Gender is shaping the COVID-19 crisis in real and significant ways. Beyond the direct, visible practices that by now we all should understand—stay home, wash your hands, step back six feet—gender and its interactions with class, race, and immigrant status impact a number of dimensions of this crisis. From epidemiology to the vulnerabilities of front-line health workers, from the distribution of care work within families to the implications of quarantine for domestic violence, we need to reflect critically on these interactions to shape a truly effective policy response to this pandemic.

Most recent reporting and analysis about gender and COVID-19 has focused primarily on women as caregivers and front-line health workers. These are crucial issues. But what seems to be getting lost is that gender affects all of us: men, women, non-binary people, and trans people. That’s because gender is not biology; it is constituted by the social norms, symbols, and power structures that define our cultural expectations for how one “should” act, dependent on one’s biological sex. The unequal death rate between men and women as a result of COVID-19 should prompt greater attention to the gendered effects of this crisis on men—particularly the role of masculinity.

The unequal death rate between men and women as a result of COVID-19 should prompt greater attention to the gendered effects of this crisis on men—particularly the role of masculinity.

The data we have so far show that while men and women contract the virus at similar rates, men are dying from it more often worldwide. According to Global Health 5050, men have accounted for 64 percent of deaths from COVID-19 globally as of March 27. This stark difference in death rates is alarming. To explain the discrepancy, researchers are considering biological factors, such as greater immunity among women due to the additional X chromosome, as well as gender factors, such as men’s lower likelihood to wash hands and their greater rates of smoking and drinking than women in some countries. Smoking and high levels of alcohol consumption can result in, or exacerbate, the underlying health conditions that make men more susceptible to the worst impacts of COVID-19.

A number of factors lead to differences in rates of smoking and drinking among men and women, but one is the societal expectation that men conform to traditional ideals of masculinity. For example, a 2019 study of Chinese men found greater prevalence of binge drinking when the man felt he was not living up to his society’s ideal of “manhood.” In the U.S., studies have found that heavy drinking (especially among young men) has long been a part of performing traditional masculinity, and, for others, a means of escaping the stress of societal expectations for attaining masculine ideals. There is some evidence that, like drinking, smoking is a stress coping mechanism, and that young men believe themselves to be physically more resilient to the harmful effects of smoking, leading them to take up the habit. It is possible that these beliefs also relate to men’s lower rates of hand washing compared to women, and their greater resistance to going to the doctor.

We know from studies of masculinity in the U.S. and the U.K. that the stress of fulfilling gender norms may fall unevenly across race and class.

Of course, some men will feel more influenced by traditional social expectations than others. We know from studies of masculinity in the U.S. and the U.K. that the stress of fulfilling gender norms may fall unevenly across race and class. For example, the expectation that men be the primary breadwinner can be especially stressful for those with few economic options.

In some countries, the links are not as clear when we look at the sex-disaggregated data. For example, despite a difference in the COVID-19 death rate between men and women that mirrors other countries, rates of smoking in Spain are similar among men and women. In the U.S. (where we unfortunately don’t yet have sex-disaggregated COVID-19 data), women are now converging with men in alcohol consumption. It may be that age plays an interactive role in mortality rates—perhaps the older men that are dying in Spain have had longer drinking and smoking patterns. Or it could be that the biological factors that may protect women outweigh the social. A lot more needs to be unraveled by research, but gender appears to be playing some role in contributing to the behaviors that lead to epidemiological vulnerabilities to COVID-19.

What does this mean for policy moving forward? If in fact these relationships between gender expectations, behavior, and disease vulnerability hold, it means we must pay greater attention to how traditional masculinity contributes to detrimental health behaviors.

If in fact these relationships between gender expectations, behavior, and disease vulnerability hold, it means we must pay greater attention to how traditional masculinity contributes to detrimental health behaviors.

Organizations like Promundo and Minnesota’s Men as Peacemakers project are cultivating more flexible forms of masculinity aimed at diminishing violence against women. Similar approaches could be taken to address personally destructive behaviors driven by the same gender influences. The trend lines, however, also indicate that we should be concerned when women “catch up” to men in turning to vices like smoking and drinking—or the next pandemic may well be more equal in its death toll.