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In: Health Behavior: New Research

Editor: Peter B. Harris

ISBN: 978-1-62618-930-0
2013 Nova Science Publishers, Inc.

Chapter 4

GENDER ISSUES IMPLICATIONS ON HEALTH

Andreea C. Brabete1,4,,
Mara del Pilar Snchez-Lpez1,4,, Virginia Dresch2,4,,
Isabel Cullar-Flores1,3,4, and Raquel Rivas-Diez1,4,
1

Universidad Complutense de Madrid, Spain

2
Universidade Federal Fluminense, Brazil
3
Hospital Universitario de Getafe, Spain
4
Research Group of Psychological Styles, Gender and Health (EPSY)
and Research Network HYGEIA

ABSTRACT
The Research Group Psychological Styles, Gender and Health
(EPSY) is working on topics such as differences between sexes in ailing
and dying and the consequences of these on health practice, quality of life
and degree of personal satisfaction, stress and psychological problems
suffered by women and men, all from the gender perspective.
In order to operationalize the gender, the group used femininity and
masculinity concepts. Mahalik et al. (2003, 2005) define femininity as the
degree of people's conformity (emotional, cognitive and/or behavioural)
with a series of gender norms that designate what is considered socially
appropriate for women, are transmitted by each culture and can be
identified as such by the members of every society. Therefore, we
consider that femininity/masculinity is a psychological dimension, which
can, moreover, be measured or assessed.

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A. C. Brabete, M. del Pilar Snchez-Lpez, V. Dresch et al.

Our findings show that some gender norms are directly related to
certain health indexes, while other norms are inversely related to the same
or different indexes. We consider that investigating the connection
between health and gender requires a multidimensional approach that
furthers our understanding of the health costs and benefits of gender
roles. These results have important implications for action on health,
since they show how important masculine/feminine gender identity is, in
regard to health behaviour, the use of medicines and presence or
recognition of these same illnesses. This knowledge has potentially
practical use in health programmes and in social health activities, and
stresses the need to introduce the gender perspective into research and
action related to health. We consider that studies on mens and womens
health will need to bear in mind the heterogeneity within each group, with
the purpose of refining analyses, detecting subgroups at risk and
promoting more effective techniques for health care.

1. SEX, GENDER AND HEALTH

Since its foundation in 1946, 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. The boundary between
health and disease is a social construction which involves a set of biological,
psychological and subjective, as well as social, cultural, demographic, political
and economical factors.
The psychologists interest in the gender variable has lately been growing
because of the observed relationship between gender and other variables:
social conduct and personality (Costa, Terracciano & McCrae, 2001; Hyde,
1984; Maccoby & Jacklin, 1974), activities and interests (Huston, 1983) and
identities and self-perceptions (Chodorow, 1978; Fernndez, 1996). The part it
has in health variables has also been highlighted (Mahalik et al., 2006;
Martnez-Benlloch, 2005; Snchez-Lpez, 2003). Thus has been considered
that the pattern of health/illness, different in men and women, is not only due
to their biological differences, but also to the lifestyle and risk factors derived
from the gender (Borrell & Artazcoz, 2007; Evans & Steptoe, 2002; Krieger,
2003; Velasco, 2005).
Although studies of gender and health have generated a wide range of
research, they have become synonymous to women and health (BayneSmith, 1996; Courtenay & Keeling, 2000). It is a paradox because on the one
hand, it leads to a bias that has eased out the invisibility of women in areas
such as health and care research and training care professionals (Snchez-

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83

Lpez, 2004) and, on the other hand, while men have been considered the
references in these studies, they didnt take into account the risk factor related
to the masculinity in men (Courtenay, 2000a; Courtenay, 2000b).
When we speak about sex we mean the biological characteristics
(chromosomal, gonadal, hormonal, cerebral and genital dimorphism, etc).
Gender is the result of an evolutionary process, a social category, which
indicates the non-existence of traits or types of conduct that might intrinsically
a priori belong to one sex or the other, and through which social norms and
expectations are interiorised. The term also refers to the individuals
psychological feeling of being male or female, including the social and
psychological types of behaviour designed by society as masculine or feminine
(Barber & Martnez-Benlloch, 2004; Fernndez, 1996, 1998; Laqueur, 1990;
Maccoby, 1990). Therefore, gender as a social concept is sensitive to
variations and changes that may take place in any society.
On the other hand, gender is a variable that must be taken into
consideration from the moment of the assessment, in order to
provide an accurate diagnosis of the reality and not only when interpreting the
results. Therefore, in our studies we have chosen two questionnaires that
evaluate peoples conformity to a series of feminine/masculine gender norms:
the Conformity to Feminine Norms Inventory (Mahalik et al., 2005) and the
Conformity to Masculine Norms Inventory (Mahalik et al., 2003) in order to
study how gender relates to health. We chose these instruments because both
measurements offer a series of advantages regarding other instruments: they
are updated instruments, since they have been created quite recently and
incorporate a multidimensional perspective of gender. In this way they work
with the constructs of femininity and masculinity not as homogeneous
entities, but as multiples (there would be different femininities and
masculinities to which people would identify themselves in different
degrees).
Regarding the concept of (emotional, cognitive and/or behavioural)
conformity to the feminine/masculine gender norms, Mahalik et al. (2005,
2003) define it as the degree of satisfaction in social expectations, for what is
considered feminine/masculine in private or public life. The statements were
designed to measure various attitudes, beliefs, and behaviours associated to
feminine gender roles, both traditional and untraditional. From this
perspective, it comes before saying that, for example, in the case of women,
they receive many messages about how they should think, feel, or be. These
norms are more or less accepted, depending on each woman. Therefore, any

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A. C. Brabete, M. del Pilar Snchez-Lpez, V. Dresch et al.

instrument that evaluates femininity should also assess the relevance of these
feminine norms for every woman.
When literature about health and gender is reviewed, many articles appear,
that take into account sex, but not gender. Although the first step in
introducing a gender perspective is to divide data by sex, results about sex
differences bring up an important phenomenon, but they explain little about
the processes that may be responsible for the observed differences (Mechanic,
1978) and ignore important within-group differences in men and women
(Addis & Mahalik, 2003).

2. HOW IS WOMENS HEALTH RELATED TO FEMININITY?

The paradox mortality / morbidity in the case of women refers to the fact
that they live longer, but suffer increased morbidity and disability (Verbrugge,
1989). Women report worse health than men in all social categories (Borrell &
Benach, 2005; Rodrguez Sanz, 2005). In Spain, according to the Health and
Gender Report 2005, the majority of women report enjoying good health until
the age of 54, while men perceive it as good until the age of 64. It comes with
the age that more people report having worse health status, and the gap
between men and women increases: one third of women over 75 believe that
their health is good or very good, but for each one of these women, there are
two men who think the same.
Since self-perceived health is a subjective assessment on how a person
feels, what factors underlie this type of assessment? Physical symptoms and
pain, chronic diseases (arthritis, depression, bronchitis and hypertension)
(Perula, Martnez, Ruiz & Fonseca, 1995), serious or long-term illnesses,
limitations in functional capacity, days spent in bed and medication use are
influential when having to report worse health. Other factors such as concerns,
psychological distress and somatization worsen perceived health (Martin
Moreno, 2001).
When discussing health, if we analyse doctor visits and days off on illness,
we can reach false conclusions, as these data report the different ways that
men and women have to face disease and not the health status that they present
(Gijsbers van Wijk, van Vliet, Kolk & Everaerd, 1991).
However, there are authors who sustain that women engage in far more
health-promoting behaviours than men and have healthier lifestyle patterns
(Walker, Volkan, Sechrist & Pender, 1988; Kandrack, Grant & Segall, 1991;
Rossi, 1992). When sex was analysed, results have shown that being a woman

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85

may, in fact, be the strongest predictor of preventive and health-promoting

behaviour (Mechanic & Cleary, 1980; Brown & McCreedy, 1986).
We believe that if we take into account only the sex variable, we can reach
conclusions that are not consistent with reality. At women, gender
socialization carries different risk factors. Health vulnerability factors for
health in women include the care for others, implying lack of a personal
project, confinement and isolation, repetitive, invisible, undervalued and
unremunerated work (Conde, 2000), lack of social and family support which
leads to physical and emotional overload, situations of emotional abuse by
family members, lack of proper time and self-care (Burn, Moncarz &
Velzquez, 1991), exposure to situations of subordination, economic
and emotional dependence. All these factors which in themselves are
already vulnerabilities, but also form the basis for any abuse, maltreatment and
violence against women (Blanco Prieto, Garca de Vinuesa, Ruiz-Jarabo
Quemada & Martn Garca, 2004). On the other hand, the pursuit of personal
and social success (Conde, 2000; Velasco, 2005), pursuing an ideal body
(Tubert, 2005), binge clothes and cosmetics and products related to appearance
(Bernrdez, 2005), and, sometimes, the urge to be a mother (Tubert, 1999) are
also associated to health and gender.
Realizing that dedication towards others is against the own interests, needs
and desires and not always this devotion does not always reach certain
recognition, produces a dissatisfaction that leads to a huge void. Hence
feelings of frustration arise, and these forcedly affect womens mood
(Gonzlez de Chvez, 2001; Martnez Benlloch & Bonilla, 2000). In order to
mute their discomfort, women find that the solution is the abuse on
prescription of psychotropic medication (Chesler, 1972; Burin, Moncarz &
Velzquez, 1991).

3. HOW IS MENS HEALTH RELATED TO MASCULINITY?

Men are expected to live less than women in most countries of the world
(Arias, Anderson, Kung, Murphy & Kochanek, 2003; White & Cash, 2003;
World Health Organization, 2000). Based on EU-27 observations for 2008, a
newborn male is expected to live an average of 76.4 years, while a newborn
female is expected to live up to 82.4 years (Eurostat, 2011). Significant
differences in life expectancy at birth are observed between the EU Member
States. There is a gender gap of six years of life expectancy in 2008; women
generally live more than men in the EU-27. However, this gap varied from one

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A. C. Brabete, M. del Pilar Snchez-Lpez, V. Dresch et al.

member state to another. Hereby, in 2009, the largest difference between the
genders was found in Lithuania (11.2 years) and the smallest in Sweden (4.1
years) (Eurostat, 2011). For a long time, men's shorter life span was
considered natural and unavoidable. Besides the unquestionable biological
component, little was known on why adult men engage in less healthy
lifestyles and adopt fewer health-promoting beliefs and behaviors. This has
reached to the point that health risks associated to men's gender or masculinity
have remained largely unproblematic and taken for granted. It is well known
that men of all ages are more likely to engage in alcohol and tobacco use
(Hudd et al., 2000; WHO, 2002, 2004). Therefore, men engage in more health
risk behaviours, compared to women (Courtenay, 2000) as part of developing
a masculine identity (Courtenay, 2001; Harrison, Chin & Ficarrotto, 1992).
Research supports this connection, resulting that men who adopt traditional
constructions of masculinity are more likely to engage in risky health practices
(Mahalik, Burns & Syzdek, 2007), drug abuse (Liu & Iwamoto, 2007; Mahalik
et al., 2003), risky sexual behavior (Mahalik, Lagan & Morrison, 2006; Pleck,
Sonenstein & Ku, 1994) or use less frequently mental health services (Addis &
Mahalik, 2003). Other works based on individual differences in masculinity
ideology and gender-role conflict have examined the relationship between
these differences and the attitudes toward help seeking (Good et al., 1995;
Wisch, Mahalik, Hayes & Nutt, 1995). The results showed that many of the
tasks associated with seeking help from a health professional, such as relying
on others, admitting a need for help, or recognizing and labelling an emotional
problem, are perceived as conflicting in regard to the messages men receive
about the importance of self-reliance, physical toughness, and emotional
control (Good, Dell & Mintz, 1989; Levant & Pollack, 1995; Pleck, 1981;
Pollack, 1998; Real, 1997).
On the other hand, some studies suggest that reliance on traditionally
masculine characteristics, such as acting independently and being assertive and
decisive, has been found to enable men to cope with cancer (Gordon, 1995)
and chronic illness (Charmaz, 1995). These studies prove that while some
masculine gender norms may often be adaptive and healthy, others may be
associated with social stress factors.

4. GROUP EPSYS RESULTS

As we stated at the beginning, the aim of this chapter is to determine
whether adapting to gender norms is related to some health variables. To

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87

achieve this aim we will analyze different research works realized by the
research group EPSY on gender and general health in women and men.
The analysis of different research works (some presented at international
conferences and other already published) is summarized in Table 1 and Table
2. At our studies, the participants are Spanish and Romanian. The Spanish
participants are college students and nurses. As for Romanian participants,
they are people who live in Romania, but also Romanian immigrants who live
in Spain.
Before starting to analyse these results, we have to mention that health
variables taken into account are not always the same, but differ from one
research to the other (in some researches, the same health indexes have been
used).
As Table 1 shows, the degree of conformity to gender norms in our studies
is related to some of the health indices contemplated. There is just one gender
norm which positively correlate to self-perceived health, and that is, in the
case of Romanian women living in Spain, Nice in Relationship. Those gender
norms that negatively correlate to self-perceived health are: Care for children,
Sexual Fidelity, Domestic, Modesty and Invest in appearance. This leads to the
conclusion that women who appreciate friendship and support feel that they
enjoy better state of health.
On the other hand, women who are interested in caring for children,
having sex within a committed relationship, women who are concerned about
home care and use resources to maintain and improve their physical
appearance have poorer self-perceived health.
Another health index used by EPSY was the one concerning the physical
complaints. Women who obtain higher scores on Nice in Relationships,
Thinness and Sexual Fidelity have more physical complaints (see Table 1).
Women who obtain lower scores on Nice in Relationship consume medication.
When it is about both alcohol and tobacco use, while Thinness, Romantic
Relationship and Invest in Appearance are positively related to these
behaviours, almost all the others norms are negatively related to the same
behaviours. At the same times, higher scores on Thinness, Modesty, Romantic
Relationship and Invest in Appearance are positively correlated to worst
mental health, whereas Care for Children is negatively correlated to worst
mental health. Women who obtain higher scores on Thinness report more
sleep problems.

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Table 1. Group EPSYs Research on Feminine Gender Norms and Health

Authors/Year

Title

Journal or Congress

Participants n

Positive
relationship

Snchez-Lpez, M.
Masculinity and Femininity as
P., Rivas-Diez, R. &
Predictors of Tobacco and
Manuscript. (being
Cullar-Flores, I.
Alcohol Consumption in
evaluated)
(being evaluated)
Spanish University Students

Spanish
university
students
: 419
: 435

Snchez-Lpez,
Health and Conformity with
M.P., Saavedra, A.I. Traditional Gender Norms in
& Dresch, V. (2012) Men and Women Nurses

Alcohol use 3, 6, 8
Spanish nurses 3
:98
Psychological
: 98
health (GHQ12) - 2

Brabete, A. C.,
Snchez-Lpez, M. The Impact of Gender Norms
P. , Cullar-Flores, I. on Alcohol and Tobacco Use
& Rivas-Diez, R. ( at Romanians
2012)

Poster. 16th Conference on

Personality (International).
Trieste (Italy)

Oral communication.
PSIWORLD Congress 2012
(International). (Romania)

Oral communication.
PSIWORLD Congress 2011
How does the Gender
(International). (Romania)
influence Peoples Health?
Data of a Sample of Romanian
people living in Spain
Manuscript. Procedia Social
and Behavioral Sciences.33,
pp. 148-152

Brabete, A. C. &
Snchez-Lpez, M.
P. (2011, 2012)

Snchez-Lpez, M.
The Impact of Gender Roles
P., Cullar-Flores, I.
on Health
& Dresch, V. (2011)

Manuscript. Women &

Health, 52(2), 182-196

Romanian
people :489
:261

Negative
relationship
Tobacco
consumption 7, 6
Alcohol
consumption - 7
Tobacco use- 2, 9
Alcohol use 5
Self-perceived
health 5
Psychological
88ealth (GHQ-12)
6

Tobacco use- 2, 4,
5
Tobacco use-8
Alcohol use- 2, 4,
5, 6, 7

Self-perceived
health - 1
Romanian
N Physical
people living in
complaints - 3
Spain :48
Tobacco use-8
:70
Alcohol use 8
Spanish
N Physical
university
complaints - 4
students

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Self-perceived
health - 2, 4, 7, 8
Medicine use - 1
Alcohol use - 2 , 4
Tobacco use-6, 7,
8, 9
Alcohol use - 6 , 7,

Authors/Year

Title

Snchez-Lpez, M. Conformity to Gender Norms

P., Cullar Flores, I. and Mental Health in Spanish
& Dresch, V. (2011) University Students

El impacto de las normas de

gnero sobre la salud: anlisis
Snchez-Lpez, M.
desde el punto de vista del
P. & Cullar Flores,
sexo y del gnero [The Impact
I. (2010)
of Gender Norms on Health:
Sex and Gender Analysis]

Dresch, V. SnchezLpez, M. P.,

Cardenal Hernez,
Femininity and Health in Span
V., Snchez-Herrero ish Students
Arbide, S. & Cuellar
Flores, I. (2009)

Journal or Congress

Participants n

: 226
: 234
Oral communication. 4th
Spanish
World Congress of Womens university
mental health (International). students
Madrid (Spain)
: 164
:164
Oral communication. VII
Congreso Iberoamericano de
Psicologa (International).
Oviedo (Spain)

Poster. 11th European

Congress of Psychology
(International).
Oslo (Norway)

Spanish
university
students
: 335
: 312

Positive
relationship

Negative
relationship
9

Psychological Psychological
health (GHQ- helath (GHQ-12) 12) - 2
6

Tobacco use- 4
N Physical
Alcohol use - 4, 6
complaints - 1 Self-perceived
health - 4

Spanish
university
students
: 200

Self-perceived
health - 8
Medicine
consumption - 1
Tobacco
consumption- 4, 6,
8, 9
Alcohol
consumption - 1,
4, 6, 9
Psychological
health (GHQ-12)
3, 5

Note.1 = Nice in relationships, 2 = Care for children, 3= Thiness, 4= Sexual fidelity, 5= Modesty, 6= Romantic relationship, 7=
Domestic, 8= Invest in appearance, 9= Total.

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Table 2. Group EPSYs Research on Masculine Gender Norms and Health

Participants n

Positive relationship

Negative
relationship

Masculinity and
femininity as predictors of
Manuscript. (being
tobacco and alcohol
evaluated)
consumption in Spanish
university students
Oral communication. 20th
Annual Interdisciplinary
Limiana-Gras,R.M. Health and Gender in
Mens Studies Conference
Snchez-Lpez, M.P., Female Dominated
(International), Minneapolis
Saavedra, A.I. &
Occupations: The case of (USA)
Corbaln, F.J. (2012) male nurses
Manuscript. The Journal of
Mens Studies (being
evaluated)

Spanish
university
students
: 419
: 435

Tobacco use- 7
Alcohol use- 4, 7

Tobacco use - 10
Alcohol use - 2

Self-perceived health
Spanish nurses - 2
:98
Alcohol use - 4, 7,
: 98
11, 12
N Doctor visits - 3

N Physical
complaints -10
Medicine use - 4
N Doctor visits
2, 6
Work satisfaction
6, 11

Health and conformity

Snchez-Lpez, M.P.,
Poster. 16th Conference on
with traditional gender
Saavedra, A.I. &
norms in men and women Personality (International).
Dresch, V. (2012)
Trieste (Italy)
nurses

Self-perceived health
Spanish nurses - 2
:98
Alcohol use - 4, 7,
: 98
11, 12
N Doctor visits - 3

N Physical
complaints -10
Medicine use - 4
N Doctor visits
2, 6
Work satisfaction
6, 11

Authors/Year

Title

Journal or Congress

Snchez-Lpez, M. P.,
Rivas-Diez, R. &
Cullar-Flores, I.
(being evaluated)

Brabete, A. C.,
Snchez-Lpez, M. P.
, Cullar-Flores, I. &
Rivas-Diez, R. ( 2012)
Brabete, A. C. &
Snchez-Lpez, M. P.

The Impact of Gender

Norms on Alcohol and
Tobacco Use at
Romanians
How does the Gender
influence Peoples

Oral communication.
PSIWORLD Congress 2012
(International). (Romania)
Oral communication.
PSIWORLD Congress 2011

Romanian
people :489
:261

Tobacco use-3, 4, 5,
6
Alcohol use- 3, 4, 7

Romanian
people living

N Physical
complaints- 4

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Self-perceived
health - 4,5, 7

Authors/Year

Title

Journal or Congress

Participants n

Positive relationship

Health? Data of a Sample (International). (Romania) in Spain :48 Tobacco use- 2

of Romanian people
:70
Alcohol use - 7 , 11
Manuscript. Procedia Social
living in Spain
and Behavioral Sciences.33,
pp. 148-152
Spanish
Snchez-Lpez, M. P.,
university
The Impact of Gender
Manuscript. Women &
Cullar-Flores, I. &
students
Alcohol use - 6, 7
Roles on Health
Health, 52(2), 182-196
Dresch, V. (2011)
: 226
: 234
Oral communication. 4th
Spanish
Conformity to Gender
Snchez-Lpez, M. P.,
World Congress of
university
Norms and Mental Health
Cullar Flores, I. &
Womens mental health
students
in Spanish University
Dresch, V. (2011)
(International).
: 164
Students
Madrid (Spain)
:164
Self-perceived health
-9
Manuscript. The 17th
Spanish
Tobacco use- 10
university
Masculinity: How It Can Annual American Men's
Cullar-Flores, I. &
Alcohol use - 6 y 7
students
Be Made
Studies Conference
Snchez-Lpez, M. P.
Regular exercise 1,
: 229
operative and Its Use in
Proceedings
3
(2011)
Health
(American Mens Studies
Intensive exercise
Association)
1, 11
Medicine use 7, 9
Oral communication. XIX Spanish
Snchez-Lpez, M. P. Conformity to masculine American Mens Studies
Psychological health
university
& Cullar Flores, I.
norms and mental health Association Conference
(GHQ-12) - 3
students
(2011)
in Spanish College men
(International) Kansas
: 300
(EEUU)
(2011, 2012)

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Negative
relationship
Medicine use - 6
Tobacco use 6,
9
Alcohol use -10

Tobacco use-10

Psychological
health (GHQ-12)
-9

Start age alcohol

use - 6
Start age tobacco
use 11

Psychological
health (GHQ-12)
-2

Table 2. (Continued)
Authors/Year

Title

El impacto de las normas

de gnero sobre la salud:
Snchez-Lpez, M. P. anlisis desde el punto de
10 & Cullar Flores, I.
vista del sexo y del gnero
[The Impact of Gender
(2010)
Norms on Health: Sex and
Gender Analysis]

Journal or Congress
Oral communication. VII
Congreso Iberoamericano
de Psicologa
(International).
Oviedo (Spain)

Negative
relationship

Participants n

Positive relationship

Spanish
university
students
: 335
: 312

Tobacco use- 1, 7
Tobacco use-10
Alcohol use 1, 10
N Physical
Self-perceived health
complaints - 2
1, 3

Note. 1= Winning, 2 = Emotional Control, 3= Risk Taking, 4 = Violence 5 = Power over women, 6 = Dominant, 7 = Playboy, 8= SelfReliance, 9 = Primacy of work, 10 = Disdain for homosexuality, 11 = Pursuit of status, 12= Total.

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93

The analysis between gender norms (conformity to masculine gender

norms) and health behaviours show that conformity to masculine gender
norms present a relationship with health (see Table 2). When self-perceived
health is analysed, it appears that this has a direct connection to Winning,
Risk-Taking and Primacy of Work. Higher scores on Emotional control,
Violence, Power over women and Playboy are related to worse self-perceived
health.
Men who obtain higher scores on the Violence scale report more ailments.
And those who have lower scores on Emotional control and Disdain for
homosexuals, also report more physical complaints. Men who use medication
are those who score higher on Playboy and Primacy of work scales. On the
contrary, those who do not use medication, register higher scores on Violence
and Dominance scales.
When we analyse tobacco and alcohol use, we see that many of the
masculine gender norms are related to these behaviours. For example,
Winning, Emotional control, Risk-taking, Violence, Power over women,
Playboy, Self-Reliance are related to tobacco and alcohol use. Those gender
norms that are inversely related to these norms are: Dominance, Self-Reliance
and Disdain for Homosexuality, in the case of tobacco use and Emotional
control and Disdain for Homosexuality, in the case of alcohol use. The age
when first started to use alcohol is related negatively to Dominance, and the
same is the case for cigarettes and Primacy of work. The age when fist started
to use alcohol is positively related to Pursuit of status, whereas exercising is
positively related to Winning, Risk-taking and Pursuit of status, and negatively
to Primacy of work.
Men who use the medical health services obtain higher scores on Risktaking. Emotional control and Dominance are inversely related to the use of
medical health assistance. Finally, poor mental health is positively related to
Risk-taking and negatively to Emotional control and Primacy of work.

CONCLUSION
These results confirm previous researches that analyzed the relationships
between gender norms and health (for example, Courtenay, 2000a; Mahalik et
al., 2003, Mahalik, Lagan & Morrison, 2006; Mahalik, Burns & Syzdek,
2007). They show that the roles assigned and assumed by men and women
have an important part in explaining their health, their behaviour and their use
of health services.

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A. C. Brabete, M. del Pilar Snchez-Lpez, V. Dresch et al.

These results suggest that gender socialization is related to health. For

example, men who adopt traditional gender norms place their health at risk
(Harrison, Chin & Ficarrotto, 1992; Courtenay, 2000a; Mahalik, Burns &
Syzdek, 2007). Risk behaviors associated to traditional masculinity (for
example, use of addictive substances or risk driving), are largely responsible
for the lower life expectancy rate at men.
Given that health behaviours contribute as much as 50% to the difference
in mortality and morbidity rated (Mokdad, Marks, Stroup & Gerberding,
2004), these conclusions have important implications on action on health.
They give testimony of the multidetermination of health, and the
multidimensional nature of gender. There are risks or specific costs for each
feminine/masculine gender norm. For example, if we analyse in our studies the
behaviour of alcohol use, in the case of women, we observe that women, who
conform to Child care and Sexual fidelity scales, are protected as there is an
inverse relationship between this behaviour and these gender norms. The
subscale Invest in appearance is directly related to the behaviour consistent to
alcohol and tobacco use.
Men who score less on Dominance and Primacy of work scales are those
who smoke and men who score higher on Playboy, Disdain for homosexuality
and Pursuit of status are most likely to use alcohol. These risk factors are
associated to diseases or accidents that occur in the middle stage of life and
can lead to premature death. Gender norms thus carry some risk behaviours
that result in higher rates of mortality due to these conducts (WHO, 2000).
The different socialization mode to women and men that determines
different values, attitudes and behaviours, as well as inequalities and poor
access to resources and the deep division of labour result in worse working
conditions for women, with lower wages and with a double burden of work
inside and outside the household, that affect their health. The paradox of
morbidity / mortality that occurs in the case of women is related to these
gender norms because on one hand, women are the transmitters of health
patterns, beliefs, attitudes and lifestyles, but, at the same time the sexual roles
are less rewarding and fulfilling and more controversial among them
(Snchez-Lpez, 2003). This fact has its consequences and generates chronic
problems, but also physical and mental ones, that extend throughout life
without causing premature death, but long-term limitations (Gispert &
Gutirrez-Fisac, 1997)
We also consider that cultural variations in femininity and masculinity
have to be taken into account in order to have an accurate vision of norms as
useful predictors of health behaviours in different populations of women and

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Gender Issues Implications on Health

95

men. In our studies, we found that gender norms are related to Health, but this
relationship differs, depending on the participants (nurses, students,
Romanians, Romanian immigrants) although some gender norms are common
to all men as a group or to all women as a group.
These conclusions have important implications on action on health, since
they show how important feminine and masculine gender identity is, with
regard to health behaviour, the use of medicines and presence or recognition of
illnesses. This knowledge has a potentially practical use in health programmes
and in social health activities, and stresses the need to introduce the gender
perspective into research and action related to health. We consider that studies
on mens and womens health status and perception will need to bear in mind
the heterogeneity within each group, with the purpose of refining analyses,
detecting subgroups at risk and promoting more effective techniques for health
care.
In practice, it has been noted that the cognitive restructuring worked in the
case of the gender patterns (e.g. Barrowclough et al; Hensley et al., 2004). The
aim of these techniques is to change the gender patterns for men and women
(Mahalik, 1999; Mahalik & Morrison, 2006) that interfere with health
behaviours. This will work on the question of prevention in order to reduce
risk behaviours and increase health-promoting behaviours.

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