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WHO report shows that women outlive men worldwide

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1631 (Published 05 April 2019) Cite this as: BMJ 2019;365:l1631
  1. Jacqui Thornton
  1. London, UK

Women outlive men everywhere in the world, and the gap in life expectancy would be even wider if women in low income countries had better access to healthcare, a new global report shows.

The World Health Organization’s World Health Statistics Overview 20191—broken down by sex for the first time—shows that when facing the same disease, men seek healthcare less than women.

Men are much more likely to die from preventable and treatable non-communicable diseases, such as ischaemic heart disease and lung cancer, and road traffic accidents.

When women can access healthcare, maternal deaths decrease, lengthening their life expectancy. But when they can’t, in low income countries, the life expectancy gap narrows.

Breast cancer, maternal conditions, cervical cancer, and Alzheimer’s disease are the causes of death that most reduce female rather than male life expectancy.

Richard Cibulskis, the report’s main author, said collecting the data was an important to help close the healthcare gender gap but admitted some countries struggled to provide it.

He said, “Collecting, analysing, and using good quality, disaggregated data is central to improving people’s health and wellbeing.”

Tedros Adhanom Ghebreyesus, WHO director general, said, “Breaking down data by age, sex, and income group is vital for understanding who is being left behind and why.

“Our task is to use these data to make evidence based policy decisions that move us closer to a healthier, safer, fairer world for everyone.”

The overview, published annually since 2005, is WHO’s annual snapshot of the state of the world’s health in 194 countries. The 2019 report shows an 18.1 year gap in life expectancy between the poorest and the richest countries (62.7 v 80.8).

Globally, at birth, life expectancy is 74.2 for women and 69.8 for men but the gap is smaller in low income countries. WHO said men in low income countries had an average life expectancy at birth in 2016 of 60.9, while women had an average of 64.5. In high income countries the corresponding figures were 78.2 and 83.4.

Of the children born in 2019, boys will live, on average, 69.8 years and girls 74.2 years—a difference of 4.4. Healthy life expectancy at birth is also greater in women than men at birth (64.8 v 62.0).

In low income countries, one in 41 women dies from a maternal cause, compared with one in 3300 in high income countries. In more than 90% of low income countries, there are fewer than four nursing and midwifery personnel per 1000 people.

These maternal deaths contribute more than any other cause to differences in life expectancy at birth between men and women. The report said these deaths could be cut by ensuring that women have high quality care before, during, and after childbirth, and access to modern contraception.

Attitudes to healthcare differs by sex. In countries with generalised HIV epidemics, for example, men are less likely than women to take an HIV test, less likely to access antiretroviral therapy, and more likely to die of AIDS related illnesses than women. Similarly, male patients with tuberculosis are less likely to seek care than female patients.

The report also highlights the difference in causes of death between men and women.

Of the 40 leading causes of death, 33 causes contribute more to reduced life expectancy in men than in women. In 2016, the probability of a 30 year old dying from a non-communicable disease before 70 years of age was 44% higher in men than women.

Global suicide mortality rates were 75% higher in men than in women in 2016. Death rates from road injury are more than twice as high in men than in women from age 15, and mortality rates from homicide are four times higher in men than in women.

Social differences associated with sex can affect mortality. For example, child marriage increases the risks related to early pregnancy among girls, whereas higher rates of male employment in the transport industry expose men to higher risks of death on the roads.

Overall, between 2000 and 2016, global life expectancy at birth increased by 5.5 years, from 66.5 to 72.0 years, while healthy life expectancy at birth—the number of years one can expect to live in full health—increased from 58.5 years in 2000 to 63.3 years in 2016.

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