Health, women live longer but in worse conditions

Despite the greater longevity of women, men have more years to live in good health: in 2023 healthy life expectancy at birth is 60.5 years for men and 57.9 for women. In addition, the higher survival rate among women results in a longer period for them to live without good health (about 27 years for women and about 20 for men).

In terms of mental health, it is still women who fare worse, along with the very young. The gap with the score for men is 4.3 points in 2023, up from 3.7 points in 2019. The psychological well-being index has its negative peaks in the 14-24 age group, then starts to decrease after the age of 45. The gender difference to the disadvantage of women is observed at all ages.

These are the data, but what is the reason for this gender gap in health status?

In the early 1990s, cardiologist and researcher Bernardine Patricia Healy asked the medical community: "Do women have to dress like men in order to be treated by doctors?" When she became director of the US National Institutes of Health (NIH), she began to bring to light how scientific research was only conducted on men and male animals. She noticed how women were clinically subjected to far fewer diagnostic and therapeutic procedures than men and reported her thoughts in an editorial entitled 'Yentl's Syndrome', where Yentl is the name of the heroine of a 19th century poem who had to dress as a man in order to attend rabbinical school. This editorial is traced back to the beginning of the reflections on 'gender medicine'.

There is undoubtedly at the root of this typically female neglect a sense of ineffectiveness, of unfulfilled listening, an idea of inadequate medicalisation that finds its greatest expression in the delivery room, for example. Obstetrical violence is increasingly denounced, but the entire medical system around pregnancy and childbirth seems to place very little value on women's biological experience in favour of protocols and procedures, which often result in trauma, discomfort and fears that compromise the bonds of care.

In episode 11 of the podcast 'Parents', curated by Francesca Barra for storielibere.fm, philosopher specialising in Infant Mental Health Cecilia Antolini says: "Maybe the point is to stop saying that when you're not well 'it's normal'. We teach this to our daughters from the first menstruation. Do you have a headache? That's normal. Do you have a bellyache? That is normal. No! There is nothing normal about being very sick. It is normal to go through challenges, it is normal in those challenges to seek help, but we cannot expect women to learn to ask for help when all their lives they have learned that help should not be asked for'.

The idea of sacrifice and the endurance of all pain has been inherent in women for generations, for a purely cultural and not biological factor. All the more accentuated and evident when there is also a caring responsibility on the woman. Let us take the case of the family carers, those that the Istituto Superiore di Sanità defines as 'persons who assist and take care, continuously and free of charge, of one of their family members who is not self-sufficient or has invalidating chronic pathologies'. Almost three million people, mostly women and especially mothers. Bureaucracy and the burden of care work on them, in addition to severely limiting their access to work, very often forces them to neglect not only their social life, but also their health.

"There is a lack of disaggregated data that allows us to delve into the health conditions of mothers once they have left the perinatal phase," write Monica D'Ascenzo and Manuela Perrone in 'Mamme d'Italia', ed. Sole24Ore. 'We cannot know exactly how they are, whether they fall ill more and of what compared to childless women. We do know that they often seem to have inexhaustible physical energy, but several studies have underlined how much different stress factors and, ultimately, the burden of caring for others affect them. Taking care of oneself, when the myth of motherhood is so strong, seems to disappear from the priorities'.

In addition to all the cultural interpretations of the lack of access to care for women, there is also the alarming data of the latest Censis report 'Hospitals and Health', promoted by Aiop, the Italian Association of Hospital and Territorial Healthcare Companies and Social and Residential Healthcare Companies under private law. The report reveals the fragility of a system incapable of containing the time needed to book services. For 53.5 per cent of Italians, the waiting time is excessively long compared to the urgency of their clinical condition, while 37.4 per cent report the presence of blocked or closed lists, despite the fact that they are formally prohibited.

Increasingly, people are turning to paid healthcare in order to be able to count on faster services: we are talking about 34.4 per cent of the lowest income earners, 40.2 per cent of the lower-middle income earners, and 43.6 per cent of the upper-middle income earners are turning to paid healthcare. But in fact, then a segment of the population often ends up procrastinating or forgoing treatment. If in the region of Lombardy an eye examination takes about 11 months to complete, an unaided mother must hope that on that very day her son or daughter does not catch a fever or some other ailment. Of course, it is always the weakest and most exposed groups who pay the price for an inefficient system: by census, by gender, by burden of care.