Bulletin Index/

What Counts in Health Research?

1. What Counts and Who’s Counted in Women’s Health Research?

2. A Full Measure: Women's Occupational Status and Health

3. Towards Gender-sensitive Health Indicators

Who's Counted in Health Research?

4. Silent Measures: Disability in the Canadian Biotechnology Strategy

5. The Challenges of Studying the Health of Women Working in Call Centres

6. Research as a Spiritual Contract: An Aboriginal Women's Health Project

Making Research Count

7. Gender-Based Analysis: Beyond the Red Queen Syndrome

8. How to Make Research Count

A Full Measure: Women's Occupational Status and Health

Currently, the determinants of health perspective conceptualizes women’s health as a complex mix of social, political, economic and biological factors. Yet measurements of women’s health have typically relied on a biomedical model, viewing health as independent from the social environment. This gap between the conceptualization of the determinants of health and measurements of health affects research, policy and practice. A new study called A Full Measure discusses this gap between conceptualizations and measurements of women’s health and suggests ways to advance measurements.

When applied to women’s health, standard measurements often result in oversights, errors, inconsistencies and simplifications. Oversights occur when crucial daily experiences of women’s lives are not considered and when women are excluded from health studies, inconsistencies in research results occur when inappropriate measurements are applied or compared, and stereotypical assumptions about women’s and men’s roles lead to simplifications of complex issues.

A literature review and analysis, A Full Measure considers conceptualizations and measurements in three areas: the biological, socioeconomic and sociocultural dimensions of women’s health. In the chapter on biological dimensions of women’s health, problems with morbidity data are examined. One problem is that these data do not indicate highly significant events in women’s lives, such as rape, or low-level problems, such as arthritis or problems with childcare.[1] The chapter on sociocultural dimensions explores the discrepancies between understandings of women’s diversity (which encompass, for example, class, race/ethnicity, immigrant status, sexual orientation, age/lifespan, geographical location and ability/disability) and measures of women’s diversity, which consider only race/ethnicity and age.

For the purposes of this article, one measurement in the socioeconomic dimension of women’s health—occupational classifications—is discussed.

Occupational Classifications
Socioeconomic status typically refers to an individual’s occupation, education, personal income, family income, or low-income geographic area. A significant barrier to understanding the link between women’s socioeconomic status and health is the way in which occupation is measured. Because women are less likely to have paid work and tend to occupy different jobs than men, standard occupational classification systems that were developed to reflect men’s work are inappropriate for understanding the relationship between women’s work and health.[2]

1. Gender segregation in work
   When women are employed they are concentrated within a limited number of occupations that tend to have relatively low wages and status. Given this entrenched gender segregation, measures based on occupations inevitably raise problems. When comparing occupational income inequalities in men and women, for example, it becomes clear that women in "male" occupations will generally remain in the least senior positions and earn less money, while men in "female" jobs are over-represented in more senior positions. This means that women are overrepresented in low-paying, low-status and low-security jobs and have a different experience and relationship to the paid labour force. The "Registrar General’s Classification" in the United Kingdom was constructed based primarily on male occupational and work experience. It remains an example of one such problematical measure that is still widely used.[3]
   
   
2. Biases in assumptions about the impact of work
   There has been some suggestion in health research that work-related factors make a greater contribution to men’s health status and that family situation and family composition factors may be more important for women’s health.[4] This assumption prevents us from fully understanding gender differences in the relationship between socioeconomic status and health. Women’s paid work has been treated as an additional rather than a primary role: this belies an unstated, stereotyped assumption of a traditional unpaid role for women as homemakers. Few studies have attempted to treat work and home conditions symmetrically, although those that do have found that work conditions may be just as or more important for women’s health as for men’s.[5]
   
   

   Women and men occupy particular sections of the labour market, though this has not been well measured or reflected in measures of work and occupation. This means that gender differences that have been found in the relationship between health and socioeconomic status may in fact indicate problems in the measurement of social status and paid work. Given that women tend to occupy particular sections of the labour market, the magnitude of socioeconomic inequalities between women and men might reflect gender differences in the measurement of social status, rather than true differences in the relationship between health and socioeconomic status for men and women.

   A telling contradiction in health research is that men who are unemployed (unpaid) are seen as experiencing a disadvantage. With few exceptions, studies of men’s health have paid less attention to their marital and parental roles.[6] Arber and other feminist researchers have stressed the importance of examining both women’s and men’s occupational position within society and the family. Socioeconomic indices, such as education, should be considered as another means to measure socioeconomic inequalities between women and men. Measuring education can "round out" or provide a more complete representation. This has been applied in studies on men’s health where there is greater inequality between men.[7] Using similar socioeconomic indicators for comparisons of men and women rather than examining different sorts of indicators for each sex[8] could produce more accurate understandings.

3. Primary and additional roles
   The demands of housework and childcare are additional stresses for women who are also paid workers. For this reason women’s employment should be examined as both a primary and an additional role. As a primary role, paid labour influences a woman’s command over financial resources and may influence her and her family’s lifestyle and life chances.[9] Women’s parental and marital roles within a particular setting are also significant, but little research has been done to examine the link between health and these roles.[10] Traditional measures also neglect the experience of lone female parents.[11]
   
   
4. Unemployment
   Some research has shown that unemployment causes poor mental and physical health. Other research on men supports the notion that it is those who are already less healthy who are selected into unemployment. Research on women’s health and paid employment complicates this debate. This research has focused on whether or not paid employment improves or inhibits women’s health. Contradictory findings have resulted: some researchers contend a "healthy worker effect," that paid work improves women’s health, while others believe that combining paid and unpaid work results in undue burdens of responsibility and "role accumulation" and can negatively impact women’s health.[12]

Implications for Research
on Socioeconomic Status and Health
The development of appropriate tools to measure women’s health has lagged behind conceptualizations of social and structural influences. Traditional measures of women’s and men’s socioeconomic status, paid and unpaid work, and childrearing must be reviewed and revised to accurately reflect the complexity and diversity of women’s and men’s lives. As women’s and men’s relations to the formal labour market and to the domestic sphere change, it is particularly timely to examine the meanings and measurements of work and class for both sexes. This research could illuminate similarities and differences that may provide clues to the causes and origins of various social inequalities in health.[13]

For a copy of the full report, A Full Measure: Towards a Comprehensive Model for the Measurement of Women’s Health (2001), contact:
British Columbia Centre of Excellence for Women’s Health
BC Women’s Hospital and Health Centre
E311 – 4500 Oak Street, Vancouver, BC Canada V6H 3N1
Tel: (604) 875-2633 Fax: (604) 875-3716
Web site: www.bccewh.bc.ca   E-mail: bccewh@cw.bc.ca

NOTES
[1] Redman S, Hennrikus DJ, Bowman JA, Sanson-Fisher RW. Assessing women’s health needs. The Medical Journal of Australia 1988;148:123-127.

[2] Matthews S, Manor O, Power C. Social inequities in health: Are there gender differences? Social Science and Medicine 1999;48:49-60.

[3] Matthews, Manor, Power, 1999.

[4] Matthews, Manor, Power, 1999.

[5] Macintyre S, Hunt K. Socioeconomic position, gender and health: How do they interact? Journal of Health Psychology 1997;2 (3);315-334.

[6] Arber A. Class, paid employment and family roles: Making sense of structural disadvantage, gender and health status. Social Science and Medicine 1991;32(4);425-436.

[7] Matthews, Manor, Power, 1999.

[8] Macintyre, Hunt, 1997.

[9] Arber, 1991.

[10] Arber, 1991.

[11] Arber, 1991.

[12] Arber, 1991.

[13] Macintyre, Hunt, 1997.

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