When you see a little boy who cant sit still, when you

inequality series ( )

Barbie & Ken:

are referred a middle-aged female with dysphonia, when you visit your GP - do you question whether gender might be influencing the treatment you give and receive? In the second of four sociological perspectives on inequality, Sarah Earle again gets us thinking.

an unequal relationship
Some studies have highlighted considerable difex and gender are two commonly used ferences in the way in which health professionals terms that are often used interchangemanage male and female clients, suggesting that ably. However, the term sex refers to the gender can be an important factor both in the different biological and physiological assessment of symptoms and in the choice of characteristics of men and women treatment. Goudsmit (1994), for example, sugwhereas gender refers to the characteristics that gests that GPs often psychologise womens illness; are socially ascribed. Thus, sex is generally perthat is, they emphasise psychological rather than ceived as permanent and unchanging, whereas physical factors. A study by Ayanian & Epstein gender is perceived to be socially constructed. (1991) also showed that women are perceived as Gender inequalities are, therefore, inequalities emotional and prone to exaggeration, hence they that arise from the socially constructed differare less likely to undergo diagnostic and therapeuences between men and women; consequently, tic procedures. Research on patient compliance gender inequalities are themselves seen to be also shows gender to be an important factor. For socially produced, rather than immutable. example, in a study of patients with hypertension, Some theorists believe that gender differences, women were more likely and hence gender inequalities, are an than men to comply with inevitable consequence of male and female The problem lifestyle recommendabiology. However, the vast majority of sociol- of boys tions, medication and ogists would agree that gender inequality is underperformance attendance requirements produced and sustained by the societies in has vexed those (Kyngas & Lahdenpera, which people live. 1999). Gender inequalities are pervasive in rela- who are tion to health, illness and healthcare. Over interested in the last few decades life expectancy has risen globally. However, since the early 1960s, life explaining gender Sociologists question the extent to which gender expectancy for women has exceeded that of inequalities in inequalities in health and men (Annandale, 1998); on average, women illness are real. There are in the UK now live five years longer than education and two main sociological men (ONS, 2002). The only exception to this schooling. explanations for differgeneral trend can be found in some parts of ences in morbidity and life expectancy between the developing world, most notably in areas of men and women: artefact, and social causation. Southern Asia, for example in Bangladesh and Artefact explanations refer to how our knowlNepal (Nettleton, 1995). edge of health and illness is influenced by the way Although women live longer than men, on averin which data are collected. So, for example, we age they have higher rates of morbidity. These could explain the higher rates of morbidity rates are usually calculated according to service amongst women by arguing that women are simply use, and records show that women are more likemore attuned to their health and more likely to ly than men to visit their GP. They are also more admit to being ill than men (Nettleton, 1995). likely than men to suffer from chronic conditions Explanations of social causation, however, highand to be diagnosed and admitted for psychoses, light the fact that the lives of men and women are neuroses and depressive disorders (Nettleton, very different, thereby leading to distinct patterns 1995). Men, on the other hand, are more likely to of illness and disease. For example, women are experience ill health and earlier death as a consemore likely to engage in multiple social roles, the quence of heart disease, lung cancer and motor nature of which may be detrimental to their accidents (Godfrey, 1993).

Distinct patterns

Read this
if you have male and/or female clients work with both men and women believe that gender is important

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003

inequality series ( )

health, rendering them vulnerable to chronic, rather than fatal, diseases (Popay, 1992). Figure 1 highlights some points to consider with respect to gender, health and healthcare. Figure 1 Gender health and healthcare: thinking points
could gender influence your assessment of a clients symptoms? could gender ever influence your choice of treatment for a client? do you think that therapists may psychologise womens illnesses? how could gender influence compliance within speech and language therapy?

Considerable discrepancies
Gender inequalities in education do not mimic those associated with class (or ethnicity). In terms of general academic performance, girls do better than boys at all educational levels, but there are still considerable discrepancies according to subject, with boys being disproportionately represented, and doing better, in traditionally male subjects. For example, at key stage 1 the percentage of girls achieving level 2 or above is greater than that of boys in all four subjects, with the widest gap, at ten percentage points, being in spelling (DfES, 2002). However, at key stage 2, boys do better than girls in mathematics and science (DfES, 2002). Within higher education, women also tend to do better than men. For example, in 2001, 56 per cent of women achieved a first or upper second class degree, compared to only 49 per cent of men. However, there are considerable differences in qualifications obtained according to subject (see figure 2). Boys are also more likely to have special educational needs and are therefore over-represented in referral rates for speech and language therapy (DoH, 2002). The problem of boys underperformance has vexed those who are interested in explaining gender inequalities in education and schooling. Recent thinking has focused on the problem of hegemonic, or traditional, masculinity and commentators have argued that it is this which discourages boys (and men) from doing well academically (Kimmel, 2000). Jackson (2002), for example, argues that doing well at school is perceived as feminine and that a culture of laddishness has developed which is at odds with the achievement of academic success. As a consequence, though, boys tend to receive more attention from teachers. In an American study conducted by Sadker & Sadker (1995), a teacher was asked why boys were given more attention and said, Because boys need it more ... Boys have trouble reading, writing, doing math. They cant even sit still. This has led some sociologists to argue that contemporary education pathologises boyhood; as Hoff Summers (1995) controversially suggests, schools for the most part are run by women for girls. This may, in part, explain why boys with special educational needs outnumber girls so disproportionately. Figure 3 highlights some points to consider with respect to gender, education and schooling.

The pattern of gender inequalities is complex and subject to flux. Every therapist seeks to provide client care on an individualised basis according to need, and yet it must be recognised that gender inequalities are pervasive and expansive. An awareness of gender inequalities is essential for speech and language therapists since gender relations can, arguably, affect all aspects of the therapeutic relationship, in both a positive and negative manner (see figure 4). Dr Sarah Earle is Senior Lecturer in Health Studies at University College Northampton. Address for correspondence: Centre for Healthcare Education, Broughton Green Road, Northampton NN2 7AL, tel. 01604 735500, e-mail sarah.earle@northampton.ac.uk.

Figure 2 First Degree obtained according to subject and gender (2001)

Subject Female Male Biological Sciences 11.9 6.6 Computer Sciences 2.7 9.8 Engineering & Technology 3.1 16.7 Languages 12.1 4.5 Mathematical Sciences 1.7 2.5 Medicine & dentistry 1.7 2.8 Physical Sciences 5.2 7.9 Social, Economic & Political 13.4 8.6 Sciences Subjects Allied to Medicine 15.5 3.9 Adapted from: Table 3: Qualifications Obtained by Students on Higher Education Courses by Level of Course, Gender and Subject Area 1996/97 to 2000/01(1), HESA (2002).

References
Annandale, E. (1998) The Sociology of Health & Medicine: A Critical Introduction. Cambridge: Polity. Ayanian, J.Z. & Epstein, A.M. (1991) Differences in the use of procedures between women and men hospitalised for coronary heart disease. New England Journal of Medicine 325, 221-225. Department for Education and Skills (2002) National Curriculum Assessments Of 7 And 11 Year Olds In England, 2002 [provisional]. London: DfES. http://www.dfes.gov.uk/statistics/DB/SFR/ [accessed 8 October 2002]. Department of Health (2002) Speech and Language Therapy Summary Information for 2000-2001 England. London: HMSO. http://www.doh.gov.uk/public/kt290001/index.htm [accessed 10 October 2002]. Godfrey, C. (1993) Is Prevention Better than Cure? In: M. Drummond & A. Maynard (eds) Purchasing and Providing Cost-Effective Health Care. London: Churchill Livingstone. Goudsmit, E.M. (1994) All in Her Mind! Stereotypic Views and the Psychologisation of Womens Illness, pp. 7-12. In: S. Wilkinson & C. Kitzinger (eds). Women and Health: Feminist Perspectives. London: Taylor and Francis. HESA (2002) Qualifications obtained by and examination results of higher education students at higher education institutions in the united kingdom for the academic year 2000/01. HESA SFR 53 http://www.hesa.ac.uk [accessed 8 October 2002]. Hoff Sommers, C. (1995) Who Stole Feminism? How Women Have Betrayed Women. Touchstone Books. Jackson, C. (2002) Laddishness as a Self-worth Protection Strategy. Gender and Education 14 (1), 37-50. Kimmel, M.S. (2000) The Gendered Society. Oxford: Oxford University Press. Kyngas, H. & Lahdenpera, T. (1999) Compliance of patients with hypertension and associated factors. Journal of Advanced Nursing 29 (4), 832-839. Nettleton, S. (1995) The Sociology of Health & Illness. Cambridge: Polity. Office for National Statistics (2002) Mortality Statistics [general]: Review of the Registrar General on Deaths in England & Wales, 2000 [DH1 No: 33] http://www.statistics.gov.uk [accessed 8 October 2002]. Pollard, N. & Walsh, S. (2000) Occupational therapy, gender and mental health: an inclusive perspective? British Journal of Occupational Therapy 63(9), 425-31. Popay, J. (1992) My health is all right, but Im just tired all the time: Womens experience of ill health, 99-120. In: H. Roberts (ed.) Womens Health Matters. London: Routledge. Sadker, M. & Sadker, D. (1995) Failing Fairness: How our Schools Cheat Girls. Touchstone Books.

Figure 3 Gender, education and schooling: thinking points

does speech and language therapy contribute to the pathologisation of boyhood? to what extent is speech and language therapy run by women, and yet suitable for males? how can therapists encourage males to succeed in education?

Figure 4 How can gender influence the therapeutic relationship?

it influences morbidity and mortality; it may affect the relationship between client and therapist; it may impact on assessment and referral; it may impact on choice of treatment; it may influence compliance to treatment; it may influence the relationship between therapists and other professionals.

Shapes the profession

The allied health professions are characterised by one factor - they are overwhelmingly dominated by women, particularly within the lower echelons. It is worth considering the extent to which this shapes the nature of the profession and how this might influence client care. Writing specifically about occupational therapy, Pollard & Walsh (2000) suggest that the early, mainly female and middle-class origins of this profession has caused a struggle to define its status and role to fit structures determined by the medical profession; arguably, similar struggles exist for speech and language therapy. However, they also suggest that within a principally female dominated profession the feminine principles of caring, connectedness and the importance of relationships should be harnessed to produce an inclusive and reflective practice.
SPRING 2003

Reflections
Do I recognise that variation between males and females goes beyond biology? Do I know what assumptions I make based on gender? Do I harness the positive and neutralise the negative aspects of gender differences?

SPEECH & LANGUAGE THERAPY IN PRACTICE