Kawachi I, Kennedy BP, Gupta V, Prothrow SD. Women's status and the health of women and men:  a view from the States. Soc Sci Med 1999;48(1):21-32.

This study takes an important step in elucidating gender differences in health among regions, using a "society-and-health lens."  The status of women by state was assessed by four indices developed by the Institute for Women's Policy Research.   These measured women's political participation, economic autonomy, employment and earnings, and reproductive rights.  The higher the level of women's political participation by state, the lower their mortality rate with male mortality even lower!  As well as overall female mortality, the association was seen with disease specific death rates for heart disease and cervical cancer which persisted after statistical adjustment for poverty, income and income inequality.  Strikingly, male mortality rates were even more strongly linked to the status of women, than female death rates, suggesting that men are better off, health-wise, where women's status is more equal to men's.  While states with more gender inequality may have more gender inequality, this is only a partial explanation.  Where women''s status is lower, the difference between male and female mortality is even greater (women have lower mortality than men to start with, so men are even more worse off when women's status is lower).  The research could not address African-American and white women differences.   The critical finding is that gender inequality has costs for men, as well as women.  In general, a society that tolerates greater gender inequalities is more likely to be less healthy for both men and women. 

Abstract

We examined the status of women in the 50 American states in relation to women's and men's levels of health.  The status of women in each state was assessed by four composite indices measuring women's political participation, economic autonomy, employment and earnings, and reproductive rights.  The study design was cross-sectional and ecologic.  Our main outcome measures were total female and male mortality rates, female cause specific death rates and mean days of activity limitations reported by women during the previous month.  Measures of women's status were strikingly correlated with each of these health outcomes at the state level.  Higher political participation by women was correlated with lower female mortality rates (r=-0.51), as well as lower activity limitations (-0.47).  A smaller wage gap between women and men was associated with lower female mortality rates (-0.30) and lower activity limitations (-0.31) (all correlations, P<0.05).  Indices of women's status were also strongly correlated with male mortality rates, suggesting that women's status may reflect more general underlying structural processes associated with material deprivation and income inequality.  However, the indices of women's status persisted in predicting female mortality and morbidity rates after adjusting for income inequality, poverty rates and median household income.  Associations were observed for specific causes of death, including stroke, cervical cancer and homicide.  We conclude that women experience higher mortality and morbidity in states where they have lower levels of political participation and economic autonomy.  Living in such states has detrimental consequences for the health of men as well.  Gender inequality and truncated opportunities for women may be one of the pathways by which the maldistribution of income adversely affects the health of women.

Keywords

women's status, women's health, political participation, economic autonomy, reproductive rights, men's health, gender inequality, poverty, income, income inequality, heart disease, cervical cancer