Life expectancy: women now on top everywhere.

The year 2006 should not be allowed to pass without at least a quiet celebration that this is the first year in human history when—across almost all the world—women can expect to enjoy a longer life expectancy than men. That the trend is moving in this direction will probably be confirmed this week in the 2006 world health report. In its world health report of 2002, the World Health Organization, using data for 2001, reported that male life expectancy exceeded female life expectancy in only six countries: Nepal, Botswana, Zimbabwe, Lesotho, Bangladesh, and Swaziland. A year later, the situation seemed to have reversed in all six countries, with two other countries (Qatar and the Maldives) reporting that men were living slightly longer than women. In its 2004 report the WHO continued to report the same 2002 data and in only those two tiny territories (the Maldives and Qatar) did women die younger than men. In the 2005 report, life expectancy data for 2003 were reported, but only to the nearest year of age, making comparison difficult. In January this year the US Central Intelligence Agency (CIA) updated its World Factbook and reported its estimates for life expectancy in 2005. According to the CIA, in Qatar and the Maldives women now lived longer than men. Elsewhere, however, women’s fate had slipped back, by the CIA estimates which do not tally with the WHO data for earlier years. According to the CIA, in Niger women could expect to live a dozen days less than men and in Botswana three dozen days less by 2005, but nearer to two years less in Zimbabwe and Kenya by 2005. The underlying source of the CIA data is vague, as befits a somewhat secretive organisation. We will never know with certainty the exact year in which women everywhere can expect to live on average longer than men, but this year— 2006—is as likely as any. Almost 30 years ago, amid much fanfare, the eradication of smallpox was announced. But when it becomes certain that women everywhere can expect to live longer than men, also a remarkable achievement, a similar announcement is unlikely. We tend to forget that in many countries of the world women could expect, until recently, to live fewer years than men and that maternal mortality in particular remains a big killer. The most reliable historical mortality records are in Europe, where states were sufficiently affluent and interested to keep accurate records. In Europe men last outlived women in the Netherlands in 1860 and in Italy in 1889. Elsewhere females’ life expectancy has long exceeded males’: in Sweden since 1751, Denmark since 1835, England and Wales since 1841. But in all western European countries the life expectancy gap between women and men is now narrowing. Except in one aberrant year, 1789, the gap reached its maximum in Sweden in 1978 (6.2 years); in Denmark in 1979 (6.2 years); and in England and Wales in 1969 (6.3 years). Greater emancipation has freed women to demand better health care and to behave more like men, and most importantly to smoke. A century ago it would have been hard to imagine such changes, or the fact that women now expect to live longer than men almost everywhere. As this transition is so recent, the processes driving it cannot be purely biological: they relate primarily to social change. In a way, women’s life expectancy is an indicator of how well everyone can do, akin to the healthy districts identified in the 1850s by William Farr, the British epidemiologist who first reported on health inequalities. In 1990 Amartya Sen, Indian economist and Nobel laureate, concluded from an analysis of unequal rights between men and women and mortality in the developing world that, worldwide, more than 100 million women were missing. The women who were born when Sen wrote this are coming of age in a very different world. We must remember, though, that life expectancy data apply from birth onwards. The picture would be different in some countries if life expectancy from conception was considered: the first doctor to be imprisoned for carrying out sex selective abortion in India was sentenced on 28 March 2006, which may be another landmark. Even the life expectancy from birth may not be a permanent achievement, given that the largest remaining untapped market for cigarettes in the world is made up of women living in poorer countries.