Cross-national differences in the gender gap in subjective health in Europe: does country-level gender equality matter?

Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis.

[1]  Berglund,et al.  Cross-national associations between gender and mental disorders in the WHO World Mental Health Surveys , 2010 .

[2]  P. McDonough,et al.  Gender and health: reassessing patterns and explanations. , 2001, Social science & medicine.

[3]  R. Hopcroft,et al.  The Sex Difference in Depression Across 29 Countries , 2007 .

[4]  A. Case,et al.  Sex differences in morbidity and mortality , 2004, Demography.

[5]  B. Gorman,et al.  Gender and Health Inequality , 2010 .

[6]  Jason Schnittker Working More and Feeling Better: Women's Health, Employment, and Family Life, 1974-2004 , 2007 .

[7]  S. Marklund,et al.  Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973–2008 , 2012, BMC Public Health.

[8]  J. Hibbard,et al.  Gender roles, illness orientation and use of medical services. , 1983, Social science & medicine.

[9]  J. Robine,et al.  Gender gaps in life expectancy and expected years with activity limitations at age 50 in the European Union: associations with macro-level structural indicators , 2010, European journal of ageing.

[10]  F. Pampel Cigarette diffusion and sex differences in smoking. , 2001, Journal of health and social behavior.

[11]  C. Mood Logistic Regression: Why We Cannot Do What We Think We Can Do, and What We Can Do About It , 2010 .

[12]  I. Kawachi,et al.  Women's status and depressive symptoms: a multilevel analysis. , 2005, Social science & medicine.

[13]  M. Lundberg,et al.  Does increased gender equality lead to a convergence of health outcomes for men and women? A study of Swedish municipalities. , 2007, Social science & medicine.

[14]  Laura D'Andrea Tyson,et al.  The global gender gap report. 2010. , 2011 .

[15]  Hendrik Jürges,et al.  True health vs response styles: exploring cross-country differences in self-reported health. , 2007, Health economics.

[16]  K. Boye Work and Well-being in a Comparative Perspective—The Role of Family Policy , 2011 .

[17]  Jeremy Freese,et al.  Using Anchoring Vignettes to Assess Group Differences in General Self-Rated Health , 2011, Journal of health and social behavior.

[18]  K. Hunt,et al.  Do women 'over-report' morbidity? Men's and women's responses to structured prompting on a standard question on long standing illness. , 1999, Social science & medicine.

[19]  D. Pope,et al.  Gender, health inequalities and welfare state regimes: a cross-national study of 13 European countries , 2008, Journal of Epidemiology & Community Health.

[20]  Y. Benyamini,et al.  Gender Differences in Processing Information for Making Self-Assessments of Health , 2000, Psychosomatic medicine.

[21]  Katia Levecque,et al.  Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. , 2010, Social science & medicine.

[22]  Laura D'Andrea Tyson,et al.  The global gender gap report , 2006 .

[23]  E. Crimmins,et al.  Gender differences in health: results from SHARE, ELSA and HRS. , 2011, European journal of public health.

[24]  L. Ferrucci,et al.  Is self-rated health comparable across cultures and genders? , 1998, The journals of gerontology. Series B, Psychological sciences and social sciences.

[25]  C. Bambra,et al.  Is patriarchy the source of men’s higher mortality? , 2005, Journal of Epidemiology and Community Health.

[26]  Y. Benyamini,et al.  Self-rated health and mortality: a review of twenty-seven community studies. , 1997, Journal of health and social behavior.

[27]  N. Moss,et al.  Gender equity and socioeconomic inequality: a framework for the patterning of women's health. , 2002, Social science & medicine.

[28]  I. Kawachi,et al.  A multilevel analysis of women's status and self-rated health in the United States. , 2004, Journal of the American Medical Women's Association.

[29]  E. Idler Discussion: Gender Differences in Self-Rated Health, in Mortality, and in the Relationship Between the Two , 2003 .

[30]  K. Hunt,et al.  Relocating gender and morbidity: examining men's and women's health in contemporary Western societies. Introduction to Special Issue on Gender and Health. , 1999, Social science & medicine.

[31]  S. Arber,et al.  Multiple roles and health among British and Finnish women: the influence of socioeconomic circumstances. , 2002, Social science & medicine.

[32]  M. Overpeck,et al.  Cross-national variation of gender differences in adolescent subjective health in Europe and North America. , 2006, Social science & medicine.

[33]  David R. Williams,et al.  Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. , 2009, Archives of general psychiatry.

[34]  W. Courtenay Constructions of masculinity and their influence on men's well-being: a theory of gender and health. , 2000, Social science & medicine.

[35]  K. Malik,et al.  Human Development Report 2013. The Rise of the South: Human Progress in a Diverse World , 2013 .

[36]  I. Kawachi,et al.  Women's status and the health of women and men: a view from the States. , 1999, Social science & medicine.

[37]  A. Winkvist,et al.  Parental share in public and domestic spheres: a population study on gender equality, death, and sickness , 2006, Journal of Epidemiology and Community Health.