Gender Equality and the Global Gender Gap in Life Expectancy: An Exploratory Analysis of 152 Countries

Document Type: Short Communication

Authors

1 Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain

2 Public Health Research Group, University of Alicante, Alicante, Spain

3 Unitat de Suport a la Recerca Terres de l´Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain

4 Unidat de Recerca, Gerència Territorial Terres de l´Ebre, Institut Catalá de la Salut, Tortosa, Spain

5 Facultat de Enfermería, Campus Terres de l´Ebre, Universitat Rovira i Virgili, Tortosa, Spain

6 Department of Health Psychology, University of Alicante, Alicante, Spain

7 University Research Institute for Gender Studies, University of Alicante, Alicante, Spain

8 Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain

9 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK

10 Division of Health Research, Lancaster University, Lancaster, UK

11 Department of Community Health Sciences, Patan Academy of Health Sciences, Kathmandu, Nepal

12 Southgate Institute for Health, Society & Equity, Flinders University, Adelaide, SA, Australia

Abstract

When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biological factors alone do not explain gender differences in LE, and examining structural differences may help illuminate other explanatory factors. The aim of this research is to analyse the influence of gender inequality on the gender gap in LE globally. We have carried out a regression analysis between the gender gap in relativised LE and the UN Gender Inequality Index (GII), with a sensitivity analysis conducted for its three dimensions, stratified by the six World Health Organization (WHO) regions. We adjusted the model by taking into consideration gross national income (GNI), democratic status and rural population. The results indicated a positive association for the European region (ß=0.184) and the Americas (ß=0.136) in our adjusted model. Conversely, for the African region, the relations between gender equality and the LE gender gap were found to be negative (ß=-0.125). The findings suggest that in the WHO European region and the Americas, greater gender equality leads to a narrowing of the gender LE gap, while it has a contrary relationship in Africa. We suggest that this could be because only higher scores in the GII between men and women show health benefits.

Keywords


  1. Liu Y, Arai A, Kanda K, Lee RB, Glasser J, Tamashiro H. Gender gaps in life expectancy: generalized trends and negative associations with development indices in OECD countries. Eur J Public Health. 2013;23(4):563-568. doi:10.1093/eurpub/cks049
  2. GBD. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1684-1735. doi:10.1016/S0140-6736(18)31891-9
  3. Thorslund M, Wastesson JW, Agahi N, Lagergren M, Parker MG. The rise and fall of women’s advantage: a comparison of national trends in life expectancy at age 65 years. Eur J Ageing. 2013;10(4):271-277. doi:10.1007/s10433-013-0274-8
  4. Austad SN. Why women live longer than men: Sex differences in longevity. Gend Med. 2006;3(2):79-92. doi:10.1016/S1550-8579(06)80198-1
  5. Marais GAB, Gaillard J-M, Vieira C, et al. Sex gap in aging and longevity: can sex chromosomes play a role? Biol Sex Differ. 2018;9(1):33. doi:10.1186/s13293-018-0181-y
  6. Kruger DJ, Nesse RM. An evolutionary life-history framework for understanding sex differences in human mortality rates. Hum Nat. 2006;17(1):74-97. doi:10.1007/s12110-006-1021-z
  7. Canudas-Romo V, Liu L, Zimmerman L, Ahmed S, Tsui A. Potential Gains in Reproductive-Aged Life Expectancy by Eliminating Maternal Mortality: A Demographic Bonus of Achieving MDG 5. PLoS One. 2014;9(2):e86694. doi:10.1371/journal.pone.0086694
  8. World Health Organization (WHO). Trends in Maternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva, Switzerland: World Health Organization; 2019.
  9. Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med. 2000;50(10):1385-1401. doi:10.1016/s0277-9536(99)00390-1
  10. Hawkes S, Buse K. Gender and global health: evidence, policy, and inconvenient truths. Lancet. 2013;381(9879):1783-1787. doi:10.1016/S0140-6736(13)60253-6
  11. Wang Y, Hunt K, Nazareth I, Freemantle N, Petersen I. Do men consult less than women? An analysis of routinely collected UK general practice data. BMJ Open. 2013;3(8):e003320. doi:10.1136/bmjopen-2013-003320
  12. Bambra C. Work, worklessness and the political economy of health inequalities. J Epidemiol Community Health. 2011;65(9):746-750. doi:10.1136/jech.2009.102103
  13. Evans J, Frank B, Oliffe JL, Gregory D. Health, Illness, Men and Masculinities (HIMM): a theoretical framework for understanding men and their health. J Mens Health. 2011;8(1):7-15. doi:10.1016/j.jomh.2010.09.227
  14. Trovato F, Lalu NM. Narrowing sex differentials in life expectancy in the industrialized world: Early 1970’s to early 1990’s. Biodemography Soc Biol. 1996;43(1-2):20-37. doi:10.1080/19485565.1996.9988911
  15. Sundberg L, Agahi N, Fritzell J, Fors S. Why is the gender gap in life expectancy decreasing? The impact of age- and cause-specific mortality in Sweden 1997–2014. Int J Public Health. 2018;63(6):673-681. doi:10.1007/s00038-018-1097-3
  16. Hassanzadeh J, Moradi N, Esmailnasab N, Rezaeian S, Bagheri P, Armanmehr V. The correlation between gender inequalities and their health related factors in world countries: a global cross-sectional study. Epidemiol Res Int. 2014;2014:1-8. doi:10.1155/2014/521569.
  17. Krieger N. Genders, sexes, and health: what are the connections—and why does it matter? Int J Epidemiol. 2003;32(4):652-657. doi:10.1093/ije/dyg156
  18. United Nations Development Programme (UNDP). Human Development Indices and Indicators: 2018 Statistical Update. New York: United Nations Development Programme; 2018.
  19. Gkiouleka A, Huijts T, Beckfield J, Bambra C. Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions - A research agenda. Soc Sci Med. 2018;200:92-98. doi:10.1016/j.socscimed.2018.01.025
  20. World Health Organization (WHO). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report. Geneva, Switzerland: World Health Organization, Commission on Social Determinants of Health; 2008.
  21. Bergeron S. Querying feminist economics’ straight path to development: household models reconsidered. In: Lind A, ed. Development, Sexual Rights and Global Governance. New York: Routledge; 2010:72-82.
  22. Beckfield J, Morris KA, Bambra C. How social policy contributes to the distribution of population health: the case of gender health equity. Scand J Public Health. 2018;46(1):6-17. doi:10.1177/1403494817715954
  23. Morris KA, Beckfield J, Bambra C. Who benefits from social investment? The gendered effects of family and employment policies on cardiovascular disease in Europe. J Epidemiol Community Health. 2019;73(3):206-213. doi:10.1136/jech-2018-211283
  24. Whitehead M. The Concepts and Principles of Equity and Health. Int J Health Serv. 1992;22(3):429-445. doi:10.2190/986L-LHQ6-2VTE-YRRN
  25. King TL, Kavanagh A, Scovelle AJ, Milner A. Associations between gender equality and health: a systematic review. Health Promot Int. 2020;35(1):27-41. doi:10.1093/yel/day093
  26. Platt J, Prins S, Bates L, Keyes K. Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders. Soc Sci Med. 2016;149:1-8. doi:10.1016/j.socscimed.2015.11.056
  27. Ricketts C. Re-Examining the gender gap in life expectancy: a cross country analysis. Int J Humanit Soc Sci. 2014;4(10-1):38-51. doi:10.30845/ijhss
  28. Kolip P, Lange C. Gender inequality and the gender gap in life expectancy in the European Union. Eur J Public Health. 2018;28(5):869-872. doi:10.1093/eurpub/cky076
  29. Medalia C, Chang VW. Gender equality, development, and cross-national sex gaps in life expectancy. Int J Comp Sociol. 2011;52(5):371-389. doi:10.1177/0020715211426177
  30. Backhans MC, Lundberg M, Månsdotter A. Does increased gender equality lead to a convergence of health outcomes for men and women? A study of Swedish municipalities. Soc Sci Med. 2007;64(9):1892-1903. doi:10.1016/j.socscimed.2007.01.016
  31. Backhans MC, Burström B, Lindholm L, Månsdotter A. Pioneers and laggards – Is the effect of gender equality on health dependent on context? Soc Sci Med. 2009;68(8):1388-1395. doi:10.1016/j.socscimed.2009.01.023.
  32. Baum F, Popay J, Delany-Crowe T, et al.  Punching above their weight: A network to understand broader determinants of increasing life expectancy. Int J Equity Health. 2018;17(1):117. doi:10.1186/s12939-018-0832-y
  33. Gender Inequality Index (GII). United Nations Development Programme website. http://hdr.undp.org/en/content/gender-inequality-index-gii.  Update 2019. Accessed July 31, 2019.
  34. World Bank International Comparison Program database. World Bank Group website. https://data.worldbank.org/indicator/NY.GNP.PCAP.PP.CD?view=char.  Update 2019.  Accessed July 31, 2019.
  35. Freedom House. Freedom in the World 2018. https://freedomhouse.org/report/freedom-world/freedom-world-2018.  Accessed April 11, 2019. Published 2018.
  36. Franco Á, Álvarez-Dardet C, Ruiz-Cantero MT. Effect of democracy on health: ecological study. BMJ. 2004;329(7480):1421-1423. doi:10.1136/bmj.329.7480.1421
  37. Mackenbach JP, Hu Y, Looman CWN. Democratization and life expectancy in Europe, 1960–2008. Soc Sci Med. 2013;93:166-175. doi:10.1016/j.socscimed.2013.05.010
  38. Strasser R, Kam SM, Regalado SM. Rural Health Care Access and Policy in Developing Countries. Annu Rev Public Health. 2016;37(1):395-412. doi:10.1146/annurev-publhealth-032315-021507
  39. Scheil-Adlung X. Global Evidence on Inequities in Rural Health Protection: New Data on Rural Deficits in Health Coverage for 174 Countries. Geneva, Switzerland: International Labour Organization; 2015.
  40. Månsdotter A, Deogan C. Further gender equality – is it good or bad for sexual health? J Gend Stud. 2016;25(3):294-302. doi:10.1080/09589236.2014.964668
  41. Kim JI, Kim G. Labor force participation and secondary education of gender inequality index (GII) associated with healthy life expectancy (HLE) at birth. Int J Equity Health. 2014;13(1):106. doi:10.1186/s12939-014-0106-2