Disparities in Life Expectancy

Eleanor Barnett, Shemar Smith, Cam Mason, Peyton Arrants, Abby Daniel-Perez, and Hannah

Bernstein

Arnold School of Public Health

Principles of Global Health HPEB 470

Dr. David Simmons

Introduction

The world of medicine has experienced significant changes throughout history. Medicine

has evolved tremendously with significant advancements in diagnosis and treatment. Lifestyle

changes have occurred as well, with a heavier emphasis on healthy diets and exercise. Despite

the increasing knowledge of healthcare in the world today, it is still a fact that women are still

outliving men. For decades, differences between men and women have been studied and

observed on a biological and social level. Many of these differences are inherent, while others

have developed over time. Historically and globally, men have a shorter life expectancy than

women. The common notion is that men are simply less intelligent than their female

counterparts. This superficial and simplified reason does not address the core issue of gender

disparities and the direct impact they have on differences in life expectancy.

Life expectancy is a common measure of health amongst a population. It refers to the

number of years a person can expect to live. This is based on an estimate of the average age that

members of a particular population will be when they die. How long we live and what proportion

of life is spent in good health are very important indicators to determine the trajectory of

society's health. Over the last few decades, public health professionals have studied people, their

health, and the factors that play a role in their health outcomes. These conditions in which people

are born, live, learn, work, play, worship, and age influence a broad range of health and

well-being outcomes and specifically life expectancy, are referred to as social determinants of

health (Gomez et. al., 2021). In 2020 life expectancy was 0.9 years higher than it was reported

for 2021. Similarly, the life expectancy of men in 2021 was 73.2 which showed a decline from

74.2 in 2020. The life expectancy for women in 2021 declined to 79.1, with a decrease of 0.8

(Arias, 2022). Social determinants of health help us explain these differences within many
different communities of people. It is also interesting to consider the disparity in life expectancy

on a global scale between a variety of races, ethnicities, and lifestyles.

Thesis

Across populations, there is a difference between life expectancy in men and women. In

almost every society, women outlive men. By examining the impact of various social

determinants of health and lifestyle factors, the gender gap in life expectancy can be better

understood.

Literature Review

Men have shorter lifespans than females for a variety of reasons. Both biological and

sociological factors play a role. Women and men are biologically different and differences in sex

hormones contribute to the longevity of women’s lifespans. In addition to the genetic differences

in men and women, lifestyle and socioeconomic factors also play a large role. Factors include

suicide, risky behaviors such as alcohol and drug use, social tendencies, and occupational

hazards A cumulation of these factors has exacerbated the gap between women living longer

both locally and globally (Pinho-Gomes, 2022).

Biologically, specific hormones and sex chromosomes favor women having a longer

lifespan. Some biological issues that lead to a higher mortality rate are the higher production of

estrogen in women. Estrogen, the female sex hormone, helps decrease the prevalence of various

diseases and chronic diseases in women (Hossin, 2021). In contrast, the androgen hormone,

which has a higher prevalence in women, is associated with a higher risk of cardiovascular

diseases (Hossin, 2021). Hormone differences between men and women also play a role as

regulators of autoimmune diseases (Cutolo, 2004).

 Men and women have different genetic makeup. Women have two X chromosomes,

while men have one X and one Y chromosome. Genetic diseases that are carried on the X

chromosome have a higher prevalence in men than women. The heterogametic sex hypothesis,

also known as the unguarded X hypothesis, explains the excess mortality in men due to genetic

disorders. Women have two X chromosomes so if one X chromosome is damaged, the second X

chromosome can compensate. Men only have one X chromosome so if this chromosome is

damaged, there is a higher likelihood the disorder will be expressed (Marais, 2018).

After considering the biological difference between men and women, it is also important

to account for the social differences that also play a role in the longevity of women's lifespans.

There is a notable difference in suicide rates between males and females. Depression forms the

background for more than half of all suicides. Although women are twice as likely as men to

suffer from depression, men are four times as likely to commit suicide than women (Murphy,

1998). Psychological risk factors such as unemployment, retirement, and being single were

found to be significant risk factors for suicide in men. These psychological risk factors were not

reported to have a statistical impact on women (Freeman, 2017).

There are a variety of behavioral differences between men and women, and on average

men engage in more risky behaviors than women. Specifically, the gender gap in alcohol

consumption has shown to have a very prominent tie to the decreased life expectancy among

men. While the issue of high alcohol consumption is present among both genders, in

middle-aged men alcohol consumption is highly prevalent, binge drinking is common, and men

are more likely to prefer beverages with high levels of ethanol than women (Trias-Llimos, 2018).

Alcohol in itself is a risky behavior, but men also experience more alcohol-related injuries and

deaths than females do (White, 2020).

Biological Risk Factor

While there are obvious behavioral and social factors that contribute to the disparities in

life expectancy between males and females, there are also underlying biological factors that can

help us better understand this trend. It appears that as soon as the moment of conception, men

tend to die much earlier than women, which is due to the fact that males are more likely to suffer

from complications in the womb and results in higher rates of preterm births and neonatal and

infant mortality rates in males compared to females worldwide (Hossin, 2021). This observation

is best explained by genetic disorders, which can account for the higher rates of mortality in men.

The heterogametic sex hypothesis, also known as the unguarded X hypothesis, explains that a

damaged gene in one X chromosome can be compensated by a similar gene on the other X

chromosome in women since they have a double X chromosome, unlike men who only have one

X chromosome (Hossin, 2021). Not only are men who suffer from genetic mutations in the X

chromosome left vulnerable to early death due to the lack of a second X chromosome, but a new

study has shown that men may also experience higher rates of mortality due to Hematopoietic

mosaic loss of Y chromosome (mLOY), which is the most common somatic change found in the

white blood cells of older men and is associated with age-related diseases (Sano, 2022). This

study revealed that LOY is something that occurs with natural aging and leads men to suffer

from an increased risk of cancers, cardiovascular issues and Alzheimer’s disease which can all

lead to premature death as a result (Riaz, 2021). While men seem to suffer from reduced life

expectancy compared to women due to chromosomal issues, they also are at a biological

disadvantage due to hormonal differences. Estrogen is known as one of the primary female sex

hormones, which acts as a protective guard against cardiovascular diseases, while the androgen

hormone, which is primarily present in men “is associated with a higher of cardiovascular
diseases” (Hossin, 2021). This paired with the female bodies’ ability to produce stronger immune

responses and antibodies could be another explanation as to why males are more likely to have a

shorter life expectancy than women (Hossin, 2021).

Suicide

Suicide is considered a taboo topic and is also negatively viewed in society. It is the 12th

leading cause of death in the United States, according to the American Foundation for suicide

prevention (AFSP, n.d.). Males accounted for “nearly 80% of those deaths'' in 2019 (Kaplan, et.,

al.). This trend is not solely endemic in the US, but it is representative of what occurs globally.

On the global level, male mortality rates by suicide were 13.9 per 100,000, while females were

6.3 deaths per 100,000 (Ritchie, 2015). The country that had the highest suicide was Greenland,

with 75 per 100,000, and Kuwait had the lowest, 3.74 per 100,000. The trend of males

committing higher rates of suicide in those countries was apparent females in Greenland had a

mortality rate of 25.15, and Kuwait females had a rate of .92 per 100,000 in 2017 (Ritchie,

2015). The factor that causes this apparent inconsistency is the means that males choose to

commit suicide. Younger females were more likely to pass away from suffocation, but as they

age, poisoning becomes more common (SPFC, n.d.). Poisoning by drug overdose resulted in

approximately 3% of fatality (Drexler, n.d.). Their male counterpart was more likely to use

firearms in the act. This is significant because 85% of attempts using firearms had a fatal ending,

while only 3% of poisoning was fatal (Drexler, n.d.). A combination of both alcohol and means

of suicide was a contributor to the discrepancy. Possible interventions would be an effective

method to close the gap.

An effective intervention to combat lifespan would be to spread awareness about the

variation in the mortality rates, to make the issue more apparent to males while also making them
more susceptible to the program. Following this would be normalizing discussing taboo topics in

a space supportive of males. Alcohol consumption, mental health disorders, drug abuse, and

having access to lethal weapons are all topics to be discussed in detail. The ideal intervention

would focus on all these topics because those factors all interact in a complex system that

ultimately ends with a shorter life span. The Population Reference Bureau states that biological

factors such as higher testosterone “contribute to greater physical activity and aggressiveness”

leading men to take more risks (Yin, 2007). On the other side, stress considered a social factor,

influences the decisions males make. Under stressful situations, research has indicated that “men

take more risk under stress, while females take less” (Humphreys, 2012). This is indicative of

social factors directly influencing biological factors because studies show there is a difference in

the brain region called the insula, which is a section “associated with computing risk”

(Humphreys, 2012). The root problem surrounding the expectancy is complex, and further

research is required to understand the general picture and apply it to this matter.

Risky Behaviors

There are a variety of behavioral differences between men and women. Certain behaviors

have been identified as key risk factors for chronic illnesses which increase the likelihood of

premature death. On average men engage in more risky behaviors. These behaviors include

drinking, smoking, and eating habits. Alcohol consumption is a leading risk factor in injury,

disease, and death worldwide and across genders. High and frequent consumption of alcohol can

result in high blood pressure, heart disease, liver cancer, etc. There is a noted difference in

alcohol consumption between men and women and this difference plays a role in the decreased

life expectancy among men. While the issue of high alcohol consumption is present among both

genders, in middle-aged men alcohol consumption is highly prevalent, binge drinking is

common, and men are more likely to prefer beverages with high levels of ethanol than women

(Trias-Llimos, 2018). Gender differences in high-risk drinking can be attributed to biological

predispositions as well as gender-role orientations.

The prevalence of high-risk drinking is five times higher in men than it is in women

(Chung, 2012). Alcohol in itself is a risky behavior, but men also experience more

alcohol-related injuries and deaths than females do (White, 2020). Excessive alcohol

consumption increases aggression and violence and men have higher rates of alcohol-related

hospitalizations than women (CDC, 2022). Alcohol is a preventable risk factor and is a behavior

that can be decreased. Due to the higher prevalence of high-risk drinking in males and the

negative health consequences which can contribute to premature death, it is important for males

to be aware of their drinking habits and how they may be impacting their life health.

Smoking is another leading risk factor in chronic illness and premature death. Men tend

to use tobacco products at higher rates than women. Men also tend to smoke more cigarettes per

day and have a higher nicotine dependence than women (Allen, 2016). There are biological as

well as physiological reasons why men are more likely to smoke and use nicotine products.

Smoking activates men’s reward pathways more than it activates women’s. This makes

dependence and addiction more prevalent in men. Nicotine is highly addictive and because it has

a greater impact on the reward pathway in men it makes it hard for men to stop smoking and

using nicotine products (NIDA, 2021). Smoking is the leading cause of lung cancer and is a risk

factor for many chronic illnesses that can result in premature death. With men being more likely

to smoke than women this puts this population at greater risk for continued usage and addiction.

In addition to the unhealthy behaviors of alcohol use and smoking which largely

contribute to premature death and the gender gap in life expectancy, an unhealthy diet plays a
major role in health conditions that lead to premature death. Among both genders consuming a

nutrient-dense diet was associated with reduced risk of death from all causes (English, 2021).

Behaviors with food such as quantities, proportions, variety, combinations of food and drink, and

nutrients in diets all play a role into what a healthy diet is and how it can contribute to health

outcomes for both men and women. There are multiple outcomes that stem from unhealthy diet

such as cardiovascular disease, diabetes, and obesity. When looking directly at dietary habits of

men versus habits of women, men have been shown to consume more calories than women and

have different eating styles than women do (Rolls et al., 1991). Over time these habits will

become normal for men and slowly increase their risk for health complications. There are many

reasons that women and men have different eating styles which include sociocultural and

psychological factors that come into play. Women experience more food-related conflict than

men do, which can be attributed to societal pressures to be thin from a much younger age than

men (Rolls et al., 1991). Food habits are built in adolescence and if people grow up in a home

where healthy habits surrounding food are not present they will most likely continue these

patterns into adulthood which further lead to health conditions and premature death. Unhealthy

eating is just one aspect of someone's diet, but in combination with other unhealthy habits like

alcohol and smoking there is a much higher risk of premature death, especially among the male

population.

Occupational Stress

One of the leading stressors worldwide is occupational stress. In 2020, 43% of residents

from over 100 countries claim they have experienced job stress, up from 38% in 2019

(Armstrong, 2021). With an increasing rate and the negative consequences associated with stress,

it is important to consider job-related stress as a contributing factor to the age disparity between
genders. From a global perspective, men are more likely to acquire occupational stress since

many countries still adhere to traditional gender roles, meaning men are still providing for the

family while females only work to serve the men. Furthermore, of the individuals who occupy

the most dangerous jobs in the world, more than 90% are males (DeVore, 2018). These jobs,

specifically, report a higher number of deaths compared to other occupations. Unsafe working

environments, long shifts, and physical demands are all characteristics of dangerous jobs. As a

result, many of these workers experience exhaustion and life-threatening scenarios every day,

which undoubtedly lead to high levels of stress (Centers for Disease Control and Prevention,

2014).

Not only are men more likely to experience a heavier amount of occupational stress

globally, but men have also been known to handle stress differently. During periods of stress, the

body releases cortisol, epinephrine, and oxytocin into the bloodstream. Cortisol and epinephrine

are responsible for increases in blood sugar levels and blood pressure (Medanta Medical Team,

2019). Cortisol also decreases the effectiveness of the immune system and suppresses the

digestive system (American Psychological Association, 2018). The release of oxytocin restricts

the production of cortisol and epinephrine, resulting in relaxing and nurturing emotions. Higher

levels of oxytocin and its ability to bind to reproductive hormones in women could explain why

most women handle stress by tending and nurturing themselves (Medanta Medical Team, 2019).

However, men produce lower levels of oxytocin and resort to flight-or-fight mechanisms when

undergoing stress. As a result, men are more likely to suppress their emotions which can lead to

depression, overeating, anxiety, and substance abuse (Medanta Medical Team, 2019).

Short-lived episodes of stress pose little risk, but when it remains unresolved, the risk of injury or
disease increases (Centers for Disease Control and Prevention, 2014). These differing coping

mechanisms are what leads to higher stress levels in men (Medanta Medical Team, 2019).

Chronic stress resulting from suppressing emotions can lead to serious health risks.

Long-term, high blood pressure from the constant release of cortisol and epinephrine increase the

likelihood of developing hypertension, heart disease, and kidney damage (Nashville General

Hospital, 2022). Because chronic stress can allow blood sugar levels to be high for a long period

of time, the body eventually begins to resist insulin which increases the risk of pre-diabetes and

diabetes (Nashville General Hospital, 2022). Furthermore, since stress affects the immune

system, the body becomes more vulnerable to infection and disease. In males, infections to the

testes, prostate gland, and urethra can negatively affect reproductive functioning (American

Psychological Association, 2018).

Overall, it is evident that occupational stress can be viewed as a contributing factor to the

lower rate of life expectancy for men. Male’s inclination to pursue more dangerous occupations

exposes them to higher levels of stress. Furthermore, the male biology allows this stress to

become chronic due to emotional suppression. These two factors combined ultimately lead to

higher risks of disease and infection among men, which negatively affect their life expectancy.

Healthcare

Healthcare access and use is a vital social determinant of health and life expectancy. Men

and women have different life expectancies in almost every country. However, growing evidence

indicates access to proper healthcare promotes a person's well-being and significantly determines

the individual's life. This piece will briefly examine how healthcare influences life expectancy in

men and women.

 Life expectancy has been continuously on the rise across the globe in recent years. Still,

there is still a global variation in life expectancy between men and women. Men tend to die

earlier, with a life expectancy average of 71.2 years at birth, while women can live up to 80.1

years on average (Pinho-Gomes et al., 2022). The disparity in healthcare access is one of the

significant factors affecting men's life expectancy. While women are more likely to be diagnosed

with diseases, men are usually prescribed less pain medications because they are thought to be

less sensitive to pain. Similarly, men are also less likely to visit a doctor, which could result in a

missed diagnosis or delayed treatment. In the U.S., men have a lower rate of health insurance

coverage than women (Statista, 2022). As a result, men are also less likely to receive regular

medical checkups that can catch and treat diseases at an early stage. Men without health

insurance are also less likely to receive treatment after a severe injury or accident, which remains

the primary cause of mortality in men.

Globally, maternal health remains one of the critical determinants of life expectancy in

women. According to the World Health Organization, 810 women are estimated to have died in

2017 alone from pregnancy- and childbirth-related avoidable causes, with low-resource

environments accounting for 94% of the cases (World Health Organization, 2019). Poor or lack

of access to quality maternal, reproductive, and healthcare services for related disabilities are the

primary cause of maternal mortality.

In conclusion, affordable and universal healthcare is crucial in improving women's and

men's life expectancy. Healthcare access must address the unique problem affecting both men

and women to close the gap in healthcare access disparities.

Cross-Cultural Comparison
 After considering many of the biological and behavioral factors that influence how life

expectancy differs between men and women, it is important to take a look outside the United

States and compare nations to one another to see if this trend is consistent. Life expectancy is one

of the primary methods used for determining the health of a population and countries have been

watching the changes in life expectancy for decades. Since 2006, in all countries around the

world, women live longer than men (Baum et al., 2021). Even in less developed countries where

high maternal mortality reduces the difference in longevity, women continue to outlive men

(PBR, 2001). This is a very important idea to consider when discussing life expectancy because

maternal mortality, especially in low-income countries, is a huge driver for premature death. So,

even when taking all of the mothers who unfortunately do not have access to healthcare that can

help them with birthing complications, they are still showing longer lifespans than males. Data

across countries has shown that in low-income countries, women are shown to outlive men by an

average of 3.82 years. In middle-income countries women outlive men by an average of 4.36

years. Lastly, in high-income countries women outlive men by an average of 5.22 years (Baum et

al., 2021). This data shows that life expectancy as a whole is not consistent across countries, but

the trend of gendered life expectancy differences is consistent. On a global scale it has been

found that women report more illnesses than men and are more likely to live in poverty, two

factors which could possibly lead to premature death. The global scale of this issue expresses

how significant the biological differences between men and women are and how they account for

health outcomes. However, this notion cannot rely on biology alone due to the fact that many

changes take place over time, geography, public policy, and socioeconomic changes throughout

the world (Baum et al., 2021). There are structural differences across cultures and populations,

but in all scenarios, gender inequality is still present due to the behaviors that exhibit across
cultures (Mateos et al., 2022). After considering many of the behavioral factors that play a role

in gendered differences in life expectancy such as workplace stress, suicide rates, diet, and

healthcare usage, we can also look at the global burden of diseases and how it has impacted men

more significantly than women. A primary example of this would be the HIV/AIDS epidemic

which largely impacts men across the globe. Additionally men are more likely to both participate

in and die in acts of war or interpersonal violence across the globe (GBD, 2015). These are just

some of the significant examples of behaviors that men will engage in across the globe that can

lead to an earlier loss of life. Overall, the trends of life expectancy are consistent no matter where

the data is taken. This cross-cultural significance is important to take note of because it shows

the severity of the gender gap and how it is truly affecting males everywhere.

Implications

Identifying the root causes of life expectancy discrepancies between males and females is

crucial for increasing life expectancy for both genders. Life expectancy is the primary metric for

assessing the health of a population (Roser, 2013). Analyzing the differences in life expectancy

between men and women would allow us to accurately predict health outcomes within each

group. More research and understanding of the differences in mortality would help close the

gender gap and decrease the differences in mortality rates between men and women. Increased

awareness of these disparities would result in a conscious change in the daily life practices of

men to help prevent premature death among this population, ultimately leading to an

improvement in happiness and satisfaction.

As the life expectancy gap continues to grow between genders more awareness needs to

be brought to this problem and lifestyle changes need to happen to close this gap. Since many

unhealthy behaviors that can lead to premature death start from such a young age, this notion
should be better understood and actions can be taken to offset this disparity. While we cannot

change biological factors, more research can be done to look into this and find more root causes

of the issue. As we addressed, suicide rates among males are much higher than females, so

placing more of an emphasis on mental health of men would help prevent some of these deaths.

Occupational stressors are never going to go away, but societies and management for these

specific jobs need to check in on their employees and systems should be put in place to help

them be safe in all aspects. As discussed there are multiple risky behaviors that men engage in on

average more than women, these differences between genders are not necessary and more

awareness needs to be brought to these issues to decrease these unhealthy behaviors among men.

Lastly, healthcare access and use should be equal among genders and should be a goal for society

as a whole. Overall, the implications of researching the disparity among life expectancy between

genders is important to increase the health and quality of life among all people.

Conclusion

Differences between the life expectancy of men and women are one of the main problems

of demography, which affects the population directly and indirectly in the economic, political,

and cultural spheres of society. Moreover, life expectancy is a significant element in assessing

the quality of population health and health systems.

This literature study aimed to identify fundamental differences between men's and

women's livelihoods to identify several specific factors that affect life expectancy. Such an

approach will not only help to publicize the problem of inequity in life expectancy but also

develop a set of actions to address the problem of the gender gap in statistics based on the results

of this study.
 In analyzing well-known and numerous literary sources, we found several specific

problems that clearly distinguish a man's life from a woman's, thus explaining the high premature

mortality. The first reason absolutely all men face at birth while still in the womb is a high

mortality rate in the coming weeks after conception. This is because, unlike female embryos,

male embryos undergo many stronger mutations that may be more likely to kill the fetus early in

development.

Through research, we also found many fundamental biological reasons that a man has to

fight for longevity. For example, a significant evolutionary factor is the unguarded X hypothesis,

which suggests that the male genome is more susceptible to various mutations that result in early

and more common health problems than females. This is because men have only one X

chromosome, the mutation of which inevitably leads to the reflection of the issues in the

phenotype. At the same time, women have two X chromosomes, which help block the expression

of specific recessive mutations if they occur on one of the chromosomes. Also, hormonal levels

directly affect life expectancy. For example, testosterone, the androgynous hormone of men,

even in average concentrations, inclines individuals to be risky and sometimes aggressive

behavior, which inevitably leads to traumatization. In addition, this hormone predisposes the

appearance of problems and diseases in the cardiovascular system. At the same time, estrogen in

women acts oppositely. Moreover, the effect of estrogen on the body significantly increases its

immunity and indirectly prolongs life. This contrast in the action of androgynous hormones

creates a visible gap in both sexes' quality and length of life.

But in addition to biological prerequisites, life expectancy is also actively influenced by

social factors that design the life of men in such a way that it affects their health. The pernicious

influence of patriarchal patterns of behavior, which are fixed in society by images of fearless and
successful men who have no right to make mistakes and complain, is reflected in the statistics in

the form of a high number of suicides, 80% of which are committed by men. Based on the

analysis, men come to this result due to unemployment, loneliness, or after retirement. These

three factors are the opposite of the image of the ideal that society requires from real men. It is

important to note that women experience such events much more accessible and are almost not

affected by them.

Responsibility, depression and work stress, which men also experience much more often

than women, can manifest in milder forms of self-harm, such as smoking, drinking, and poor

diet. Such actions can result in diabetes, stroke, lung cancer, or simple trauma and death while

intoxicated. These are some of the main factors that most influence the creation of the gender

gap in life expectancy. Understanding the causes will make it possible to find ways to eliminate

them, solving the problem of premature male mortality in the future.

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