The Croham Hypothesis and Its Relevance for Dissolving the "Gender and Health Paradox"

Marc Luy, Vienna Institute of Demography

Understanding the mechanisms behind inequalities in health is at the heart of the interdisciplinary health research. A major challenge lies in the fact that empirical evidence often disagrees with intrinsic expectations. An example is the so-called "gender and health paradox" which describes the phenomenon that women spend more life years in poor health than men even though they have a higher life expectancy (LE). I argue that such differentials are strongly affected by the cross-sectional association between health and mortality (CroHaM). The CroHaM hypothesis states that the longitudinal health dimension-specific expansion and compression effects exist equivalently in the cross-sectional context, affecting differences in the number of healthy life years between populations and subpopulations with different levels of LE. I apply the CroHaM hypothesis to the "gender paradox" and estimate gender differences in LE and unhealthy life years (ULY) at age 50 for the year 2012 for 30 subgroups of the German population. LEs are estimated with the "Longitudinal Survival Method", using data of the German Life Expectancy Survey. ULY are estimated with the "Sullivan Method" for self-perceived health and global activity limitation which are closer related to mortality, and chronic morbidity with a less strong link to mortality. Data on age-, sex- and subgroup-specific prevalence of these health dimensions is taken from the Actual German Health Study 2012. Finally, gender differences in ULY are decomposed into the effects caused by differences in health and in mortality. Results confirm the CroHaM hypothesis: the extent of the gender gap in ULY depends strongly on the health dimension, being the larger the weaker the considered health dimension is related to mortality. Consequently, most of the women’s disadvantage in health is explained by their advantage in longevity, suggesting that the "gender and health paradox" is not as paradoxical as it might seem.

Presented in Session 1171: Health, Wellbeing, and Morbidity