Women and longevity: more years of life, but not always in good health

Spain is among the countries in the world where people live the longest, along with regions of Japan, Italy, South Korea, and Switzerland. As in most developed countries, Spanish women live longer than men. According to the latest data from the National Statistics Institute, life expectancy in Spain is around 83.8 years. Broken down by sex, women reach an average of 86.3 years at birth, while men live, on average, up to 81.1 years. This difference of just over five years is not unique to Spain but reflects a global trend: worldwide, women outlive men.

At first glance, this might seem like good news. But if we look closely, there is an important detail: although women live longer, they also live with more illnesses, more chronic pain, and greater cognitive decline. In other words, they live longer, but not necessarily better. This apparent contradiction is known as the “gender health paradox,” and it has been the subject of numerous studies. And what does it mean to live in poor health? To assess whether a person is in good or poor health, different indicators can be used. Some of the most common include the presence of chronic illnesses, self-rated health, or cognitive decline, which includes memory loss, lack of attention, and other mental functions. These health measures allow us to calculate what is scientifically known as “unhealthy life expectancy”: the years a person can expect to live with some type of illness or impairment that affects their daily well-being.

In addition to the health indicator used, there are other social, economic, cultural, and behavioral factors that could help explain the reasons for a gap between men and women in the number of years lived in poor health. Educational level is a powerful determinant of health in adulthood and operates through multiple pathways, including access to material resources, health literacy, and social and cognitive resources. Although the associations between low educational attainment and poorer health outcomes are well documented scientifically, it is still not sufficiently understood to what extent these associations vary across different domains of health, demographic subgroups, and institutional contexts. This leads us to ask in the Spanish context: Do people with less schooling live worse? Does this disadvantage affect women more? Can education serve as a shield against deterioration in old age?

Several researchers have studied the direct relationship between education and health in the Spanish population. With higher educational attainment, both men and women live fewer years with health problems. Likewise, women live more years in poor health than men, at all educational levels, although they also live more years in good health (given their higher life expectancy). However, when focusing on the difference by educational level in time lived in poor health, this is especially striking among women. For example, a 45-year-old woman with basic schooling may live about 8 more years in poor self-rated health than another woman of the same age with a university degree. In the case of men, the difference also exists, although it is practically half—slightly more than 4 years. Thus, the combination of gender and educational level creates a double disadvantage: being a woman and having low education translates into a greater burden of years lived with illness. This suggests that education protects women in particular against a deteriorated old age—in other words, they benefit more from the positive impact of education on health.

Why does this happen? Education is usually associated with better working conditions, higher income, more knowledge about healthy habits, and better access to the health care system. Education, often seen merely as a tool to find employment, is also a powerful preventive medicine, as it provides greater capacity to make informed decisions about one’s own health. In addition, women with lower levels of education tend to be more affected by accumulated inequalities throughout life: precarious jobs, greater family responsibilities, chronic stress, or less time for self-care. Taken together, all these factors impact our quality of life. And here lies the paradox: although women live longer, this is not necessarily an advantage if those years are marked by poor health. What seems like an achievement in demographic terms can, in daily experience, be lived as a burden.

That said, we should not forget the other side of the coin: even women with low educational attainment live more years in good health than men at the same level, which qualifies the apparent paradox. One explanation lies in different disease profiles. Among women, chronic conditions such as back pain are more prevalent—affecting quality of life but not necessarily survival. By contrast, among men, diabetes, obesity, and cardiovascular diseases are more common, which are more closely tied to mortality. In other words, men die earlier, but they also accumulate fewer years in poor health because their illnesses are more lethal.

Thus, one of the most effective ways to reduce this health gap is to invest in education, especially among women with low educational attainment. Although the benefits of more years of schooling are not immediately visible, in the long term they translate into better quality of life, more health, and fewer inequalities. This is particularly relevant in a country like Spain, which is experiencing a major demographic shift characterized by rapid population aging, where many women over the age of 65 belong to generations with low levels of schooling. In fact, European women experienced a major expansion in their educational level during the second half of the 20th century, and although this expansion occurred later in Spain, as younger, more educated cohorts age, it could have a significant impact—even without reducing age-specific prevalence of health issues.

In short, the evolution of the distribution of educational attainment should improve the healthy life expectancy of the total population and reduce the gender gap in the number of years lived in poor health. However, while waiting for more educated cohorts to arrive, reducing health problems across the entire population—especially among women with only primary education or less—should be a priority to promote active aging and delay the disability process.

Thinking about public health not only involves strengthening hospitals or expanding medical coverage; it also means ensuring equitable, quality education from an early age. In this way, with statistical data in hand, very different life stories can be understood. Women who live longer, but not better. Men who, with more schooling, age with greater autonomy. And a social system that still has progress to make so that the extra years of life are also years of well-being.

Reference scientific articles:

Solé-Auró A, Zueras P, Lozano M, and Rentería E (2022). Gender Gap in Unhealthy Life Expectancy: The Role of Education Among Adults Aged 45+. International Journal of Public Health 67:1604946. doi: 10.3389/ijph.2022.1604946

Spijker, J. J. A., & Rentería, E. (2023). Shifts in Chronic Disease Patterns Among Spanish Older Adults With Multimorbidity Between 2006 and 2017. International Journal of Public Health, 68(1606259). doi:10.3389/ijph.2023.1606259