How do gendered expectations impact health outcomes?

The Lancet recently published a series of five papers (free registration required) on how gender norms influence health outcomes. Specifically, “how biology, social power, and social experience combine within a gender system to create health-related inequities.” They’re attempting to make a data-based case that improving global health requires gender equality and the abolition of restrictive gender norms.

From an interview with Gary Darmstadt:

“As we were looking at inequality it became clear that there is an underlying set of values, set of assumptions, norms. These unspoken or spoken rules that kind of govern what’s acceptable behavior. Power is apportioned around these norms. They’re extremely powerful. We felt there was not enough attention, not enough scholarship in this area and we really wanted to bring a strong evidence base to understand how do norms impact health? And it turns out that they do so enormously. What emerged is that restrictive gender norms affect all of us. Gender inequalities are primarily levied primarily against women and girls. But when it comes to restrictive gender norms, these are things that all of us are navigating every day of our lives and being influenced by. And it turns out they have massive influences on our health. We have created systems that do not serve health, wealth for any of us. The health systems we have are gendered in their structure, in their delivery of services, and as a result they are underperforming. What we really want is for people to recognize this.”

Reading the papers, a few things jumped out at me. 

In the first paper, the authors define gender in the feminist/sociological sense, thusly: “Gender is a social system that defines men and women as different and distributes power, resources, and status on the basis of that difference.” 

I’m not sure how I feel about that definition. Looking at the abstract of the article cited, I think I agree. Assumptions about men and women compound over lifetimes to help shape an individual’s attainment of power, resources, and status. The authors point to a study of ten to 14 year olds across 15 countries and found that people consistently encourage boys to demonstrate strength and independence and girls to exhibit vulnerability and the need for protection. It’s hard to imagine a reality in which that wouldn’t influence boys’ and girls’ decision-making going forward.

Ultimately it would be nice if we had more data. Unfortunately, sexism hinders our ability to obtain good data. “Questions are often unbalanced by sex of the respondent (eg, only women are asked about child health and care) and phrasing of questions frequently uncovered underlying gender biases in research,” the authors of the second paper write. 

I think it’s great that these researchers are studying the issue and I look forward to learning more.