Periodic Reporting for period 2 - GENDHI (Gender and Health Inequalities : from embodiment to health care cascade)
Berichtszeitraum: 2022-01-01 bis 2023-06-30
Social inequalities in health represent a serious social injustice, and are an increasing concern for policymakers. The aim of the Gender and Health Inequalities (Gendhi) project is to understand health inequalities over the life course using a multi-disciplinary intersectional approach. We divide research into two main sections. The first, called “Gendered embodied health”, refers to the events, conditions and processes that shape health outcomes, the risk of exposure and the ability to identify a disease before being in contact with the healthcare system. The second, the “Gendered health care cascade”, refers to the nature and type of symptoms and requests expressed by patients, the way these are interpreted and treated by health professionals, how patients interact with the health system, and their trajectory therein. Gendhi focuses on four health conditions: cardiovascular pathologies, depression, colorectal cancer, and Covid-19.
Our secondary objectives are to:
1. Analyse processes of socialisation in childhood, adolescence, and young adulthood that result in different embodied dispositions contributing to health inequalities in the short and long term. We focus specifically on the way class and gender interact, producing these different dispositions within individuals. We analyse whether girls’ and boys’ education can account for subsequent gender health inequalities and how this process varies according to class and race/ethnicity.
2. Investigate how exposure to major protective or risk factors (such as diet, alcohol, tobacco, physical activity, professional exposures) that relate to the four studied pathologies is gendered and how gender differences intersect with social class and race/ethnicity from childhood to adulthood. Particular attention will be paid to transitional phases in which gender roles and experiences diverge (adolescence, entry and exit from the workforce, parenthood) shaping differential health exposures and differential use of healthcare.
3. Analyse how men and women from different social backgrounds recognise a given health problem and express their symptoms.
4. Analyse the gendered nature of current medical guidelines.
5. Analyse possible pathways to the health system, including access to screening tests.
6. Observe how doctor-patient interactions are gendered and their effect on medical diagnosis, decisions, and prescriptions, and on patient’s ‘compliance’ and subsequent health trajectories.
7. Estimate the cost of delayed or inadequate treatment due to gendered professional practices.
Our secondary objectives are to:
1. Analyse processes of socialisation in childhood, adolescence, and young adulthood that result in different embodied dispositions contributing to health inequalities in the short and long term. We focus specifically on the way class and gender interact, producing these different dispositions within individuals. We analyse whether girls’ and boys’ education can account for subsequent gender health inequalities and how this process varies according to class and race/ethnicity.
2. Investigate how exposure to major protective or risk factors (such as diet, alcohol, tobacco, physical activity, professional exposures) that relate to the four studied pathologies is gendered and how gender differences intersect with social class and race/ethnicity from childhood to adulthood. Particular attention will be paid to transitional phases in which gender roles and experiences diverge (adolescence, entry and exit from the workforce, parenthood) shaping differential health exposures and differential use of healthcare.
3. Analyse how men and women from different social backgrounds recognise a given health problem and express their symptoms.
4. Analyse the gendered nature of current medical guidelines.
5. Analyse possible pathways to the health system, including access to screening tests.
6. Observe how doctor-patient interactions are gendered and their effect on medical diagnosis, decisions, and prescriptions, and on patient’s ‘compliance’ and subsequent health trajectories.
7. Estimate the cost of delayed or inadequate treatment due to gendered professional practices.
We conducted regular meetings with the PIs, the coordination and broader research teams, and organised workshops and seminars to discuss the progress of the project. We proposed a novel theoretical and methodological framework on the contribution of embodiment to health inequalities over the life course and its potential uses in epidemiology, integrating Krieger’s eco-social model of embodiment with an intersectional approach (Kelly-Irving & Delpierre, 2021; Soulier et al., 2021).
Ethnographic work on neuro-cardiovascular disease indicated that gender and class-based predispositions relate to individuals’ cultural capital and attitudes towards health practices (Darmon, 2021). This work also revealed that recovery from a pathology can be class-based; patients from lower socioeconomic groups are more vulnerable to functional impairments than those from higher socioeconomic groups (Darmon, 2021). Moreover, the loss and recovery of physical abilities vary by gender and social class (Darmon, 2022). We are investigating gendered embodied health using data from the Étude Longitudinale Française depuis l'Enfance (ELFE), to examine how differential child socialisation may affect child development outcomes.
Analyses using survey data from the Épidémiologie et conditions de vie (EpiCov) French cohort confirmed an unequal exposure to health risk factors: During the early phase of Covid-19, immigrants, racialized minorities, male manual workers, and female caregivers in France were more likely to live in densely populated areas, overcrowding housing, work outside the home, and use public transportation; risk factors that rendered these groups more vulnerable to Covid-19 (Bajos, Counil, et al., 2021; Gosselin et al., 2022).
Using mixed methods, we are examining the unequal pathways to the health system. Ethnographic work on neuro-cardiovascular disease suggests that men and women recognise a given health problem and express their symptoms differently (Darmon, 2021). Analyses of attitudes towards infection risk were performed using a supplementary questionnaire of an existing panel of young individuals in France, and showed that risk acceptance was higher among men, unemployed people, and more educated individuals (Etilé & Geoffard, 2022). Analyses using EpiCov indicates that individuals at the bottom of the social hierarchy, racial minorities, and those who distrust the government were more reluctant to get vaccinated against Sars-Cov-2 (Bajos, Counil, et al., 2021; Bajos et al., 2022a,b).
We are investigating the interaction between gender, social class, and place of residence, and their impact on the risk of occurrence and management of colorectal cancer using data from the Constances cohort. Two other studies focus on the relation between gender and other markers of social position in the diagnosis and management of psychological disorders, particularly depression. Current research is investigating other aspects of doctor-patient interactions shaping health outcomes.
Ethnographic work on neuro-cardiovascular disease indicated that gender and class-based predispositions relate to individuals’ cultural capital and attitudes towards health practices (Darmon, 2021). This work also revealed that recovery from a pathology can be class-based; patients from lower socioeconomic groups are more vulnerable to functional impairments than those from higher socioeconomic groups (Darmon, 2021). Moreover, the loss and recovery of physical abilities vary by gender and social class (Darmon, 2022). We are investigating gendered embodied health using data from the Étude Longitudinale Française depuis l'Enfance (ELFE), to examine how differential child socialisation may affect child development outcomes.
Analyses using survey data from the Épidémiologie et conditions de vie (EpiCov) French cohort confirmed an unequal exposure to health risk factors: During the early phase of Covid-19, immigrants, racialized minorities, male manual workers, and female caregivers in France were more likely to live in densely populated areas, overcrowding housing, work outside the home, and use public transportation; risk factors that rendered these groups more vulnerable to Covid-19 (Bajos, Counil, et al., 2021; Gosselin et al., 2022).
Using mixed methods, we are examining the unequal pathways to the health system. Ethnographic work on neuro-cardiovascular disease suggests that men and women recognise a given health problem and express their symptoms differently (Darmon, 2021). Analyses of attitudes towards infection risk were performed using a supplementary questionnaire of an existing panel of young individuals in France, and showed that risk acceptance was higher among men, unemployed people, and more educated individuals (Etilé & Geoffard, 2022). Analyses using EpiCov indicates that individuals at the bottom of the social hierarchy, racial minorities, and those who distrust the government were more reluctant to get vaccinated against Sars-Cov-2 (Bajos, Counil, et al., 2021; Bajos et al., 2022a,b).
We are investigating the interaction between gender, social class, and place of residence, and their impact on the risk of occurrence and management of colorectal cancer using data from the Constances cohort. Two other studies focus on the relation between gender and other markers of social position in the diagnosis and management of psychological disorders, particularly depression. Current research is investigating other aspects of doctor-patient interactions shaping health outcomes.
Our results are still preliminary; yet, we see the potential to go beyond the state of the art. The Gendhi project not only addresses important questions to disentangle the different ways in which social factors affect health inequality, but it does so from a novel multi-methods and multi-disciplinary perspective. Gendhi’s researchers come from different disciplines, sociology, demography, economy, epidemiology, etc., addressing different relevant research questions, proposing a variety of fields for data collection and analyses, and engaging in rich discussions about terminology, theory, and methodology. This unique set of conditions makes of Gendhi an enriching research environment that fosters the ambition to produce findings reaching beyond the sum of results of individual disciplines.
Our multi-disciplinary discussions have resulted in novel cross-discipline approaches to investigate structural inequalities. One of these approaches revisits the study of the process of socialisation. Gendhi is integrating insights from sociology and epidemiology to understand how differential socialisation by class and gender, results in different attitudes and predispositions towards health, and thus, different embodiment of risk factors. Another section of the project integrates insights from sociology, demography and economy to shed light on the factors that explain differences in mortality and healthy life between women and men among the elderly. Combining sociological, economic and epidemiological perspectives, we are studying the gendered nature of medical guidelines regarding the diagnosis and follow-up of patients with cardiovascular pathologies. Drawing from sociological, epidemiological and medical persectives, we opened up the discussion about the conceptual and methodological challenges of the definitions of sex and gender in quantitative resarch (Colineaux et al., 2022).
The emergence of Covid-19 also changed the scope of the project. We included Covid-19 as one of the pathologies studied in Gendhi. This addition improved the visibility of Gendhi among the general public, the research community, and policy makers. At the same time, our initial focus on Alzheimer's /dementia evolved towards a broader research question on health inequality at old age, and the process of embodiment and ageing over the life course. We expect that Gendhi will shed light on the ways that social health inequalities are produced and maintained from different perspectives, in a way that has not yet been done in social sciences research.
Our multi-disciplinary discussions have resulted in novel cross-discipline approaches to investigate structural inequalities. One of these approaches revisits the study of the process of socialisation. Gendhi is integrating insights from sociology and epidemiology to understand how differential socialisation by class and gender, results in different attitudes and predispositions towards health, and thus, different embodiment of risk factors. Another section of the project integrates insights from sociology, demography and economy to shed light on the factors that explain differences in mortality and healthy life between women and men among the elderly. Combining sociological, economic and epidemiological perspectives, we are studying the gendered nature of medical guidelines regarding the diagnosis and follow-up of patients with cardiovascular pathologies. Drawing from sociological, epidemiological and medical persectives, we opened up the discussion about the conceptual and methodological challenges of the definitions of sex and gender in quantitative resarch (Colineaux et al., 2022).
The emergence of Covid-19 also changed the scope of the project. We included Covid-19 as one of the pathologies studied in Gendhi. This addition improved the visibility of Gendhi among the general public, the research community, and policy makers. At the same time, our initial focus on Alzheimer's /dementia evolved towards a broader research question on health inequality at old age, and the process of embodiment and ageing over the life course. We expect that Gendhi will shed light on the ways that social health inequalities are produced and maintained from different perspectives, in a way that has not yet been done in social sciences research.