Sex and Gender are different – and so are our health outcomes

Our sex and biological bodies have a big impact on the epidemiology of certain diseases, and it could lower or increase the risk of developing specific conditions whether you are born male or female.

But our genders – how we identify – affects gender roles, norms and behaviours. This, then, also affects how girls, boys, women and men get access to healthcare services and our health outcomes at the end of the day.

what the world says:

The World Health Organisation recognises sex and gender as key determinants of health, and studying it provides:

  • A better understanding of the social construction of identity
  • A deeper understanding of the impact of unbalanced power relations between men and women
  • A recognition of the effects on the risks, health-seeking behaviour and health outcomes of men
how does my sex affect my health?

Biologically speaking, females and males are different. We have different hormones circulating in our blood at different times, for different reasons. We are anatomically different, and this affects our physiological responses too.

For obvious examples, if you are born female, there is no way for you to get testicular or prostate cancer. If you are born male, Fallopian and uterine cancer is also impossible. But here’s where the differences aren’t so clear-cut:

Males are more at risk of heart disease – BUT WHY?

The way females and males distribute body fat are different from each other. For women, most of the fat concentrates in the hips and thighs. For men, it is more concentrated in the middle of the body, like the belly and torso.

We call both body types and the type of fat distribution ”gynoid” (pear-like) and ”android” (apple-like) respectively. It kinda looks like this:

The location of the fat – which varies depending on our sex – actually makes a difference in health outcomes. While female fat is concentrated at a lower section of the body, male fat accumulated in the visceral (internal) areas.

Because of this, android fat is also considered ”visceral fat”. This mid-body fat concentration increases the risks of heart and circulatory diseases in males. Females are less at risk.

Where sex and gender intersect – a case example

Let’s say a woman comes up to you with a hand on their back. They’re arching a bit, walking slowly in pain, having a severe headache and a belly that hurts a lot.

What do you assume they have? Probably their period. Females go through menstruation with varying degrees of intensity. But did you know that that menstrual symptoms actually resemble heart attack symptoms?

Just because a female is less at risk than getting a heart attack, it doesn’t mean that they can’t get them. But our gendered expectations of how people react to afflictions can lead to many misdiagnoses of heart attacks in women, which can ultimately be detrimental and fatal.

We typically associate heart disease symptoms with a weak and painful left-side, and shortness of breath – which is what males exhibit, and that’s all we usually learn – but we forget that females express heart attack symptoms differently, because of their sex.  Since the woman showed menstrual symptoms, we assumed that that’s what she was having based on her being a woman, but in reality, she was going to need a trip to the hospital.

Females are more at risk of osteoporosis

Anatomical differences also means differences in development. While male bones are longer, larger and more plentiful at birth females start off with less of a bony integrity. Part of that is because females tend to be smaller sized, so mechanically the bones don’t need as much strength to carry the body.

But females have an incredibly high incidence of developing osteoporosis (os, being bone, and porosis, having pores – or holes), which essentially means having an increasingly fragile and fissure-prone skeleton post-menopause. When females secrete oestrogen, it prevents certain bone-degenerative elements from attacking the bones. But as menopause ensues, oestrogen secretion decreases, so does bone mass.

How does my gender affect my health?

This POV has an important interdisciplinary approach to it. On a social scale, it’s easy to see how gender differences can affect our health outcomes.

rapid-fire examples:
  • Women tend to be victims of domestic violence and sexual assault == bad health outcome
  • Men tend to engage in dangerous, high-risk or violent behaviour== bad health outcome
  • Women are more likely to go consult a doctor for a health concern == greater health outcome
  • Men are more likely to avoid visiting the hospital for an injury or illness == bad health outcome
  • Women are more likely to have lower personal and political capital == bad health outcome
  • Men are more likely to hold personal and political capital == greater health outcome

But lets take a look at some examples a bit more in depth.

Gender norms, hyper-masculinity a detriment to men’s mental health

While it is more common for women to be victims of domestic violence, there are many instances where a man is victim of emotional abuse.

In most cultures, hyper-masculinity says that a man should be strong, built, shouldn’t give in to demands of women, should have the control, be the alpha male, and should have little emotions.

That puts pressure and expectations on other men – and there are a lot – that do not fit into that category, to fold or to comply to some of these aspects. Should a man be victim of emotional violence, they will most likely not talk to anyone about it and seek help. If it is the case, they will be shamed and told to ”be a man and deal with it.” The victim, then, has no escape and is stuck in a cycle of emotional violence, which is detrimental to their mental health.

This also ties into the fact that a lot of men internalise their emotions for fear of displaying them, since it is ”not the masculine thing to do”. This internalisation is often dangerous and could explain why men have a higher suicide rate than women.

Gender norms, access to employment – a two sided coin

Because men tend to engage in more high-risk and physically demanding employment, such as construction or mining, they are the primary victims of workplace accidents.

So if you’re a man working in dangerous conditions, you are more likely to die than women who do not. A coal miner is probably going to get black lung disease instead of the secretary in an office with air filters.

But that’s because of gender norms and gender roles. Because we expect men to head into these trades, a lot of cynicism and bias comes into play when there are women applicants. Since this is the case, women are less likely to hold these jobs, are more likely to be rejected and are limited employment.

In my previous article, I talk about how money is crucial for the well-being of an individual. The higher capital they have, the healthier they are.

Women, on average, earn less than men. Intersectional feminism tells us that marginalised transgender women earn even less than the average woman. If that’s the case, the underemployment of these womyn leads to negative health outcomes for them.

A gender-role paradox

It is interesting to note that today, there are more women in academia than men. This means that there are less men with higher education than women – and due to this lucrative positions requiring university degrees won’t be open to them.

So that means that women have a better chance at landing that job. But ironically, women in academia struggle to this day to be respected in their fields. There are many horror stories of women not being taken seriously by their male counterparts, and whose ideas were simply stolen, silenced or discredited. This of course limits their social, political and personal capital that they can hold.

SOLUTIONS

Obviously, there’s not much we can really do to address biological health inequalities except advancing medical science to prevent the diseases from developing in the first place.

But we can actually try a few things to address gender inequality and make life better for everyone involved. These are idealistic, and sometimes very hard things to do, but we’re getting better at it every day:

  • Introduce institutionalised gender parity (just like the Trudeau and Macron cabinets have done) for an equal proportion of men and women in power.
    • Make sure diversity is included amongst these folk, with members of First Nations communities, the LGBTQ+ community, members who have a disability, and members from marginalised communities.
  • Introduce equitable and equal pay for men and women salaries in their respective positions.
  • Encourage women to pursue the same careers as men in male-prevalent sectors via grants or bursaries.
  • Encourage men to pursue the same careers as women in women-prevalent sectors via grants or bursaries.
  • Create shelters for male victims of domestic and sexual violence.
  • Focus on mental health for all genders and address the factors leading to poor mental health.
  • Denounce discrimination of every form, especially sexism and gender violence.
  • Educate future professionals in the realities of sex and gender and the role they have on health.
  • Put into question our own personal views and breakdown our expectations of sex and gender roles.
final thoughts

Previously, I talked about 1/12 of the determinants of health. Now, having talked about sex and gender, it makes it 2/12. There’s a long road ahead – I’ll keep writing about the other 10 – but until then we must continue to dismantle gender roles and create new realities in which everyone has an equal chance of success.

Did I miss anything? Care to propose another solution? They are more than welcome in the comments.

But for now, stay happy, and healthy!

-Max