Analyzing Gender, Health and Communicable Disease: Guidelines from the Liverpool School of Tropical Medicine
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egotiating New Health Systems
Analyzing Gender, Health and Communicable Disease: Guidelines from the Liverpool School of Tropical Medicine RACHEL TOLHURST
ABSTRACT Rachel Tolhurst uses a framework for the analysis of gender and health developed by the Liverpool School of Tropical Medicine (1999) to outline some of the ways in which gender relations and manifestations of globalization such as the liberalization and expansion of markets may interact to produce gender inequities in health, with a focus on communicable disease.
Patterns of health and illness Gender divisions of labour and resources, norms of male and female behaviour, and differences in bargaining power may interact with global market forces and policies to produce particular forms of risk for women or men. For example, the available evidence suggests that the effects of increased exports of traditional cash crops in Africa have tended to benefit women less than men (Fontana, Joekes, and Masika, 1998). This is partly because women farmers may be less able to take advantage of incentives to farm different crops due to their low access to and control over productive resources relative to men. Women may not necessarily control their own labour and may be required to work on cash crops as unpaid labour for male relatives (Sen, 1996: 821–9). They may reduce their production of subsistence crops, or they may maintain subsistence production but face a heavier labour burden as a result. If subsistence production declines this may lead to reduced nutrition levels for whole households. Alternatively, if women’s workloads are increased, this may lead to a negative balance between energy inputs and energy expenditure, leading to undernutrition (Mebrahtu, 1991). Vulnerability to infectious diseases is increased as a result of body weight changes associated with malnutrition (Birley and Lock, 1998). The risks of infection and severe disease may be increased where malnutrition coincides with biological vulnerability such as the reduced immunity and anaemia associated with pregnancy. Anaemia,
Development 42(4): Negotiating New Health Systems particularly nutritional anaemia, is known to contribute considerably to the recurrence of malaria episodes. Changes in the overall burden of ill-health also may also affect women and men differently. For example, an increase in infectious disease prevalence due to environmental change may particularly affect women because they carry the bulk of the burden of caring for the sick. Responses to ill-health Gender relations also affect the responses of individuals, households and communities to their own ill-health and that of others. In the context of health sector reform, the introduction of user fees in many formal health facilities has meant that access to and control over cash has become a significant influence on treatment-seeking behaviour. In some contexts the need to find cash to seek care may mean that women’s access to services is dependent on decisions made by male or senior household members and/or upon their bargainin
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