Cover: Constrained Choice

Constrained Choice

Why Are Some Women and Men Able To Create and Maintain Healthy Lifestyles, While Others Are Not?

Published Apr 10, 2008

by Chloe E. Bird, Patricia P. Rieker

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Research Brief

Men and women differ markedly in patterns of illness and longevity. In their book Gender and Health: The Effects of Constrained Choices and Social Policies, RAND sociologist Chloe Bird and Harvard Medical School sociologist Patricia Rieker provide a new way to think about gender and health, as well as insight into the factors that contribute to men's and women's opportunities to create a healthy lifestyle. They describe how decisions made and actions taken at the family, work, community, and government levels shape in different ways men's and women's opportunities throughout their lives. Based on those opportunities, individuals make choices — from where to live and what job to take to how to care for children and elderly parents. Bird and Rieker explore how these social processes, life choices, and biological mechanisms interact to produce observed differences in men's and women's health, providing specific examples of the ways in which men's and women's lifestyles alter their individual health risk and exposure.

Conceptualization of Constrained Choice

SOURCE: Bird CE and Rieker PP, Gender and Health: The Effects of Constrained Choices and Social Policies, New York: Cambridge University Press, 2008.

To explain these influences, they introduce a model of constrained choice (see figure) that addresses how policy decisions can have unintended and cumulative effects by discouraging or preventing healthy behavior. For example, constrained choice can result from

  • national-level social policies that focus on the needs of women and children over those of men
  • community decisions about neighborhoods that limit opportunities for walking and exercise
  • workplace actions that limit employees' autonomy over their work and schedule
  • health research that overlooks the consequences of the growing complexity of balancing work and family.

Bird and Rieker argue that health is not only an individual responsibility but one shared by decisionmakers at each level. They urge the research community to provide decisionmakers with the information they need to enact healthconscious policies. Decisionmakers, in turn, must then integrate gender-based analysis of potential health impacts into the drafting of social policies, with the aim of increasing opportunities for people to pursue better health.

Bird and Rieker suggest that making constrained choice a platform for prevention could lessen the disease burden and spiraling costs associated with the large aging population confronting virtually every country. People will be more productive and happy, and communities will be inviting places in which to live and work.

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