COVID-19 and the gender health paradox

Abstract

This article examines gender-based health inequalities arising from the COVID-19 pandemic by drawing on insights from research into the ‘gender health paradox’. Decades of international research shows that, across Europe, men have shorter life expectancies and higher mortality rates than women, and yet, women report higher morbidity. These gender-based health inequalities also appear to be evident within the pandemic and its aftermath. The article starts by providing an overview of the ‘gender health paradox’ and the biological, social, economic and political explanations for it. It then outlines the international estimates of gender-based inequalities in COVID-19 morbidity and mortality rates – where emerging data suggests that women are more likely to be diagnosed with COVID-19 but that men have a higher mortality rate. It then explores the longer term consequences for gender-based health inequalities of the aftermath of the COVID-19 pandemic, focusing on the impacts of government policy responses and the emerging economic crisis, suggesting that this might lead to increased mortality amongst men and increased morbidity amongst women. The essay concludes by reflecting on the pathways shaping gender-based health inequalities in the COVID-19 pandemic and the responses needed to ensure that it does not exacerbate gender-based health inequalities into the future.

Sex Differences and Predictors of In-Hospital Mortality among Patients with COVID-19: Results from the ANCOHVID Multicentre Study

“…Another topic that should be addressed in future studies is the long-term impact of the pandemic, as it might be greater on women. Several authors [58,74] have made a call to address the sex-and gender-specific long-run effects of COVID-19 on population health: healthcare systems are facing the growing demand for care and the mental health fallout [51]. To this end, governments must allocate resources [75] to overcome barriers to health services access and expand social protection.…”

“…Women live longer but have fewer healthy years, experiencing pain [48], certain diseases [49] and mental health problems [50] more often than men. Women are also more vulnerable during epidemics for a variety of reasons: some risk factors for mental health disorders (e.g., social isolation) are disproportionately frequent in women [51]; the gender pay gap [52] and the barriers in the labour market compromise women's financial security in times of crisis; publications and public health documents usually fail to address gender issues [53], for instance, by only taking into account one modality of care (formal healthcare) [54]; access to specific treatments is delayed as women are underrepresented in drug development research [55], and those pregnant or breastfeeding are excluded from most clinical trials [56]. To further complicate matters, epidemics exacerbate gender inequities-women take on the functions that the system can no longer assume [57]-and the ongoing pandemic is not an exception [58].…”

“…The first wave of the pandemic witnessed gender-based consequences of coronavirus disease and the implementation of lockdowns. Social disruption increased the risk of suicide [65]; furthermore, it has been suggested that women particularly struggled to maintain their mental wellbeing [51], which should not come as a surprise, given the unique stress, fear and guilt that women carry during epidemics [66]. It is also worth mentioning that lockdowns had indirect health effects on women, including: a considerably higher rate of caesarean delivery [67], a lack of access to abortion [68] and a concerning increase in gender-based violence [69].…”

Intimate Partner Violence against Women during the COVID-19 Lockdown in Spain

“…This divide could reproduce and even increase inequalities by gender, socioeconomic status, age, and ethnicity—among other social factors influencing the health and social well-being of the population [ 7 ]. IPV constitutes the ultimate expression of gender inequality and also seems to have been aggravated by the current health and social crisis worldwide [ 8 , 9 , 10 ].…”

“…Other measures implemented included transforming tourist accommodation into emergency shelters for women, but this varied according to the specific autonomous community [ 12 ]. The differences in the responses produced, along with the already-known variations in case distributions at a national level [ 9 , 13 ], could have influenced the impact of the SARS-CoV-2 lockdown on IPV incidence.…”