(CW: In this blog, I’m discussing an recent Lancet article that uses data classifying people as male” or “female”; the researchers acknowledge that this binary doesn’t accurately describe the population, but notes that data using other classifications are sparse. They add that future research needs to include more categories in order to better understand sex and gender-based global health outcomes.)
Just this month, a comprehensive study came out, comparing the factors for men and women that contribute to disease burden globally. Global Burden of Disease is a term (and whole area of public health and medical research) that “looks at ways to quantify health loss across places and over time, so that health systems can be improved and disparities eliminated.” If this seems like a gnarly complicated business, that’s because it is. It’s also extremely important, especially for identifying and addressing sources of inequities in healthcare systems.
This latest article’s findings are interesting, and also paint a complicated picture of gender-based health disparities. Globally, women live longer than men, but they spend more of their lives with non-fatal illnesses and conditions than men do. Here’s a graph to illustrate, produced for the Guardian news outlet, using the data from the paper:
What are the highlights here? It turns out that the conditions that predominantly affect women– low back pain, depression, headaches, and musculoskeletal disorders– don’t strongly reduce lifespan, but rather increase disability and reduce disease-free function. Contrast this with the conditions that affect men more strongly– COVID-19, road injuries, and heart disease/stroke, liver and respiratory disease– which do shorten lifespan, but don’t necessarily produce years of disability and suffering.
So, women live longer, but in more pain and with trouble functioning. Men live shorter lives, but with fewer chronic conditions that cause pain and limit function.
Here’s what the study’s co-lead author, Gabriela Gil, of the Institute for Health Metrics and Evaluation, said we should conclude about this disparity:
“It’s clear that women’s healthcare needs to extend well beyond areas that health systems and research funding have prioritised to date, such as sexual and reproductive concerns.”
“Conditions that disproportionately impact females in all world regions, such as depressive disorders, are significantly underfunded compared with the massive burden they exert, with only a small proportion of government health expenditure globally earmarked for mental health conditions.
“Future health system planning must encompass the full spectrum of issues affecting females throughout their lives, especially given the higher level of disability they endure and the growing ratio of females to males in ageing populations.”
Yes, we already knew that mental health is much less well funded around the globe. It’s interesting (in a bad way) that conditions like headache disorders, which predominantly affect women, are not very effectively treated. We can see this in some graphs showing the temporal patterns of the 20 top causes of global burden of disease, 1990–2020 (p. e290). For conditions like heart disease, tuberculosis, stroke and some others, we see improvements, largely due to advances in medical technology. But for conditions like headache disorders, depression disorders, lower back pain and musculoskeletal disorders (primarily affecting women), the graphs are flat, indicating no improvement over 30 years. I leave conclusions to the reader.
In order to address these sex-and-gender health inequities, we need to be able to measure them. That includes expanding our gender categories and also devising sex-and-gender-specific ways of preventing and treating these causes of ill health, say the authors of the study. I couldn’t agree more.
