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Gender health gap study reveals ‘stark’ differences between men and women
The health differences between men and women grow with age, researchers have found
Women live longer than men but experience more years in poor health, a global gender health gap analysis has shown, underscoring the need for gender-responsive approaches to health.
The study, published in the Lancet Public Health journal, found that globally, there are substantial differences between men and women when it comes to health, with limited progress in bridging these health gaps over the past 30 years.
Non-fatal conditions that lead to health loss through illness and disability, including musculoskeletal conditions, mental health conditions and headache disorders, particularly affect women globally, the research suggested, while men are disproportionally affected by conditions that cause premature death, such as COVID-19, cardiovascular diseases and respiratory and liver diseases.
The health differences between men and women, however, continue to grow with age, leaving women with higher levels of illness and disability throughout their lives, as they tend to live longer than men.
“This report clearly shows that over the past 30 years global progress on health has been uneven,” said senior author, Dr Luisa Sorio Flor, at the Institute for Health Metrics and Evaluation (IHME), University of Washington.
“Females have longer lives but live more years in poor health, with limited progress made in reducing the burden of conditions leading to illness and disability, underscoring the urgent need for greater attention to non-fatal consequences that limit women’s physical and mental function.
“Similarly, males are experiencing a much higher and growing burden of disease with fatal consequences.
“This kind of critical, comparable and comprehensive research is important, both to understand the magnitude and distribution of the diverse and evolving health needs of females and males around the world and to identify key opportunities for health gain at all stages of life.”
The study is also a call for countries to boost their reporting of sex and gender data, said Sorio Flor.
“The timing is right for this study and call to action – not only because of where the evidence is now, but because COVID-19 has starkly reminded us that sex differences can profoundly impact health outcomes.
“One key point the study highlights is how females and males differ in many biological and social factors that fluctuate and, sometimes, accumulate over time, resulting in them experiencing health and disease differently at each stage of life and across world regions.
“The challenge now is to design, implement and evaluate sex- and gender-informed ways of preventing and treating the major causes of morbidity and premature mortality from an early age and across diverse populations.”
The study looked at the disparities in the 20 leading causes of illness and death between men and women, across ages and regions.
The modelling research used data from the Global Burden of Disease Study 2021, and did not include sex-specific health conditions, such as gynaecological conditions or prostate cancers.
The analysis estimated that for 13 out of the top 20 causes of illness and death, including COVID-19, road injuries and a range of heart, respiratory and liver diseases, the rate was higher in men than women in 2021.
Among the conditions evaluated, the study suggested the biggest contributors to health loss globally disadvantaging women are low back pain, depressive disorders, headache disorders, anxiety disorders, other musculoskeletal disorders, Alzheimer’s disease and other dementias, and HIV/AIDS.
These conditions predominantly contribute to illness and disability throughout life as opposed to leading to premature death, the research found.
For conditions with the greatest gap disadvantaging women, such as mental health conditions and musculoskeletal disorders, the differences in health loss between men and women begin early in life and continue to intensify with age, the findings also showed.
“Large causes of health loss in women, particularly musculoskeletal disorders and mental health conditions, have not received the attention that they deserve”, said co-lead author Gabriela Gil from IHME.
“It’s clear that women’s healthcare needs to extend well beyond areas that health systems and research funding have prioritized to date, such as sexual and reproductive concerns.”
She added: “Conditions that disproportionately impact females in all world regions, such as depressive disorders, are significantly underfunded compared with the massive burden they exert, with only a small proportion of government health expenditure globally earmarked for mental health conditions.
“Future health system planning must encompass the full spectrum of issues affecting females throughout their lives, especially given the higher level of disability they endure and the growing ratio of females to males in ageing populations.”
The global differences in health loss between men and women have been largely consistent for the past 30 years, but for some diseases, such as diabetes, the differences have grown, researchers found.
At the same time, there has been a disproportionate rise in global health loss caused by depressive disorders, anxiety, and some musculoskeletal disorders disadvantaging women.
The authors stressed that the health differences identified begin to emerge in adolescence, coinciding with a critical time when gender norms and attitudes intensify and puberty reshapes self-perceptions.
This pattern, they said, underscores the need for targeted responses from an early age to prevent the onset and exacerbation of health conditions and for adopting a life course approach when planning for health systems so that they are well-equipped to handle the needs of the populations they serve.
Dr Vedavati Patwardhan from the University of California, San Diego, said: “Our analysis highlights the need for targeted policies and planning to address the health needs of diverse populations.
“Without granular insights on risk behaviours, social dynamics, economic conditions and access to health care for all people in various parts of the world, the systemic barriers that sustain health inequities will remain.”
Australia’s drug advisory committee has recommended wider funding of triptorelin for women with breast cancer or endometriosis.
The recommendation comes after AstraZeneca announced plans to remove Zoladex from the market, risking leaving more than 7,500 women with breast cancer without an alternative treatment.
Both medicines block the release of oestrogen and testosterone and can be used as part of treatment, or for fertility preservation, in some forms of cancer.
The Pharmaceutical Benefits Advisory Committee met urgently in July and recommended making triptorelin unrestricted under the Pharmaceutical Benefits Scheme (PBS), which would mean it was funded for all uses.
The drug has been listed on the PBS for prostate cancer since 2006.
Triptorelin and Zoladex can also be used to treat endometriosis and to block puberty for either precocious puberty or gender-affirming care.
Vicki Durston, director of policy and advocacy at Breast Cancer Network Australia, described the recommendation as “a significant step forward” and said access to the medicine could mean the difference between life and death for some patients.
She said some women had already chosen to have their ovaries removed because of uncertainty over Zoladex supplies.
Marilla Druitt, Victorian state chair of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said it remained unclear whether triptorelin would work exactly the same way as Zoladex, but the recommendation was likely to be positive for patients with endometriosis and pelvic pain.
She said: “I’m glad we’ve got an alternative.”
“That’s fantastic, and it remains to be seen whether or not it will be as good, but pain is so complex, pain is a really hard thing to study because it’s got so many contributors.”
Druitt said further research would be needed after the medicine was introduced.
If accepted by the federal government, the recommendation would also allow PBS funding of triptorelin for puberty suppression in precocious puberty and gender-affirming care.
This would make gender-affirming care federally funded through the PBS for the first time and would remove a financial barrier for transgender children in Queensland and the Northern Territory.
Stuart Aitken, medical director of Gender Health Australia, said the recommendation had sparked “absolute joy” among his patients.
He said: “It takes away a huge barrier to accessing evidence-based care.”
“It means that the ban has a very limited effect.”
By Women’s HealthX
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Sahar Abid is a Science Associate at Ema EQ, where she works on cultural sensitivity and bias in AI.
A woman asks an AI health assistant about postpartum depression.
She mentions that her in-laws are telling her to “push through” and skip medical help, even as her symptoms get harder to manage. She never says where she is from or names her background.
The assistant describes the condition and gives her a hotline number. It sounds correct, but it misses what she needs.
That gap is more common than the industry admits, and it points to a blind spot in how we test health AI for bias.
Most bias testing looks at what people explicitly say.
The typical way to check an AI for bias is to label a prompt with someone’s demographic details and see if the answer changes. That catches some problems but misses a bigger one.
Most people do not lead with their identity. They lead with their situation. The woman above told the assistant everything it needed to help her, just not in the form of a label.
Her real question was not only “what is postpartum depression?” It was “how do I get care when the people around me don’t want me to?
When family members hold sway over health decisions, and in many communities they do, advice that asks someone to overrule their family is not something they can act on.
The AI didn’t say anything factually wrong. It answered a different question than the one she was living.
We call this culturally implicit bias, meaning the AI misses the cultural context a situation implies rather than the context a person spells out.
When systems are trained to notice only the explicit cues, they fall back on a default answer built for the majority. For everyone else, the response can feel generic, off-target, or discouraging enough that they stop looking for help.
In health, that is not small. The people most likely to be missed are often the ones the system already underserves.
What we set out to test.
At Ema, we wanted to know how well AI picks up on cultural context that is implied but never stated. So we built our own way to test for it, across a range of communities and real situations like postpartum depression and fertility, using questions that carried cultural meaning without announcing it.
The patterns were consistent. Models often missed the meaning underneath the question. They dropped the specific details a person did share and smoothed them into something generic.
And even when they pointed toward real care, they tended to offer one option instead of choices that might actually fit a person’s life. Any one of those can be the difference between someone following the advice and walking away from care.
Why this matters for anyone building health AI.
Getting this right is the right thing to do, and it also works better.
When an answer reflects a person’s real context, people trust and act on the recommendations more, so they get the help and support they need.
Testing for it is harder than the shortcut most teams use. Swapping a name or a demographic label in and out is easy. Checking whether a model actually understands the human context around a question takes more care.
The shortcut teaches models to perform cultural competence instead of practicing it. No matter how much or how little someone chooses to share, they deserve an answer that is warm, complete, and usable.
A better question.
The bar for equitable health AI should be “does it serve someone who never told you who they are?” It is the harder test, but it determines whether real people get help.
The work of getting there is far from finished, and it is exactly what we are building toward at Ema.
Sources: Naidoo, V., & Chadha, K. K. (2025), Culturally responsive AI chatbots: from framework to field evidence, Computers in Human Behavior: Artificial Humans. Souligne, N., & Subbian, V. (2026), FairLogue: A toolkit for intersectional fairness analysis in clinical machine learning models.
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