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Gender bias in health findings

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Women are more likely to be ill than men, says the analysis, whose validity some question

Centre for Bhutan Studies: In what is cited as a significant yet distressing finding, gender is the most powerful explanation for health in Bhutan, an analysis on the social dimensions of health by the Centre for Bhutan Studies (CBS) has found.

On any account, a woman is more likely than men to be sick in Bhutan, the centre’s president, Dasho Karma Ura, told health officials yesterday.  The findings on health were presented to help the ministry in planning its 11th Plan programs.

The analysis, based on GNH survey findings for demographic, psychological and social variables, showed that ‘women are on average four percent more likely to report an incident of poor physical and mental health in the last month than men.’

Among those who have been ill, women are around 50 percent more likely to report more days spent physically or mentally ill. “This is a very distressing information,” Dasho Karma Ura said. “I’d like to say we’re puzzled by the findings, and it must have a huge implication on your planning.”

It was found that a randomly chosen woman in Bhutan is 1.6 – 7.6 percent more likely to report poor physical health; 1-9 percent more likely to report less positive emotions; 2-8 percent more likely to report poor mental health and 3-11 percent more likely to report being less spiritual.

At any given time, she is also 8-15 percent more likely to report less social support; 8-16 percent more likely to report more stress; 9-16 percent more likely to report lower subjective wellbeing; 10-18 percent more likely to report more negative emotions, and 12-19 percent more likely to report finding less meaning in her life than men in Bhutan.

While CBS has reported on gender determining income, class and status, this was the first time it being reported for health, Dasho Karma Ura said.

On why women report worse physical and mental health, CBS researchers explained that, while it is possible that there is no objective difference, men underreport illness, perhaps due to social norms, while women interpret illness to include ordinary body functions, such as menstruation and breastfeeding.

However, it is “odd”, they said, that similar results were obtained for mental illness.  The sample was, however, not large enough to test this result for post-menopausal women, and further qualitative studies are necessary to arrive at a firm conclusion.

Psychiatrist Dr Chencho Dorji said it was a very subjective study, because everything was asked. “We know worldwide that women are more expressive and emotional as compared with men, who are more stoic and sometimes chauvinistic,” he said.

This could be the reason why women in Bhutan are more likely to report sick. “I don’t think it’s easy for us to judge whether women are more sick, because it was also found that women work more than men,” he said.

Public health’s chief program officer Tandin Dorji said biologically men and women were different, and that women went through a monthly cycle of mensuration, where, if the questions were not asked carefully, these could be taken as sick days.

Dasho Karma Ura said he could answer only to the extent of the data, and that it still needed to be studied on why women could be more prone to falling ill.

“You can’t say that women tend to complain more because on the range of emotions, it was found that the range from one spectrum to another, from excellent to frustration, women operate on the centre,” he said.

On the reproductive aspect, he said it’s true, because if women above 50 years are excluded, then the gender influence on health disappears. “But that can’t be discounted because, if someone is suffering after childbirth, she’s still suffering.”



Another significant finding from the regression exercise was that there is no evidence of a “meaningful relationship between income and physical and mental illness.”

“This is one of the most important findings and the effect of any type of income on health is almost zero,” Dasho Karma Ura said. “This is a very robust result and it’s the same either way you check.”

Health minister Zangley Dukpa, however, said it could be because healthcare was free in the country.

Urologist Dr Lotay Tshering, said he was surprised that income was not found to have any relation on health, even though the GNH studies  found that stress, which can be triggered by income, does cause ill health.

Department of medical services’ director general Dr Ugen Dophu, commented income has an impact on health, when meeting the basic needs for food, cloth and shelter. “After that it’s like a double-edged sword, if you don’t use it wisely; because, if used well, it has good impact on health.”

While the data tend to show that age has an influence on sickness, it was found that age, according to the regression exercise, does not have significant effect on health.

For every year, a person lives extra, there are on average three persons more likely to report more days spent physically ill, and about one person to report days spent mentally ill.

According to the 2010 GNH survey, 4.9 percent of the population above 65 years and 3.8 percent between 61-65 years self rated their health status as poor.

Another important finding was the “very strong” relationship between negative emotions, such as anger and greed, in all three indicators of health outcomes. “Those, who experience such negative emotions, are more likely to report physical and mental illness,” he said.

Stress was also found to be a very important cause of ill health because, among those who reported ill health, a unique increase in stress indictor was associated with 45 percent increase in the number of sick days and 112 sick days in the case of mental health.

“Mentally ill health is a sort of stress, which explains the correlation and those, who  report stress, are 45 percent more likely to get an increase in number of physical sickness,” Dasho Karma Ura said.

By Sonam Pelden | Thimphu

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