Structural Sexism and Health in the United States: A New Perspective on Health Inequality and the Gender System

Abstract

In this article, I build a new line of health inequality research that parallels the emerging structural racism literature. I develop theory and measurement for the concept of structural sexism and examine its relationship to health outcomes. Consistent with contemporary theories of gender as a multilevel social system, I conceptualize and measure structural sexism as systematic gender inequality at the macro level (U.S. state), meso level (marital dyad), and micro level (individual). I use U.S. state-level administrative data linked to geocoded data from the NLSY79, as well as measures of inter-spousal inequality and individual views on women’s roles as predictors of physical health outcomes in random-effects models for men and women. Results show that among women, exposure to more sexism at the macro and meso levels is associated with more chronic conditions, worse self-rated health, and worse physical functioning. Among men, macro-level structural sexism is also associated with worse health. However, greater meso-level structural sexism is associated with better health among men. At the micro level, internalized sexism is not related to physical health among either women or men. I close by outlining how future research on gender inequality and health can be furthered using a structural sexism perspective.

Gender imbalance in executive management positions at the Mexican National Institutes of Health

“…Also, by looking beyond individual actors and behaviors, a structural sexism perspective highlights the discriminatory character of institutional arrangements. Let us consider some possible mechanisms that may be present in healthcare systems [60].…”

Cancer Screening Participation and Gender Stratification in Europe

“…Although recent research on macrolevel determinants of educational inequalities in (preventive) health has provided valuable new insights on the importance of taking into account social and political contexts, there remains large potential for additional research (Montez et al 2019). One important aspect of macrostructural inequality that has received little attention in the contextualization of (preventive) health inequalities is macrolevel gender inequality (Homan 2019). The few existing studies have mainly focused on the impact of macrolevel gender equality on women's health.…”

“…Additionally, we aim to contribute to existing research that focuses on the impact of macro conditions by going beyond the typical factors of economic development that are usually focused on in health inequalities research. More specifically, we will devote special attention to the impact of an important aspect of macrostructural social inequality that is often overlooked: macrolevel gender stratification (Homan 2019).…”

Health Consequences of Laws and Public Policies That Target, or Protect, Marginalized Populations

“…While no research has directly assessed the relationship between health outcomes and laws and public polices related to sexism, there is some evidence that such a relationship likely exists. Homan (), for instance, finds that a higher proportion of men in state legislatures is related to higher infant mortality, and a measure of “macro‐structural sexism” (which includes proportion of men in state legislatures and abortion access) is related negative health outcomes for women (Homan, , p. 501). In another example, laws and policies that protect against discrimination on the basis of obesity (Pomeranz, ; Pomeranz & Puhl, ) may positively impact the health of obese people, though I know of no research that has tested this proposition directly.…”