Your Identity Can’t Make You Sick
It’s common to see statistics like “Indigenous Canadians are more likely to have diabetes”, “gay men are more likely to be HIV+”, or “trans people are more likely have depression”. And because gender, sexual orientation, race, and similar categories are often framed as innate, biological categories, it’s easy to conclude that the reason for these disparities is simply biological – genetic or hormonal perhaps.
But the truth is, these categories are social categories, not biological ones. So then what’s causing these differences in health risk?
Well….society is.
Social vs biological categories
Race, gender, and sexual orientation are all social categories – that is, they are ways of dividing humans up in a way that is socially and culturally significant and useful, despite the loose biological divisions between people who fit into different categories. The biological link is different for each of these categories, and ranges from nonexistent to complexly correlated.
But what’s important to know is that the frequently reported “increased risks” of various illnesses aren’t necessarily because of inherent biological differences.
So what are these risks caused by?
Well, the biggie which extends across all of these examples, is oppression. This includes:
the stress of being marginalized and the coping methods that come with that,
the income and housing instability that comes from discriminatory employer and landlord policies,
difficulty accessing healthcare, and then poor treatment by healthcare providers when it is accessed.
It can also be caused by factors that are more specific to each category. For example, the prevalence of diabetes in Indigenous communities is partly due to the fact that they have been stripped of sovereignty over their traditional food sources. HIV is only more common among men who have sex with men and their communities because governments did not care for their lives at the time of the initial AIDS crisis. The difference in risk for any given condition between men and women is often accounted for by differing occupational exposures - a purely behavioural difference that has nothing to do with “male” or “female” physiology!
Photo by Zackary Drucker for The Gender Spectrum Collection
Even conditions that seem to be based on a firm biological division between sexes may not be quite so cut and dried: hormone-based risks are usually stratified within the male or female population – for example, based on the age that someone started and stopped menstruating, whether they have been pregnant or breastfed, and other factors. Importantly, the risk isn’t purely because of their biological sex, or and certainly not their gender. It’s because of their roles, behaviours, and the way they fit into society.
And all of these things are modifiable – which means we don’t just have to accept our statistic-proclaimed fates. These disparities can be changed.
Changing fate
On an individual level, understanding what puts you at risk for certain diseases puts the power back in your hands to change the things that you have control over. For example, if you read that you have hand eczema because you’re a woman, it might be empowering to know that your gender isn’t the reason you have eczema, but rather, the reason women tend to have more hand eczema is because they wash their hands and use irritating products more. So you can start wearing gloves when you wash the dishes and choose gentler hand cream.
But there are some things you have less control over. You may be able to choose a doctor who affirms and supports you. In fact, we know that Black patients who have Black doctors have better health outcomes, including lower infant mortality! But you can’t really get around the fact that the medical system often does not serve marginalized people well. So if you can’t change these problems as an individual, what can you do?
Photo by Zackary Drucker for The Gender Spectrum Collection
Well, we know from research on mental health and sexual orientation that LGBTQ2SIA+ people who are supported by friends and family, and are proud of their identities are protected from the mental health struggles that those who have little support and lower self esteem experience. And given that at least some of the disparities caused by oppression are mediated by stress, having community support and good self esteem should help temper those effects too.
So before resigning yourself to the mental and chronic illnesses that statistics seem to promise you based on your identity,
Research what kind of steps YOU can take as an individual to reduce your risk.
Make sure the members of your healthcare team support and advocate for you.
Surround yourself with people who make you feel good about yourself, your culture, and your identity (create a community who cares for you with this blog post).
A lot of the time, we’re led to believe that certain things about who we are lead us to get sick. And this is true of some things – genetics, the way we developed, and other biological factors are the causes of many illnesses. But we shouldn’t lump social categories in with those and pretend that they are biological. This only serves to promote stereotypes, justify dividing humans by race, gender, and sexuality, and disempower marginalized people.
Your identity can’t make you sick. But the way you behave and are treated based on that identity can.
This post is based on an article I co-authored with Dr. Cyndi Gilbert, ND in the Canadian Association of Naturopathic Doctors (CAND) Journal. It appears in Volume 28, No. 1: Health Equity.