Sex and gender shape health: being a man or woman interacts with other variables, such as race, socioeconomic status, age or sexual orientation, and precipitates a diverse health path, with increased risk of one disease or another and a different life expectancy. An American investigation, published this Wednesday in The Lancet Public Health, delves into these differences and concludes that men experience a greater degree of health loss and have a higher burden of diseases that lead to premature death, such as road accident injuries or heart problems. Women, on the other hand, suffer much more from pathologies that lead to poor health and reduce quality of life: lower back pain, depression and anxiety, for example, especially affect them. The authors of this article warn that these divergences in health outcomes between men and women imply “diverse health needs” and emphasizeton the “urgent need” for health policies based on age and sex.
In the world, the life expectancy of women at birth is 74 years and that of men is 69—specifically, in Spain it is 86 and 80, respectively. Both sex, which determines the biological factors associated with sex chromosomes and reproductive anatomy, and gender, which appeals to a social construct that is related to the roles and behaviors socially attributed to men and women and people of diverse genders, shape The health and scientific community, beyond the gross mortality figures, tries to explore the differences in the impact on health. “Most illnesses that disproportionately affect women or men, such as depressive disorders, anxiety disorders, and road injuries, begin to differentiate in adolescence. Existing research suggests that this period coincides with a crucial age in which gender norms and attitudes intensify and puberty reshapes self-perceptions,” the authors reflect.
The researchers turned to data from the 2021 Global Burden of Disease (GBD) Study, which quantifies health loss from more than 300 diseases in about 200 countries on a regular basis. In this specific case, they focused on twenty pathologies, the 20 that generate the most health loss in individuals over 10 years of age. For example, heart attacks, strokes, lung cancer, cirrhosis, back pain, depression and anxiety, tuberculosis, road accident injuries, Alzheimer’s, diabetes or HIV, among others. To gauge the health impact of these ailments, researchers used disability-adjusted life years (DALYs), an indicator that measures all that time of healthy and full life lost due to illness, associated poor health to her or premature death.
“The findings of our research reveal substantial differences in global health between women and men, with little progress to reduce these health differences between 1990 and 2021,” the authors summarize in the study. The rates of years of healthy life lost due to the disease were higher in men in 13 of the 20 pathologies analyzed: covid, for example, or ischemic heart disease, affected them much more than women. The seven conditions with higher DALY rates in women than in men were low back pain, depression, headaches, anxiety, musculoskeletal disorders, dementia and HIV. “Historically, attention to women’s health has focused largely on sexual and reproductive issues, which, while crucial, do not encompass the full spectrum of health problems that affect women throughout their lives (. ..). Non-communicable diseases that most frequently affect women continue to be deprioritized in research funding, scientific literature and, most notably, in health systems planning,” the authors state. The scientists admit that the study has limitations, such as that the estimates and data used adhere to a binary framework (female or male) and the health impact cannot be analyzed or estimated for groups with gender diversity or diverse sex.
Luisa Sorio Flor, author of the study 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 life.” ”. “Our findings indicate that, in general, men experience a greater degree of health loss. We observe that women disproportionately suffer from conditions that primarily lead to morbidity that, while not necessarily fatal, significantly decrease quality of life. In contrast, men show a greater burden of diseases that more frequently result in premature mortality. Therefore, our study highlights that focusing solely on mortality or morbidity would fail to tell the full story of the health gaps between women and men,” reflects the researcher.
The study, which analyzed data from 1990 to 2021, has not found great progress in bridging this gap in health between men and women. There has been a global decrease in years of healthy life lost due to poor health or premature death in some diseases, such as chronic obstructive pulmonary disease (COPD), ischemic heart disease, stroke or tuberculosis, which tend to affect men more. However, the health gap between them, says Sorio Flor, “has persisted and, in some cases, has widened in certain diseases.” “The gap has progressively increased in the case of diabetes, negatively affecting men more over time, and in depressive disorders, anxiety and other musculoskeletal disorders, which have increasingly disadvantaged women.”
The influence of gender roles
The authors do not analyze the factors that influence these disparities, but Sorio Flor assures that their findings align with the scientific literature that reflects how sex and gender impact health. Evidence suggests, for example, 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 to men and Hormonal factors have been linked to variations in musculoskeletal and mood disorders among women. On the gender side, social and cultural factors play an important role: the disproportionate burden of household chores, care responsibilities and social expectations imposed on women can contribute both to physical tension, leading to conditions such as back pain. back, as well as psychological stress, which exacerbates mental health problems.” The researcher also points out the gender bias or prejudice that may exist in healthcare environments: “Studies have shown that women are more likely to be diagnosed with mental health disorders, in part due to the stereotypes that women are viewed with.” as more emotionally expressive or vulnerable. “This can lead to a gender bias in diagnostic practices, where similar symptoms could be interpreted differently depending on the gender of the patient.”
On the other hand, gender roles and the behaviors linked to them can influence health outcomes, agrees Sorio Flor. “Specifically, traffic injuries serve as a pertinent example that illustrates how social expectations and gender norms can drive health disparities. Men tend to engage more in behaviors perceived as risky or aligned with traditional notions of masculinity, such as smoking, excessive drinking, and aggressive driving. These activities are not only culturally reinforced in many contexts, but are also linked to higher rates of accidents and chronic illnesses. The gap in the burden of traffic injuries, which emerges at an early age between genders, highlights the role of risk behaviors,” explains the researcher.
The study highlights that these “persistent” differences found in health according to sex and gender begin “at an early age”, in adolescence. The authors consider this time to be “a stage of life marked by pubertal changes and intensified gender socialization, when gender identity, roles, and norms diverge markedly and gain prominence, underscoring the need for early and specific”. In a commentary attached to the publication of the article, researchers Sarah J. Hawkes, Angela Y. Chang, from the Institute for Global Health at University College London, lament that data disaggregated by sex is often “overlooked or simply ignored in decision-making processes” “We have not seen the same level of attention paid to the issue of integrating gender sensitivity into responses aimed at reducing DALYs or extending 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 determines a large part of the observed differences in health and life expectancy between people,” they warn.
Jordi Alonso, researcher at the Hospital del Mar Research Institute and deputy scientific director of the Networked Biomedical Research Center for Epidemiology and Public Health, points out that this research delves into what they already knew. “Women live longer, but disease-free life expectancy is a little lower. It is already known, but it helps to see the type of diseases and quantifies the relationships between pathologies,” says the scientist, who has not participated in this study. Alonso agrees with the authors that these findings show the need to “solve these problems and confront them.” “He identifies and quantifies the situation better and makes it clear that we must deepen our knowledge of possible causes and interventions. Furthermore, it focuses on the most disabling health problems that are inadequately attended to,” he says.
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