defense
William James, in his 1880 lecture "Great Men, Great Thoughts, and the Environment", published in the Atlantic Monthly,
forcefully defended Carlyle and refuted Spencer, condemning what James
viewed as an "impudent", "vague", and "dogmatic" argument.
William James was a 19th-century philosopher and psychologist.
James' defence of the great man theory can be summarized as follows: The unique physiological
nature of the individual is the deciding factor in making the great
man, who, in turn, is the deciding factor in changing his environment in
a unique way, without which the new environment would not have come to
be, wherein the extent and nature of this change is also dependent on
the reception of the environment to this new stimulus. To begin his
argument, he first sardonically claims that these inherent physiological qualities have as much to do with "social, political, geographical [and] anthropological conditions" as the "conditions of the crater of Vesuvius has to do with the flickering of this gas by which I write".
James argues that genetic anomalies in the brains of these great men
are the decisive factor by introducing an original influence into their
environment. They might therefore offer original ideas, discoveries,
inventions and perspectives which "would not, in the mind of another
individual, have engendered just that conclusion ... It flashes out of
one brain, and no other, because the instability of that brain is such
as to tip and upset itself in just that particular direction."
James then argues that these spontaneous variations of genius, i.e. the great men,
which are causally independent of their social environment,
subsequently influence that environment which in turn will either
preserve or destroy the newly encountered variations in a form of
evolutionary selection. If the great man is preserved then the
environment is changed by his influence in "an entirely original and
peculiar way. He acts as a ferment, and changes its constitution, just
as the advent of a new zoological species changes the faunal and floral
equilibrium of the region in which it appears." Each ferment, each great
man, exerts a new influence on their environment which is either
embraced or rejected and if embraced will in turn shape the crucible for
the selection process of future geniuses.
In the words of William James, "If we were to remove these
geniuses or alter their idiosyncrasies, what increasing uniformities
would the environment exhibit?" James challenges Spencer or anyone else
to provide a reply. According to James, there are two distinct factors
driving social evolution: personal agents and the impact of their unique
qualities on the overall course of events.
He thus concludes: "Both factors are essential to change.
The community stagnates without the impulse of the individual. The
impulse dies away without the sympathy of the community."
Other responses
Before the 19th century, Blaise Pascal begins his Three Discourses on the Condition of the Great
(written, it seems, for a young duke) by telling the story of a
castaway on an island whose inhabitants take him for their missing king.
He defends in his parable of the shipwrecked king, that the legitimacy
of the greatness of great men
is fundamentally custom and chance. A coincidence that gives birth to
him in the right place with noble parents and arbitrary custom deciding,
for example, on an unequal distribution of wealth in favour of the
nobles.
Leo Tolstoy's War and Peace
features criticism of great-man theories as a recurring theme in the
philosophical digressions. According to Tolstoy, the significance of
great individuals is imaginary; as a matter of fact they are only
"history's slaves", realising the decree of Providence.
Jacob Burckhardt
affirmed the historical existence of great men in politics, even
excusing the rarity among them to possess "greatness of soul", or magnanimity:
"Contemporaries believe that if people will only mind their own
business political morality will improve of itself and history will be
purged of the crimes of the 'great men'. These optimists forget that the
common people too are greedy and envious and when resisted tend to turn
to collective violence." Burckhardt predicted that the belittling of
great men would lead to a lowering of standards and rise in mediocrity
generally.
Mark Twain suggests in his essay "The United States of Lyncherdom"
that "moral cowardice" is "the commanding feature of the make-up of
9,999 men in the 10,000" and that "from the beginning of the world no
revolt against a public infamy or oppression has ever been begun but by
the one daring man in the 10,000, the rest timidly waiting, and slowly
and reluctantly joining, under the influence of that man and his fellows
from the other ten thousands."
In 1926 William Fielding Ogburn, an American sociologist,
noted that Great Men history was being challenged by newer
interpretations that focused on wider social forces. While not seeking
to deny that individuals could have a role or show exceptional
qualities, he saw Great Men as inevitable products of productive
cultures. He noted for example that if Isaac Newton had not lived, calculus would have still been discovered by Gottfried Leibniz, and suspected that if neither man had lived, it would have been discovered by someone else. Among modern critics of the theory, Sidney Hook is supportive of the idea; he gives credit to those who shape events through their actions, and his book The Hero in History is devoted to the role of the hero and in history and influence of the outstanding persons.
In the introduction to a new edition of Heroes and Hero-Worship, David R. Sorensen notes the modern decline in support for Carlyle's theory in particular but also for "heroic distinction" in general. He cites Robert K. Faulkner as an exception, a proponent of Aristotelian magnanimity who in his book The Case for Greatness: Honorable Ambition and Its Critics,
criticises the political bias in discussions on greatness and heroism,
stating: "the new liberalism's antipathy to superior statesmen and to
human excellence is peculiarly zealous, parochial, and antiphilosophic."
Ian Kershaw wrote in 1998 that "The figure of Hitler,
whose personal attributes – distinguished from his political aura and
impact – were scarcely noble, elevating or enriching, posed self-evident
problems for such a tradition." Some historians like Joachim Fest
responded by arguing that Hitler had a "negative greatness". By
contrast, Kershaw rejects the great man theory and argues that it is
more important to study wider political and social factors to explain
the history of Nazi Germany. Kershaw argues that Hitler was an unremarkable person, but his importance came from how people viewed him, an example of Max Weber's concept of charismatic leadership.
The World Health Organization (WHO) has defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Identified by the 2012 World Development Report as one of two key human capital endowments, health can influence an individual's ability to reach his or her full potential in society. Yet while gender equality has made the most progress in areas such as
education and labor force participation, health inequality between men
and women continues to harm many societies to this day.
While both males and females face health disparities,
women have historically experienced a disproportionate amount of health
inequity. This stems from the fact that many cultural ideologies and
practices have created a structured patriarchal society where women's
experiences are discredited. Additionally, women are typically restricted from receiving certain opportunities such as education
and paid labor that can help improve their accessibility to better
health care resources. Females are also frequently underrepresented or
excluded from mixed-sex clinical trials and therefore subjected to physician bias in diagnosis and treatment.
Definition of health disparity
Health disparity has been defined by WHO
as the differences in health care received by different groups of
people that are not only unnecessary and avoidable, but also unjust and
prejudiced. The existence of health disparity implies that health equity
does not exist in many parts of the world. Equity in health refers to
the situation whereby every individual has a fair opportunity to attain
their full health potential. Overall, the term "health disparities", or "health inequalities", is
widely understood as the differences in health between people who are
situated in different positions in a socioeconomic hierarchy.
Gender as an axis of difference
Bias against females
The social structures of many countries perpetuate the marginalization and oppression of women in the form of cultural norms and legal codes.
As a result of this unequal social order, women are usually relegated
to positions where they have less access to and control over healthcare
resources, making women more vulnerable to suffering from health
problems than men. For example, women living in lower-income areas have
acutely restricted protection of their health because they are less
likely to have access to tertiary education and employment. As a result, female life expectancy at birth, nutritional well-being, and immunity against communicable and non-communicable diseases, are often lower than those of men.
Bias against males
There are situations in which men tend to fare poorer. One example is lower life expectancy for men in most countries. Another such instance is armed conflicts,
where men are often the immediate victims. A study of conflicts in 13
countries from 1955 to 2002 found that 81% of all violent war deaths were male. Apart from armed conflicts, areas with high incidence of violence, such as regions controlled by drug cartels, also see men experiencing higher mortality rates. This stems from social beliefs that associate ideals of masculinity with aggressive, confrontational behavior. Lastly, sudden and drastic changes in economic environments and the loss of social safety nets, in particular social subsidies and food stamps, have also been linked to higher levels of alcohol consumption and psychological stress
among men, leading to a spike in male mortality rates. This is because
such situations often make it harder for men to provide for their
families, a task that has been long regarded as the "essence of
masculinity." A retrospective analyses of people infected with the common cold found that doctors underrate the symptoms of men, and are more willing to attribute symptoms and illness to women than men. Women live longer than men in all countries, and across all age groups, for which reliable records exist. In The United States, men are less healthy than women across all social
classes. Non-white men are especially unhealthy. Men are
over-represented in dangerous occupations and represent a majority of
on-the-job deaths. Further, medical doctors provide men with less
service, and less advice, and spend less time with men than they do with
women per medical encounter.
Bias against intersex people
Another axis of health disparity is within the intersex community. Intersex people are people born with sex characteristics, such as chromosomes, gonads, or genitalia, that do not fit typical binary notions of male and female bodies.
Healthcare of intersex persons is centered around what may
be considered "cultural understandings of gender" or the binary system
commonly used as gender. Surgeries
and other interventions are often used for intersex persons to attempt
to physically change their body to conform with one sex. It has been
debated whether or not this practice is ethical. Much of this pressure
to choose one sex to conform to is socially implemented. Data suggest
that children who do not have one gender to conform to may face
embarrassment from peers. Parents may also pressure their children to having cosmetic surgery to
avoid being embarrassed themselves. Particular ethical concerns come
into play when decisions are made on behalf of the child before they are
old enough to consent.
Intersex people can face discrimination when seeking
healthcare. Laetitia Zeeman of University of Brighton, UK writes, "LGBTI
people are more likely to experience health inequalities due to
heteronormativity or heterosexism, minority stress,
experiences of victimization and discrimination, compounded by stigma.
Inequalities of LGBTI health(care) vary depending on gender, age,
income, and disability as well as between LGBTI groupings." James Sherer of Rutgers University Medical School also found, "Many
well-meaning and otherwise supportive healthcare providers feel
uncomfortable when meeting an LGBT patient for the first time due to a
general lack of knowledge about the community and the terminology used
to discuss and describe its members. Common mistakes, such as incorrect
language usage or neglecting to ask about sexual orientation and gender
at all, may inadvertently alienate patients and compromise their care."
Types of gender disparities
Male-female sex ratio
Map indicating the human sex ratio by country.
Countries with more females than males.
Countries with approximately the same number of males and females.
Countries with more males than females.
No data
At birth, boys outnumber girls with the ratio of 105 or 106 male to 100 female children. However, after conception, biology favors women. This is because
women, on the whole, are more resistant to diseases and less prone to
debilitating genetic conditions. However, the ratio of women to men in developing regions such as South Asia, West Asia, and China can be as low as 0.94, or even lower. This deviation from the natural male-to-female sex ratio has been described by Indian philosopher and economist Amartya Sen as the "missing women" phenomenon. According to the 2012 World Development Report, the number of missing
women is estimated to be about 1.5 million women per year, with a
majority of the women missing in India and China.
Female mortality
In many developing regions, women experience high levels of mortality. Many of these deaths result from maternal mortality and HIV/AIDS infection. Although only 1,900 maternal deaths were recorded in high-income nations in 2008, India and Sub-Saharan Africa experienced a combined total of 266,000 deaths from pregnancy-related causes. In Somalia and Chad, one in every 14 women dies from causes related to childbirth. However, some countries, such as Kenya, have made great strides in eliminating maternal and neonatal tetanus.
In addition, the HIV/AIDS epidemic also contributes significantly to female mortality. The case is especially true for Sub-Saharan Africa, where women account for 60% of all adult HIV infections.
Health outcome
Women tend to have poorer health outcomes than men for several reasons, ranging from sustaining greater risk to diseases to experiencing higher mortality rates. In the Population Studies Center Research Report by Rachel Snow that compares the disability-adjusted life years (DALY) of both males and females, the global DALYs lost to females for sexually transmitted diseases such as gonorrhea and chlamydia are more than ten times greater than those of the males. Moreover, the female DALYs to male DALYs ratio for malnutrition-related diseases such as Iron-Deficiency Anemia are often close to 1.5, suggesting that poor nutrition impacts women at a much higher level than men. Additionally, in terms of mental illnesses, women are also two to three
times more likely than men to be diagnosed with depression.
In developed countries with more social and legal gender
equality, overall health outcomes can disfavor men. For example, in the
United States, as of 2001, men's life expectancy is 5 years lower than
women's (down from 1 year in 1920), and men die at higher rates from all
top 10 causes of death, especially heart disease and stroke. Men die from suicide more frequently, though women more frequently have
suicidal thoughts and the suicide attempt rate is the same for men and
women (see Gender differences in suicide). Men may suffer from undiagnosed depression more frequently, due to gender differences in the expression of emotion. American men are more likely to consume alcohol, smoke, engage in risky behaviors, and defer medical care.
Incidence of melanoma has strong gender-related differences which vary by age.
Women outlive men in 176 countries. Data from 38 countries shows women having higher life expediencies than
men for all years both at birth and at age 50. Men are more likely to
die from 13 of the 15 major causes of death in the U.S. However, women
are more likely to suffer from disease than men and miss work due to
illness throughout life. This is called the mortality-morbidity paradox,
or Health Survival paradox This is explained by an excess of psychological, rather than physical,
distress among women, as well as higher smoking rates among men. Androgens also contribute to the male deficit in longevity.
Access to healthcare
Women tend to have poorer access to healthcare resources than men. In certain regions of Africa, many women often lack access to malaria treatment as well as access to resources that could protect them against Anophelesmosquitoes during pregnancy. As a result of this, pregnant women who are residing in areas with low
levels of malaria transmission are still placed at two to three times
higher risk than men in terms of contracting a severe malaria infection. These disparities in access to healthcare are often compounded by
cultural norms and expectations imposed on women. For example, certain
societies forbid women from leaving their homes unaccompanied by a male
relative, making it harder for women to receive healthcare services and
resources when they need them most.
Gender factors, such as women's status and empowerment (i.e., in education, employment, intimate partner relationships, and reproductive health), are linked with women's capacity to access and use maternal health services, a critical component of maternal health. Still, family planning
is typically viewed as the responsibility of women, with programs
targeting women and overlooking the role of men—even though men's
dominance in decision making, including contraceptive use, has
significant implications for family planning and access to reproductive health services.
To promote equity in access to reproductive health care, health programs, and services should conduct analyses to identify gender inequalities
and barriers to health, and determine the programmatic implications.
The analyses will help inform decisions about how to design, implement,
and scale up health programs that meet the differential needs of women
and men.
Access to sexual and reproductive healthcare for men is
important. Engaging men in sexual and reproductive health helps to
decrease their risk-taking behaviors and increase gender equity.
However, a scoping review in the Nordic countries has shown that men are
facing healthcare difficulties related to sexual and reproductive
health.
Causes
Cultural norms and practices
Cultural norms and practices are two of the main reasons
why gender disparities in health exist and continue to persist. These
cultural norms and practices often influence the roles and behaviors
that men and women adopt in society. It is these gender differences
between men and women, which are regarded and valued differently, that
give rise to gender inequalities as they work to systematically empower
one group and oppress the other. Both gender differences and gender
inequalities can lead to disparities in health outcomes and access to
health care. Some of the examples provided by the World Health Organization of how cultural norms can result in gender disparities in health include a woman's inability to travel alone, which can prevent them from receiving the necessary health care that they need. Another societal standard is a woman's inability to insist on condom use by her spouse or sex partners, leading to a higher risk of contracting HIV.
Son preference
One of the better-documented cultural norms that augment gender disparities in health is the preference for sons. In India,
for instance, the 2001 census recorded only 93 girls per 100 boys. This
is a sharp decline from 1961, when the number of girls per 100 boys was
nearly 98. In certain parts of India, such as Kangra and Rohtak the number of girls for every 100 boys can be as low as in the 70s. Additionally, low female to male numbers have also been recorded in other Asian countries – most notably in China
where, according to a survey in 2005, only 84 girls were born for every
100 boys. Although this was a slight increase from 81 during 2001–2004,
it is still much lower than the 93 girls per 100 boys in the late
1980s. The increasing number of unborn girls in the late 20th century has been
attributed to technological advances that made pre-birth sex
determination, also known as prenatal sex discernment, such as the ultrasound
test more affordable and accessible to a wider population. This allowed
parents who prefer a son to determine the sex of their unborn child
during the early stages of pregnancy. By having early identification of
their unborn child's sex, parents could practice sex-selective abortion, where they would abort the fetus if it was not the preferred sex, which in most cases is that of the female.
Additionally, the culture of son preference also extends beyond birth in the form of preferential treatment of boys. Economic benefits of having a son in countries like India also explain
the preferential treatment of boys over girls. For example, in Indian
culture it is the sons who provide care and economic stability to their
parents as they age, so having a boy helps to ensure the futures of many
Indian families. This preferential care can be manifested in many ways, such as through
differential provision of food resources, attention, and medical care.
Data from household
surveys over the past 20 years has indicated that the female
disadvantage has persisted in India and may have even worsened in some
other countries such as Nepal and Pakistan.
Harmful cultural practices such as female genital mutilation
(FGM) also cause girls and women to face health risks. Millions of
females are estimated to have undergone FGM, which involves partial or
total removal of the external female genitalia for non-medical reasons. It is estimated that 92.5 million females over 10 years of age in Africa
are living with the consequences of FGM. Of these, 12.5 million are
girls between 10 and 14 years of age. Each year, about three million
girls in Africa are subjected to FGM.
Often performed by traditional practitioners using
unsterile techniques and devices, FGM can have both immediate and late
complications. These include excessive bleeding, urinary tract infections, wound infection, and in the case of unsterile and reused instruments, hepatitis and HIV. In the long run, scars and keloids can form, which can obstruct and damage the urinary and genital tracts. According to a 2005 UNICEF
report on FGM, it is unknown how many girls and women die from the
procedure because of poor record keeping and a failure to report
fatalities. FGM may also complicate pregnancy and place women at a higher risk for obstetrical problems, such as prolonged labor. According to a 2006 study by the WHO involving 28,393 women, neonatal mortality increases when women have experienced FGM; an additional ten to twenty babies were estimated to die per 1,000 deliveries.
Psychological complications are related to cultural
context. Women who undergo FGM might be emotionally affected when they
move outside their traditional circles and are confronted with the view
that mutilation is not the norm.
Violence and abuse
National
Institute of Health: Among more than 1,400 adult females, childhood
sexual abuse was associated with increased likelihood of drug
dependence, alcohol dependence, and psychiatric disorders
Violence against women is a widespread global occurrence
with serious public health implications. This is a result of social and
gender bias. Many societies in developing nations function on a patriarchal
framework, where women are often viewed as a form of property and as
socially inferior to men. This unequal standing in the social hierarchy
has led women to be physically, emotionally, and sexually abused by men,
both as children and adults. These abuses usually constitute some form
of violence. Although children of both sexes do suffer from physical maltreatment, sexual abuse,
and other forms of exploitation and violence, studies have indicated
that young girls are far more likely than boys to experience sexual abuse.
In a 2004 study on child abuse, 25.3% of all girls surveyed experienced
some form of sexual abuse, a percentage that is three times higher than
that of boys (8.7%).
Such violence against women, especially sexual abuse, is
increasingly being documented in areas experiencing armed conflicts.
Presently, women and girls bear the brunt of social turmoil worldwide,
making up an estimated 65% of the millions who are displaced and
affected. Some of these places which are facing such problems include Rwanda, Kosovo, and the Democratic Republic of the Congo. This comes as a result of both the general instability around the region, as well as a tactic of warfare
to intimidate enemies. Often being placed in emergency and refugee
settings, girls and women alike are highly vulnerable to abuse and
exploitation by military combatants, security forces, and members of rival communities.
The sexual violence
and abuse of both young and adult women have both short and long-term
consequences, contributing significantly to a myriad of health issues
into adulthood. These range from debilitating physical injuries, reproductive health issues, substance abuse, and psychological trauma. Examples of the above categories include depression and post-traumatic stress disorder, alcohol
and drug use and dependence, sexually transmitted diseases, lower
frequency of certain types of health screenings (such as cervical
cancer), and suicide attempts.
Abused women often have higher rates of unplanned and problematic pregnancies, abortions, neonatal and infant health issues, sexually transmitted infections (including HIV), and mental disorders (such as depression, anxiety disorders, sleep disorders and eating disorders) as compared to their non-abused peers. During peacetime,
most violence against women is perpetrated by either male individuals
whom they know or intimate male partners. An eleven-country study
conducted by WHO between 2000 and 2003 found that depending on the
country, between 15% and 71% of women have experienced physical or
sexual violence by a husband or partner in their lifetime, and 4% to 54% within the previous year. Partner violence may also be fatal. Studies from Australia, Canada, Israel, South Africa and the United States show that between 40% and 70% of female murders were carried out by intimate partners.
Other forms of violence against women include sexual harassment and abuse by authority figures (such as teachers, police officers or employers), trafficking for forced labour or sex, and traditional practices such as forced child marriages
and dowry-related violence. At its most extreme, violence against women
can result in female infanticide and violent death. Despite the size of
the problem, many women do not report their experience of abuse and do not seek help. As a result, violence against women remains a hidden problem with great human and health care costs. Worldwide men account for 79% of all victims of homicide. Homicide statistics by gender
Poverty
Poverty is another factor that facilitates the continual existence of gender disparities in health. Poverty is often directly linked with poor health. However, indirectly it affects factors such as lack of education,
resources, and transportation that have the potential to contribute to
poor health. In addition to economic constraints, there are also cultural
constraints that affect people's ability or likelihood to enter a
medical setting. While gender disparities continue prevalent in health,
the extent to which it occurs within poor communities often depends on
factors like the socioeconomic state of their location, cultural
differences, and even age.
Children living in poverty have limited access to basic
health needs overall, however, gender inequalities become more apparent
as children age. Research done on children under the age of five
suggests that in low to middle-income countries, approximately 50% of
children living in poverty had access to basic health care. There was also no significant difference between boys and girls in
access to healthcare services, such as immunizations and treatment for
prevalent diseases such as malaria for both. Research focused on a wider age range, from infancy to adolescence,
showed different results. It was found that in developing countries
girls had more limited access to care, and if accessed they were likely
to receive inferior care to that of boys.Girls in developing countries were also found to be more likely to suffer emotional and physical abuse inflicted by their family and community.
Gender inequalities in health for those living in poverty continue into adulthood. In research that excluded women's health
disadvantages (childbirth, pregnancy, susceptibility to HIV, etc.) it
was found that there was not a significant gender difference in the
diagnosis and treatment of chronic conditions. In fact, women were diagnosed more, which was attributed to the fact
that women had more access to healthcare due to reproductive needs, or
from taking their children in for checkups. By contrast, research that was inclusive of women's health disadvantages revealed that maternal health
widened the gap between men's and women's health. Poor women in
underdeveloped countries were said to be at greater risk of disability
and death. The lack of resources and proper nourishment is often a cause of death
and contributes to issues of preterm birth and infant mortality, as well
as a contributor to maternal mortality. It is estimated that about 800 women die daily from maternal mortality,
and most cases are preventable. However, 99% of the cases occur in
poverty-ridden regions that lack the resources to access prompt, as well
as preventive medical care.
The gendered health differences were slightly different
for people living in poverty in wealthier countries. Women were reported
to be more low-income than men, and more likely to forgo medical
treatment due to financial circumstances. In the United States the Patient Protection and Affordable Care Act (PPACA)
made it more possible for more people living in poverty to have access
to healthcare, especially for women, however it is argued that the Act
also promotes gender inequality because of differences in coverage. Gender-specific cancer screenings, such as for prostate cancer are not covered for men, while similar screenings for women are. At the same time, screenings such as counseling and other services for
intimate partner violence are covered for women and not for men. In European countries the results were different than those of people
in the United States. While in the United States, poor men had less
quality healthcare than women, in European countries men had less access
to healthcare. The studies revealed that people, age 50 and over, who
struggled to make ends meet (subjective poverty) were 38% more likely to
decline in health than those who were considered low income or had low
overall wealth. However, men with subjective poverty of the same age group were 65% more likely to die than women, within a 3 to 6-year period.
Healthcare system
Not being listened to is a common experience of women in healthcare
The World Health Organization defines health systems as "all the activities whose primary purpose is to promote, restore, or maintain health". However, factors outside of healthcare systems can influence the impact
healthcare systems have on the health of different demographics within a
population. This is because healthcare systems are known to be
influenced by social, cultural, and economic frameworks. As a result,
health systems are regarded as not only "producers of health and health
care", but also as "purveyors of a wider set of societal norms and
values," many of which are biased against women.
In the Women and Gender Equity Knowledge Network's Final
Report to the WHO Commission on Social Determinants of Health in 2007,
health systems in many countries were noted to have been unable to
deliver adequately on gender equity
in health. One explanation for this issue is that many healthcare
systems tend to neglect the fact that men's and women's health needs can
be very different. In the report, studies have found evidence that the healthcare system
can promote gender disparities in health through the lack of gender equity in terms of the way women are regarded – as both consumers (users) and producers (carers) of health care services. For instance, healthcare systems tend to regard women as objects rather
than subjects, where services are often provided to women as a means of
something else rather on the well-being of women. In the case of reproductive health services, these services are often provided as a form of fertility control rather than as care for women's well-being. Additionally, although the majority of the workforce in health care
systems are female, many of the working conditions remain discriminatory
towards women. Many studies have shown that women are often expected to
conform to male work models that ignore their special needs, such as
childcare or protection from violence. This significantly reduces the ability and efficiency of female caregivers providing care to patients, particularly female ones.
Structural gender oppression
Structural gender inequalities in the allocation of resources, such as income, education, health care, nutrition and political voice, are strongly associated with poor health and reduced well-being. Very often, such structural gender discrimination of women in many other areas has an indirect impact on women's health. For example, because women in many developing nations are less likely to be part of the formal labor market,
they often lack access to job security and the benefits of social
protection, including access to health care. Additionally, within the
formal workforce, women often face challenges related to their lower
status, where they suffer workplace discrimination and sexual harassment.
Studies have shown that this expectation of having to balance the
demands of paid work and work at home often gives rise to work-related fatigue, infections, mental ill-health, and other problems, which results in women faring poorer health.
Women's health is also put at a higher level of risk as a
result of being confined to certain traditional responsibilities, such
as cooking and water collection. Being confined to unpaid domestic labor
not only reduces women's opportunities for education and formal job
employment (both of which can indirectly contribute to better health in
the long run) but also potentially exposes women to a higher risk of
health issues. For instance, in developing regions where solid fuels are used for cooking, women are exposed to a higher level of indoor air pollution due to extended periods of cooking and preparing meals for the family. Breathing air tainted by the burning of solid fuels is estimated to be responsible for 641,000 of the 1.3 million deaths of women worldwide each year due to chronic obstructive pulmonary disorder (COPD).
In some settings, structural gender inequity is associated
with particular forms of violence, marginalization, and oppression
against females. This includes violent assault by men, child sexual abuse, strict regulation of women's behavior and movement, female genital mutilation, and exploitative, forced labor. Women and girls are also vulnerable to less well-documented forms of abuse or exploitation, such as human trafficking or "honor killings"
for perceived behavioral transgressions and deviation of their social
roles. These acts are associated with a wide range of health problems in
women such as physical injuries, unwanted pregnancies, abortions, mental disorders such as depression, and anxiety, substance abuse, and sexually transmitted infections, all of which can potentially lead to premature death.
The ability of women to utilize health care is also
heavily influenced by other forms of structural gender inequalities.
These include unequal restriction on one's mobility and behavior, as
well as unequal control over financial resources. Many of these social
gender inequalities can impact the way women's health is regarded, which
can in turn determine the level of access women have to healthcare
services and the extent by which households and the larger community are
willing to invest in women's health issues.
Other axes of oppression
Uninsured Children by Poverty Status, Household Income, Age, Race and Hispanic Origin and Nativity in the United States in 2009
Apart from gender discrimination, other axes of oppression
also exist in society to further marginalize certain groups of women,
especially those who are living in poverty or of minority status in
which they live.
Race and ethnicity
Race is a well-known axis of oppression, where people of color tend to suffer more from structural violence. For people of color, race can serve as a factor, in addition to gender, that can further influence one's health negatively. Studies have shown that in both high-income and low-income countries, levels of maternal mortality may be up to three times higher among women of disadvantaged ethnic groups than among white women. In a study on race and mother death within the US, the maternal mortality rate for African Americans is close to four times higher than that of white women. Similarly in South Africa,
the maternal mortality rate for black/African women and women of color
is approximately 10 and 5 times greater respectively than that of
white/European women.
Socioeconomic status
Although women around the world share many similarities in
terms of health-impacting challenges, there are also many distinct
differences that arise from their varying states of socioeconomic
conditions. The type of living conditions in which women live is largely
associated with not only their own socioeconomic status but also that
of their nation.
At every single age category, women in high-income countries tend to live longer and are less likely to suffer from ill health and premature mortality than those in low-income countries.
Death rates in high-income countries are also very low among children
and younger women, where most deaths occur after the age of 60 years. In
low-income countries, however, the death rates at young ages are much
higher, with most deaths occurring among girls, adolescents, and younger
adult women. Data from 66 developing countries show that child
mortality rates among the poorest 20% of the population are almost
double those in the top 20%.
The most striking health outcome difference between rich and poor countries is maternal mortality.
Presently, an overwhelming proportion of maternal mortality is
concentrated within the nations that are suffering from poverty or some
other form of humanitarian crises,
where 99% of the more than half a million maternal deaths every year
occur. This comes from the fact that institutional structures that could
protect women's health and well-being are either lacking or poorly
developed in these places.
The situation is similar within countries as well, where
the health of both girls and women is critically affected by social and
economic factors. Those who are living in poverty or of lower socioeconomic status
tend to perform poorly in terms of health outcomes. In almost all
countries, girls and women living in wealthier households experience
lower levels of mortality and higher usage of healthcare services than
those living in poorer households. Such socioeconomic status-related
health disparities are present in every nation globally, including
developed regions.
Environmental Injustice
Environmental injustice
at its core is the presence of distributional injustice including both
the distribution of decision-making power as well as the distribution of
environmental burden. Environmental burdens, which include water
pollution, toxic chemicals, etc., can disproportionately impact the
health of women. Women are often left out of policy-making and decisions. These
injustices occur because women are generally affected by the
intersectionality of oppression which leads to lower incomes and less
social status. The Root cause of these injustices is the fundamental presence of
gender inequality, particularly in marginalized communities (Indigenous
women, women from low-income communities, women from the Global South,
etc.) that will become amplified by climate change.These women are often reliant on natural resources for their
livelihoods and, therefore, are one of the first groups of people to be
severely impacted by global climate change and environmental injustice. In addition, women all around the world are held responsible for providing food, water, and care to their families. This has sparked a movement to make the literature, research, and teaching more gender aware in the sphere of feminism.
However, women continue to face oppression in the sphere
of media. CNN and Media Matters have reported that only 15% of those
interviewed in the media on climate change have been women. Comparatively, women make up 90% of environmental justice groups across the United States. UN climate chief Christiana Figueres
has publicly recognized gender disparity in environmental injustice and
has pledged to put gender at the center of the Paris talks on climate
change. "Women are disproportionately affected by climate change. It is
increasingly evident that involving women and men in all decision-making
on climate action is a significant factor in meeting the climate
challenge". Studies have shown that women's involvement and participation in policy
leadership and decision-making has led to a greater increase in
conservation and climate change mitigation efforts.
When we analyze root causes, it is clear that women
experience climate change with disproportionate severity precisely
because their basic rights continue to be denied in varying forms and
intensities across the world. Enforced gender inequality reduces women's physical and economic
mobility, voice, and opportunity in many places, making them more
vulnerable to mounting environmental stresses. Indigenous pregnant women
and their unborn children are more vulnerable to climate change and health impacts by way of environmental injustice. Indigenous women, women from low-income communities, and women from the
Global South bear an even heavier burden from the impacts of climate
change because of the historic and continuing impacts of colonialism,
racism and inequality; and in many cases, because they are more reliant
upon natural resources for their survival and/or live in areas that have
poor infrastructure. Drought, flooding, and unpredictable and extreme weather patterns
present life-or-death challenges for many women, who are most often the
ones responsible for providing food, water, and energy for their
families.
Gender bias in clinical trials
Gender bias is prevalent in medical research and diagnosis. Historically, women were excluded from clinical trials,
which affects research and diagnosis. Throughout clinical trials,
Caucasian males were the normal test subjects and findings were then
generalized to other populations. Women were considered more expensive and complicated clinical trial
subjects because of variable hormone levels that differ significantly
from men's. Specifically, pregnant women were considered an at-risk population and thus barred from participation in any clinical trials.
In 1993, the U.S. Food and Drug Administration
(FDA) published "Guidelines for the Study and Evaluation of Gender
Differences in the Clinical Evaluation of Drugs", overwriting the 1977
decision to bar all pregnant women from clinical trials. Through this, they recommended that women be included in clinical
trials to explore differences in the sexes, specifying that the
population included in clinical trials should be indicative of the
population to whom the drug would be prescribed. This mandated the inclusion of female participants in clinical trials sponsored by the National Institutes of Health (NIH). The FDA's 1998 "Presentation of Safety and Effectiveness Data for
Certain Subgroups of the Population in Investigational New Drug
Application Reports and New Drug Applications" regulations mandated that
drug trials prove safety and efficacy in both sexes to gain FDA
approval and led to drugs being taken off the market due to adverse
effects on women that had not been appropriately studied during clinical
trials. Several more recent studies determined in hindsight that many federally
funded studies from 2009 included a higher percentage of female
participants but did not include findings specified between males and
females.
In 1994, the FDA established an Office of Women's Health,
which promotes that sex as a biological variable should be explicitly
considered in research studies. The FDA and NIH have several ongoing formal efforts to improve the
study of sex differences in clinical trials, including the Critical Path
Initiative, which uses biomarkers, advanced technologies, and new trial
designs to better analyze subgroups. Another initiative, Drug Trial Snapshots, offers transparency to subgroup analysis via a consumer-focused website. However, despite such work, women are less likely to be aware of or to participate in clinical trials.
Although the inclusion of women in clinical trials is now
mandated, there is no such mandate for the use of female animal models
in non-human research. Typically, male models are used in non-human research and results are generalized to females. This can complicate diagnosis. A 2011 review article examined sex bias
in biomedical research and found that while sex bias has decreased in
human clinical trials, particularly since the US National Institute of
Health Revitalization Act of 1993, sex bias has increased in non-human
studies. Additionally, studies often fail to analyze results by sex specifically. Another example of this is the thalidomide
epidemic. In the late 1950s thalidomide was prescribed to pregnant
women to treat morning sickness. Its use unexpectedly resulted in severe
birth defects in over 10,000 children. However, proper studies were not conducted to determine adverse effects
in women, specifically those who are pregnant and it was determined
that mice, the animal model used to test thalidomide, were less
sensitive to it than humans.
Gender bias in diagnosis
A 2018 literature review of 77 medical articles found
gender bias in the patient-provider encounter as it related to pain.
Their findings confirmed a pattern of expectations and treatment
differences between men and women, "not embedded in biological
differences but gendered norms." For example, women with pain were viewed as "hysterical, emotional, complaining, not wanting to get better, malingerers, and fabricating the pain, as if it is all in her head." Women suffering from chronic pain are often erroneously attributed
psychological rather than somatic causes for their pain by physicians. And in searching for the effect on pain medication given to men and
women, studies determined that women received less effective pain
relief, less opioid pain medication, more antidepressants, and more
psychiatric referrals.
Chronic pain disproportionately affects women, with 70% of
chronic pain sufferers being female. While women are more likely to
experience chronic pain, 80% of pain studies are conducted on male
subjects. One study on gender differences in pain found that women tend
to experience pain more intensely and more frequently than men. Even so,
men are given more aggressive treatments and higher doses or stronger
painkillers than women.
Management
The Fourth World Conference on Women asserts that men and
women share the same right to the enjoyment of the highest attainable
standard of physical and mental health. However, women are disadvantaged due to social, cultural, political and economic factors that directly influence their health and impede their access to health-related information and care. In the 2008 World Health Report, the World Health Organization
stressed that strategies to improve women's health must take full
account of the underlying determinants of health, particularly gender inequality. Additionally, specific socioeconomic and cultural barriers that hamper women in protecting and improving their health must also be addressed.
Gender mainstreaming
Training rural women in Oral Health Promotion activities in Nepal
Gender mainstreaming was established as a major global strategy for the promotion of gender equality in the Beijing Platform for Action from the Fourth United Nations World Conference on Women in Beijing in 1995. Gender mainstreaming is defined by the United Nations Economic and Social Council in 1997 as follows:
"Mainstreaming
a gender perspective is the process of assessing the implications for
women and men of any planned action, including legislation, policies or
programmes, in all areas and at all levels. It is a strategy for making
women's as well as men's concerns and experiences an integral dimension
of the design, implementation, monitoring, and evaluation of policies
and programmes in all political, economic, and societal spheres so that
women and men benefit equally and inequality is not perpetuated. The
ultimate aim is to achieve gender equality".
Over the past few years, "gender mainstreaming"
has become a preferred approach for achieving greater health parity
between men and women. It stems from the recognition that while
technical strategies are necessary, they are not sufficient in
alleviating gender disparities in health unless the gender discrimination, bias and inequality that in organizational structures of governments and organizations – including health systems – are being challenged and addressed. The gender mainstreaming approach is a response to the realisation that gender concerns must be dealt with in every aspect of policy development
and programming, through systematic gender analyses and the
implementation of actions that address the balance of power and the
distribution of resources between women and men. In order to address gender health disparities, gender mainstreaming in
health employs a dual focus. First, it seeks to identify and address
gender-based differences and inequalities in all health initiatives; and
second, it works to implement initiatives that address women's specific
health needs that are a result either of
biological differences between women and men (e.g. maternal health) or
of gender-based
discrimination in society (e.g. gender-based violence; poor access to
health services).
Sweden's
new public health policy, which came into force in 2003, has been
identified as a key example of mainstreaming gender in health policies.
According to the World Health Organization, Sweden's public health policy is designed to address not only the broader social determinants of health but also the way in which gender is woven into the public health strategy. The policy specifically highlights its commitment to address and reduce gender-based inequalities in health.
Female Empowerment
The United Nations has identified the enhancement of women's involvement as a way to achieve gender equality in the realm of education, work, and health. This is because women play critical roles as caregivers, formally and
informally, in both the household and the larger community. Within the
United States, an estimated 66% of all caregivers are female, with
one-third of all female caregivers taking care of two or more people. According to the World Health Organization, it is important that
approaches and frameworks that are being implemented to address gender
disparities in health acknowledge the fact that majority of the care
work is provided by women. A meta-analysis of 40 different women's empowerment projects found that
increased female participation have led to a broad range of quality of life
improvements. These improvements include increases in women's advocacy
demands and organization strengths, women-centered policy and
governmental changes, and improved economic conditions for lower class women.
In Nepal, a community-based participatory intervention to identify local birthing problems and formulate strategies is effective in reducing both neonatal and maternal mortality in a rural population. Community-based programs in Malaysia and Sri Lanka that used well-trained midwives as front-line health workers also produced rapid declines in maternal mortality.
International states of gender disparities in health
South-East Asia region
Women in South-East Asia
often find themselves in subordinate positions of power and dependency
on their male counterparts regarding cultural, economic, and societal
relations. Because there is a limited level of control and access
granted to women in this region, the capability of daughters to
counteract generational biases regarding gender-specific roles is highly
limited. In contrast to many other industrialised countries, life
expectancy is equal or shorter for women in this region, with the
probability of surviving the first five years of life for women equal to
or smaller than that of males.
A potential explanation as to why there are disparate
differences in health status and access between genders is due to an
unbalanced sex ratio-for example, the Indian
subcontinent has a ratio of 770 women per 1000 men. Neglect of female
children, limited or poor access to health care, sex-selective
abortions, and reproductive mortality are all additional reasons why
there is a severe inequity between genders. Education and increased socioeconomical independency
is projected to assist in the leveling of healthcare access between the
genders, but there are sociocultural circumstances and attitudes
concerning the prioritization of males over females that stagnate
progress. Sri Lanka
has repeatedly been identified as a role model of sorts for other
nations within this region, as there are minimal differences in health,
educational, and employment levels between genders.
European Region
According to the World Health Organization (WHO)
gender discrimination in relation to lack of access, and provision of
health in this region is supported by concrete survey data. In the
European Region, 1 in 5 women have been domestic violence victims, while honour killings, female genital mutilation, and bride kidnapping
still occur. Additional studies done by the WHO have found that
immigrant women face a 43% higher risk of having an underweight child, a
61% greater risk of having a child with congenital malformations, and a
50% higher chance of perinatal mortality. In European countries, women
make up the majority of those unemployed, earning an average of 15% less
than men while 58% were observed to be unemployed. Differences in wages
are even greater in the Eastern part of the region, as represented in
the comparison of wages between women (4954 US dollars) in Albania versus men (9143 US dollars.)
Eastern Mediterranean Region
Access to education and employment are key elements in achieving gender equality in health. Female literacy rates in the Eastern Mediterranean were found by the WHO to fall sharply behind their male counterparts, as evident in the cases of Yemen (66:100) and Djibouti
(62:100.) Further barriers other than the prioritization of providing
opportunities for males, include the inability for females in this
region to pursue anything more than a tertiary education because of
economic constraints. Contraceptive usage and knowledge of reproductive
options were found to be more present amongst women who had received
higher levels of education in Egypt, the rate of contraceptive usage being 93% among those who were university-educated versus illiterate.
In regards to the influence of employment upon a woman's
capability to know of and fight for equity in health care, in this
region, women were found by the WHO to participate less in the labor
market than in other regions (at an average of 28%.) The lowest number
of women in paid employment within this region was found in Saudi Arabia and other countries of the Gulf Cooperation Council (GCC), while the highest number of women with paid employment were in Morocco, Lebanon, and Yemen.
The lack of availability of health care services in this
region particularly complicates matters as certain countries are already
strained by ongoing conflict and war. According to WHO, the ratio of
physicians per population is drastically lower in the countries Sudan, Somalia, Yemen, and Djibouti, while health infrastructures are nearly nonexistent in Afghanistan.
With additional complications of distance to and from medical services,
the access to health care services is even more complex for women in
this region as the majority are unable to afford the transportation
costs or time.
Western Pacific Region
Gender-based division of labor in this region has been
observed by the WHO as reason for the differences in health risks that
the two genders are exposed to in contrast to one another. Most
commonly, women of this region are engaged in insecure and informal
forms of labor, therefore being unable to gain related benefits such as
insurance or pension. In regards to education, the gap between males and
females is relatively small in primary and secondary schools, however,
there is undeniably an uneven distribution of literacy rates between the
various countries within this region. According to the WHO substantial
differences in literacy rates between men and women exist particularly
in Papua New Guinea (55.6% for women and 63.6% for men) and Lao People's Democratic Republic (63.2% for women and 82.5% for men.)
