No one wins: Mapping the gendered pathways of structural sexism and health

Existing scholarship defines structural sexism as systematic inequality in power and resource distribution across political, economic, and social institutions within a given gender system. Despite growing recognition of structural determinants of health, researchers have not adequately addressed the specific pathways through which early exposure to structural sexism shapes later health outcomes. Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 10,009), we examine the link between adolescent exposure to structural sexism and self-rated health in midlife, focusing on mediation through health behaviors, psychosocial strain, and socioeconomic resources. We find that the relationship between structural sexism and health is asymmetric, gendered, and pathway-specific, yet the direct association with midlife health is small for both women and men. For women, structural sexism is associated with poorer midlife self-rated health and is mediated across behavioral, psychosocial, and socioeconomic domains, with individual pathways accounting for 9-25% of the total effect. For men, the direct association with self-rated health is weaker and less consistent, but structural sexism remains linked to health primarily through behavioral mechanisms such as smoking (24%) and unhealthy eating (17%). These findings suggest that structural sexism shapes health less through large direct effects than through the behavioral and socioeconomic pathways by which gendered inequalities become embedded over the life course, and raise further questions about how structural inequalities may reconstitute themselves as gender norms shift, potentially creating new forms of health stratification.