Inequalities in the health of queer and trans people: Cis-heteropatriarchy as a theoretical approach


Aida Parnia, University of Toronto

The higher rates of adverse mental health outcomes have been consistently documented in queer and trans people compared to cisgender and heterosexual groups. Much of the literature in the sociology of health explains these inequalities in mental health using the minority stress theory, which describes how the stress resulting from the stigma associated with being a minority group impacts mental health. This theory has been expanded to describe differences by gender identity or sexual orientation and has been used in explaining worse health outcomes in those with multiple marginalized identities. The main contribution of minority stress theory is in how stressors and sources of resilience are experienced and contribute to one’s mental health. However, it fails to explain how and why specific stressors are distributed in the population. Being a minority in a society does not explain why certain groups are oppressed and how this oppression impacts them. In other words, there is a need for theories that describe the social conditions of queer and trans people in order to understand the distribution of health outcomes in this population. This paper proposes using cis-heteropatriarchy as a framework to understand the structures that shape oppression, expropriation, and exploitation on the basis of sex, gender, and sexuality. Cis-heteropatriarchy refers to all of the ways that our lives are impacted by our relationship to our sex, gender, and sexuality. The binary understanding of gender and sex, as fixed and undifferentiated, is central to defining social roles and the conditions associated with them, including harms and privileges. Heterosexuality represents the institutionalization of these gender relations in several dimensions of life, including intimacy, family, work, and religion. The role of the nuclear family is critical in this structure as it forms the primary unit of social reproduction in capitalist societies, with severe material effects for those excluded from it. Experiences of queerness and gender transition describe deviations from the norms of cis-heteropatriarchy and lead to varying degrees of consequences for the individuals. Explaining the health of queer and trans people within the structures of cis-heteropatriarchy provides several benefits to empirical research, particularly quantitative studies. First, in interpreting the health inequalities, this framework provides a language to describe what is unjust about the disparities observed beyond being associated with minority groups. Furthermore, it allows for interpreting health inequalities within queer and trans communities, which are often homogenized in the analyses. Second, this framework is consequential in how sex, gender, and sexuality are conceptualized and measured. The changes to the measurements of these variables have been discussed in the literature concerning the need for inclusion. However, using this framework would require researchers to consider how to measure the social location of individuals within the structures of cis-heteropatriarchy. Third, cis-heteropatriarchy represents structural forces and suggests the need for indicators to measure these forces. Measurement of structural oppression on race and gender has been a growing body of literature on social inequalities in health. While some of these indicators are also consequential in understanding the health of queer and trans people, there is a need to conceptualize indicators particular to the social conditions of this group. Lastly, this framework allows us to understand queer and trans health in a changing world. The increasing hostility toward trans people at the same time as greater acceptance of same-sex marriage is a piece of evidence that there is not a linear path toward greater acceptance and better social positions. There is a need to understand how structures of cis-heteropatriarchy are changing as a result of different social movements.

This paper will be presented at the following session: