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APRIL 2022: Gender inequalities in the past affect women’s health today

Did you know that the age-old gender gap in education has made women more vulnerable to developing dementia as they get older? Women, for example, account for about two-thirds of Alzheimer’s disease cases.


Gender inequalities in education and risk of dementia

Women are more educated today than at any time in history. For most of human history, girls have received less formal education than boys. For a long time, most girls were not formally educated at all, receiving mostly domestic education, sometimes just learning to read, write and count. That was all they needed to know in order to be good wives and mothers. Higher education was hindered or strongly discouraged, even for girls from more affluent families. It was believed for a long time that knowledge and study were against their nature, against the teachings of the Bible, and that education could affect their fertility. For boys too, education depended on social class, but they potentially had access to higher education and a wider range of disciplines, unlike girls. Over the past two centuries, the gender gap has gradually narrowed in many countries, with girls also slowly entering higher education.

Not everyone knows that education protects our brain against disease, just like having an active lifestyle, exercising, eating healthy, and socializing. In short, in the event that a disease affects a certain set of neurons, the individual with a high level of education and a healthy lifestyle will have a large reserve of alternative neurons or neural networks that underlie the same function and which they would use instead of the damaged one. This way, they will probably not have any symptoms and can continue to live normally.


In a couple of very interesting studies published in The Lancet Public Health, researchers from the University College London and the University of Paris studied very large samples of individuals born between the beginning of the 20th century and the 1960s. The generation born after the Second World War had a higher average socio-cultural level than previous generations, and a lower risk of having disability or dementia in old age. This was especially true for women. In other words, the increase in years of education and in the employment rate made women’s risk of dementia or disability more similar to that of men. The reduction in socioeconomic disparities that occurred in the second half of the 1900s reduced women’s health disadvantage. This means that gender inequalities in education and work in the past partly explain why older women are at greater risk of dementia than men today.


When women had the same level of education as their male counterpart, their cognitive abilities such as memory were equal or superior to men, disproving what has long been proposed in the past about women’s alleged cognitive inferiority.


Women are living longer (at least these days)


There are of course other factors involved. For example, women outlive men in almost all societies. The average life expectancy at birth is currently just under 80 years for women and 72 years for men (66 for women and 63 for men in developing countries). Women who are older today have had healthier lifestyles on average than men. They consumed less tobacco and alcohol, were exposed to a lower risk of accidents (at work for example), and do more prevention than men. Estrogen levels are also said to protect women from various diseases. Longer life expectancy put women at increased risk of age-related diseases, such as Alzheimer’s dementia. However, as life habits are increasingly similar between women and men, men are gaining ground and this gap in life expectancy should gradually narrow.


Biological sex differences contribute to the different risk of dementia


Like many other animals, female and male human bodies are different from each other. In addition to differences in the reproductive system, men have on average more body mass than women, less body fat percentage, more stomach acids, slightly different kidney or liver function, different sex hormone levels, etc. At the brain level, there are data, still controversial, on possible differences in the size of certain brain regions and in the proportion of white and gray matter. These physiological and morphological sex differences have developed over millions of years and have been an advantage for reproduction and survival.

Since the bodies have certain differences, the two sexes can be different when it comes to pathology. Some pathologies are sex-specific, such as all complications of pregnancy, ovarian cancer, prostate cancer, etc. The hormonal changes that occur with menopause, especially when it is early, are a sex-specific condition that puts women at higher risk for various conditions, including dementia.


Other pathologies may affect one sex more frequently than the other or be expressed differently in the two sexes. For example, some digestive problems have different prevalence in the two sexes. Men with myocardial infarction more often have chest pain, while women with myocardial infarction more often experience fatigue, fainting and shortness of breath. Similarly, dementia, such as Alzheimer’s disease, can mainly affect women due to their hormone levels, brain specificities and certain genetic factors. These biological factors would therefore contribute to the risk of dementia along with socio-cultural factors.


There is still some work to be done


In conclusion, the gender gap in education persists even in wealthier countries, albeit in a different form than in the past. Today it mainly concerns higher education and employment in senior academic positions. Closing the gender gap in education has an impact on several levels for the community and for the individual, including reducing the cases of Alzheimer’s dementia, which is a major public health issue.


Written by Federica Cacciamani, PhD Researcher in neuroscience at the Bordeaux Population Health

Learn more about this

1: Bloomberg M, Dugravot A, Landré B, Britton A, Steptoe A, Singh-Manoux A, Sabia S. Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis. Lancet Healthy Longev. 2021 Dec

2: Bloomberg M, Dugravot A, Dumurgier J, Kivimaki M, Fayosse A, Steptoe A, Britton A, Singh-Manoux A, Sabia S. Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies. Lancet Public Health. 2021 Feb


Disclaimer

In this article, males and females are compared as two distinct and mutually exclusive categories. This is a reflection of what is proposed by the scientific literature on which this article is based. The under-representation of those who identify outside the binary in the discussion above is not intentional. There is still some work to be done

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