Gender Inequalities in the Health Sector: Links with Socioeconomic Determinants

Social determinants also have a direct impact on different lifestyle habits (healthy eating, sports, etc.), which contribute to increased social health inequalities. In France, for example, 70.5% of the most educated people eat vegetables on a daily basis, compared to 62.1% of the least educated. In addition, the richest 25% consume three times fewer sugary drinks than the poorest 25%. These health inequalities are observable even before birth: among pregnant women in 2016, 94% of managers said they had not smoked in the third trimester of pregnancy, compared to 66% of working-class women.

What socio-economic health inequalities are observed between men and women specifically?

In all countries, indicators of life expectancy at birth show that women live longer. In OECD countries, the difference is 5.3 years on average (83.6 years for women against 78.3 years for men). It should be noted that this "female advantage" is not found in all social spheres, as women are mostly disadvantaged in many others (wages, political power, domestic tasks, etc.).

In France, a woman aged 65 can expect to live another 23.2 years, but the average number of years left without disability is only 11.2 years. For men, the remaining life expectancy at age 65 is 19.4 years, but life expectancy without disability is only 10.1 years. Therefore, the gap between men and women is reduced to only 1.1 years if we focus on life expectancy in good health. Moreover, the onset of reduced autonomy in the form of severe or moderate limitations occurs around age 75 for men and age 76 for women. As such, the initial claim of a female health advantage on this front can be questioned - all the more so as it varies according to social background and pathologies. 

The approach is centered on four pathologies that affect populations differently:

• Cardiovascular disease, which women are generally less affected by, but the risk of deterioration or even death is about twice as high among women than among men in cases where the former are affected. Women tend to be diagnosed later, which is not unrelated to the fact that myocardial infarction is often wrongly considered to be a case of "men stressed at work".


• Depression, a pathology for which gender relations may play to the disadvantage of men in the diagnosis phase. Indeed, women are more exposed to risk factors for depression linked to their socio-economic context (precariousness, mental load, violence…). In 2017, women were twice as likely as men to have experienced a depressive episode. However, women with the highest incomes are at a lower risk of depression compared to other income groups, to the tune of 30%. 


• Colorectal cancer, a disease that affects men and women equally and that is diagnosed through a biological test, shows variations in screening depending on the target audience. The test participation rate is higher for women than for men (35.7% versus 33.5%) and varies according to the place of residence (17.3% participation in Corsica versus 49.2% in Maine-et-Loire). 


• Covid-19, which seems to primarily affect immigrant populations and men. According to Santé publique France (a governmental institution reporting to the French Ministry of Health), excess mortality is up to 9 times higher among immigrants. As for men, the WHO indicates that the proportion of cases that end in death is 57%, compared to 43% among women. The Gendhi project’s aim is to understand how social inequalities in relation to Covid-19 are constructed and what factors explain different groups’ levels of exposure.

How can we measure and fight against social health inequalities?

In order to measure and characterize these health inequalities, it is necessary to observe the courses of life and care practices that begin in early childhood and continue until the end of life. It is important to understand the ways in which gendered socialization to health issues during childhood creates inequalities depending on social background, origin, etc. It is key to decipher how these differences in practices can influence the resort (or not) to healthcare, the relationship with the body and various symptoms. These inequalities, which are present from a very young age, intensify throughout an individual’s life. 

The project uses qualitative and quantitative data to understand how health inequalities operate and are constructed. Several epidemiological surveys are consulted, such as Constances, EpiCov, HBSC (European cohort of adolescents), Elfe (INE) and SHARE. Field studies are conducted by researchers who participate in a family’s life for a certain period of time to observe and analyze health and care practices, and interviews are conducted with patients and health professionals. Medical recommendations published by acclaimed sources are also analyzed to identify possible biases regarding the treatment of patients according to their gender. 

Gendhi's theoretical model can be applied to other countries and can help public authorities in their decision-making regarding public health prevention policies. 

Copyright: SABEL INFANTES / AFP