How gender affects health: living longer, but in worse health | Health and wellness

Sex and gender shape health: Being male or female interacts with other variables, such as race, socioeconomic status, age, or sexual orientation, to precipitate a diversity of health trajectories with increased risk of a given disease and different life expectancy. An American investigation published this Wednesday in Public Health Lancet, delves into these differences and concludes that men experience greater degrees of health loss and have a higher burden of diseases that lead to premature death, such as injuries from road traffic accidents or heart problems. Women suffer much more from pathologies that lead to poor health and a decrease in quality of life: for example, they are especially affected by lower back pain, depression and anxiety. The authors of this article warn that these differences in health outcomes between men and women imply “different health needs” and emphasize thatTon “urgent need” for age- and gender-sensitive health policies.

In the world, life expectancy at birth for women is 74 years, for men – 69, in particular, in Spain – 86 and 80 years, respectively. Both sex, which determines biological factors related to sex chromosomes and reproductive anatomy, and gender, which appeals to the social construct associated with the roles and behaviors ascribed in society to men and women and people of different genders, shape health and science. The community is trying to look at differences in health impacts beyond overall death numbers. “Most conditions that disproportionately affect women or men, such as depressive disorders, anxiety disorders and road traffic injuries, begin to differentiate during adolescence. Existing research suggests that this period coincides with a crucial age when gender norms and attitudes are strengthened and puberty changes self-perception,” the authors reflect.

The researchers turned to data from the 2021 Global Burden of Disease (GBD) study, which routinely estimates health losses from more than 300 diseases in about 200 countries. In this particular case, they focused on twenty pathologies, 20 of which cause the greatest loss of health in people over 10 years of age. For example, heart attacks, strokes, lung cancer, cirrhosis of the liver, back pain, depression and anxiety, tuberculosis, injuries from road traffic accidents, Alzheimer’s disease, diabetes or HIV and others. To estimate the health impact of these diseases, the researchers used disability-adjusted life years (DALYs), a metric that measures all the healthy, productive life time lost due to disease, related ill health, or premature death.

“Our study results show significant differences in the health of women and men globally, with little progress in reducing these health disparities between 1990 and 2021,” the study authors summarize. The rates of years of healthy life lost due to disease were higher in men for 13 of the 20 pathologies analyzed: Covid, for example, or coronary heart disease affected them much more than women. The seven conditions with higher DALY rates in women than men were low back pain, depression, headaches, anxiety, musculoskeletal disorders, dementia and HIV. “Historically, attention to women’s health has focused primarily on sexual and reproductive issues, which, although critical, do not cover the full range of health problems that affect women throughout their lives (…). Noncommunicable diseases, which most often affect women, continue to be underprioritized in research funding, scientific literature and, most importantly, health system planning,” the authors state. The researchers acknowledge that the study has limitations, such as the assessments and data used follow a binary structure (women or men), and health effects cannot be analyzed or assessed for gender-diverse or sex-diverse groups.

Louise Sorio Flor, study author and researcher at the Institute for Health Metrics and Evaluation at the University of Washington (USA), emphasizes that “women and men experience health and illness differently throughout the life course.” “Our results show that, overall, men experience a greater degree of health loss. We observe that women are disproportionately affected by conditions that primarily lead to morbidity that, while not necessarily fatal, significantly reduces quality of life. In contrast, men have a greater burden of disease, which is more likely to lead to premature mortality. Thus, our study highlights that focusing solely on mortality and morbidity will not provide a complete picture of health differences between women and men,” the researcher reflects.

The study, which analyzed data from 1990 to 2021, found little progress in closing this health gap between men and women. There is a global decline in the number of years of healthy life lost due to poor health or premature death from certain diseases, such as chronic obstructive pulmonary disease (COPD), coronary heart disease, stroke or tuberculosis, which tend to affect men more. However, the health gap between them, according to Sorio Flor, “remains, and in some cases even widens for some diseases.” “The gap is gradually widening in the case of diabetes, which has an increasingly negative impact on men over time, and in the case of depressive disorders, anxiety and other musculoskeletal disorders, which increasingly disadvantage women.”

Impact of gender roles

The authors do not analyze the factors influencing these differences, but Soriot Flor says their findings are consistent with the scientific literature showing the influence of sex and gender on health. For example, evidence suggests that differences in the prevalence of mental disorders or back pain are due to a combination of biological and gender factors: “From a biological perspective, different physiological responses to pain compared with men and hormonal factors are associated with variations in musculoskeletal disorders. apparatus and mood in women. On the gender side, social and cultural factors play an important role: the disproportionate burden of household chores, caregiving responsibilities and social expectations placed on women can contribute to both physical stress, leading to conditions such as back pain, and psychological stress. stress that exacerbates mental health problems.” The researcher also points out gender bias or prejudice that may exist in healthcare: “Research has shown that women are more likely to be diagnosed with mental disorders, in part due to stereotypes that perceive women as more emotional.” expressive or vulnerable. “This can lead to gender bias in diagnostic practice, where similar symptoms may be interpreted differently depending on the patient’s gender.”

On the other hand, gender roles and associated behaviors can influence health outcomes, agrees Sorio Flor. “Road traffic accidents in particular provide an apt example to illustrate how social expectations and gender norms can lead to health inequalities. Men tend to be more likely to engage in behaviors that are considered risky or consistent with traditional ideas of masculinity, such as smoking, excessive drinking, and aggressive driving. These activities are not only culturally reinforced in many contexts, but are also associated with higher rates of accidents and chronic disease. The gap in the burden of road traffic injuries that occurs early in life between the sexes highlights the role of risk behaviour,” explains the researcher.

The study highlights that these “persistent” health disparities by sex and gender begin “early in life,” in adolescence. The authors consider this time “a stage of life marked by pubertal changes and increased gender socialization, when gender identities, roles, and norms diverge markedly and take on salient importance, emphasizing the need for early and specific.” In a commentary accompanying the paper, researchers Sarah J. Hawkes and Angela Y. Chang from the Institute of Global Health at University College London lament that sex-disaggregated data is often “overlooked or simply ignored in decision-making.” “We have not seen the same level of attention given to integrating gender sensitivity into responses aimed at reducing DALYs or increasing life expectancy. However, it is gender – that is, the unequal distribution of power and privilege in the systems and structures that determine health and well-being – that accounts for most of the observed differences in health and life expectancy between people,” they warn.

Jordi Alonso, a researcher at the Hospital del Mar Research Institute and deputy scientific director of the Network Biomedical Research Center for Epidemiology and Public Health, notes that this study goes deeper into what they already knew. “Women live longer, but disease-free life expectancy is slightly lower. It is already known, but it helps to see the type of diseases and quantify the connections between pathologies,” says the scientist, who was not involved in this study. Alonso agrees with the authors that these results show the need to “address and confront these issues.” “It better defines and quantifies the situation and makes it clear that we need to increase our knowledge of possible causes and interventions. In addition, the focus is on the most disabling health problems that are not receiving enough attention,” he assesses.

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