Gender Equality Index 2021: Health

• Overall, women tend to report worse health than men. In the 27 Member States of the EU (EU-27), 66 % of women and 71 % of men perceive their health to be good or very good. In all age groups, health limitations tend to have a greater effect on the activities of daily living in women than in men. The greater likelihood of women experiencing poor health also manifests in data on healthy life years. Women and men in the EU can expect to be in good health until 65 and 64 years of age^[1], respectively. However, as women tend to live longer, more of their life is spent in poor health – an average of 19 years, compared with 14 years for men.
• Looking at mental well-being specifically, the same trend can be seen, with women being more likely to report poor mental well-being. Analysis of the World Health Organization Five Well-Being Index (WHO-5) – where a score of 100 represents the best imaginable well-being while scores of 50 or lower indicate risk of depression – shows that the self-rated mental health index is higher for men (66 points) than for women (62 points). Analysis of self-assessed mental well-being across population groups shows that women report lower levels of mental well-being regardless of family composition, age, income, country of birth and disability.

• Overall, health and risk behaviours are clearly gendered in the EU. There are persistent gender gaps in health-promoting behaviour, such as healthy eating and physical activity. While more women meet the World Health Organization (WHO) target of consuming five portions of fruit or vegetables a day (14 %)^[2], more men meet the target of 180 minutes of physical activity a week (47 %)^[3]. However, more men engage in high-risk behaviours such as tobacco smoking and hazardous drinking. These gendered health and risk behaviours are already visible in adolescence, and the gap between men and women widens with age.

• Universal access to health services has not yet been achieved in the EU. Gender inequalities and gender norms intersect with socioeconomic, geographic and cultural factors and create structural barriers when accessing healthcare. Several population groups, such as lone parents, older people, migrants and people with disabilities, and within each of these groups women in particular, stand out as being highly vulnerable to unmet healthcare needs. Overall, about 7 % of women and 6 % of men with disabilities report unmet needs for medical services in the EU, but the levels are much higher in Estonia (29 % of women and 23 % of men), Romania (25 % of women and 23 % of men) and Greece (25 % of women and 22 % of men). In Denmark, Sweden, Hungary, Bulgaria, the Netherlands and Luxembourg, among those with disabilities, men are more likely than women to report unmet medical needs.
• Many factors can inhibit access to medical services, such as the cost associated with them, experiences of discrimination and issues related to cultural sensitivity and a lack of gender sensitivity. The cost of medical services as a barrier to access is more frequently mentioned by people aged 65 years or older than by the general population (40 % of women and 34 % of men aged 65 or older, compared with 33 % of women and 29 % of men in the adult population as a whole). Data shows that large segments of the EU population would find it difficult to pay for unexpected dental care (41 % of women and 35 % of men), mental health services (39 % of women and 33 % of men) and other hospital or medical specialist services (32 % of women and 29 % of men)^[4].
• The COVID-19 pandemic has further exacerbated barriers to access to healthcare services in the EU either as a result of deferment and deprioritisation of certain medical procedures or because of fear of infection. In particular, the European Foundation for the Improvement of Living and Working Conditions (Eurofound) COVID-19 e-survey found that 21 % of respondents had missed a medical examination or treatment during the pandemic. This proportion was highest in Hungary, Portugal and Latvia. In spring 2021, 18 % of respondents were experiencing a health issue for which they could not get treatment (Eurofound, 2021c).

• Sexual and reproductive health and rights (SRHR) are heavily gendered within the EU. Although 95 %^[5] of women in the EU can meet their need for contraceptives, health inequalities still exist. Availability, access, cost and stigma issues around contraceptives introduce barriers to SRHR, especially for young people. Laws, policies and comprehensive sexuality education vary across Member States (BZgA and IPPF EN, 2018). Access to safe abortion and high-quality maternal care remains unequal across the EU, especially for vulnerable groups such as young women and migrants.
• Severe gender data gaps persist in key areas of SRHR, ranging from comprehensive data on contraceptive use to disaggregated epidemiological data on sexually transmitted diseases (STDs) in the EU. Gender bias frames sexual and reproductive health (SRH) as a concern mainly for women and girls, leading to caveats. In particular, men are overlooked in the data collection concerning SRH, and the needs of men in the areas of reproductive health are underexplored in the scientific literature.

• The data shows that the likelihood of being infected with COVID-19 is similar for women and men^[6], but men are at higher risk of severe disease and have a higher risk of death, with gender differences increasing with age. Data from the European Centre for Disease Prevention and Control (ECDC) for 10 EU Member States shows that, as of June 2021, overall, 8 % of women and 10 % of men infected with COVID-19 were hospitalised; however, among those aged 70–79 years, 24 % of women and 33 % of men were hospitalised. For patients aged 80 years or older, the rate of hospitalisation reached 31 % for women and 45 % for men. Since the beginning of the pandemic, men have accounted for 55 % of COVID-19 deaths. The risk of dying from COVID-19 is higher for men than for women in almost all EU countries for which data is available, with the exception of Lithuania and Slovenia.
• Women have been disproportionately exposed to infection by COVID-19 as a result of being over-represented among essential workers and frontline workers. Eurostat data shows that women represent 88 % of personal care workers, 84 % of cleaners and helpers, 73 % of education workers and 72 % of health professionals in EU countries^[7]. A study of 10 European countries, including seven Member States^[8], found that infections among working-age women far outnumber those among working-age men until about the age of 60 years. The authors found that higher rates of infection among women have been linked to their presence in the caring professions, especially healthcare (Tomáš Sobotka et al., 2020). This is consistent with findings that poor working conditions, including the lack of appropriate occupational health and safety measures and precarious employment, contribute to high infection levels in women-dominated frontline sectors (OECD, 2020b; Pelling, 2021; Shallcross et al., 2021).
• Emerging evidence points to significant numbers of people with COVID-19 continuing to have symptoms weeks or even months after contracting the virus (Dennis et al., 2020). Women of working age, people with disabilities, those living in deprived areas and people working in care professions are most likely to be affected by ‘long COVID’ (Ayoubkhani, 2021). Most of those affected report that symptoms adversely impact their day-to-day activities.
• Apart from the direct health consequences of the virus, there are also secondary impacts on physical and mental health. These are likely to be gender specific and long-lasting. Major stressors include social isolation, fear of infection for oneself and loved ones, grief and financial distress. In spring and early summer 2021, mental well-being was at its lowest level since the outbreak began, with large segments of the population at risk of depression (Eurofound, 2021c). Women have had lower levels of mental well-being than men in each of the three pandemic waves, with the lowest levels recorded among working-age women during the third wave. Evidence is mounting on the profound mental health toll of the pandemic on frontline workers, particularly in the care sector. The true extent of the pandemic’s mental health consequences will take time to unfurl, with experts warning that the peak may come long after the pandemic is controlled.
• The restrictions and economic uncertainties resulting from the COVID-19 pandemic have given rise to a ‘shadow pandemic’ of gender-based violence; in particular, there has been a surge in intimate partner violence. Forced cohabitation brought about by lockdowns and economic and labour instability are considered stressors associated with an increase in intimate partner violence (Buller et al., 2018; Buttell and Ferreira, 2020; Jarnecke and Flanagan, 2020). Furthermore, the increase in psychological distress during lockdowns (S. K. Brooks et al., 2020; Gillespie et al., 2021) is another risk associated with intimate partner violence (Clemens et al., 2019; Curtis et al., 2019; Straus and Douglas, 2019). Lockdown measures may have compounded risks of violence against vulnerable groups such as women with disabilities; homeless women, undocumented migrants or migrants with temporary visas; families with low socioeconomic status or children; and lesbian, gay, bisexual, transgender, intersex, queer,+ (LGBTIQ*) couples (Arenas-Arroyo et al., 2020; De Schrijver et al., 2021; Flatau et al., 2020; Pleace et al., 2021; Segrave and Pfitzner, 2020; Zero and Geary, 2020).

[1] Eurostat, ‘Healthy life years by sex (from 2004 onwards)’, https://ec.europa.eu/eurostat/web/products-datasets/-/hlth_hlye, 2019.

[2] Eurostat, ‘Daily consumption of fruit and vegetables by sex, age and educational attainment level’, https://ec.europa.eu/eurostat/web/products-datasets/-/hlth_ehis_fv3e

[3] Eurostat, Persons performing physical activity outside working time by duration in a typical week, educational attainment level, sex and age’, https://ec.europa.eu/eurostat/web/products-datasets/-/ilc_hch07.

[4] European Quality of Life Survey (EQLS), 2016. Respondents were asked, for each type of medical service, ‘How easy or difficult would it be for you to cover expenses for each of the following services, if you needed to use it tomorrow?’ The percentages in the text are the proportions responding to ‘Rather difficult’ or ‘Very difficult’.

[5] UN Database, ‘Family planning indicators’, https://www.un.org/development/desa/pd/data/family-planning-indicators, 2017.

[6] At the time of writing, over half of all COVID-19 cases in EU countries for which data is available were among women (52 % among women and 48 % among men). Source: The Sex, Gender and COVID-19 Project, Global Health 50/50, the African Population and Health Research Center and the International Center for Research on Women. Accessed from https://globalhealth5050.org/the-sex-gender-and-covid-19-project/ on 25 June 2021. EU: authors’ elaboration for (BG, HR, CY, MT, data was not available). Updated on 21 June 2021.

[7] EIGE, COVID-19 web page, https://eige.europa.eu/covid-19-and-gender-equality/essential-workers. Data from EU-LFS, 2018.

[8] Belgium, Czechia, Denmark, Germany, Italy, Norway, Portugal, Spain, Switzerland and the United Kingdom.