Sex, gender, and health: the need for a new approach

doi:10.1136/bmj.323.7320.1061

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Lesley Doyal, professor in health and social care (l.doyal@bristol.ac.uk)

School for Policy Studies, University of Bristol, Bristol BS8 1TZ

The past two decades have seen considerable activism by women to improve the quality of their health and health care. Recently men too have begun to draw attention to the negative implications of “maleness” for their health. There is an increasing danger that these campaigns could be drawn into conflict with each other as they compete for public sympathy and scarce resources. If conflict is to be avoided there needs to be a much clearer understanding of the impact of both sex and gender on health. This can then provide the foundation for gender sensitive policies that take seriously the needs of both women and men.

Summary points

Men are now following the example of women in drawing attention to the links between gender, health, and health care

The health of both sexes is influenced by biological factors including, but not confined to, their reproductive characteristics

Socially constructed gender characteristics are also important in shaping the capacity of both women and men to realise their potential for health

Gender inequalities in access to health promoting resources have damaging effects on women's wellbeing

Men face particular problems because of the relation between masculine identities and risk taking

Greater sensitivity to sex and gender is needed in medical research, service delivery, and wider social policies

Sex and health: the biology of risk

The differences between male and female reproductive systems have always been an important consideration in healthcare delivery. This reflects the crucial role of high quality family planning and obstetric services in enabling women to realise their potential for health. Despite recent progress, around half a million women continue to die each year as a direct consequence of pregnancy and childbirth, and more than 10 times that number are seriously disabled.1 It is the centrality of these issues in women's lives that has led many to adopt the concept …