Recently in my public health studies, I was asked to explore some ways in which gender has an impact on health. Here’s some of my thoughts:

Experiences, health conditions, or personal identity that deviate from cultural gender norms can expose people to considerable health risks. Stigma, rejection and/or victimisation from family, peers, and community, and lack of access to resources such as education, work, and medical care, each compound in a vicious cycle for many people. As a result, they then face all the health risks of people exposed to unemployment, loneliness, poverty, mental illness, and so on.

There’s a range of ways people can violate gender norms. The norms themselves vary from culture to culture and at different historical times. Cultures are more flexible about some variations and more rigid about others. Some cultures have more overlap between qualities seen as ‘male’ and those seen as ‘female’, and the value placed on each varies. Many cultures have third gender, transgender, both gender and other options. When gender is a rigid organising principle it often determines opportunities, risks, and the power permitted in various life spheres.

In many cultures ‘female’ identified skills, roles, and behaviours are associated with less power in their personal and political lives, less access to the market economy, and are seen as less essential. Some cultures (such as ours) permit women to identify or behave in ways seen as ‘male’ more readily than the reverse because of this disparity. So it is now largely acceptable for girls to wear trousers, while boys wearing dresses/skirts/kilts is a source of controversy.

Women are more likely to operate in a gift/barter economy alongside the men in their lives, performing more unpaid work such as child raising, care giving for sick and elderly, housekeeping. When women are employed they are more often part time and unemployed, and more often working in the lower paid ‘welfare workforce’ using ‘traditionally female skills’ such as child care and support work. They are more vulnerable to poverty, domestic abuse, depression, homelessness, and lack of control over their bodies and choices.

In such an arrangement, men are less socially connected, have more options for education and wealth without having to choose between paid work and having children, and are less likely to participate in unpaid work. They are more vulnerable to loneliness (particularly once retired), less likely to seek support, slower to access health care particularly in matters that contradict ‘male’ stereotypes such as for concerns about virility or mental health, more likely to be assaulted by other men, and much more likely to kill themselves.

The health risks and vulnerabilities are considerably higher for those who do not or cannot fit this binary. Binary transgender people (those who were identified as male at birth but experience themselves as female, and vice versa) for example are at much higher risks of suicide, violence from strangers and family, rejection, homelessness, mental illness, and unemployment. Non-binary people (who identify as agender, gender fluid, both genders, multiple, and so on) are likewise disadvantaged. People who are attracted to their own gender are often also the recipients of social rejection and stigma as attraction to the ‘opposite’ gender is often a key aspect of the gender norms: ‘manly men’ are ‘supposed’ to be attracted to women, not men, for example. Same sex attraction violate gender segregation norms that presume same sex spaces are free from attraction. People who identify as the gender they were assigned at birth but who diverge from it in choices such as career, interests, or appearance also face risks.

Intersex people and those with hormone variations and disorders can experience severe medical trauma within health services that seek to ‘normalise’ them and fit them back into a gender binary they may not identify with.

Many of the groups already experiencing some other form of disadvantage are more represented in gender diverse communities, such as autistic people. Experiencing more than one form of diversity such as being disabled and queer, or indigenous and queer puts people at much higher risk due each community not understanding the other. For example for many years ‘bisexual privilege’ was spoken of with the assumption that being able to blend in and ‘look straight’ gave bisexual people an advantage over monosexual queer people (lesbians and gay men) who were constantly dealing with the stress and risks of being outed. More research suggests the opposite, that the stress of being invisible and feeling unwelcome at times within both straight and queer communities seems to be the cause of the much higher rates of physical and mental illnesses suffered by bisexuals than straight or queer monosexuals. Bisexuals who are in same sex relationships and are validated as queer face fewer health risks than those in binary relationships who are usually assumed to be straight.

This suggests that not only does each gender experience health risks differently, but some forms of divergence from gender norms are associated with greater risks than others. Some resources are safer and more accessible for some forms of ‘validated diversity’ and may be hostile or harmful to others who are divergent in other ways. There is for example, conflict at times between binary and non binary trans people about the legitimacy of their identity and how they are perceived by the wider community.

A final group who face severe health risks due to gender are often forgotten about. In the book ‘Dead Boys Don’t Dance’, a study found that suicide rates were higher for queer boys than straight boys. But the highest rates of all were in a largely unstudied subgroup – boys who had been perceived as and labelled by their peers as gay, but who did not themselves identify that way. These straight boys experienced all the risks and rejection from the straight community suffered by queer boys, and also lacked the protection of a sense of engagement and belonging with the queer community. Their invisibility, misidentification, and lack of peers was frequently a lethal combination.

So when we talk about gender and health, the costs of a rigid gender binary, norms, roles, we are talking about costs for all these people. Different levels of risk and types of vulnerability, but no one escapes a troubling cost to losing access to some aspects of what it is to be human and what we need in order to thrive. There’s no winners in this list,but some of the people paying the highest prices are also the most invisible and overlooked in conversions about gender and health. We can do better.