PRB

(June 2009) Men and women face distinct challenges in late life. Paradoxically, men tend to have shorter lives but women have more health problems at any given age. In other words, women have lower mortality but higher morbidity than men. Addressing why women live longer but have more health problems and why men die earlier can help reduce health care and long-term care costs for the elderly and narrow the gender health gap.

“Gender Differences in Functional Health and Mortality Among the Chinese Elderly,” by Toshiko Kaneda, Population Reference Bureau; Zachary Zimmer, University of Utah; and Xianghua Fang and Zhe Tang, Capital Medical University (published in Research on Aging in May 2009), examines a sample of older adults in Beijing to determine gender differences in health and mortality after a five-year period. The authors studied 1992 and 1997 data from the Capital Medical University, using a representative survey of older adults in three districts in Beijing selected on the basis of their ability to represent varied socioeconomic, demographic, and geographical characteristics.

The Aging of China and Local Context

China has one of the fastest-aging populations in the world. According to Toshiko Kaneda, the proportion of China’s population that is elderly will triple by 2050, from 8 percent to 24 percent of the population. “There may be no other country in the world where the aging of the population is as consequential as China,” says Kaneda, “and Beijing represents a kind of microcosm of the country. It is one of the most rapidly developing areas of the country and has a population that is greater than two-thirds of the world’s countries.” The policy implications are immense for long-term care and demands on public expenditures and families.

One of the study’s findings is that although some factors are consistent across geography, the local context of social norms, culture, and political factors is important for determining men and women’s vulnerability to social risk factors. Some findings were consistent with previous research on gender differences in late life health in North America and Europe, while others were unique to China. For instance, earlier research from the West suggests that elderly women benefit from frequent and intense social support and care. However, in China, social support brought little health benefit. Education also had a surprising effect on health in China. The researchers found, as expected, that a lack of formal education was associated with higher health risks for women. But they found that a lack of education was associated with a greater mortality risk for men than for women. Zachary Zimmer speculated that “…in a society with…a male-dominated culture based on Confucian teachings, as in China, men without formal education have particularly low status, which in turn may have some influence on health.”

Exposure vs. Vulnerability

Are gender differences in health a result of different levels of contact with risk factors, or are they a result of different reactions to the same risk factors? In other words, is the relative health of older women and men determined by exposure or vulnerability to risk factors? This question has been largely unanswered and few studies have examined the relative importance of the exposure and vulnerability hypotheses.

Although the levels of exposure to risk play a role, the study lends more support for the vulnerability hypothesis. The data on older Beijing residents over a five-year period indicate that men are more likely to die earlier and women are more likely to be dependent later in life largely because of the different ways in which men and women are affected by the same risk factors. What kind of risks do men and women face? “Women tend to be disadvantaged when it comes to things like education and other socioeconomic factors,” says Zimmer. “They are also disadvantaged with respect to some psychological factors like feelings of control over their life, or what is often called locus of control. Men are disadvantaged in behaviors, like smoking, and also social support.”

While exposure to various risks and how this affects health is easy to identify, gauging why vulnerability to risk factors differs among men and women is more difficult. The authors looked at a range of data on potential social risk factors ranging from socioeconomic status, health care access, health behaviors, social support, and psychological characteristics.

Conclusion

Biological and genetic factors partially account for differences in late life health. However, the specific social environment one lives in significantly affects late-life health, which means that programs and policies can affect the well-being of the elderly and reduce the health gap between men and women in their later years. While this study sheds light on how men and women are affected differently by the same social risk factors, more research into the causes and factors of gender differences in late life health and mortality is needed. “Older adults are the fastest growing segment of the population throughout the [developed and developing] world,” says Kaneda. “The costs associated with this increase in older adults are going to be enormous and have huge implications for both [developed and developing countries], but the impact may be felt more in developing countries that overall have fewer resources to deal with an aging situation.”

Eric Zuehlke is an editor at the Population Reference Bureau.