The COVID-19 gender gap: Why fewer women are dying

By Dina Gerdeman, hbswk.hbs.edu

According to a survey of citizens in eight countries, women are much more likely than men to view COVID-19 as a severe health problem.

They are also more willing to wear face masks and follow other public health recommendations to prevent the spread of the virus countries.

The research suggests that public health officials should target their pandemic messaging to men differently than to women, to encourage safer behaviors and reduce the spread of the disease globally.

Research shows that men are dying from COVID-19 in much higher numbers worldwide than women — as much as 50% more often.

Malawi highlights

* From the total cases registered at 11,223 January 15, 67.3% were male

* The average age of the cases at  35 years

* Youngest case aged two weeks, the oldest at 98 years old

Experts have cited several factors that may make men more vulnerable to severe illness, including biological differences, higher smoking rates, and a greater reluctance to seek health care.

This new study points to another reason men may be at higher risk: a more cavalier and macho attitude toward the virus and a refusal to abide by public health rules, according to the article “Gender Differences in COVID-19 Attitudes and Behavior: Panel Evidence from Eight Countries ” in the Proceedings of the National Academy of Sciences.

“If men don’t take the virus as seriously as women do, and they’re not wearing masks and social distancing as much, that could help explain why they are suffering the consequences more,” says Harvard Business School Associate Professor Vincent Pons, who co-authored the article with researchers in Italy and France.

In addition, Pons believes that since women are wearing masks and following other health guidelines more often, they’re less likely than men to contaminate others with COVID.

“This research helps us understand not only who is getting the disease, but who is transmitting it more to others.”

A worldwide gender gap

It’s particularly striking, Pons says, that the gender gap is so widespread, found consistently among the 21,649 people across the globe in all eight countries surveyed: Australia, Austria, France, Germany, Italy, New Zealand, the United Kingdom, and the United States.

While all of these countries are part of the Organisation for Economic Co-operation and Development and all have high income per capita and advanced health care systems, each was affected differently by the pandemic.

The United States, the United Kingdom, and Italy have had some of the highest COVID-19 fatalities globally, while Australia and New Zealand have had relatively few deaths.

The survey results are in line with reports that female-led countries like New Zealand and Germany responded swiftly and effectively to contain the pandemic, whereas some of the countries with the worst outcomes, including the United States and Brazil, “are led by men who have projected strong masculinity attitudes and dismissed the need for precautionary practices, such as wearing masks,” the article says.

When Pons and his team surveyed participants in March, as most countries were beginning to implement lockdowns and stay-at-home orders, 59% of women respondents considered COVID-19 a very serious health problem, compared to 49% of men.

When the research team surveyed people again a month later, in mid-April, the numbers decreased by more than 15% for each group. But a significant gender difference remained: 40% of women still saw the virus as a serious risk, compared to 33% of men.

“The numbers were lower across the board in April last year, but the gap between men and women remained,” says Pons, whose team also conducted surveys in the summer and fall that haven’t yet been analyzed.

“We’re all adjusting to the pandemic in a rapid way, and there’s a lot of uncertainty about what will come next — whether we’ll see a strong second wave and where treatments and vaccines stand. So it’s important to track people’s perceptions over time.”

Survey respondents also answered questions about how much they agreed with a variety of restrictive public policy measures, including closing schools, shutting down nonessential shops, and imposing quarantines.

In March last year 54% of women agreed with these measures as a whole, compared with 48% of men.

The closing of nonessential shops inspired a particularly substantial gender gap in April, with 55 percent of women believing the closures were necessary, compared to 46 percent of men.

Fewer men than women take precautions

Studies show the main route for the spread of COVID-19—airborne transmission—is largely reduced by wearing face masks, with 78,000 fewer infections in Italy in a month and 66,000 fewer in New York City over a three-week period once masks were mandated.

Yet in April, as public health officials in many countries including the United States were urging people to wear masks in public places, 49 percent of women said they complied with mask-wearing, compared to 43% of men.

Women were much more likely than men to follow public health recommendations as a whole, not just mask-wearing, but also washing their hands frequently and distancing from others. In April, 78% of women followed these rules, versus 72 percent of men.

These gender differences persisted even after researchers controlled for various socioeconomic factors, such as age, education, income, employment, religion, and health status.

Other factors were psychological and behavioral, like political affiliation and how much people trust the scientists responsible for making health recommendations.

Why are women behaving more cautiously than men toward COVID? Prior research shows that, in general, women are more risk-averse than men.

Similar gender differences emerged in response to an outbreak of severe acute respiratory syndrome (SARS) in 2002, Pons notes. This latest research also suggests women may be more inclined than men to look out for others’ welfare.

“The gender gap was especially big when we asked whether people coughed and sneezed into their elbows,” notes Pons, whose research shows 84% of women used their elbows versus 76% of men.

“That’s a behavior that only protects other people, rather than yourself, so it suggests that gender differences may come from the fact that women are more altruistic than men.”

While the gender divide in response to COVID was significant among all respondents, the differences were slightly smaller for a few particular groups. Younger men and women disagreed less than older respondents, as did married couples and others who lived with the opposite gender, showing that people who live in the same household influence each other’s views of the pandemic.

“You see families where everyone is wearing a mask or no one is wearing a mask,” Pons says. “And we see a bigger gap among men who live alone than men who live with women.”

Gender differences were also less pronounced among people who have had COVID-19 symptoms or have known others who have had them, suggesting that “first-hand experience of the pandemic enables men to bridge part of the gap with women,” according to the article.

Pons co-wrote the study with Vincenzo Galasso of Università Bocconi-IGIER in Italy; Paola Profeta of Università Bocconi in Italy; Michael Becher of the Institute for Advanced Study in Toulouse in France; and Sylvain Brouard and Martial Foucault of Centre de recherches politiques in France.

This research should spur public health officials to consider targeting men when communicating recommendations around COVID-19 to attempt to increase compliance with safety regulations—for their own good and the good of society, Pons says.

“You can imagine that some men may want to appear strong and that they’re not afraid of the disease, so they’re refraining from adopting these rules.

“So we may need to work on some stereotypes. We may need to show men that wearing a mask is not unmanly, and it’s something that is necessary to protect themselves and others.”

The author: Dina Gerdeman is a senior writer at Harvard Business School Working Knowledge