Natural phenomena occur all around us without the classification, judgement, or interjection of human imagination. In fact, this planet existed without human thought or intellect for a very long time, meaning that the concept of linking thought to phenomena from a human perspective is very new.

Humans use language to create narratives that shape and support world-views which in turn are used to steer cultural goals. This is key to learning and passing on knowledge within a culture. The west, which in this document is used to reference the philosophy of supremacy that anchors colonialism and imperialism, thrives on hierarchies. These hierarchies are established through classifications, such as race, class, disability, sexuality, sex, and gender. It is important to understand that each classification is a product of human cognition set within a particular culture and not a universality. In other words, how one culture organises and generates thought may not be the same for other cultures, giving way to multiple lexicons, narratives, imaginations, and realities.

For example, in western culture, a specific set of chromosomes, genitals, and physiological features are classified into two sexes (female and male), which are then organised into two genders (woman and man) which align with, and steer, social norms. Many other cultures do not organise an ecosystem of constant life-sustaining activities, such as digestion, respiration, reproduction, perspiration, and so on, which we call “the body” in the binary terminologies of “man” and “woman” as done in the west (source). They may not even break down the phenomena into various parts. For example, in Chinese philosophy, they use the same word for heart as they do for mind, making no separation or distinction between them.

The key takeaway is that sex and gender are one way of conceptualising a complex ecosystem made up of multiple cells and microbes which digests, reproduces, thinks, and loves, rather than a universal truth. Ideas about sex and gender vary greatly across the world and throughout time, all with their own stories, societal roles and examples of people who transgress them. Looking at western culture right now, trans people are presenting a multitude of challenges to the dominant, simplistic and binary conceptualisation of gender and sex. Trans people – their knowledge, ideas, and lived experience of transgression – are redefining gender, the relationship between our bodies and gender, and the roles we play through our bodies. Meanwhile, there are numerous cultures for whom the idea of gender that goes beyond a binary is nothing new. The Zapotecas have a muxe community, which is often erroneously conceptualised through a western lens, saying they are a “third gender”. However, they are neither. They are, as many say: “muxe”. Despite the fact many muxe do not identify as trans, seeing it as a primarily western phenomenon unaligned with their cultural experience of gender, sometimes they feel they must organise under the political label of “trans” to make their experiences more legible, especially when it comes to their fight for human rights and against discrimination. In a culture that thrives on categorisations of people to create hierarchies that support supremacy, these transgressive conceptualisations – old, new, and ever-changing – of the human body are being acutely and violently challenged.

In terms of health, the experiences we have due to the classifications our bodies have been given by western culture contribute to disease pathology. For instance, if a person is classified as Black and male, then they are more likely to be a transit bus driver in many US and UK cities. The combination of long periods of sitting, long term exposure to air pollution, shift work, and poor access to bathroom facilities increases the risk of bladder cancer. In health statistics and lexicon, this phenomenon would be articulated as a blanket statement “Black men are more at risk of bladder cancer”. However, is it being a “man” which is the risk of bladder cancer or is it the experiences of being a Black man in a racialised society that is the risk?

Gender is an important factor to consider when it comes to planning kind and robust healthcare. Whilst there is a significant and growing knowledge bank regarding how the ways we are gendered  affect health habits, such as smoking, drinking, or seeking preventive health, the wider lived experience of gender – the expectations, experiences and roles attached to the idea of being a “man” or “woman” is generally ignored. This is a substantive knowledge gap for care. It is not good enough to be told that women are more at risk for breast cancer, when “both sexes” have breast tissue, or that ovarian cancer is more prevalent in women simply because they are part of what is labelled as “the female anatomy”. Should the external environment of these sexed and gendered organs be taken into account? We must also consider Trans People: how can we better understand their organ function in the context of the gendered experiences of being both trans and expected to fulfil a role of “man” or “woman”?

In this document we are advocating for the following:

1. Gender as mentally conceptualised by the west is not a universal truth.

2. Being gendered drives exposure to endocrine disruptors and environmental stressors. 

3. The differences in exposure should be an added factor when studying health disparities between genders and within gender. 

4. Gender is interlinked with other identifiers such as race and class.

GLOSSARY AND ETYMOLOGY

The West: The culture of supremacy that currently steers global imperialism, capitalism, and governance structures. This is not a reference to a specific location as imperialism and colonialism have spread the western mentality across the globe. Furthermore, there are Indigenous Peoples who live in the geographical west who are excluded from “western life”.

Supremacy: The state or condition of being superior to all others in authority, power, or status. The mechanism that separates humans from all other beings and Nature.

Whiteness: It is the illegitimate categorisation of people that are able to present as European as above all other peoples. It operates as a system that organises culture, governance, and societal norms to fit its purpose and ensure its survival. As a system it stays in operation through the generation of capital by any means necessary, including violence, and it is dependent on a constant cheap labour force.

Historically, whiteness was directly related to people of western European descent, who participated in the creation of race, gender, and class for the purposes of generating a labour force for the maximisation of profits (source). At its core, its objective has been to preserve power specifically within white heteronormative men. The role of women in this society is to either produce labour or an heir. As whiteness is a concept and not always literal to a skin tone, a person who is not seen as phenotypically white can still enact the concepts of whiteness. Another consideration is that those who do not actively uphold whiteness will be marginalised, those who are seen as being “less than” and therefore only of use in the context of cheap labour are marginalised, and those who are not able to produce profit in the regulated manner expected by capitalism are marginalised (source) (source 1) (source 2). For example, disabled peoples are also acutely ostracised and devalued by white society, as they are often very limited in the kinds of work they can access and/or perform, with many unable to participate in capitalist labour at all, and they are less likely to become parents due to a mix of physiological factors and a lack of support, in a culture where disabled people are still sterilised without consent and found “unfit” to be parents by social services purely on the basis of them being disabled (source). Finally, whiteness is also about hoarding resources for those who fit within its norms (source).

In real terms, whiteness sustains itself through direct and systemic violence, it has been responsible for the kidnapping and enslavement of Indigenous Peoples from the African continent, the genocide and enslavement of Abayala and Turtle Island, continual imperialism and colonisation around the world. In more recent history, it is responsible for zoning of the multi-ethnic people in areas of high contamination, preventing human rights to Trans Peoples, discarding those who are disabled, poor worker rights, the continual deforestation of the Congo and Amazon rainforest, the contamination of the Pacific Islands and Ocean, and the dysregulation of our planet. The list is endless (source, source 1, source 2, source 3, source 4).

Woman: Old English wiffmon meaning wife (source). The history of the word wife is much more complex and steeped in social norms of Northern European societies. It ranges from wiif which its root started as the equivalent of “bitch” and has now been softened to “girl” or “babe”. Some proto-Indo-European roots for wife are weip, which is to twist, turn, or wrap, maybe related to a “veiled person”. Then there is ghwibh a root meaning “shame”. Given that the roots of this word are so grounded in European culture, is it for everyone to use or adopt, especially those of us who are not from these cultures? And if we do use them, how do we decolonise the meaning? In modern times, we take this word as a universality that translates in meaning across cultures; however, maybe that should not be the case (source).

Man: Man, was used in Old English as an indefinite pronoun “one, people, they”. There was no gender or sex assignation, often it also was a name for “people”. Therefore, it evolved to mean, or directly relate to, those with bodies labelled as “male” later in history, which is an interesting component to consider when thinking of language and the normalisation of gender (source).

Both Sexes:​​ When we use phrases like this, we note that it is for simplicity/legibility to refer to the ways in which our dominant societal conceptualisations still identify bodies into one of two sexed categories, which we recognise is a gross oversimplification.

Female: From Old French fernelle, used interchangeably to mean female or woman (source).

Male: Latin masculus and Displaced native Old English wǣpned “male”, literally “penised”, derived from the noun wǣpn “weapon” (source).

Endocrine Disruptors:  External chemicals that have harmful effects on the body's endocrine (hormone) system (source). 

Current Structures of Care

How we heal people is tied to societal perspectives and norms which are driven by culture. In the west, healing is often centred by the word care, as in healthcare. The etymology comes from old high German meaning grief, and from old Norse meaning sickbed. More recently care is defined by the Cambridge Directory as “the process of protecting someone or something and providing what that person or thing needs”. It is noteworthy that healing in the west has roots in grief, which by extension suggests sadness and an end point. Additionally, this perfectly exemplifies how in western society “care” has been reduced to something that is done by one person for another, it is a unidirectional relationship; there is a “carer” and a “ person to be cared for”. This makes sense given its Norse linguistic foundations of being a moment of a person’s deathbed.

The inclusion of “protecting” highlights another pervasive idea about care, which is that it is done by a “stronger” person for a person who is presumed fragile and weaker. Finally, the word “needs” points to a common supremacy belief that to require care is to be a “less than” and a burden, therefore, suggesting that as a people we should seek to minimise how burdensome we are by limiting requests for care. This has been highlighted in the current pandemic, where it was easy to “sacrifice” those who were identified as “weak”, and currently Long Covid is being ignored as supremacy believes that only those who are “less than'' get sick. In this unidirectional structure, care is also limited: we often hear statements such as, “How are we going to care for everyone?” or “The NHS is going to collapse under so much sickness”. Disabled people are familiar with this idea that care is to be rationed, with many people believing benefit rates should only ever allow those dependent on them to meet their basic survival needs, with nothing left over for pleasure or life-enhancing purchases. Similarly, the role of a “carer” is largely considered to simply be carrying out the acts necessary to keep someone alive, with  little interest in providing care to aid someone in achieving their wants, dreams and playful whims. Asking for care that goes beyond survival and aids in life-enhancement is a quick way to get labelled as “greedy”, especially for disabled people,who are often quietly expected to be grateful for the simple fact enough is being done to keep them alive (and even this low bar is not guaranteed).

Not only is there disinterest, there is also fear. In a society where your ability to produce is so intertwined with your perceived value – which in turn often shapes your financial/material conditions – it is no surprise people want to believe they are independent, that they do not need anything from anyone, and that if they just work hard enough they can succeed. In this way of thinking, needing care is a threatening reminder that what we can do, what we can produce, is linked to what other people do for us. In order to preserve the myth of independence, we must keep our conceptualisation of “care” small and easily compartmentalised. “Care” is what we must do for the weak: young children, the elderly, or disabled people. There is also lower-case “care” — the feeling of warmth we have for one another and the small acts we do to show it — but this is considered non-essential and lighthearted, and thus firmly conceptually separate from upper-case “Care”, which is much more serious, much more burdensome, and much more scary to imagine needing.

Finally, in this current structure of “care” those of us who have be systematically marginalised through the western lenses of race, sex, class, disability, and, of course, gender, face further struggles when attempting to find healing. Seeking healthcare can come with a mixture of fear, awe, and confusion. There is plenty of research of Trans Peoples being ignored and not given full attentive healthcare, or Black women being erroneously perceived as feeling less pain, leading to a lesser quality of care.  Therefore, when we are seeking health justice, we must look to conceptualising care independently from current supremacy structures. We are going to anchor health justice around gendered health, as it is an exemplification of supremacy structures, the effects of cultural norms on health, and the inaccuracies in current healthcare practices.

Understanding Gender

Gender is a western construct that categorises and defines the phenomena of an interconnected and dynamic ecosystem of processes, systems, and feelings (i.e. the body) to fit their societal organisation. The categorisation pertains to specific phenotypic characteristics that are said to be underpinned by biology. For example, a set of certain physiological factors, such as chromosomes (XX) and hormonal thresholds that create specific genitalia and phenotypes, such as increased fat deposits in certain parts of the body, are used to categorise bodies with these factors as being of “female sex”, which then leads to a “woman” gender assignation. These physical, bodily factors, with these linguistic identifiers, carry a wide-ranging set of social expectations and stereotypes. According to the World Health Organisation gender also includes norms, behaviours, and roles associated with being a woman, man, girl, or boy, and how they interact with each other and society (source). The last component to consider is how gender dictates specific experiences, which in turn affect health. For instance, 60.3% of racialised women are cleaners or housekeepers in the United States (source). This intersection of race, gender, and class, which are all artificial classifications of western imagination, drives a disproportionate exposure to endocrine disruptors through the use of cleaning chemicals. In addition to this there is further disruption to the endocrine system through shift work, which is often associated with these professions (source, source 1). Finally, we also have to consider how those who experience discrimination through class, gender, and race are more likely to live in neighbourhoods with higher levels of air pollution (source, source 1). All of these factors driven by a gendered experience lead to racialised women having higher rates of breast cancer, diabetes, and obesity (source, source 1, source 2).

We are proposing that, as part of an ecological approach to health, we consider how gender plays a role in the exposure to endocrine disruptors and other stressors. In understanding this we can consider wider preventive healing strategies that are more robust and ecological (e.g., better work rights to ensure that racialised women are not exposed to harmful chemicals or forced into constant shift work).

Learning Provocations

In this section, we will look at 5 questions to start a dialogue and begin to understand the origins of gender, how it ties to the lived experience, and how this affects our quality of life.

How do sex and gender intersect?

It is normally accepted that sex is biological and gender is societal assignation. However, queer theory would suggests that “‘biological sex’ is discursively constructed, rather than an absolute reality based in biology or nature” (source) (source 1). Gender theorists have also suggested “that the way we view gender, gender roles and gender norms dictates the way we view bodies, not the other way around (source). To contextualise this in real-world terms, from approximately the late 1940s to the late 1970s an artificial oestrogen called DES was being prescribed by paediatricians in the United States to stunt the growth of healthy teenage girls (source). The doctors believed that these perfectly healthy girls were going to reach a height that was not within the feminine aesthetic prescribed by white social norms (source). In other words, when these girls reached full biological maturation they were not going to be desirable to their white male counterparts and thus not serve their purpose of entering a heteronormative relationship to create more labour and heirs of capital (source).

To make matters worse, by the early 1970s, DES was a known cause for cancer in those gendered as women. Therefore, doctors were prescribing healthy teenage girls drugs that put their health at risk to fulfil a biological and societal ideal. If sex and gender are separate then why not let bodies labelled as “female” develop independently from gender ideals? This, of course, is not the only example; many racialised Black women are critiqued at a biological level for not fitting within white structures (source).

It is also important that whilst there is a difference between bodies that are categorised within white culture as “female” and “male”, scientifically and technically the biological boundaries between the sexes are quite blurred (source). For instance, we share most organs and their functions, including our brains (there is a size variation but not a function variation), and one only has to look to Trans people to see how easily our bodies accept the introduction of exogenous hormones different to the ones we endogenously produce, often totally transforming our secondary sex characteristics, notably the sex characteristics almost all of our gendered assumptions of people are based on (source).

What is the epistemology of gender?

Epistemology is to do with the theory behind knowledge and how the mind conceives reality from their experience with phenomena. Therefore, the ecosystem of bacteria, cells, and nerves that digests, reproduces, feels, breaths, and lives is conceptualised depending on culture. The body (even this word is conceptualisation) receives their identification, naming, and meaning in the same way as other phenomena: not from their inherent beingness or properties, but from an intricate combination of language, culture, epoc, and place. “The ‘femaleness’ or ‘maleness’ of a body part is not natural but imbued with meaning by the discourse of social actors (source)”.

Why do gender and sex exist?

As it has been established both gender and sex are cognitive products of white imagination and have been created to uphold it. Writer and sociologist professor Katerina Deliovsky explains that in a white society there is intrinsic value in aligning with and performing whiteness and heterosexuality (source). We would go further, whiteness can only exist through heteronormativity, as it supports a patriarchal wealth generation and retention model.

As part of transitioning Europe from a land-based society into feudalism, they needed structures to justify land ownership. Who owned land, who inherited land, and who worked the land was determined and sustained by societal norms (source) (source 1) (source 2). One of the key strategies was to control the sexuality (heteronormativity), sex (reproduction), and gender (norms + behaviours) of white European woman (source). Historically, for wealthy white women, their role in whiteness was to produce the next white male heirs (source). For the white working class women, their role was to produce cheap land labour (source). To keep birthing labourers and heirs, the society needed a defined class structure as well as a binary gendered and heteronormative structure.

As time and greed progressed, European landowners set their violent ambitions to the rest of the world. A new justification was needed, one that would support the kidnapping, enslavement, torture, and genocide of Indigenous Peoples from Africa, Turtle Island, and Abya Yala. Colonisation imposed the white ideation of class, gender, and race on our Peoples. Indigenous Peoples from Africa living under systemic slavery in the Americas were needed not only for enslaved labour but also to produce more enslaved labour (source). They were grotesquely diminished to “breeders”, their sexuality, sex, and gender controlled for the continuity of enslaved labour (source). In this new domain, white women were then needed for the “reproduction of European domination”. The worldwide spread of heteronormativity, including gender norms, is “specifically tied to colonial rule and contemporary geopolitical arrangement  (source).”

So, what is the purpose of this? The generation of profit, or now, in modern terms, capitalism. Capitalism needs people to continue reproducing for the purposes of either heirs or cheap labour; it cannot sustain itself without this. Furthermore, whiteness needs funding which comes from the continual generation of wealth. We cannot divorce heteronormativity from gender, sex, or the generation and sustenance of wealth. Breaking gender norms is often perceived as a threat, which can be punished through social sanctions, and this can lead to poor health outcomes. The very real implications of transgressing norms include violence, homelessness, and exclusion from work and from health care. (source)

Who is allowed to participate in gender?

Gender for racialised peoples has a violent, oppressive, and dangerous history. The Indigenous Peoples violently kidnapped from Africa and enslaved in the Americas were gendered for the purposes of creating more enslaved labour. Significantly, the intersection of gender and race, was used to justify and legally legitimise (those racialised as Black, were not legally considered people) the forced and violent sexual violation of those gendered as women. Their bodies, biologically and otherwise, were thought to belong to the white male plantation owners. Therefore, if more labour was needed, the white male owner had the legal and moral right to force reproduction on them. There are a couple of things to consider: if those racialised as Black were not people and their gender norms so heavily controlled, did womanhood or manhood actually belong to them and was it at par with white womanhood or manhood?

Bell Hooks wrote in Ain’t I a Woman, “contemporary Black women could not join together to fight for women’s rights because we did not see womanhood as an important aspect of our identity”. In the 1960s Black men protested with signs reading “I am a Man”, which pointed to not being seen as men at that time. More recently, we should consider that Black and Indigenous men are disproportionately incarcerated across the Americas, leaving them invisible to society (source) (source 1). In the UK, Black men are also disproportionately imprisoned (source). Across the Americas, there has also been a long history of forced sterilisation of Indigenous women, in this case their sex and gender controlled by white supremacy for the access to land. Sterilisation has also been a tool to eliminate those who biologically and socially do not fit into heteronomy, such as disabled people, imprisoned people, and immigrant parents (US) (source).

So, if a human's entire personhood is denied or made socially invisible, how do they participate in gender? Some final questions to consider: should those of us who come from these histories abide by gender? Or strive to fit into gendered norms? Is gender for us?

Is gender a universal idea?

Many Indigenous Peoples across the world do not imagine the body in the same way as white imagination, therefore, the idea of gender may not always fit. Additionally, colonisation introduced legal frameworks and social norms that “repressed Indigenous and alternative sexualities, forcing people to conform to a particular cis-heternormative lifestyle” (source). For instance, in pre-colonised Philippines, Indigenous cultures were gender plural and diverse (source).

There are some translations that name Muxe who are Zapoteca Peoples who do not adhere to gender, as being third gendered (source). However, we have to be careful with these translations, as there is no literal translation from the Nahuatl language to English. Language is the code of a culture, and if a culture does not have a concept such as non-gender, it will not have the language; therefore, approximations have to be used. Often these approximations fall short (source), and we must be careful that we do not simply try to translate other conceptualisations of the body into western frameworks.

Trans Peoples also have a history of challenging white gender norms, which is met with attempts to control their transness, usually through normalisation or eradication. Until fairly recently, Trans Peoples largely aimed to slip under the radar by assimilating into heteropatriarchy, as a form of survival. This was aided by the fact most people were unaware that trans people even existed. Transmasculine people were sometimes able to assimilate even without hormonal intervention if they took on a “husband” role: doing “men’s” work and marrying women (source).

The idea of being “openly trans” is a relatively recent one, making the challenge trans people present to mainstream gender visible to the general public for the first time. Whiteness can be quite astute, in terms of how it aims to erase anyone who challenges their imagination or norms, and this is evident in how Transness is pathologised. Some trans people consider the ways transness has been pathologised to be another form of normalisation, once again serving primarily to assimilate people into one of two clear gender boxes (source).

“As trans people, we are often required to replicate the formal conventions of a bloody medical discourse in order to access medical resources. If you want access to hormones, you must submit to diagnosis; if you want access to surgical care of any kind, you must produce a resume for your gender as a pathology necessitating intervention. Because the integrity of gender is vital to maintaining and reproducing the conditions that capitalism requires to operate, any attempt to intervene in the process of producing gender must be articulated in a way that leaves that integrity intact, or else be denied entrance.” - Dickinson, Nathaniel, and Jordy Rosenberg. “Seizing the Means: Towards a Trans Epistemology.” (In Transgender Marxism, edited by Jules Joanne Gleeson and Elle O’Rourke, 204–18. Pluto Press, 2021)

“Everything is genderable against you. 'Transition' is a model of conversion torture as much as it is a system of coordinating healthcare. 'Dysphoria,' as a concept, pathologises transness. Transsexuals are insolent subjects of the British state. Direct political actions are needed to stop trans pathologisation and conversion torture.” - (The Manifesto of THE STRAP (Trans Health Equality – Stop Trans Pathologisation), a paper zine)  

As time progresses and we continue our push back against white supremacy structures, we are seeing more people take control over their bodies and how they wish to be perceived. It is so important that we all have the opportunity to imagine ourselves in our ways, specifically away from white imagination. “Normalising” trans people has become an increasingly unrealistic ambition, as more people are coming out as trans, and more trans people are choosing to live as openly trans, rather than going “stealth” and attempting to assimilate into cis society.

Presenting yet another threat to western conceptualisations of gender, not only are more Trans people openly identifying as such, there are also a growing number of Trans people rejecting not only their assigned genders, but societal ideas of gender as a whole. This rejection comes both through theory – with new lexicons, broadening conceptualisations of “gender” and questions regarding its usefulness at all – and decisions on how to live and present. Increasing numbers of trans people present with visibly non-conforming gendered traits (such as wearing dresses and makeup, whilst also keeping their facial hair), there are ever-expanding ways of utilising hormones and surgery in new combinations to achieve more “androgynous” appearances, and more and more people refusing the labels of both “woman” and “man”. This open and unapologetic defiance of the “gender binary” and often key ideas about what “gender” is in the first place refuses any attempt at normalisation. This is where eradication comes in. The huge surge in pushback to transness is an attempt to control through fear, to make transness seem like a danger, or an impossibility. Trans Peoples challenge many mainstream ideas about gender, and since gender is such an essential pillar for many people’s understanding of the world, this challenge often elicits fear, which frequently manifests as anger and/or denial. Trans Peoples are ultimately not just a challenge to ideas about gender, but ideas about everything, because if we could be so wrong about gender, what else might we be wrong about?

Trans Peoples are also a clear example of the power of autonomy, and the possibility of deviation. By refusing to live as the gender assigned to them, they refuse a huge set of ideas about what their lives should look like, and they're often happier because of it. When trans people repeatedly describe their lives as happier and more fulfilling after deviating from the prescribed path, it begins to suggest that not only is deviation possible, it can also be life-enhancing. This is a dangerous suggestion for capitalism and white supremacy, which rely on resignation to the idea that “things are the way they are”.

Side Box on Intersex Peoples

A lot of biological depth and detail are needed to do a full dive into Intersex Peoples, which this report does not have full capacity to cover. They are a very important part in the conversation of gender and sex, as their natural physiology does not fit with the ideals, norms, or structures of white imagination. The usual strategy of whiteness when presented with a phenomenon that is outside their norms or that challenges their worldview is to discard it through erasure (source) (source 1) (source 2). If full erasure cannot be achieved, then they are seen as exception or anomaly, which has been the case for Intersex Peoples.

“Intersex is an umbrella term used to describe a wide range of natural variations that affect genitals, gonads, hormones, chromosomes or reproductive organs. Sometimes these characteristics are visible at birth, sometimes they appear at puberty, and sometimes they are not physically apparent at all. According to experts, around 1.7% of the population is born with intersex traits – comparable to the number of people born with red hair. This comparison is used to highlight that intersex peoples are a normal occurrence of Nature not an anomaly as often conceptualised. Nonetheless, It is important to note that anomalies in Nature are not a window for human “rectification” or erasure. 

The term intersex is still widely misunderstood, and intersex people are massively underrepresented (source). Despite the high numbers, many white societies, including science, still works under the idea that Intersex Peoples are an anomaly and outside the biological and physiological “norm”. Here again we are faced with the actuality that social norms and goals influence how we interpret the body, rather than allowing bodies to simply be.

Historically, Intersex Peoples were not medically or socially acknowledged (source). There is an abhorrent line of erasure, which has led to people enduring unnecessary, life changing and, at times, life threatening, changes to their bodies, just so they would codify as “normative” (source) (source 1). Many Intersex Peoples have spoken against the surgeries and medical procedures that have been enacted on their bodies without consent and the subsequent trauma, but despite this, these surgeries continue to be carried out across the world (source) (source 1).

Here again is an example of how biology is not separate from socialisation; it is a myth that society can experience natural phenomena without the lens of culture, society or language, and one that leads to myriad harms to all kinds of people. This is to the argument that sex is biological or natural, rather sex is a conceptualisation that is based dictated by culture. 

Lived Experience, Gender and Health

This report has identified the link between gender, sex and supremacy, which is the platform from which capitalism operates. It is a system that justifies and advocates for its legitimacy in order to survive. It does this through long-standing narratives and norms; therefore, it is imperative that we understand these strategies, in order to dismantle and/or live outside them. This is crucial for our liberation and healing.

We have established throughout the report that gender and sex are western conceptualisations rather than a universal truth. However, due to its hegemony, many of us live our life under the western experience of gender and its consequences. In this section, we will be discussing how the interplay between being gendered and lived experience impacts health outcomes.

In science there has been a long-standing paradox between the health outcomes of the two binary genders. Whilst western women on average live a longer life than men, they live with more nonfatal, acute, prolonged, and chronic conditions and disabilities (source). The rate of mental health diseases are similar, however, their presentation, symptoms, and comorbidities differ (source).  Given how physiologically similar we are, having the same organs and functions, this paradox is very interesting. There is a hormonal component to consider: on average, there is a higher oestrogen threshold in those identified as female, which could account for some of the differences. For example, the decrease of oestrogen during menopause is a factor that is being considered for depression at this stage of life (source).

However, we see health disparities not just in non-communicable diseases, they also occur in communicable diseases. This is relevant for two reasons. The first is that it highlights that differences in communicable diseases cannot not only be driven by physiological “sex” differences. In other words communicable diseases like Covid, should technically affect everyone the same regardless of “sex” have the same physiological systems and functions, yet we see a wide range of differences between gender and even race and class. Second, it highlights that lived experience is a key factor. Malaria, a disease passed on by mosquitos, should be even between the two genders, given that we have highly similar physiological make-ups. However, the exposure is driven by gender norms: those gendered as men were more likely to work in forestry which has a high mosquito population (soure). The gender experience also affects how the illness is treated, the support received from family, and even the experience of the illness (soure).

Behaviours versus the Lived Experience

When looking at the relationship between gender and health disparities between those identified as “men” and “women”, it is usually under the confines of behaviour (source) (source 1); 

• Due to various gendered expectations, men are less likely to engage in preventive health check-ups than women.

• Men are more likely to engage in behaviours like smoking or drinking.

However, this is not the full picture, as there are more nuanced aspects of the lived experience that should be considered; 

• What are the types of jobs that men are forced to do because of their gender expectations, and how do these work environments affect health? (source) The same questions would be for women. We must also ask how race, class, and disability intersect with these questions. For instance, Indigenous women are more likely to be domestic workers, so how does this intersect with their access to healthcare, being listened to by medical practitioners, and their exposures to stressors? (source)

• How are people treated by the medical profession due to social norms and expectations? This is important to consider for populations that are ostracised by all formal aspects of society such as Trans Peoples and racialised peoples (source) (source 1).

• How does the lived experience of discrimination affect health of the various groups, e.g., Trans, Black men and women, Indigenous Peoples? (source) (source 1)

• We must also consider how gender affects the development and health outcomes of children. A study from the United States looked at 1,755 mainly white adolescents, which highlighted the differences in the intake of calories, vegetables, and fruit, all essential for the development of the mind and body (source). Additionally, when a person lacks essential nutrients during key development stages it can impact a person in adulthood and old age (source). Could this nutrient and calorie difference play a role in future rates of depression, endocrine dysregulation, and other non-communicable illnesses? The disparities stemmed from the gendered beauty expectations placed on both. Gay, cisgendere boys were more likely to binge than their heterosexual conterparts. In this case, there is a dynamic between gender, sexuality, class, and race.

Whilst all these gender-driven behaviours are important, we need to delve deeper into the full spectrum of the lived experience.

Sex Organs and Health

Another prominent part of the current gender and health discourse is the narrative that disease differences are simply due to being different sexes. Bodies labelled “female” get ovarian and breast cancer and bodies labelled “male” get prostate and testicular cancer due to their inherit biological sex (source). However, should we not enquire about the ecosystem the breast tissue finds itself in? Firstly, both identified sexes have breast tissue that is susceptible to breast cancer. Therefore, the differences in breast cancer go beyond mere physiology. The gendered experience typically exposes those identified as women to more endocrine disruptors (EDs) through their jobs. Nurses – a workforce disproportionately made up of (often racialised) women – for instance, are exposed to EDs through their work environment, they work shifts which dysregulates the sleep/wake cycle causing hormonal disruption, and they can be exposed to harassment from both patients and “higher-ranked” medical professionals, which is a psychosocial stressor (source) (source 1) (source 2). There are also other areas, such as the use of cosmetics (source), and multi-ethnic working class women are exposed to more air pollution due to making more and longer trips on public transport (source). Finally, we should consider how aesthetic demands and expectations play a role in exposure. Racialised Black women are expected to abandon their natural biological hair for chemical straighteners, which are notoriously filled with EDs for the sake of looking “presentable” in the workplace (source) (source 1).

All of these factors need to be considered when communicating health disparities. It is not the question of breast tissue being the risk to health or a persons’ societally assigned gender, as it is often communicated. Women are not more at risk of breast or ovarian cancer because of their innate nature, they are more at risk because of the gender-rooted societal demands and expectations, which then drive exposure to health risks. Additionally, it can lead to more accurate preventive health strategies, ones that include worker rights, healthier work conditions, and anti-racist frameworks.

Environmental Stressors and Endocrine Disruptors

For the purposes of narrative, this report will be looking at three categorisations of stressors; psychosocial, physiological, and endocrine disruptors. Technically endocrine disruptors are their specific phenomena, however, there is a physiological interplay between psychosocial and environmental stressors and the endocrine system. For example, air pollution is an environmental stressor that disrupts the function of the stress response (source), which is hormonally mediated (source). It is also an endocrine disruptor (source), which changes the function of the endocrine system, independently to the stress response (source). However, as the stress response is hormonally mediated, if a person is exposed to endocrine disruptors, this too will affect the function of their stress response (source). Secondly, psychosocial stressors like the experience of violence can also disrupt the function of the endocrine system (source).

Endocrine Disruptors (EDs)

Endocrine disruptors are chemicals that are ingested from our external environment through our skin, respiratory tracks, and mouth. Once inside the body, they mimic the body’s hormones, which can cause dysregulation of the endocrine system (source). The endocrine system regulates and mitigates the function of our hormones, which in turn regulate the function of many of our physiological processes, such as digestion, sleep/wake cycle, skin repair, metabolism, blood pressures, stress response, emotional regulation, and reproduction (source). In short, the endocrine system is a significant part of our human physiology (source).

Therefore, when chemicals disrupt or dysregulate this system, it is has the potential to be part of the disease pathology of a wide range of diseases and illnesses. EDs have been linked to various cancers, including those in our reproductive system, depression, anxiety, Parkinson’s, dementia, autoimmune disorders, obesity, diabetes, miscarriages, neurodevelopmental disruption in the womb, and the list continues (source) (source 1) (source 2) (source 3) (source 4).

Endocrine disruptors are mainly man-made due to industrialisation. As this list highlights, they have been insidiously introduced to every single part of our life. Without strict regulation that supports life rather than capital, they are almost impossible to avoid. Furthermore, as materiality can be cheaper to produce with EDs, those who are economically impoverished due to societal discriminations and marginalisation are the most exposed. For instance, cheap social housing that contains cheap and synthetic materiality in carpets, furniture, paint, and walls contains ED. Another factor to consider when it comes to the inequity of exposure is that the multi-–ethnic working class also has more exposure due to working in many of the places that produce materiality with EDs, or their work requires them to be in close and constant contact with EDs. Hygiene workers, long-haul drivers, factory workers, nurses, miners, etc. are all over-exposed to EDs. (source) (source 1) (source 2) (source 3).

Animal products: Non-organic and mass-industrialised animal products contain EDs, as they are put in their feed. We ingest the EDs through the consumption of these animals.

Built environment materiality: All indoor and outdoor built environments contain EDs. From the asphalt that paves our roads, to the paint, carpets, and furniture we use in our homes, to the air pollution from all vehicles (including electric vehicles).

Cleaning materials: All non-natural cleaning materials at both industry and home level contain EDs: this includes washing-up liquid, fabric softeners, washing detergent, and surface cleaners.

Clothes: Clothes that use certain dyes and petrol-based materials, such as fleeces, rayon, polyester, etc.

Cooking ware: Teflon and heated plastic, including food containers.

Cosmetics: Unless you are using all-natural products, such as coconut oil, most cosmetics including shampoo, conditioners, relaxers, face and body creams, make-up, etc. all contain EDs.

Food: Any food that is mass-produced and non-organic will contain EDs due to the use of pesticides: fruit, vegetables, canned products, and dried products.

Food processing: Many canned and processed foods contain BPAs (which is an ED).

Industrial sites: Any place where there is industrial activity will contain a range of EDs. Examples are: construction, warehouses, air ports, chemical plants, and commercial, non-organic farms.

Landfill sites: Depending on the type of rubbish and how it is treated, these sites can be full of EDs.

Pesticides: Are sprayed on crops and are ingested through respiratory tract, skin, and when we eat food contaminated with pesticides.

Scents: Many people use scented candles or air fresheners in their homes and cars. Both, if not made from all-natural materials, may contain EDs.

Transport: All transport from trains to planes emit air pollutants which are both an environmental stressor and an ED.

The Land:  The Land is a term for all of our natural ecosystems: waterways, soil, air, oceans, etc. They are all contaminated by industrial activity, which also affects non-human beings. The contamination directly causes the death of vegetation and biodiversity. It also makes habitats, such as rivers, uninhabitable. There is also the ED factor, which is ingested by non-human animals and insects that also dysregulated their physiological functions.

Water: Drinking bottled water that has been in the sun can contain EDs due to the chemical exchange between plastic and heat. Sadly our water quality is going down and many sources contain synthetic chemicals that are classified as EDs.

(source) (source 2) (source 3) (source 4) (source 5)

Key stats and facts

• EDs are in our Land, and they are in our bodies, as there is no separation. Therefore, when we fight for our own health justice we are fighting for the health of all of our Kin. 

• In the past, DES, an ED which mimics the function of oestrogen in the body, was prescribed to women from the 1940s to the 1970s (source). 

• “Since 1952, more than 140000 synthetic chemical compounds have been made, while each year over 70 000 different industrial chemicals are synthesised and sold.” (source) EDs are a huge business and they generate a lot of profit, which affects the motivation for banning them all together. We only need them because of capitalism and industrial growth.

• “Billions of pounds of chemicals make their way annually into our bodies and ecosystems.” (source)

• “More than 358 industrial chemicals and pesticides have been detected in the cord blood of minority American infants.” (source)

• We are all exposed to EDs, as capitalism has made it ubiquitous. However, depending on your lived experience, which is in part regulated by race, class, and gender, exposure is varied. The multi-ethnic working class, who are living in poverty, are exposed through the food they eat, as cheaper mass-produced and/or processed foods contain EDs, and through cheap housing, which often means the use of cheap materials which cost little to produce, leaving homes filled with EDs - from carpets to furniture. Finally, this demographic will have gendered work roles, such as housekeeping or long-haul driving, which exposes people to EDs. This means their exposure is for longer and sustained, leaving plenty of time for dysregulation to occur.

Environmental Stressors

There are two stressor categories, physical and psychosocial, and they interplay with the stress response, which is mediated by the Hypothalamus-Pituitary-Adrenal Axis (HPA-Axis). This term is used to represent the interaction between the hypothalamus (located in the brain), pituitary gland (located in the brain), and adrenal glands (located above the kidneys). The HPA-Axis is a system that communicates with all other major systems in the body; endocrine, digestion, gut biome, cardiovascular, and respiratory (source).

The diagram also points to the physical transition between experiencing a stressor (an acute change in the internal and external environment) and stability, through a process called allostasis (source). Allostasis means stability through change. In other words, the body adapts to the stressor via a series of physiological and cognitive changes (source). When this process is engaged at a constant and continual basis it creates a multitude of cardiovascular, metabolic, and inflammation responses to stress. This is commonly known as allostatic load, which leads to general wear and tear on the body (source) (source 1).

Stress and Health

The cumulative science linking stress to negative health outcomes is vast. Stress can affect health directly, through autonomic and neuroendocrine responses, but also indirectly, through behaviours influenced by the invention of gender (source).

Stress impacts multiple biological systems and these systems interact with each other in order to adapt and respond to changing environmental demands that are perceived as stressful. While the field has attracted much criticism for the heterogeneity in the way stress has been conceptualised and measured, this variability has also played an important role in enhancing our understanding of what types of stress affect health and in what ways. Moreover, we have clearly moved away from a simple model of stress, in which it results in too much cortisol, reduced HRV, heightened blood pressure or impaired immunity, to an understanding that these systems interact and become dysregulated in more nuanced ways (source).

We are now seeing that stress can alter the production of stress mediators in ways that can increase and blunt, upregulate and downregulate, all of which are likely to have serious implications for disease pathology. Future work ought to consider further the importance of early life adversity and continue to explore how each of these systems interacts in the context of stress and gendered health research (source).

A Gendered Lived Experience

Diagram 2 highlights how gender influences societal norms, which then steers our lived experiences, and how those lived experiences lead to the exposure of environmental stressors and endocrine disruptors. The norms and genders identified are dictated by the heteronormative culture that underpins white supremacy, which is dictated upon us in the west. 

NB: Trans Peoples may adhere to the norms of either the gender they identify as, or the gender they are perceived to be (these may differ, while for many Trans Peoples they are correctly perceived as their gender) due to societal pressures and a need for safety that is often only available through assimilation into these norms. They may experience a mix of lived experience across their lifetime, from adhering to different norms before and after realising they are trans and/or beginning social and/or medical transition. 

Diagram 2

A MENTAL EXERCISE

Using Diagram 2, trace your lived experience and list all the places that you are exposed to either environmental stressors or endocrine disruptors. This is not to take an individualised approach but to create awareness of how our gendered lived experience impacts our health. Do this exercise for a person that also intersects with low living wages and other marginalisations such as race.

Part of our health justice strategies need to include policy changes that will put a stop to “the right to pollute”. Capitalism, through its norms and pollution, is killing us. Finally, if you can, get involved in local government and ask MPs what they are doing to stop industrial polluters. We also need scientists and medical professionals to be in solidarity with us. The EU, for example, held a conference to demand ED labels on all products as well as awareness of its harmful health effects (source).

Discrimination as a Stressor

The factors, activities, and their interconnections of a person’s lived experience are vast and complex. At its core, this report examines how the dynamics of gender, race, and class generate discriminations. We could say that the classification of humans inherently creates social hierarchy whose natural outcome will be discrimination. As we have learned from the second diagram, our lived experience is in part influenced by how we fit into supremacy frameworks and those of us who are dispensable to the system will be systematically marginalised and socially discriminated against on a daily and constant basis (source) (source 1) (source 2) (source 3) (source 4) (source 5).

All of these discrimination factors cause the stress response to constantly engage, leading to allostatic overload (source). Additionally, research suggests that discrimination impacts health primarily through three major pathways: psychosocial stress, access to health and social resources, and violence and bodily harm. These pathways interact with one another. For instance, denied access to jobs and housing is a cause of psychosocial stress. Discrimination acts as both a stressor and a cause of other stressors, and can directly and indirectly lead to harm for those who experience it. The experience of discrimination, when perceived as such, leads to a cascade of stress-related emotional, physiologic, and behavioural changes (source). Stress evokes negative emotional responses, such as distress, sadness, and anger; physiologic changes meant to maintain homeostasis through the stressful event; often an increase in behaviours that harm health (such as alcohol, tobacco, and other substance use); and a decrease in activities often beneficial to health (such as sleep and physical activity) (source).

Instances of discrimination

These are some examples of how discrimination affects all aspects of the lived experience. This is not a complete list; there also are childcare, education, healthcare access, time poverty, family dynamics, etc. to consider.

1. Where you work, your work environment, and payment

   1. Racialised Black women disproportionately represent care workers in the UK (source). This work requires shift work, high levels of psychosocial stress, and low wages.

   2. For many racialised women, they are not able to stop sexual harassment at work due to fear of being fired and, in some cases, fear of being deported. There are many cases where racialised women are forced into sexual violence for fear of their families being deported by their employer. Racialised women also experience sexual harassment at work at disproportionately higher rates than their white counterparts. (source) (source 1) (source 2)

2. Wages

   1. Racialised Black and Indigenous women earn less than their white counterparts in the United States (source) (source 1).

3. The type of work 

   1. Multi-ethnic working class men are more likely to be long-haul drivers in the UK and US. This includes bus drivers, delivery drivers, truck drivers, and taxi drivers (source) (source 1).

4. Where you live

   1. Due to discrimination in the job market, many who are systemically discriminated are forced to live in neighbourhoods that offer inadequate housing and poor air quality, and that are noisy and unsafe. They are also likely to be in areas that are at higher risk of acute weather events (source).

   2. However, more local discrimination, such as private landlords not providing housing or providing poor housing to Trans or racialised Peoples, is quite common (source) (source 1).

5. Accessing Food

   1. Access to work is a direct pathway to accessing nourishing food on a constant basis in this capitalist society. Those who are disabled, Trans, and racialised are often discriminated against from work opportunities, which leaves them unable to finance access to nourishing food. Beyond affording the energy, appliances and ingredients needed to cook, some people may be unable to cook due to lack of time or physical ability.(source) (source 1) (source 2)

Trauma and Hyper-vigilance

The cumulative experience of discrimination can lead to a life that is filled with trauma, and it can also lead to specific acute experiences of violence, which is a form of trauma (source). One of the consequences of trauma is the feeling that we need to be in constant alert in our socialisations and physical environments. Most of our trauma is rooted in the social dynamics dictated by supremacy structures. Whether it is gender-based violence, such as femicide, or the constant emotional and physical abuse of Trans and racialised Peoples (source) (source 1) (source 2).

Hyper-vigilance can also lead to specific poor health pathways. Hyper-vigilance, or a heightened awareness and anticipation of protecting oneself against additional trauma, is a key feature of post-traumatic stress disorders (source) and is one of the proposed pathways through which trauma leads to poor cardiovascular and metabolic health, substance abuse (source), and sleep disturbances (source). Anticipatory stress and vigilance, or the impact of anticipating a discriminatory experience, are also examined in discrimination research. In a review of racial discrimination, vigilance was also positively associated with sleep disturbances, high blood pressure, waist circumference, and depression (source).

The Reality

What we have learned in the report has real world consequences and it is affecting all of our health. Gender and its current norms, expectations, and demands are not working for us; they are generating a life of discrimination, violence, and poor health outcomes. It is not as simple as to say we get rid of ‘gender’, it is much more nuanced than that. We are also not saying that if you are comfortable in your gendered life that anything needs to change, we are simply highlighting a more ecological, nuanced, and accurate health framework for understanding gender-induced health differences.

Here are some stats that are influenced by the gendered lived experience.

• Bus drivers are 40% more likely to develop bladder cancer. This is due to exposure to air pollution and exhaustion. Men, specifically white working class men (US) are more likely to be in this profession (source) (source 1) (source 2).

• Among racialised Black taxi drivers, 36% were living with obesity, due to cumulative factors, such as smoking, air pollution exposure, sedentary activity, exhaustion, and shift work (source).

• There are disproportionate rates of skin and respiratory cancer amongst Indigenous men and women who work in agriculture due to exposure to pesticides, heat, and sun (source).

• The risk for breast cancer was 10–15% higher among those gendered as women who were classified as moderate and frequent users of beauty products than among women classified as infrequent users of beauty products (source).

• 1.5 million black men between the ages of 25 and 54 years are missing from daily life as a result of premature mortality or incarceration (source).