The advent of the #MeToo movement showed how quickly we can challenge the sort of discrimination that was become so normal we barely batted an eyelid.
Perhaps it is same sort of social uprising needed to address the health gap of gender; a gap that sees women and the LGBQI community worse off, but also negatively impacts everyone's health.
The gender health gap is real and it affects us all.
A new series, published in the Lancet last week, explores the potent effect of gender norms on health.
According to research cited in the series, children aged between ten and 14 years already have fixed attitudes about what it means to be masculine and feminine: boys are consistently encouraged to be strong and independent, whereas girls are seen as vulnerable and in need of protection.
At puberty, boys are expected to prove their toughness and sexual prowess, whereas girls are judged for attracting male attention. Concerns about their sexuality and reputation lead parents to tightly control their daughters’ behaviour. Boys who do not behave in a "masculine" way are bullied, whereas girls who are seen as sexual are shamed and punished.
These "norms" have lifelong health implications for everyone.
“While the specific manifestations of gender inequality and restrictive gender norms may vary between Australia, the United States, Brazil and Bangladesh, the variation reflects a system of discriminatory values and practices that is similar across these settings,” explains co-author Dr Margaret Greene, president of US public health research group GreeneWorks.
“An example is the extent to which women engage in body altering surgeries. In patriarchal societies, the female body in particular becomes the entity where traditions and culture are enforced. Though a great deal of attention has focused on female genital cutting in sub-Saharan Africa, labial surgery has increased sharply in rich countries, partly as a result of the spread of pornography.”
Men also become victims of entrenched attitudes.
“As a consequence of gender roles and expectations, men spend more time on the road, are more prone to speeding, and are more likely to drive under the influence of alcohol or other drugs,” Dr Greene says. “Nearly three-quarters of all deaths from road traffic crashes globally occur in adolescent boys and men.”
The way manhood is typically defined in society also fuels and sustains violence. The authors of the Lancet series draw attention to the World Report on Violence and Health, which highlights male violence as a major factor in morbidity and mortality for both men and women.
Gender biases – including the gender stereotype of “men cure, women care” – mean, globally, women spend up to ten times more time caring for children, older people, and the sick.
This time spent doing unpaid work is the equivalent of $US1.5 trillion ($2.14 trillion) annually.
Then, when women need care for themselves, pay gaps mean they are less likely to be able to afford it or their access to healthcare may be impeded by male “gatekeepers” who control finances and household decisions.
If women can seek healthcare, “unconscious gender biases” and “blatant sexism” may affect the care they receive.
Globally, women spend up to ten times more time caring for children, older people, and the sick.
“Because women are stereotyped as fragile and overemotional, women’s health-related complaints are very often interpreted as exaggerated and women’s physical symptoms are attributed to psychosomatic rather than physical causes,” explain the authors.
“Even in high-income countries, women frequently receive inferior care to men: they are screened for disease less often and receive less aggressive treatment and substandard follow-up.”
Some of the biases in healthcare are attributed to gender inequality within the medical system and the under-representation of women in the top jobs.
“These issues are not exclusive to poor countries. During the past three years, it was uncovered that Japan’s premiere medical school has for decades rigged its entrance exam to limit female admissions and female doctors in the USA and the UK earn 20 per cent to 40 per cent less than their male counterparts,” the authors say.
Women aren’t the only ones who are disadvantaged as a result of biases. Health research “ignores” transgender and non-binary experiences and the health care system is “particularly bad” for sexual, gender and ethnic minorities.
One study of more than 6000 transgender adults found nearly one in three (28 per cent) had experienced harassment in healthcare settings. Nineteen per cent were refused care, and 2 per cent had even experienced violence in their doctors’ offices.
“The neglect of the LGBTQI community from health research reinforces the stigma and marginalisation they face,” says Dr Greene. “No data mean no funding and no programming to address the specific needs of the invisible populations. The lack of data makes it possible for governments and providers to deny the existence of and to continue discriminating against LGBTQI populations.”
While minorities endure the most, we all suffer as a result of inequalities.
One study of more than 6000 transgender adults found nearly one in three (28 per cent) had experienced harassment in healthcare settings.
When men or women don’t conform to gender roles— including hyper-masculinity and hyper-femininity — there are mental health consequences as they are more likely to be bullied, ostracised, punished or become the recipients of violence.
The good news is these outcomes are not fixed.
“In an era of #MeToo and #TimesUp, the opportunity of connecting global social movements for health and gender equality is real, urgent, necessary, and achievable,” said Dr Richard Horton, editor-in-chief of the Lancet, in a statement.
“The struggle for gender equality and the relaxation of restrictive gender norms is everyone’s struggle,” Dr Greene says. “Health is a fundamental human right.”
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