Sex Differences in Health: Evidence and Explanations 387Summary
Men have higher mortality rates than
women, but women have higher morbidity
rates than men. In this chapter, I have
reviewed the different classes of explanations
for this paradox. Although biological factors
certainly contribute to health, biology alone
cannot explain the increase in the size of
the sex difference in life expectancy that
occurred over the 20th century and the
changes in the size of the sex difference in life
expectancy that have occurred more recently.
SES factors contribute to health but are
unable to explain sex differences in health.
Although heart disease is the leading cause of
death for women as well as men, women are
not treated as aggressively as men for heart
disease and have poorer outcomes.
A major contributor to sex
differences in morbidity and mortality is
health behavior. Women engage in more
preventive health care compared to men.
Although this difference should theoretically
lead to women’s lower mortality rates, no
evidence supports this conjecture. Instead,
women’s preventive behavior gets counted
as physician visits in indexes of morbidity.
Smoking is a major contributor to mortality.
That men smoke more than women
accounts for a portion of the sex difference
in mortality as well as the sex difference in
specific diseases (e.g., coronary heart disease,
lung cancer). That women have increased
their rates of smoking during the last half
of the 20th century accounts for the fact
that the sex difference in life expectancy has
narrowed. Men also have higher rates of
alcohol and drug usage compared to women.
Other health behaviors pose greater
risks to women’s than men’s health: obesity
and lack of exercise. More women than men
are obese in the United States, and the sex
difference is particularly striking amongBlacks and Hispanics. Women also exercise
less than men, although more girls are
becoming involved in sports.
Another explanation for sex differences
in mortality and morbidity focused on the
contribution of women’s and men’s social
roles. One of men’s social roles is working
outside the home, and men are exposed to
more hazards at work compared to women.
It is also men’s social role to drive: Men drive
more than women, drive less safely, and are
involved in more driving accidents. In general,
many of the behaviors that pose dangers for
men’s health can be conceptualized as general
risk-taking behavior. Men’s work, home,
and leisure activities are riskier than those
of women, which undoubtedly contribute to
men’s higher death rates from accidents.
The female social role has the
advantage of making women more
concerned with health matters, but the
disadvantage of making women the
caretakers of other people’s health. The
nurturant role exposes women to more
illness, is a source of fatigue among women,
makes them more susceptible to illness,
and prevents women from taking care of
themselves when they are ill.
Other explanations for sex differences
in morbidity have to do with women being
more sensitive than men to symptoms, more
likely to enact the sick role, and more likely
to seek medical care. Women appear to have
a lower threshold and tolerance for pain in
experimental studies of pain perception.
The explanation for this sex difference is
not clear. It does not appear that women are
more sensitive than men to changes within
their bodies. However, women are more
likely to respond to symptoms by restricting
their activities and taking care of themselves,
in other words, enacting the sick role. OneM10_HELG0185_04_SE_C10.indd 387 6/21/11 8:54 AM