What this article is about

• Why women spend more years with illness or health restrictions despite a longer life expectancy

• How a structural research deficit continues to influence the diagnosis and treatment of women today

• What are the specific consequences of this in everyday clinical practice — using cardiovascular diseases as an example

• What is currently changing in research — and what that means for women

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Women live longer than men. This applies worldwide, across all income groups and cultures, and it has been regarded as secure knowledge for decades. On average, a woman outlives her male counterpart by around five years.

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What is discussed less frequently is that these additional years of life are often not healthy. An analysis of data from 183 countries shows that women worldwide have an average 2.4 years longer gap between life expectancy and healthy life years than men. Although they live longer, they spend proportionally more time with illness, limitations and the need for care.

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This paradox has a name: the Male-Female Health-Survival Paradox. And it has causes that go far beyond biology.

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A research system that has long used men as the standard

Medical research has made a structural mistake over decades: It has treated the male body as the norm. Clinical studies were conducted primarily with male participants — partly for pragmatic reasons (no hormonal fluctuations, no pregnancy risks), partly due to a simple lack of reflection. The results were then transferred to women as if this were a matter of course.

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A 2025 report from the National Academies of Sciences documents that women remain underrepresented in clinical trials — particularly in early study phases, in cardiology and oncology. Even more striking: Even when women are included, the data is often not evaluated according to gender. Gender-specific differences in the effectiveness and tolerability of drugs thus remain invisible.

This has direct consequences: Dosage recommendations, diagnostic limits and treatment guidelines have been developed for a body that is not the female. Only 7% of biopharmaceutical research goes into diseases that exclusively affect women — and less than 1% of that goes into diseases beyond cancer.

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What that means in practice: The example of heart disease

Cardiovascular disease is the most common cause of death among women worldwide — more common than breast cancer, lung cancer and chronic lung diseases combined. And yet they are systematically identified later in women and treated less frequently.

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The reason lies partly in biology: women often show different symptoms of a heart attack than men. While classic chest pain also occurs in women, they also experience nausea, back pain, jaw pain, or unusual exhaustion — symptoms that are easily mistaken for something else.

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A systematic review in the journal Cureus (2024) shows: Heart disease in women was often misinterpreted as gastrointestinal or psychological complaints. As a result, women received diagnostic tests such as ECG or coronary angiography less frequently and were referred to cardiologists less frequently. This supply gap is reflected in the survival rate.

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This is not an isolated case. Similar patterns can be seen in stroke, autoimmune diseases, chronic pain, and mental illnesses. Depression is twice as common among women worldwide as among men — yet antidepressant drugs were developed historically in studies in which women were underrepresented or results were not evaluated by gender.

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More than biology: The social dimension

The lower performance of women in Healthspan cannot be explained by research deficiencies alone. Socio-economic factors play a significant role. Multiple burdens due to care work, more precarious employment in old age and increased poverty in old age have a direct impact on health — and disproportionately affect women.

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There is also a more subtle dimension: the way women perceive symptoms in the medical system. Studies show that women are more likely than men to experience their complaints being psychologized or minimized — a phenomenon described in literature as “referral bias.” This delays diagnoses, sometimes for years.

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What is changing — and why it's a slow process

Awareness of this gap is growing. In recent years, international institutions — from WHO to the World Economic Forum to the EU Commission — have identified the underrepresentation of women in medical research as a structural problem and have introduced policy measures. In the USA, a federal law has required the inclusion of women in NIH-funded studies since 1993; in 2024, the Biden Administration signed an initiative to promote women's health research.

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Yet progress is slow. Political guidelines do not yet guarantee consistent implementation. And even where women are included in studies today, there is often a lack of gender-specific evaluation. The problem is not just who is in a study — but how the data is then analyzed and used.

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For women, this means that the knowledge that doctors have available today is still incomplete in many areas — not out of malice, but because the basis for it was systematically narrower for decades.

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Evidence: Well documented

The structural research deficit is well documented by institutional reports, meta-analyses and epidemiological data; individual clinical consequences (e.g. specific diagnostic gaps) are well documented, but still incomplete in other areas

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What we know

• Women worldwide spend more years with illness or limitations than men — despite a longer life expectancy

• Medical research has systematically underrepresented women, which continues to influence diagnostic and treatment guidelines today

• In the case of heart disease, there are well-documented diagnostic gaps in women with measurable effects on treatment and survival

• Socio-economic factors further strengthen the Healthspan gap among women

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What we don't know

• The extent to which the research deficit in individual clinical patterns actually leads to avoidable deaths — this has not yet been precisely quantified for many areas

• How large is the proportion of biological versus social factors in the Healthspan gap — the interactions are complex and still insufficiently investigated

• Whether and how quickly current policy measures lead to measurable improvements in care

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What is often overinterpreted

• The research deficit does not mean that medicine is fundamentally ineffective for women — it means that important data is missing or not being used in certain areas

• Not every worse diagnosis in a woman is due to gender bias — there are also biological differences that justify legitimate differences in diagnosis and treatment

• The gap is not automatically closed by more women in medicine — the decisive factor is how research questions are asked and data is evaluated