Tag: quality of life

Gender Gap in Life Expectancy and Its Socio-Economic Implications

Posted on October 1, 2024 | FROGEE Brief, Policy Brief

Silhouetted crowd of people walking in a public square, symbolizing societal impacts of the gender gap in life expectancy.

Today women live longer than men virtually in every country of the world. Although scientists still struggle to fully explain this disparity, the most prominent sources of this gender inequality are biological and behavioral. From an evolutionary point of view, female longevity was more advantageous for offspring survival. This resulted in a higher frequency of non-fatal diseases among women and in a later onset of fatal conditions. The observed high variation in the longevity gap across countries, however, points towards an important role of social and behavioral arguments. These include higher consumption of alcohol, tobacco, and fats among men as well as a generally riskier behavior. The gender gap in life expectancy often reaches 6-12 percent of the average human lifespan and has remained stubbornly stable in many countries. Lower life expectancy among men is an important social concern on its own and has significant consequences for the well-being of their surviving partners and the economy as a whole. It is an important, yet under-discussed type of gender inequality.

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Gender Gap in Life Expectancy and Its Socio-Economic Implications

Today, women on average live longer than men across the globe. Despite the universality of this basic qualitative fact, the gender gap in life expectancy (GGLE) varies a lot across countries (as well as over time) and scientists have only a limited understanding of the causes of this variation (Rochelle et al., 2015). Regardless of the reasons for this discrepancy, it has sizable economic and financial implications. Abnormal male mortality makes a dent in the labour force in nations where GGLE happens to be the highest, while at the same time, large GGLE might contribute to a divergence in male and female discount factors with implications for employment and pension savings. Large discrepancies in life expectancy translate into a higher incidence of widowhood and a longer time in which women live as widows. The gender gap in life expectancy is one of the less frequently discussed dimensions of gender inequality, and while it clearly has negative implications for men, lower male longevity has also substantial negative consequences for women and society as a whole.

Figure A. Gender gap in life expectancy across selected countries

Source: World Bank.

The earliest available reliable data on the relative longevity of men and women shows that the gender gap in life expectancy is not a new phenomenon. In the middle of the 19th century, women in Scandinavian countries outlived men by 3-5 years (Rochelle et al., 2015), and Bavarian nuns enjoyed an additional 1.1 years of life, relative to the monks (Luy, 2003). At the beginning of the 20th century, relative higher female longevity became universal as women started to live longer than men in almost every country (Barford et al., 2006). GGLE appears to be a complex phenomenon with no single factor able to fully explain it. Scientists from various fields such as anthropology, evolutionary biology, genetics, medical science, and economics have made numerous attempts to study the mechanisms behind this gender disparity. Their discoveries typically fall into one of two groups: biological and behavioural. Noteworthy, GGLE seems to be fairly unrelated to the basic economic fundamentals such as GDP per capita which in turn has a strong association with the level of healthcare, overall life expectancy, and human development index (Rochelle et al., 2015). Figure B presents the (lack of) association between GDP per capita and GGLE in a cross-section of countries. The data shows large heterogeneity, especially at low-income levels, and virtually no association from middle-level GDP per capita onwards.

Figure B. Association between gender gap in life expectancy and GDP per capita

Source: World Bank.

Biological Factors

The main intuition behind female superior longevity provided by evolutionary biologists is based on the idea that the offspring’s survival rates disproportionally benefited from the presence of their mothers and grandmothers. The female hormone estrogen is known to lower the risks of cardiovascular disease. Women also have a better immune system which helps them avoid a number of life-threatening diseases, while also making them more likely to suffer from (non-fatal) autoimmune diseases (Schünemann et al., 2017). The basic genetic advantage of females comes from the mere fact of them having two X chromosomes and thus avoiding a number of diseases stemming from Y chromosome defects (Holden, 1987; Austad, 2006; Oksuzyan et al., 2008).

Despite a number of biological factors contributing to female longevity, it is well known that, on average, women have poorer health than men at the same age. This counterintuitive phenomenon is called the morbidity-mortality paradox (Kulminski et al., 2008). Figure C shows the estimated cumulative health deficits for both genders and their average life expectancies in the Canadian population, based on a study by Schünemann et al. (2017). It shows that at any age, women tend to have poorer health yet lower mortality rates than men. This paradox can be explained by two factors: women tend to suffer more from non-fatal diseases, and the onset of fatal diseases occurs later in life for women compared to men.

Figure C. Health deficits and life expectancy for Canadian men and women

Source: Schünemann et al. (2017). Note: Men: solid line; Women: dashed line; Circles: life expectancy at age 20.

Behavioural Factors

Given the large variation in GGLE, biological factors clearly cannot be the only driving force. Worldwide, men are three times more likely to die from road traffic injuries and two times more likely to drown than women (WHO, 2002). According to the World Health Organization (WHO), the average ratio of male-to-female completed suicides among the 183 surveyed countries is 3.78 (WHO, 2024). Schünemann et al. (2017) find that differences in behaviour can explain 3.2 out of 4.6 years of GGLE observed on average in developed countries. Statistics clearly show that men engage in unhealthy behaviours such as smoking and alcohol consumption much more often than women (Rochelle et al., 2015). Men are also more likely to be obese. Alcohol consumption plays a special role among behavioural contributors to the GGLE. A study based on data from 30 European countries found that alcohol consumption accounted for 10 to 20 percent of GGLE in Western Europe and for 20 to 30 percent in Eastern Europe (McCartney et al., 2011). Another group of authors has focused their research on Central and Eastern European countries between 1965 and 2012. They have estimated that throughout that time period between 15 and 19 percent of the GGLE can be attributed to alcohol (Trias-Llimós & Janssen, 2018). On the other hand, tobacco is estimated to be responsible for up to 30 percent and 20 percent of the gender gap in mortality in Eastern Europe and the rest of Europe, respectively (McCartney et al., 2011).

Another factor potentially decreasing male longevity is participation in risk-taking activities stemming from extreme events such as wars and military activities, high-risk jobs, and seemingly unnecessary health-hazardous actions. However, to the best of our knowledge, there is no rigorous research quantifying the contribution of these factors to the reduced male longevity. It is also plausible that the relative importance of these factors varies substantially by country and historical period.

Gender inequality and social gender norms also negatively affect men. Although women suffer from depression more frequently than men (Albert, 2015; Kuehner, 2017), it is men who commit most suicides. One study finds that men with lower masculinity (measured with a range of questions on social norms and gender role orientation) are less likely to suffer from coronary heart disease (Hunt et al., 2007). Finally, evidence shows that men are less likely to utilize medical care when facing the same health conditions as women and that they are also less likely to conduct regular medical check-ups (Trias-Llimós & Janssen, 2018).

It is possible to hypothesize that behavioural factors of premature male deaths may also be seen as biological ones with, for example, risky behaviour being somehow coded in male DNA. But this hypothesis may have only very limited truth to it as we observe how male longevity and GGLE vary between countries and even within countries over relatively short periods of time.

Economic Implications

Premature male mortality decreases the total labour force of one of the world leaders in GGLE, Belarus, by at least 4 percent (author’s own calculation, based on WHO data). Similar numbers for other developed nations range from 1 to 3 percent. Premature mortality, on average, costs European countries 1.2 percent of GDP, with 70 percent of these losses attributable to male excess mortality. If male premature mortality could be avoided, Sweden would gain 0.3 percent of GDP, Poland would gain 1.7 percent of GDP, while Latvia and Lithuania – countries with the highest GGLE in the EU – would each gain around 2.3 percent of GDP (Łyszczarz, 2019). Large disparities in the expected longevity also mean that women should anticipate longer post-retirement lives. Combined with the gender employment and pay gap, this implies that either women need to devote a larger percentage of their earnings to retirement savings or retirement systems need to include provisions to secure material support for surviving spouses. Since in most of the retirement systems the value of pensions is calculated using average, not gender-specific, life expectancy, the ensuing differences may result in a perception that men are not getting their fair share from accumulated contributions.

Policy Recommendations

To successfully limit the extent of the GGLE and to effectively address its consequences, more research is needed in the area of differential gender mortality. In the medical research dimension, it is noteworthy that, historically, women have been under-represented in recruitment into clinical trials, reporting of gender-disaggregated data in research has been low, and a larger amount of research funding has been allocated to “male diseases” (Holdcroft, 2007; Mirin, 2021). At the same time, the missing link research-wise is the peculiar discrepancy between a likely better understanding of male body and health and the poorer utilization of this knowledge.

The existing literature suggests several possible interventions that may substantially reduce premature male mortality. Among the top preventable behavioural factors are smoking and excessive alcohol consumption. Many studies point out substantial country differences in the contribution of these two factors to GGLE (McCartney, 2011), which might indicate that gender differences in alcohol and nicotine abuse may be amplified by the prevailing gender roles in a given society (Wilsnack et al., 2000). Since the other key factors impairing male longevity are stress and risky behaviour, it seems that a broader societal change away from the traditional gender norms is needed. As country differences in GGLE suggest, higher male mortality is mainly driven by behaviours often influenced by societies and policies. This gives hope that higher male mortality could be reduced as we move towards greater gender equality, and give more support to risk-reducing policies.

While the fundamental biological differences contributing to the GGLE cannot be changed, special attention should be devoted to improving healthcare utilization among men and to increasingly including the effects of sex and gender in medical research on health and disease (Holdcoft, 2007; Mirin, 2021; McGregor et al., 2016, Regitz-Zagrosek & Seeland, 2012).

References

About FROGEE Policy Briefs

FROGEE Policy Briefs is a special series aimed at providing overviews and the popularization of economic research related to gender equality issues. Debates around policies related to gender equality are often highly politicized. We believe that using arguments derived from the most up to date research-based knowledge would help us build a more fruitful discussion of policy proposals and in the end achieve better outcomes.

The aim of the briefs is to improve the understanding of research-based arguments and their implications, by covering the key theories and the most important findings in areas of special interest to the current debate. The briefs start with short general overviews of a given theme, which are followed by a presentation of country-specific contexts, specific policy challenges, implemented reforms and a discussion of other policy options.

Disclaimer: Opinions expressed in policy briefs and other publications are those of the authors; they do not necessarily reflect those of the FREE Network and its research institutes.

Alcohol-Related Costs and Potential Gains from Prevention Measures in Latvia

Posted on February 26, 2024 | Policy Brief

20240226 Alcohol Prevention Measures Image 01

Latvia has the highest per capita registered alcohol consumption rate among EU and OECD countries (OECD, 2024). In this brief, we show that the total budgetary (direct) and non-budgetary (indirect) costs associated with alcohol consumption in Latvia in 2021 amounted to 1.3–1.8 percent of the GDP. Non-financial costs from alcohol abuse amounted to a loss of nearly 90 thousand years spent in good health and with a good quality of life. We assess the potential effects of five alcohol misuse prevention measures, all recognized by the World Health Organization (WHO) as effective in reducing harmful alcohol consumption – especially when implemented together. Our analysis focuses on the individual effects of each measure and shows that raising the minimum legal age for alcohol purchases and enforcing restrictions on alcohol advertising and marketing are likely to yield the largest reductions in alcohol-related costs, although these effects will take time to fully materialize.

Introduction

Alcohol consumption is an important risk factor for morbidity and premature death worldwide. It is associated with over 200 diagnoses recorded in the International Statistical Classification of Diseases and Related Health Problems (CDC, 2021), including liver diseases, injuries, malignancies, and diseases of the heart and circulatory system (WHO, 2018). Alcohol consumption at any level is considered unsafe (Burton & Sheron, 2018).

Globally, an average of 3 million people die each year due to alcohol-related harm, accounting for 5.3 percent of all deaths (Shield et al., 2020). In 2019, alcohol consumption was the main risk factor for disease burden in people between 25 and 49 years of age and the second most important risk factor in people aged 10-24 years (GDB, 2019).

Alcohol use is associated not only with health problems but also with social issues, posing risks to people’s safety and well-being. It causes harm not only to the individual but also to family members and society at large (Rehm & Hingson, 2013). Various sectors, including health, justice, home affairs, and social care agencies, are involved in preventing the consequences of alcohol misuse and reducing the harm this causes. This demonstrates the multiple negative impacts of alcohol use on public health and well-being (Flynn & Wells, 2013).

Latvia has the highest per capita registered alcohol consumption rate among the EU and OECD countries (OECD, 2024), and no clear trend of declining levels has been observed in recent years. Moreover, the consumption of spirits, which can potentially cause more harm than other alcoholic beverages (Mäkelä et al., 2011), is steadily increasing. According to WHO data (WHO, 2024), the high per capita consumption of registered absolute alcohol in Latvia, compared to other countries, is largely due to the consumption of spirits. In Latvia, the share of spirits in total consumption is around 40 percent. By comparison, in the Czech Republic and Austria, where total per capita alcohol consumption is similar to Latvian levels, spirits account for only 25 and 16 percent of total consumption, respectively, while the proportions of beer and wine are higher.

This policy brief reports the estimated costs related to alcohol use in Latvia in 2021, based on the study Alcohol Use, its Consequences, and the Economic Benefits of Prevention Measures (Pļuta et al., 2023). It also provides an overview of the expected benefits from implementing preventive measures, such as raising the minimum legal age for buying alcohol and restricting alcohol advertisements.

Costs of Alcohol Use in Latvia

We estimate three types of costs associated with alcohol consumption:

  • Direct costs: These include budgetary costs related to alcohol consumption, such as healthcare, law enforcement and social assistance costs, as well as expenses for public education.
  • Indirect costs: These costs represent unproduced output in the economy and arise from the premature deaths of alcohol users, as well as their reduced employment or lower productivity.
  • Non-financial welfare costs: This type of cost arises from the compromised quality of life of alcohol users, their families, and friends.

We estimate direct costs by utilizing detailed disaggregated data on alcohol-related budget costs in the healthcare sector, law enforcement institutions (including police, courts, and prisons), costs of public education (e.g., educating schoolchildren about the consequences of alcohol consumption), costs of awareness-raising campaigns, and social assistance costs. For cost categories that are only partially attributable to alcohol consumption, we classify only a fraction of these costs as attributable to alcohol use (e.g., liver cirrhosis is attributable to alcohol usage in 69.8 percent of the cases, so only this fraction of the budget costs on compensated medicaments is attributable to alcohol use). To estimate social assistance costs, including public expenditure on social services, sobering-up facilities, social care centres, orphanages, and specialized care facilities for children and out-of-family care, we conduct a survey among social assistance providers.

To estimate non-budgetary costs, we construct a counterfactual scenario where alcohol is not being overly consumed, ensuring higher productivity, a lower rate of unemployment, and lower mortality within the labour force. Finally, non-financial welfare costs are estimated by measuring the reduction in quality of life or QALYs lost (quality-adjusted-life-years) (for details, see the methodology section in Pļuta et al. (2023)).

The total direct and indirect costs of alcohol abuse in 2021 amounted to 1.3–1.8 percent of Latvia’s GDP. In comparison, revenues from the excise tax on alcoholic beverages in 2021 accounted for 0.7 percent of the GDP.

Direct costs, which entail expenses directly covered by the state budget, comprised 0.45 percent of the GDP. Among these costs, healthcare expenses were the largest component, constituting 37.8 percent  of total direct costs and 2.7 percent of general government spending on healthcare. Nearly half of these healthcare costs were attributed to the provision of inpatient hospital treatment for patients diagnosed with alcohol-related conditions. Another significant component of budgetary costs is associated with addressing alcohol abuse and combating illicit trade through law enforcement, accounting for 31.9 percent of total direct costs and 6.5 percent of general government spending on public order and safety.

Alcohol-related indirect costs amount to 0.9-1.3 percent of Latvia’s GDP. Despite not being directly covered by the state budget, they represent unproduced output and thus entail economic losses. The primary components of these indirect costs are linked to decreased output resulting from higher unemployment and reduced economic activity (0.6-0.8 percent of the GDP), as well as decreased output due to premature death among heavy drinkers (0.2-0.4 percent of the GDP). Notably, indirect costs attributed to alcohol misuse by males constitute almost two-thirds of the total indirect costs.

Finally, the non-financial costs from alcohol abuse in 2021 are estimated to reach 88 620 years spent in good health and with a good quality of life. These losses primarily stem from the distress experienced by household members from alcohol users, the decline in the quality of life among alcohol users themselves, and the premature mortality of such individuals.

The Effects of Preventive Measures

We consider five alcohol misuse preventive measures, all of which are included in the list of WHO “best buys” policies that effectively reduce alcohol consumption (WHO, 2017):

  • Reducing the availability of retail alcohol by tightening restrictions on on-site retail hours
  • Raising the minimum legal age for alcohol purchase from 18 to 20 years
  • Increasing excise tax on alcohol
  • Lowering the maximum allowed blood alcohol concentration limit for all drivers from 0.5 to 0.2 per mille (currently 0.2 for new drivers and 0.5 for all other drivers)
  • Restricting alcohol advertising and marketing

Our estimates of the expected reduction in alcohol-related costs resulting from these measures are based on two main components:

  • (1) our own estimates of alcohol-related costs in Latvia, as described above, and
  • (2) external estimates of the impact of the five misuse preventative measures on alcohol consumption derived from existing literature on other countries.

We then apply these external estimates to the calculated alcohol-related costs and Latvian data on alcohol consumption to determine the estimated impact for Latvia (for further details, see the methodology outlined in Pluta et al. (2023)).

Our findings indicate that the most substantial reduction in direct costs attributed to alcohol misuse is anticipated through raising the minimum alcohol purchase age to 20 years (yielding an 11.4-15.8 percent estimated cost reduction). Previous literature has shown that early initiation of alcohol use significantly increases the likelihood of risky drinking, and that risky drinking during adolescence significantly increases the risk of heavy drinking in adulthood (Betts et al., 2018; McCarty, 2004). Hence, raising the minimum legal age for alcohol purchase represents an effective tool to reduce alcohol consumption also among the adult population.

Another highly effective measure to reduce alcohol consumption is imposing restrictions on advertising, which results in a 5.0-8.0 percent estimated reduction of direct costs. There is a large body of literature indicating that alcohol advertising increases alcohol consumption among young people, as well as significantly increases the likelihood of alcohol initiation among adolescents and young adults (Noel, 2019; Jernigan et al., 2017). Also, among the adult population, alcohol consumption decreases with stricter advertising restrictions (see Casswell, 2022; Rossow, 2021).

However, it is important to emphasize that the full impact of both above discussed preventative measures will only manifest in the long run.

The Effect of Illicit Markets

It is often argued that illicit alcohol markets, which provide access to cheaper alternative alcohol than registered commercial markets, can limit the effectiveness of preventive measures on overall alcohol consumption (Rehm et al., 2022).

To explore the interplay between illicit alcohol circulation and alcoholism prevention measures we conduct semi-structured interviews with experts regarding the prevalence of illicit alcohol circulation in Latvia and strategies to mitigate it.

While our main findings emphasize the inherent challenge of precisely quantifying the size of the illicit alcohol market, our analysis suggests that the share of illicit alcohol in total alcohol consumption in Latvia is relatively low. We also conclude that the size of the illicit alcohol market has been diminishing in recent years, and that public interest in engaging with illicit alcohol is declining. Given these findings, the current scope of the illicit market is unlikely to substantially undermine the efficacy of alcohol control measures. This is especially true as the consumers of illicit alcohol represent a specific group minimally affected by legal alcohol control measures in the country.

Conclusion

Our findings underscore the substantial costs associated with the large alcohol consumption in Latvia. In 2021, budgetary (direct) and non-budgetary (indirect) costs reached 1.3–1.8 percent of Latvia’s GDP. Furthermore, non-financial costs from alcohol abuse represent a loss of nearly 90 thousand years spent in good health and with a good quality of life.

Furthermore, non-financial costs from alcohol abuse represent a loss of nearly 90 thousand years spent in good health and with a good quality of life. This stems primarily from the distress experienced by alcohol users’ household members, and the decline in life quality and premature mortality among users themselves.

Latvia stands out as a country with exceptionally high levels of absolute alcohol consumption per capita compared to other countries. Policy makers should implement effective preventive measures against alcohol consumption to maintain the sustainability of a healthy and productive society in Latvia.

Acknowledgement

This brief is based on a study Alcohol Use, its Consequences, and the Economic Benefits of Prevention Measures completed by BICEPS researchers in 2023, commissioned by the Health Ministry of Latvia (Pļuta et al., 2023).

References

Disclaimer: Opinions expressed in policy briefs and other publications are those of the authors; they do not necessarily reflect those of the FREE Network and its research institutes.

What Ukrainians Expect From Reforms

Posted on March 2, 2015 | Policy Brief

Author: Tom Coupé, KSE.

Ukraine needs reforms badly. However, there is a huge difference in how the government, the expert community, and the general public understand reforms. According to a recent survey conducted by a prominent Ukrainian newspaper, people expect that reforms should, in the first place, improve their personal wellbeing. However, research findings beware that in the short run structural changes in the country can worsen economic performance and increase inequality. To reduce the pain of unmet expectations and popular discontent, the government should openly communicate any difficulties to come, and wisely mix the most painfull measures, like the increase of tariffs for the use of public infrastructure, with empowering changes that give citizens a sence of progress, like actions that strengthen democracy and help SMEs to flourish.