Men and women age differently

8 World Health • SOth Year, No. 4, July-August 1997 Men and women age differently Astrid Stuckelberger Women everywhere are living longer than men, but the longevity of women is offset by a higher sickness rate than that of men; women suffer more from non-lethal diseases. Throughout this century, health , social and technological ad-vances have been causing an unprecedented demographic and epidemiological transition whose consequences are becoming ever more apparent. In many countries, people are living longer and enjoy- ing better living conditions than ever before, but differences are emerging between various groups, between women and men, and are particu- larly marked in old age. The basic biological differences between the sexes, especially as regards their reproductive role, have ensured a lifetime chronology specific to each sex and this in turn has led to un- equal social conditions in such matters as opportunities in life, literacy, training, marriage, and paid jobs. The longer life-span, the decline in fertility and the growing complex- ity of family life as a result of di- vorce, widowhood and remarriage all add to the disadvantages women suffer in their old age, leading to more precarious lives than those of men. The "feminization" of old age is already advanced in the developed world, and is growi ng even faster in the developing countries. It is caused mainly by the growing proportion and number of women in the popula- tion as a whole, and their longer life expectancy. Current demographic data give a very clear "statistical snapshot" of the ageing population. In this age group, women now constitute the majority in practically every country in the world. In 1995, UN estimates for the population aged 60 and over (almost one-tenth of the world's population) showed 302 million women and 247 million men. In the developed countries, women aged 60 and over represented over 20% of the total female population while the corresponding figure for men was only 16%. Projections suggest this divergence is accelerating at the global level , but is even more rapid in the developing world. This is largely explained by the fact that among people aged 80 years and over, the proportion of women is increasing faster than at lower ages. Today 61 % of the world's women aged over 80 live in developed Differences in the health of men and women become mare marked as they advance in age. Photo HelpAge lnternatianal/N. Cooper© World Health • SOth Yeor, No. 4, July-August 1997 "Feminization " of old age is advancing rapidly worldwide, mainly because the proportion of women to men is on the increase, as well as women 's life expectancy. Photo WHO/) & P Hubley countries; by 2025 , the majority of them will be living in developing countries . Lower mortality rate Calculations of life expectancy at birth and at 65 years show almost everywhere a divergence in favour of women. Worldwide in 1995, the average figure at birth was 67 years for women and 63 years for men. At one extreme is Japan, where women at birth can expect to live on average for over 83 years and men for nearly 77 years; at the other extreme is sub- Saharan Africa where the average figures are 52 years for women and 49 years for men. Women in all age groups have a lower rate of mortality than men for practically all causes of death. In some countries, however, women show a greater death rate at younger ages, which stems from high levels of mortality linked to pregnancy, childbirth and abortion, the precari- ous social status of women, or the advantages given to sons at birth and during child rearing. Whereas the mortality risks for women are princi- pally linked to their reproductive role and their greater susceptibility to certain infections, especially those that are sexually transmitted, those for men relate mainly to high-risk behaviour, especially work-related or traffic accidents, suicide and such lifestyle risks as smoking and drink- ing. The greater longevity of women is offset by a higher sickness rate than that of men. Although men 's unhealthy lifestyles.:... which are known to increase mortality - may arouse great epidemiological interest in future, the greater longevity of women is also a concern, since they are more affected than men by conditions linked to physical and psychological capacity and the need for care as well as social conditions such as widowhood, poverty and isolation. It is very clear that women's lives, especially in old age, are di- verging from those of men every- where in the world and that their status is evolving at quite different speeds in different parts of the world. Two principal trends can be seen. • In the developed countries, where women have greatly improved their social standing and moved towards more equality with men (for instance in literacy, health care, social security and wages) , they are living longer than men and the gap is widening as their social status becomes more equal. • In the developing countries, where women remain deeply disadvantaged in relation to men, with, for instance, high illiteracy rates, poor earning levels, high fertility and high rates of mar- riage between 15 and 19 years of age, their living conditions as they grow older are highly depen- dent on those of their children and grandchildren. 9 The social conditions of women and men and the very concept of the family are rapidly changing through- out the world. Having played tradi- tional roles with very clear-cut rules and raised their children accord- ingly, the elderly are now gradually being confronted - particularly through the media - with the image of quite different roles, especially in the area of "equal opportunities" for men and women. These contrasts must be taken into account in assess- ing the needs and expectations of the elderly. The tendency today is not merely to record the differences between health data by sex but to examine the reasons for these variations and their implications. Using this comparative approach, it may be found that what benefits one sex can be used to bene- fit the other. For example, a clearer understanding of the factors which influence unequal mortality and morbidity as well as those which contribute to or hinder unequal physical, psychological , social and economic well-being will make it possible to take positive measures in favour of the disadvantaged sex. • Dr Astrid Stuckelberger is Deputy Director of the Swiss Research Programme on Ageing at the Swiss National Science Foundation, and a Scientific Collaborator with the University of Geneva. Her address is: Swiss Research Programme on Ageing, 16 Rue Butini, I 202 Geneva, Switzerland. In India, as in most societies today, the respective social roles of men and women are still very di fferentiated. Photo WHO/ A. Stuckelberger