There are mainly three explanatory approaches for gender differences in health: biological, methodological, and social explanations. While biological explanations focus on the role of sex hormones and other differences in physiological systems, methodological explanations assume that women are more likely to seek medical advice, report health problems in interview situations, and report differentially when seeking help (Acciai and Hardy
2017). Studies that empirically test such claims are scarce and the few existing studies focusing on well-being and depression provided no evidence supporting this hypothesis (Acciai and Hardy
2017; Oksuzyan et al.
2019). Furthermore, gender stereotypes might influence the practice of medical diagnosis and the expression of symptoms by women and men (Sen et al.
2002). It has also been argued that men tend to use health services less frequently than women, possibly resulting in an underdiagnosis of certain diseases. However, it has been shown that gender differences in doctor consultations are attenuated or even reversed when overall health or the severity of health conditions is considered (Roy and Chaudhuri
2012; Courtenay
2000).
Social explanations highlight the importance of social determinants of health—i.e. the conditions in which people are born, grow, live, work, and age. One key social determinant of health is
gender, that is, ‘the socially constructed roles, behaviour, activities, and attributes that a particular society considers appropriate for men and women’ (WHO
2019). Gender roles affect the way women and men engage in education, the labour market, domestic and care work, and health behaviours (Loretto and Vickerstaff
2015; Courtenay
2000; Haberkern et al.
2015). Additionally, they affect the design of formal institutions and policies, constraining or incentivising individuals’ choices throughout the life course (Bonsang et al.
2017; Bird and Rieker
2008). Social explanations for gender inequalities in health stress the relevance of
health behaviours, such as tobacco and alcohol consumption, dietary habits, physical activity, and healthcare utilisation (Oksuzyan et al.
2010; Mahalik et al.
2007; Luy
2003),
socio-
economic factors, such as financial resources and working conditions (Read and Gorman
2011), and
psychosocial factors, such as critical life events, social network characteristics, and coping styles (Thoits
2011; Lachman et al.
2011). From this point of view, gender differences in health arise from a gendered access to protective resources (e.g. education, income, and social support) and a differential exposure to health risks (e.g. occupational hazards, family responsibilities like caring for older relatives, and unhealthy behaviours).
Recent studies have revealed considerable differences between European societies regarding gendered patterns of family responsibilities (Schmid et al.
2012; Brandt
2013) and labour market participation (Cipollone et al.
2012; Edge et al.
2017) so that country differences in the gender health gap come with little surprise. Further, gender differences in health promoting resources and health risks do not only vary depending on the country context, but are also likely to differ between age groups and people of different birth cohorts. Thus, separate analyses by age groups are necessary—also because aggregated data over all age groups would bias results towards younger ages due to their typically greater number of cases. Still, most studies on gender differences in health do not differentiate between age groups so that between-age-group variation remains hidden. Our study provides an analysis of the gender health gap in old age for several generic health indicators and more specific morbidity outcomes. We compare the health status of women and men between 16 European countries stratified by age both unadjusted and adjusted for relevant socio-demographic characteristics.