What global health data reveals about gender lifespan

In a waiting room, two people sit side by side. One has likely seen a doctor sooner, received an earlier diagnosis, and begun treatment on time. The other has more often delayed seeking care, skipped preventive services, and arrived sicker as a result. Which one is which? A new analysis published in PLOS Medicine offers an answer. More often than not, men are the ones showing up late and dying younger, while women are living longer but often with chronic conditions that limit their quality of life.

The study, conducted by an international team of researchers including Alessandro Feraldi (Sapienza University of Rome), Virginia Zarulli (University of Padova), Kent Buse and Sarah Hawkes (Global Health and Monash University Malaysia), and Angela Y. Chang (University of Southern Denmark), investigates one of global health’s most persistent puzzles: how sex and gender shape who gets sick, who gets treated, and who survives.

A health “pathway” for men and women

The researchers introduce a useful way of thinking about illness: what they call the health pathway. Imagine it as a journey, starting with exposure to risks (like smoking or unsafe sex), moving through disease onset (hypertension, diabetes, HIV), passing through the “care cascade” (diagnosis, treatment, and control), and ending with survival, or death.

When they mapped this pathway for men and women across more than 200 countries, the patterns were clear. Men are more likely to pick up risky behaviors (smoking, heavy drinking, drug use) and more likely to die from the diseases they develop, whereas women are more likely to live with risk factors like obesity and face barriers from gender norms, but once in the system, they often receive diagnosis and treatment earlier and stick with care more consistently.

To dig deep, the researchers focused on three conditions where global sex-specific data were available: hypertension (high blood pressure), diabetes, and HIV/AIDS. As far as hypertension, men smoke far more than women almost everywhere, 176 out of 204 countries. Unsurprisingly, men are more likely to die from high blood pressure. Women, on the other hand, are more often obese, particularly in low- and middle-income countries. When it comes to diagnosis and treatment, women generally fare slightly better. For diabetes, the pattern repeats. Men have higher death rates from diabetes in about half the countries studied. Women are more likely to live with obesity, which raises diabetes risk, but paradoxically, once diagnosed, they tend to receive treatment more consistently. Finally, when it comes to HIV and AIDS, the story is more complicated. Globally, men are more likely to acquire HIV through drug use, while women are more affected by unsafe sex. Once infected, women again tend to be diagnosed earlier and stay in care. Men, by contrast, are more likely to die of AIDS-related causes.

Why these differences?

The numbers alone don’t tell the whole story. Behind them lies a mix of biology, social norms, and health system design. First, Biology matters. Male and female bodies process alcohol, fat, and even viruses differently. Second, Social norms matter even more. Ideas about masculinity often discourage men from seeking preventive care, real men don’t need checkups, the cultural script goes. Women, by contrast, often interact more with health systems, especially during pregnancy, which may normalize medical visits. Also, Health systems play a role. Clinics may be open during hours that suit mothers with children, but not men working long shifts. Prevention campaigns often target women and children, leaving men behind.

The end result is what one might call a “double burden” for men: they’re more likely to get sick and more likely to die once sick. Women carry their own burden, living longer but often with chronic conditions that reduce their quality of life.

These findings should inform how we design health policies. Right now, many national health plans are still “gender blind”, they don’t consider that men and women experience illness differently. Also, the study points out that during the COVID-19 pandemic, 91% of national health policies ignored gender entirely. That means governments rolled out strategies without asking how men’s reluctance to seek testing or women’s caregiving roles might affect infection and survival. Ignoring gender differences doesn’t make them go away. It just means our interventions miss the mark.

One of the biggest takeaways from this study is how little reliable information we actually have. For eight major conditions reviewed, only three (hypertension, diabetes, HIV/AIDS) had enough sex-disaggregated data to analyze globally. Think about that: we cannot say with confidence how men and women differ in accessing care for tuberculosis, lung cancer, or depression at a global level. That’s a huge blind spot that prevents research from taking the leap.

The authors argue that we need better, more standardized reporting systems, data that not only separates outcomes by sex but also takes into account gender identity, age, and other factors like income or race. Without this, we’re essentially flying blind.

So what would it look like if health systems took these differences seriously? For men, it would mean more outreach around preventive care, making services accessible outside working hours, and challenging harmful masculinity norms that equate toughness with avoiding doctors. For women, improved health systems should tackle the obesity epidemic with community-led solutions, addressing the social drivers of unsafe sex, and make sure women receive the same quality of care as men when they present with conditions like heart disease. And for all, health systems should collect and publish better data, so policies aren’t based on guesswork but on actual evidence of who is being left behind.

If you’re a man reading this, the data suggests you’re less likely to see a doctor when you should, more likely to smoke, and more likely to die prematurely from preventable disease. If you’re a woman, you may live longer, but with higher rates of obesity and conditions that linger for years. Yes, this is clearly a generalization. But it shows that health is a journey, a pathway. Right now, too many people are falling off at different points along the way. With better data, smarter policies, and a willingness to confront the role of gender head-on, we could make that pathway smoother and longer for everyone.

If you want to learn more, read the original article titled "Sex-disaggregated data along the gendered health pathways: A review and analysis of global data on hypertension, diabetes, HIV, and AIDS" on PLOS Medicine at http://dx.doi.org/10.1371/journal.pmed.1004592.