Poverty, low wages and marginalization are so frequently associated with poor health that when we’ve written about it here in the past, the reaction we get on social media is sometimes along the lines of “well, duh.”
But it’s not universally true that people who are poorer or less powerful are in worse health or have shorter lives.
Women do worse than men on a range of socio-economic factors that are often associated with poor health. Women make less money than men—even for the same work. They’re more likely to live in poverty, with all of the health risks that go along with that. They’re more likely to be beaten, raped and sexually assaulted by people they know. They’re over-represented at the bottom of the wage hierarchy, and under-represented in positions of power and leadership.
In spite of all this, American women generally live longer, healthier lives than men. A baby girl born last year is expected to live to be 81.2 years old; a boy will live to be 76.3, according to the National Center for Health Statistics.
How much of that gap is determined by biology? Not as much as you might think. Women may benefit from certain protective qualities of estrogen, and from stronger immune systems. Women around the world live longer than men, but the difference between male and female life expectancy varies hugely by country. Women live 11 years longer than men in Belarus, and less than a year longer in Bangladesh.
In the United States, there was minimal difference in male and female mortality before around 1880, according to a 2015 study of historical data from 1800 to 1935. The gap increased for the better part of the twentieth century; researchers say women benefited from better reproductive health care and a decline in deaths from child birth as well as overall improvements fighting infectious diseases, while men took up smoking in greater numbers. A high-fat diet—heavy on the meat—may also have taken a bigger toll on men.
Since the 1970s, though, the gap between male and female mortality has been shrinking. In part, more egalitarian tastes in smoking have meant more egalitarian death rates, too.
So does all this mean that gender inequality isn’t a health equity issue? After all, women seem to be doing pretty well, judging by lifespan.
Not so fast.
First of all, lifespan is not the only way to judge health. For instance, American women are more likely than men to experience anxiety and depression.
Another way to think about this is that American women would be living even longer if they weren’t disproportionately burdened by poverty, hobbled by bias and routinely pushed out of the work force by caregiving responsibilities.
After all, women are by no means immune to poverty’s effects. Women in the bottom 10 percent of earners live 13 fewer years than women in the top 10 percent.
On the other hand, men’s “excess mortality,” as researchers put it, in comparison to women continues to be juiced by behavioral risks. Much of what American society regards as traditionally masculine behavior turns out not to be very healthy. Men drink more alcohol, and are much more likely to die of chronic liver disease. They’re much more likely to die from homicide, suicide and unintentional injuries. They still smoke more than women (for now).
Put another way, American masculinity is toxic… to men. They may be better off packing Joey’s lunch and taking grandma to the doctor.
Meanwhile, women tend to have more close friends and family members on whom they can draw support and advice. And these social ties are crucial to good health and long life.
If our policies and practices supported true gender equality in the workplace and in the home—if women made as much money as men, and men were expected to do more in taking care of children and elders, and nurturing close friendships—perhaps we’d all live longer.
Here are what the numbers tell us about the costs of being an American woman:
The gender wage gap
What causes the wage gap? There are a mix of different factors. Some research has shown that women with the same qualifications as men are less likely to be hired for high-wage jobs, or more likely to be offered a lower salary. Two-thirds of low-wage jobs are held by women; fields like home health care, fast food and child care are primarily staffed by women. Caregiving responsibilities also fall disproportionately on women—often with little institutional support, such as paid parental leave or access to affordable, high-quality child care.
Discrimination certainly plays a role. One of the most disheartening recent findings of researchers studying this phenomenon is that work done by women is valued differently because it is done by women. A comprehensive study of decades’ worth of census data showed that when women enter a field in greater numbers, the pay drops.
Some research indicates that the wage gap contributes to anxiety and depression among women. Women may internalize differences in pay, and blame themselves. The wage gap also doesn’t take into account the unpaid housework that often falls to women, and which can contribute to stress.
Related to the gender wage gap but not the same, poverty also affects women at a far higher rate than men.
Women living in poverty can mean entire families living in poverty. The poverty rate among children in the U.S. remains unconscionably high—nearly one in five children lives in poverty, according to the 2015 data. More than half of them lived in families headed by women.
The toxic stress of poverty can be very damaging, especially for children and young adults. Poverty is also linked to other important social determinants of health; people living in poverty are more likely to live in inadequate housing, to lack access to high-quality education, and to see and experience more violence, among other things.
Violence and trauma
For decades, American men were more likely to be victims of violent crime than women. But the rates of victimization have recently converged, as violence against men dropped more quickly in the 1990s and early 2000s than did violence against women.
In 2015, women were victims of violent crime at a slightly higher rate than men, according to the Bureau of Justice Statistics. While men are more likely to be victims of homicide, women are more likely to be victims of sexual violence and intimate partner violence.
Sexual violence is a crime with broad impunity compared with other types of violence. Less than a third of rapes are reported to police. Only an estimated six out of 1,000 rapes result in jail or prison time for the rapist.
Survivors of sexual abuse are at much higher risk of depression, anxiety disorders, eating disorders and post-traumatic stress disorder.
Not all women make great advocates for other women, but there’s some research to support the idea that greater political representation by women improves health for both men and women. Unfortunately:
Political representation is important not only for the policies promoted by women, but as one marker of the overall social status of women. And social status itself can be a determinant of health.
Kristin Jones is The Trust’s assistant director of communications. Tracey Rosen is an anthropologist and postdoctoral fellow at Princeton University.