In countries that are more biased against women, higher COVID-19 death rates in men may not tell an accurate story

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Publisher’s Note: Yeva Aleksanyan, Ph.D. Colorado State University economics candidate and Jason Weinman, associate professor of radiology at the University of Colorado Anschutz Medical Campus, wrote this article for The Conversation in February 2022. The State of Colorado is a contributing institution to The Conversation, an independent Collaboration between editors and academics who provide informed news analysis and commentary to the general public. The full list of contributing faculties and their articles can be found here.

Gender norms can affect every aspect of a person’s life, including their health.
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Pandemics and recessions have the potential to exacerbate existing health inequalities between men and women.

Many social factors can put women at higher risk of infection during a pandemic. In almost all societies, women take on the role of the primary caregiver when family members fall ill. They are also more likely to be on the front lines of healthcare.

Despite this increased vulnerability to infection, the Ebola and Zika outbreaks have highlighted that women are more likely to have unequal access to resources and health care, and have limited decision-making powers over their own health and finances.

COVID-19 is no different. We are researchers in the fields of economics and health, and our recent study found that COVID-19 cases and deaths among women may be underreported in countries with higher gender discrimination.

A medical worker wearing a headscarf looks through a drawer of medical supplies in an intensive care unit.
Although women carers are more likely to be exposed to COVID-19, they are less likely to have access to healthcare themselves.
Mazen Mahdi/AFP via Getty Images

Gender differences in COVID-19 rates

To examine the impact of the COVID-19 pandemic on gender health disparities, we analyzed male and female COVID-19 case and death rates in 133 countries from 2020 to 2021. We used data from Global Health 50/50, an organization that tracks COVID-19 cases and deaths by gender worldwide.

We found that most countries, such as the United States, the Netherlands, France, Ukraine, and Armenia, report about the same or slightly higher rates of infection in women. But 14% of the countries we surveyed said over 65% of their COVID-19 cases and deaths were in men. For example, 88% and 85% of confirmed COVID-19 cases in Bahrain and Qatar, respectively, were in men. Similarly, over 74% of all COVID-19 deaths in Chad, Bangladesh, Malawi and Pakistan were men.

But what caused these price differences between countries? We considered both biological factors, such as gender differences in healthy life expectancy and mortality rates from chronic and infectious diseases, and social factors, such as employment rates and gender norms. We assessed gender norms against publicly available indices that measure how countries perform in terms of women’s peace and security, financial inclusion, access to resources, and family household status.

We found that biological differences, which should result in more consistent case and death rates across locations, cannot alone explain these trends. Instead, social factors such as greater gender discrimination within the family and reduced access to wealth and education were significantly associated with larger differences in male and female COVID-19 case and death rates.

Consideration of gender in health

Gender norms play a role in what opportunities and resources are available to different people. Women often fall through the cracks in the healthcare system because of gender bias and their poorer socioeconomic status. In many developing countries, women resort to informal, unlicensed health care providers and inexpensive medicines, while men spend more of the family’s resources on their own health needs. And in some parts of the world, a woman’s husband or father must give her consent before she can receive medical treatment.

When women have less independence and decision-making power over their lives, they have to rely on their family members for access to health care. In societies where women are devalued and lack decision-making power, a household may prioritize its resources on COVID-19 testing and hospitalization for men. Therefore, we hypothesize that countries report more male COVID-19 cases and deaths because female cases and deaths go unreported.

Parent and child walk together holding hands under an umbrella.
In some families, men’s health takes precedence over women.
Xinhua News Agency via Getty Images

This underreporting extends to other areas as well. For example, our data source excludes transgender and non-binary people. And country-level data on gender disparities in access to healthcare for other diseases and treatments are also unavailable. The European office of the World Health Organization has urged countries to collect gender data through their health information systems. Although efforts have been made to improve data collection in healthcare systems worldwide, collecting reliable data remains a challenge.

Although our results show a strong association between gender norms and COVID-19 health disparities, they do not prove causality like a controlled experiment would. However, such studies are not possible during a pandemic. And results may vary regionally due to cultural and social differences. For example, a recent study found that more men die from COVID-19 than women in the United States because they are less likely to adhere to masks and social distancing guidelines.

Despite these limitations, it is clear that social factors play a role in health outcomes from COVID-19. Ignoring gender bias in healthcare can serve to exacerbate long-standing inequalities that existed before the pandemic.

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This article was republished by The Conversation under a Creative Commons license. Read the original article.

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