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What is Sex

In the Equality Act 2010 ‘sex’ means a woman or a man or a group of women or men. Sometimes it is hard to understand exactly what is meant by the term ‘sex’ , and how it differs from the closely related term ‘gender’.

Our sex is determined by the sexual organs we are born with – men are born with a penis, women a vagina.

Gender relates to the types of behaviours society expects of men and women. We learn these behaviours as we grow through a range of images and messages given to us by parents, schools, friends and the media. For example, young girls might be given dolls to play with and princess outfits to play in, while boys may be given guns and soldier uniforms.

Society has a set of gender expectations of women and men that differ for each sex. Currently, masculine characteristics are more highly valued than feminine characteristics and world-wide, this ascribes more power and wealth to men than to women. This in turn reinforces sets of behaviour, which have significant implications for the pathways into poor health.

In terms of gender, some people describe themselves as gender fluid or non- binary The difference between gender fluidity and non-binary people is the fact that gender fluidity is one aspect of the non-binary spectrum. A range of people on the gender identity spectrum do not see themselves as male or female. They could be agendered, trans or simply identify as non-binary

Sex and Discrimination

Sex discrimination exists when a person (man or woman) or group of people (men or women) are treated unfairly solely on the basis of their sex. An understanding of gender is important to understanding inequality between women and men. Discrimination on the basis of gender is both subtle and persistent.

Women are expected to be ‘natural carers’ which has led to a huge imbalance in the types of jobs women do, how much they earn, how much housework/ caring they do and disapproval of society if they do not conform to this stereotype.

Men are expected to be ‘strong’ and unemotional, and they can often experience barriers when seeking jobs that require a degree of caring or empathy. Their masculinity can single them out for additional duties that rely on physical capacity rather than capacity to care.

There is a very serious side to this imposed difference. It means that women consistently earn less than men throughout their lives and often live in poverty when they are older. This lack of economic power has also meant that women have less power in society and less access to positions of power in politics.

In most cases we grow up feeling a sense of comfort or acceptance with our gender (as prescribed by biological sex at birth). However, a small number of us (around 1 in 11,500) find as we grow our prescribed gender is so different from our internal sense of where we exist in relation to being a boy/girl, man/women that we express a wish to live in the opposite, more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender people’ also covered by the Equality Act 2010.

Some people describe themselves as non-binary – not seeing themselves as male or female. In recognition that non-binary people experience extreme levels of discrimination in Scotland, the Scottish Government set up a working grouo in 2021

What is sex discrimination? – a short film by the Equality & Human Rights Commission

Sex and Other Protected Characteristics

Sex differences cut across all the other protected characteristics such as age, race and social class.

For example:

  • Male life expectancy is six years lower than for females across NHSGGC
  • In NHSGGC, there is a nine-year gap in male life expectancy between East Dunbartonshire (77.7 years) and North Glasgow (68.6 years)
  • Asian women aged between 15-35 are two to three times more vulnerable to suicide and self harm than their non-Asian counterparts
  • Retired women and lone parents are most at risk of poverty and average incomes of women in work are lower

Other inequality issues can prevent people from receiving health services and treatment appropriate to their sex. For example, some disabled women have been told that they do not need cervical smear tests because of assumptions about their sexual behaviour.

How we are addressing sex issues

‘A Fairer NHSGGC 2016-20 – Meeting the requirements of Equality Legislation’ sets out what the organisation is doing to ensure it meets its responsibilities to promote gender equality and remove sex discrimination across all its services and functions. Most actions in this document involve addressing issues around sex. In addition, actions on closing the health gap between affluent and deprived communities in NHSGGC take into account the different needs of women and men.

Some examples of actions include:

  • Equality Impact Assessments undertaken throughout NHSGGC has a strong gender element
  • An NHSGGC Gender-based Violence Action Plan has been in place for a number of years
  • Women and child poverty work has gained increasing prominence in NHSGGC, endorsed by the Scottish Government funded Healthier Wealthier Children Project
  • Sex issues are key within Human Resources Equality Scheme actions (e.g. Equal Pay Audit,Audit of family friendly policies)
  • A gender analysis of our equality scheme, ‘A Fairer NHSGGC’, which sets out how we will meet the needs of equality legislation
People’s Experiences

John’s Story

John is a survivor of childhood sexual abuse. Now in his 40s, he has struggled to cope throughout adulthood with the experience and knowledge of being abused and has felt that many areas of his life have been negatively affected.

“I’d lost family, friends and jobs – that one major incident was affecting my whole life. I knew I needed help to stop the slide, so I spoke to my GP.

“I was referred to nine different counsellors. None of them specialised in childhood sexual abuse issues. After listening to me talking about my abuse experience, they would pass me on to another counsellor.”

The whole experience left John extremely depressed and contributed to a major breakdown.

John finally contacted Thrive, a counselling service for adult male survivors of childhood sexual abuse which is part of the Sandyford Initiative – NHSGGC’s sexual, reproductive and emotional health service.

“The initial telephone contact was really helpful – the person I spoke to was very supportive and put me at my ease. At my appointment, they explained how the counselling service would be run. They told me that counselling could take a long time and I appreciated that, I didn’t want to be kidded on.

“Hearing those words (‘we can help you’) made such a difference.   When I left I cried all the way to the Underground, I was just so full of relief and happiness.”

Dr Rosie Ilett, Head of Planning and Partnerships at Sandyford, developed the original funding application for Thrive and appreciates the importance of gender sensitivity in services. “Thrive has been developed because we know that many men have real difficulties seeking professional help about sensitive issues – it’s just not considered ‘manly’.   Experience of abuse can test men to breaking point.   Understanding what makes men tick and the barriers that living up to a stereotype of masculinity can impose on them helps our counsellors work effectively with the most challenging cases and start the healing process”.

Thrive is based at the Sandyford Initiative in Glasgow. Men can access the service by calling the direct line on 0141 211 8133 or visit the Sandyford Initiative website at: www.sandyford.scot

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Support and Resources
Why sex matters to Health

NHS evidence has shown that treating women and men the same, without considering the differences between them, means that underlying sex-related links to health problems are ignored and patients’ health needs are not met. 

There is recognition by the Scottish Government that gender discrimination affects women and their health (Scotland’s Women’s Health Plan 2021-2024 – Health Inequalities) The health and societal differences for women and men are shown in the examples below-

  • Women are more likely to live in poverty, be lone parents, experience abuse and  have less access to citizenship opportunities than men, due to historical gender stereotyping in society. This affect health differently during the life course.
  • One in four women are likely to experience domestic abuse over their life course and that prevalence rates for child sexual abuse are estimated at around 21% of girls and 7% of boys.
  • Men are more likely to participate in risk-taking behaviour which leads to premature mortality and to use their power to commit acts of violence and abuse which affect themselves and women and children of both sexes.
  • Men are also less likely than women to participate in health improvement activity or to present to primary care in the early stages of illness.
  • Where men have experienced abuse in childhood, this experience can manifest itself in a range of health and social problems in both childhood and adulthood but is often not identified as part of medical presentations.
  • Women still tend to have multiple social roles as employees, as carers and as the primary managers of households. This imposes stresses that can have physical and psychological impacts on their health.
  • Some diseases have been seen solely as ‘women’s’ or ‘men’s’ diseases due to gendered biases in medical research, leading to delays in diagnosis and treatment (e.g. heart disease – leading cause of mortality in UK women but still seen as a ‘male disease’)

Other examples of where gender expectations affect health are:

  • In NHSGGC, like the whole of Scotland, women are between two and two and a half times more likely to report experiencing depression and anxiety than men.
  • Suicide rates are almost three times higher in men than in women.
  • Men are more likely than women to die of injuries outside the home.
  • The gap between women’s and men’s smoking rates is changing, with more young girls taking up the habit than boys.
  • Young men aged 16-24 are most at risk of becoming a victim of violent crime