Women experience higherĀ stress, moreĀ chronic disease, moreĀ depression, more anxietyĀ and are more likely to be victims ofĀ violence. Women earn less than men, and in many countries they donāt have the same human rights asĀ men.
Despite theĀ social inequalityĀ women experience, they live longer than men. This is the case without a singleĀ exception, in all countries.
For instance, in the U.S. in 2015 female full-time workers made only 80 cents for every dollar earned by men, indicating aĀ 20 percentĀ gender wage gap. Yet, life expectancy for women in the U.S. isĀ 81.2 yearsĀ compared to 76.4 for males.
Even in countries with larger wage gaps or extreme gender inequalities,Ā women live longer than men.
As a researcher who studiesĀ cross-countryĀ andĀ genderĀ differences in health, I am always fascinated by how the intersection of these factors influences health. So why do women live longer, despite their lower social rank and worse health?
Is it basic biology?
Gender refers to social aspects of being a woman or a man such as social stress, opportunity and social expectations.
Sex, on the other hand, refers to biology. Biology can contribute to this difference in life expectancy. Women have biological advantages that let themĀ live longer.
For instance, estrogenĀ benefits womenĀ because it lowers low-density lipoprotein cholesterol (or LDL, what you may know as ābadā cholesterol) and increases high-density lipoprotein cholesterol (or HDL, the āgoodā cholesterol), which reduces cardiovascular risk.
Testosterone, on the other hand, increases blood levels of the bad cholesterol and decreases levels of good cholesterol. This puts men at greater risk of hypertension, heart disease and stroke.
When it comes to chronic diseases, women tend to have more of them. But there is a caveat here. Men and women have different types of chronic disease. Women have more nonfatal, chronic conditions, while men have more fatal conditions.
For example, women have more arthritis, which does not kill, even if disabling. In contrast, men are at higher risk of chronic diseases that are leadingĀ killers. Heart disease starts 10 years earlier in men thanĀ women.
So, biological differences play a role in this life expectancy gap, but gender, I argue, plays a bigger role.
Women are more health aware
Studies have shown that, in general, women are moreĀ health conscious, and they haveĀ higher awarenessĀ of their physical and mental symptoms. These all result in healthier lifestyles and better health care use. Women also communicate better about their problems, which helps theĀ processĀ ofĀ diagnosis.
Being a man meansĀ delayedĀ initiation of treatment of any kind.Ā Men are less adherent to treatment.
These issues collectively cause males to be vulnerable to therapeuticĀ failure.
Masculinity is a socially learned construct, and it can haveĀ unhealthyĀ effects. Many men defineĀ unhealthy and risky behaviorsĀ as masculine, while they see health care use and health-promoting behaviors as feminine.
Risky behavior and sensation-seeking
Testosterone puts men at risk biologically, but it also puts men at risk behaviorally. It increases aggressiveness, and, in a cascading effect, results in higher death rate fromĀ accidents and homicide.
My colleague and I followed more than 250 youth and found that baseline testestrone predicts futureĀ violentĀ behaviors.
Women systematically overestimate risk of any type, while men consistentlyunderestimateĀ it. This pattern has been observed regardless of the context. These include examples ranging from crossing a road to perception of risk of volcano, smoking or a terrorist attack. AmongĀ pedestrians, males violate more rules than females. Among drivers, men more commonlyĀ break the rules.
Accidents, like motor vehicle crashes, are far more common amongĀ menĀ than women. This is due in part to menās greater risk-taking, underestimation of risk, sensation-seeking, and tendency to be more impulsive.
This difference extends to almost any task inĀ real life. This in part explains why women internalize and menĀ externalizeĀ (which requires low perception of risk).
Substance use is also more common amongĀ menĀ than among women. While that gap is narrowing,Ā according to a 2011 study, men were 2.2 times more likely to abuse drugs than women, and 1.9 times more likely to have drug dependence.
Among those who have drug use problems, men tend to have more severe problems, defined by frequency of use, using more than one substance and risky behaviors such asĀ injectionĀ drug use. Men with drug use problemsĀ seek careĀ later than women do. Men also drive under the influence of drugs and alcoholĀ more frequently than women. Men are responsible for four out of every five cases of driving under the influence of a drug or alcohol.
So why do men have a higher tendency to abuse illicit drugs and alcohol than women?
This is in part due toĀ sensation-seeking, which makes some men search for experiences and feelings that are varied, novel, complex and intense. Higher acceptabilityĀ for men of risky behaviors,Ā peer pressureĀ andĀ gender rolesĀ also have a role. Although some of this may be due to testosteroneĀ levels, a considerable part of it is due to learnedĀ gender roles.
In addition to higher sensation-seeking, men have moreĀ impulsive traitsĀ and have higher thresholds forĀ punishment.
And our previous research has shown thatĀ masculinityĀ plays a role for depression and alcohol use.
Suicide
InĀ most countries, men are more likely to die by suicide. In theĀ United States, for example, men are 3.5 times more likely than women to die from suicide. This is mainly because men useĀ more lethal methodsĀ for suicide, such asĀ firearms.
In the U.S. most suicides areĀ white men. In fact, suicides among this group are one reason why mortality for middle-aged white American men isĀ increasing.
One reason behind the high suicide rate among men is theĀ high stigmaĀ about psychiatric disorders as well as mental health care use. So when men experienceĀ stressĀ they are at higher risk ofĀ mental health problems such as depressionĀ than women, possibly because they do not talk about their emotions and they do not seek care. Such a tendency toĀ avoid mental health careĀ is directly related to masculinity, gender norms and social expectations for men.
UnemploymentĀ is a major cause of suicide globally and in the U.S. Unemployment may have aĀ bigger roleĀ as a cause of suicide for men, as it results in a larger āhuman capital lossā among men than women.
Thinking about gender
Our gender can determine how our parents treat us, which in turn make us learn to behave in a certain way, as dictated by societal beliefs, values, attitudes and examples. Boys and girls start facing social norms that define āmasculineā and āfeminineā for them from an early age.
Gender differences in mortality are mainly behavioral and thus preventable, as they are learned in society and manifested in behavioral and psychological ways. Although our brain is involved, it is not in our genetics. It is learned socially and it can be unlearned.
Gender differences are rules rather than exceptions. While in many factors, women do worse than men, in the case of life expectancy, men do worse. Theese are mainly due to a wide range of social, psychological and behavioral factors such as sensation-seeking, risk-taking traits, stigma, masculinity, worse health care use, and a tendency for externalizing behavior. Males require more self-control, stigma reduction (by mass media) and incentives to seek and use professional care.
