Recently, I had the pleasure of corresponding with sociologists Chloe Bird and Pat Rieker about their book Gender and Health: Constrained Choices and Social Policies (Cambridge University Press, 2008), credited as the “first book to examine how men’s and women’s lives and their physiology contribute to differences in their health.” I was curious how the authors see their research relating to some of the health topics that have made headlines in recent months.

Nack: Starting off with the topic of mental, health, you’ve written about sex-based differences.  Reflecting on recent articles, like NYT’s In Anxious Times, Medical Help for the Mind as Well as the Body, how does your book add to our understanding of and concern for policies like the Mental Health Parity Act?

Rieker:  Our book provides concrete data for why the Mental Health Parity Act is such a strategic and critical addition to general health care policy.  We focus on gender differences in mental health, particularly depression and substance abuse disorders.  Although the overall rates of mental illness are similar between men and women, if you look at it by specific disease, then you see large gender differences.  Women’s depression and anxiety rates are double that of men’s; while men’s rates of substance abuse and impulse control disorders are double that of women’s. Available research shows that individuals with serious mental health problems also have more physical health issues, including a lower life span. Both social and medical interventions are needed to prevent and treat these socially and financially costly conditions which create enormous health burdens on individuals, who may become unable to perform work and other social roles, and their families, Employers and society, as a whole, bear additional costs. 

Bird:  Also, differences in men’s and women’s lives can affect their utilization of mental health care and the effectiveness of specific interventions. We need systematic assessments of the effectiveness of treatments/approaches for both men and women, which can ultimately lead to better physical and mental health outcomes. The US has fallen behind Canada and other countries which require this approach in federally-funded research. 

Nack: How are the differences between men’s and women’s mental health problems particularly relevant as we consider the impact of the economic downturn, in general, and, with regard to healthcare coverage, the rising numbers of uninsured and underinsured Americans?

Rieker:  In the current poor economic climate, many men and women are experiencing increased stress/anxiety when losing jobs which may have provided dependable incomes and health insurance. Constant worry, itself, leads to ill health and exacerbates existing underlying conditions (e.g., cardiovascular and respiratory conditions).  Our framework of constrained choice illustrates how social and economic policy can reduce or enhance the options and opportunities for individuals to engage in healthy behaviors such as not smoking, not drinking to excess, eating well, and exercising.  While some individuals respond to economic downturns by temporarily limiting costly habits of smoking or drinking, we argue that more could be done at different policy levels to encourage positive health behaviors and coping strategies that improve physical and mental health.

Nack: Let’s switch our focus to the connection between work policies and health. Your research addresses some ways in which workplace policies (or lack thereof) are likely impacting individuals and public health.

Rieker: Lots of companies have worksite day care. Daycare concerns affect men and women and how they balance family and work. That attempt to balance is one of the greatest sources of stress in American life.

Nack: A recent NYT article cautioned “Lack of Paid Sick Days May Worsen Flu Pandemic.” How does your book’s discussion of worksite daycare expand our understanding of the concerns expressed in this article and those articulated in a recent GWP post by fellow sociologist Virginia Rutter?

Bird:  Both the NYT article and Rutter’s post point to costs faced by individuals who need to stay home due to their own illness or to care for sick family members.  The flu pandemic has brought greater attention to the constraints individuals face in bearing the costs and other penalties (explicit and implicit) for taking a paid or unpaid sick day.  Social and labor policy decisions, as well as employer practices, affect an individual’s opportunity to pursue a healthy life and to work in an setting where coworkers are able to stay home when they or their family members are not well.  Moreover, as labor economist John Schmitt stated (and Rutter cited in her GWP post),

Denmark, Germany, and seven other countries with more generous statuatory paid sick days policies all have lower sickness absence rates than the United States. 

Cross-national comparisons of policies and of health and health care utilization can help us learn to support individuals in staying home as needed and reduce the risk to coworkers of flu exposure or workplace accidents caused by coworkers who are working while ill. 

Nack: Staying on the topic of worksite daycare as a policy issue that directly impacts health, in a previously published interview, I appreciated how you expanded the conversation to breastfeeding.

Bird: Onsite day care also provides a greater possibility for women to breastfeed. This is another example of how biology is relevant to this discussion. Both men and women benefit from onsite child care, but breastfeeding is proven to lessen women’s chances of breast cancer, so this policy benefits women physically as well as mentally and emotionally. There are also the public health benefits to consider as well; breast-fed babies are sick less often than formula-fed babies.

Nack: Your book addresses how workplace policies, like onsite daycare, can support breastfeeding as a choice that research shows to likely improve the health of mothers and babies. What role do you see the media, in particular recent celebrity endorsements of breastfeeding, as potentially influencing women’s choices? And, do you see it as a positive or a negative if articles, like the NYT’s “Breast-Feed the Baby, Love the Calorie Burn“ spotlight postpartum weight-loss as a reason to breastfeed?

Bird:  Promoting breastfeeding as a way to “get your body back” brings to mind Shari Dworkin and Faye Wachs’ book Body Panic which examines how health and fitness magazines encourage the creation of gendered bodies, rather than healthy and fit bodies.  Breastfeeding has multiple benefits for mothers and their babies including short and long-term health effects and substantial savings on infant formula.  Overemphasizing the potential for weight-loss may leave some mothers feeling frustrated or misled.  Many moms find that breastfeeding makes it harder to lose the last of their pregnancy weight due to increased appetites, and for some, breastfeeding appears to cause the body to hold on to some extra weight. 

Rieker:  Having celebrities or others endorse breastfeeding for the purpose of weight loss reinforces the appearance of women’s bodies over their health.  This is one of many gendered expectations that feminist women’s health movements were designed to challenge.

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With President Obama asking Congress to focus on our nation’s healthcare problems, we need to keep in mind the findings of social and behavioral health researchers and make sure that issues of sex and gender are factored into new policies.