Abstract
The health disparity associated with gender has raised attention on the rampant health inequity issues in China. This gender-health disparity is further complicated by the contrasting evidence in several substantive demographic phenomena such as the female survival paradox and female morbidity paradox. The current study proposes a theoretical model to reveal the counterbalancing mechanisms contributing to gender-health disparity in China. Specifically, health behaviors and labor market disadvantages are two sets of counterbalancing factors that, when considered altogether, reveal the true extent of gender-health disparity. Using a 2020 survey in the poverty counties in two provinces of China, the current study investigates the counterbalancing mechanisms in gender-health disparity through mediation and suppression effects. With painful feeling and the number of chronic illnesses as dependent variables, this study showed that health behaviors and labor disadvantages are indeed counterbalancing mechanisms. The gender disparity in pain/ chronic illnesses disappeared after labor disadvantages were controlled for, but reemerged in greater magnitude after health behaviors were controlled were. For chronic illnesses, the previously non-existent gender disparity emerged after health behaviors were controlled for. Were it not for women’s salubrious health behaviors, they would suffer worse pain and chronic illnesses than men’s. This study informs the literature of the hidden counterbalancing mechanisms in gender-health disparity, and women’s inferior position in formal and informal labor domains blocks the goal of eradicating health inequity in China.
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Notes
We have further analyzed what type of missing values are (MCAR, MAR, or MNAR) and re-treat the issue of missing values carefully. We have found no significant correlation (p > 0.5) between known variables and the missing cases. For missing at random incomplete dataset, listwise deletion is justified.
References
Arah, O. A. (2008). The role of causal reasoning in understanding Simpson’s paradox, Lord’s paradox, and the suppression effect: Covariate selection in the analysis of observational studies. Emerging Themes in Epidemiology, 5(1), 5. https://doi.org/10.1186/1742-7622-5-5
Artazcoz, L., Benach, J., Borrell, C., & Cortès, I. (2004). Unemployment and mental health: understanding the interactions among gender, family roles, and social class. American Journal of Public Health, 94(1), 82–88. https://doi.org/10.2105/AJPH.94.1.82
Banerjee, B. (2014). Occupational segregation and gender differentials in earnings in Macedonia. IZA Journal of European Labor Studies, 3(1), 4. https://doi.org/10.1186/2193-9012-3-4
Barnett, R., Yang, T., & Yang, X. Y. (2021). Smoking Environments in China: Challenges for Tobacco Control. Springer. https://doi.org/10.1007/978-3-030-76143-1
Beardsworth, A., Bryman, A., Keil, T., Goode, J., Haslam, C., & Lancashire, E. (2002). Women, men and food: The significance of gender for nutritional attitudes and choices. British Food Journal, 104(7), 470–491. https://doi.org/10.1108/00070700210418767
Beckfield, J. (2018). Political sociology and the people’s health. Oxford University Press.
Bird, C. E., & Rieker, P. P. (2008a). Gender and health. The Effects of Constrained Choices and Social Policies.
Bird, C. E., & Rieker, P. P. (2008b). Gender and health: The effects of constrained choices and social policies. Cambridge University Press.
Bonilla-Silva, E. (2019). Feeling race: theorizing the racial economy of emotions. American Sociological Review, 84(1), 1–25.
Boo, S., & Oh, H. (2019). Women’s smoking: relationships among emotional labor, occupational stress, and health promotion. Workplace Health & Safety, 67(7), 361–370. https://doi.org/10.1177/2165079918823214
Bourdieu, P. (2001). Masculine domination. Stanford University Press.
Buttrick, N. R., & Oishi, S. (2017). The psychological consequences of income inequality. Social and Personality Psychology Compass, 11(3), e12304. https://doi.org/10.1111/spc3.12304
Cao, Y., & Hu, C.-Y. (2007). Gender and job mobility in postsocialist China: A longitudinal study of job changes in six coastal cities. Social Forces, 85(4), 1535–1560. https://doi.org/10.1353/sof.2007.0065
Crimmins, E. M., Shim, H., Zhang, Y. S., & Kim, J. K. (2019). Differences between men and women in mortality and the health dimensions of the morbidity process. Clinical Chemistry, 65(1), 135–145. https://doi.org/10.1373/clinchem.2018.288332
Fodor, J. G., & Tzerovska, R. (2004). Coronary heart disease: Is gender important? Journal of Men’s Health and Gender. https://doi.org/10.1016/j.jmhg.2004.03.005
Germov, J., & Williams, L. (1996). The epidemic of dieting women: The need for a sociological approach to food and nutrition. Appetite, 27(2), 97–108. https://doi.org/10.1006/appe.1996.0038
Glaser, G. (2014). Her best-kept secret: why women drink-and how they can regain control. Simon and Schuster.
Gorman, B. K., Lariscy, J. T., & Kaushik, C. (2014). Gender, acculturation, and smoking behavior among US Asian and Latino immigrants. Social Science & Medicine, 106, 110–118. https://doi.org/10.1016/j.socscimed.2014.02.002
Holmila, M., & Raitasalo, K. (2005). Gender differences in drinking: Why do they still exist? Addiction, 100(12), 1763–1769. https://doi.org/10.1111/j.1360-0443.2005.01249.x
Homan, P. (2019). Structural sexism and health in the United States: A new perspective on health inequality and the gender system. American Sociological Review, 84(3), 486–516. https://doi.org/10.1177/0003122419848723
Krieger, N. (2012). Methods for the scientific study of discrimination and health: An ecosocial approach. American Journal of Public Health, 102(5), 936–944. https://doi.org/10.2105/AJPH.2011.300544
Lennon, M. C., & Rosenfield, S. (1992). Women and mental health: the interaction of job and family conditions. Journal of Health and Social Behavior, 33(4), 316–327. https://doi.org/10.2307/2137311
Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior. https://doi.org/10.2307/2626958
Link, B. G., & Phelan, J. (2010). Social conditions as fundamental causes of health inequalities. Handbook of Medical Sociology, 6, 3–17.
Louie, P., & Wheaton, B. (2019). The Black–White paradox revisited: understanding the role of counterbalancing mechanisms during adolescence. Journal of Health and Social Behavior, 60(2), 169–187. https://doi.org/10.1177/0022146519845069
Luy, M. (2003). Causes of male excess mortality: insights from cloistered populations. Population and Development Review, 29(4), 647–676. https://doi.org/10.1111/j.1728-4457.2003.00647.x
Luy, M., & Minagawa, Y. (2014). Gender gaps-Life expectancy and proportion of life in poor health. Health Reports, 25(12), 12.
MacKinnon, D. P., Krull, J. L., & Lockwood, C. M. (2000). Equivalence of the mediation, confounding and suppression effect. Prevention Science, 1(4), 173–181. https://doi.org/10.1023/A:1026595011371
Manley, J. E. (1995). Sex-segregated work in the system of professions: the development and stratification of nursing. The Sociological Quarterly, 36(2), 297–314. https://doi.org/10.1111/j.1533-8525.1995.tb00441.x
Masood, A. (2019). Doing gender, modestly: Conceptualizing workplace experiences of Pakistani women doctors. Gender, Work & Organization, 26(2), 214–228. https://doi.org/10.1111/gwao.12308
McDonald, S. (2011). What’s in the “old boys” network? Accessing social capital in gendered and racialized networks. Social Networks, 33(4), 317–330. https://doi.org/10.1016/j.socnet.2011.10.002
Newman, A. B., & Brach, J. S. (2001). Gender gap in longevity and disability in older persons. Epidemiologic Reviews, 23(2), 343–355. https://doi.org/10.1093/oxfordjournals.epirev.a000810
Orzack, S. H., Stubblefield, J. W., Akmaev, V. R., Colls, P., Munné, S., Scholl, T., Steinsaltz, D., & Zuckerman, J. E. (2015). The human sex ratio from conception to birth. Proceedings of the National Academy of Sciences of the United States of America, 112(16), E2102-2111. https://doi.org/10.1073/pnas.1416546112
Pearlin, L. I. (1999). The stress process revisited. Handbook of the Sociology of Mental Health (pp. 395–415). Springer. https://doi.org/10.1007/0-387-36223-1_19
Pearlin, L. I., Menaghan, E. G., Lieberman, M. A., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22(4), 337–356. https://doi.org/10.2307/2136676
Peters, B. L., & Stringham, E. (2006). No booze? You may lose: Why drinkers earn more money than nondrinkers. Journal of Labor Research, 27(3), 411–421. https://doi.org/10.1007/s12122-006-1031-y
Phillips, M. R., Li, X., & Zhang, Y. (2002). Suicide rates in China, 1995–1999. The Lancet, 359(9309), 835–840. https://doi.org/10.1016/S0140-6736(02)07954-0
Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression: Critical review. The British Journal of Psychiatry, 177(6), 486–492. https://doi.org/10.1192/bjp.177.6.486
Quintero, O. L., Amador-Patarroyo, M. J., Montoya-Ortiz, G., Rojas-Villarraga, A., & Anaya, J.-M. (2012). Autoimmune disease and gender: Plausible mechanisms for the female predominance of autoimmunity. Journal of Autoimmunity, 38(2), J109–J119. https://doi.org/10.1016/j.jaut.2011.10.003
Read, J. G., & Gorman, B. K. (2010). Gender and health inequality. Annual Review of Sociology, 36, 371–386.
Rieker, P. P., & Bird, C. E. (2005). Rethinking gender differences in health: why we need to integrate social and biological perspectives. The Journals of Gerontology: Series B, 60(Special_Issue_2), S40–S47. https://doi.org/10.1093/geronb/60.Special_Issue_2.S40
Rogers, R. G., Everett, B. G., Saint Onge, J. M., & Krueger, P. M. (2010). Social, behavioral, and biological factors, and sex differences in mortality. Demography, 47(3), 555–578.
Ronsmans, C., & Graham, W. J. (2006). Maternal mortality: Who, when, where, and why. The Lancet, 368(9542), 1189–1200. https://doi.org/10.1016/S0140-6736(06)69380-X
Ross, C. E., & Bird, C. E. (1994). Sex stratification and health lifestyle: Consequences for men’s and women’s perceived health. Journal of Health and Social Behavior, 35(2), 161–178. https://doi.org/10.2307/2137363
Schieman, S., & Reid, S. (2009). Job authority and health: Unraveling the competing suppression and explanatory influences. Social Science & Medicine, 69(11), 1616–1624. https://doi.org/10.1016/j.socscimed.2009.08.038
Silver, H. (1993). Homework and domestic work. Sociological Forum, 8(2), 181–204. https://doi.org/10.1007/BF01115489
Tu, Y.-K., Gunnell, D., & Gilthorpe, M. S. (2008). Simpson’s Paradox, Lord’s paradox, and suppression effects are the same phenomenon—the reversal paradox. Emerging Themes in Epidemiology, 5(1), 2. https://doi.org/10.1186/1742-7622-5-2
Wang, Y., Mi, J., Shan, X.-Y., Wang, Q. J., & Ge, K.-Y. (2007). Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. International Journal of Obesity, 31(1), 177–188. https://doi.org/10.1038/sj.ijo.0803354
Williamson, J. B., & Boehmer, U. (1997). Female life expectancy, gender stratification, health status, and level of economic development: A cross-national study of less developed countries. Social Science & Medicine, 45(2), 305–317. https://doi.org/10.1016/S0277-9536(96)00346-2
Yang, X. Y. (2017). How community-level social and economic developments have changed the patterns of substance use in a transition economy? Health & Place, 46, 91–100. https://doi.org/10.1016/j.healthplace.2017.05.009
Yang, X. Y. (2020). Class status and social mobility on tobacco smoking in post-reform China between 1991 and 2011. Nicotine & Tobacco Research, 22(12), 2188–2195. https://doi.org/10.1093/ntr/ntaa103
Yang, X. Y., & Hendley, A. (2018). The gendered effects of substance use on employment stability in transitional China. Health Sociology Review, 27(3), 312–329. https://doi.org/10.1080/14461242.2018.1495572
Zilberman, M., Tavares, H., & El-Guebaly, N. (2004). Gender similarities and differences. Journal of Addictive Diseases, 22(4), 61–74. https://doi.org/10.1300/J069v22n04_06
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This study is funded by Guangdong Office of Philosophy and Social Science, GD21YSH05.
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Yang, X.Y., Wu, N. & Hou, J. Gender-health disparities: exploring the counterbalancing mechanisms of labor disadvantage and health behaviors in rural China. China popul. dev. stud. 6, 186–205 (2022). https://doi.org/10.1007/s42379-022-00106-z
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DOI: https://doi.org/10.1007/s42379-022-00106-z