Does the UK really have the 12th largest ‘female health gap’ in the world?

A widespread claim that the UK has the largest female health gap in the G20, and the 12th largest in the world, is based on unreliable research from a male wellness company, Manual. A major Full Fact investigation into the claim has now resulted in a string of high-profile corrections, and seen the original research deleted.

The “female health gap” in this context refers to the difference between a country's ranking for women's health and its ranking for men's health, as calculated by Manual's study.

But the research, which Full Fact found with the help of our AI tools, generated implausible results. For instance, Manual’s study rated Niger one of the healthiest countries in the world, and New Zealand one of the least healthy—which is the reverse of what we see in more reliable sources.

We have spoken to two independent experts who agreed that this research would not reliably measure a population’s health—Emmanuelle Nunes, a Statistical Ambassador for the Royal Statistical Society, and Dr Saloni Dattani, a researcher in global health at Our World in Data.

Ms Nunes told us: “My opinion, just from looking at the methodology, is I don’t think this research is reliable at all… If you are basing a claim about the gender health gap on this article, then I would not trust it.”

Nevertheless, claims based on Manual’s data have been repeated by:

• the libraries of the House of Commons and the House of Lords
• three Labour MPs, one Liberal Democrat MP and three peers in the House of Lords
• the Scottish government and the Welsh Parliament
• the NHS Confederation, Ipsos, the British Medical Association and the Lancet
• in many media reports, including in the Times, the Guardian, the BMJ, WIRED and Harpers Bazaar.

Searches in March for “gender health gap UK” on Google also produced this claim at the top of its AI Overview.

We’ve seen this claim shared frequently on Facebook and Instagram as well. One post on Facebook shows the claim being shared at a university event by a senior lecturer.

Full Fact secures corrections

Following contact from Full Fact, the libraries of the House of Commons and the House of Lords both deleted references to Manual’s research from their briefing documents, to which they added a note saying: “On review, we did not feel this met our standards of reliable research.” The Welsh Parliament also deleted its article on the subject, and the Scottish government, the BMA, the NHS Confederation, the Guardian and the Lancet amended theirs.

Since we made contact with Google, its search results appear to have stopped highlighting this claim with an AI overview. We approached every other claimant for comment.

Manual itself told us at the end of April that it had deleted the research from its website, following a review. In a statement to the Guardian, the company said: “While our research was intended to prompt discussion around this important issue, it was not (and was not represented as being) undertaken to the standard of professional academic clinical or public health research.”

What is ‘the gender health gap’?

We’ve not been able to find any generally accepted definition of the “gender health gap”, so we can’t clearly say what it is in the UK, or how the UK compares with other countries. In 2022 the Conservative government at the time seemed to use the phrase to refer to gender gaps in medical research, training and policy, rather than in health outcomes themselves, when announcing its Women’s Health Strategy for England.

There are many reported examples of disparities in the health of women and men. For instance, research has found women are about 50% more likely than men to receive the wrong initial diagnosis for a heart attack, whereas the BBC reported that men are about 60% more likely to die before the age of 75.

There are also differences in the way that men's and women’s health are treated and researched. There are often different ways of measuring these differences, too. In short, there seem to be many different gender health gaps.

At the most basic level, men in the UK, and most countries of the world, have a shorter life expectancy and can expect fewer years of healthy life than women. Women also spend more years in poor health.

Where this claim came from

It appears that the male wellness company Manual published what it called a study on the male health gap in 2020, which is the earliest that we can find an archived record of the page on its website. The study appears not to have been peer-reviewed, or published in any scientific journal.

Manual said it expected to find “evidence of widespread inequality between men’s and women’s health” in different countries around the world. Describing its definition of “the female health gap”, it said: “There are countries that don’t follow the trend of men being unhealthier throughout their lives. These countries therefore have female health gaps; where their rank for women’s health is lower than their rank for men’s health.”

However, the way that Manual measured men’s and women’s health is unreliable.

As Manual explained in its methodology section, countries were ranked according to their average score across ten categories for men and women. The notes claimed that “a higher rank implies a healthier country”.

For several reasons, both the independent experts we consulted agreed that the average score across these ten categories would not provide a reliable indicator of a population’s health.

For instance, one category is “Life Expectancy”, a very important measure of overall mortality risk. But two more specific types of mortality risk—“Work-Related Death Rate” and “Suicide Rate”—are also included.

As Dr Dattani told us: “It’s very strange that they’ve almost double-counted death rates from some causes but not from others. The work-related death rates, the suicide rates, those would already be included in life expectancy to some degree.”

Another problem was the inclusion of categories like “Average Daily Alcohol Consumption” and “Insufficient Exercise”, which are risk factors for health problems, but not health problems in themselves. So a country where people have less disposable income to spend on alcohol, or where sedentary lifestyles are less common, might look “healthy” in these categories even if it also had other poverty-related health risks that the study didn’t consider.

“I think the other issue is that for some of these metrics, the level of data quality is much higher than others,” Dr Dattani said. “So for the prevalence of mental health disorders, for example, there isn’t very good data from a lot of poorer countries. Their data is estimated based on what we have for richer countries. So there is a lot of modelling involved in some of these metrics.” Instead, Dr Dattani suggested using either life expectancy or the expected number of years lived in good health to measure the health of men and women in different countries.

The results looked very wrong

Clear signs that Manual’s study was not reliable could be found in its two tables of results. These showed each country’s rank for men’s and women’s health, and the gap between them: a “male health gap” where a country ranks higher for men’s health, and a “female health gap” where it is higher for women.

Many of these country rankings contradicted—sometimes to an extreme degree—the findings of authoritative research. To choose one example, the WHO describes Niger as “one of the world’s poorest countries with a very young population [which] urgently needs innovations in the health sector to reduce gaps and deliver better results”, yet Manual’s study ranked it as the second-healthiest country in the world for men, and the fifth healthiest for women.

Meanwhile, a recent WHO report says about New Zealand: “Many of its health indicators are among the best in the world and among its high-income peers of the Organisation for Economic Co-operation and Development (OECD)”. Yet Manual’s study placed it near the bottom of its rankings, at 145th out of 156 for men, and 153rd for women.

These rankings contrast starkly with the latest data (for 2021) from the Institute for Health Metrics and Evaluation (IHME), which estimates that people in New Zealand can expect about 16 years more life in good health than people in Niger.

Manual did conclude, as was widely reported, that the gap between the UK’s male and female ranking is the largest of the G20 countries, and the 12th largest globally. But we cannot rely on this study to measure the health of men and women in the UK accurately. And it can’t be a reliable guide to gaps between them either.

Ms Nunes told us: “The gender health gap is a very complex topic. And I think people should be talking about gender biases, not just in healthcare but in everything. But we need to do it based on reliable research, not on some metric that someone decided to create that has no real validation.”

Are men or women healthier?

In Manual’s research, the gender health gap was intended to measure how much “healthier” men or women were in a given country. For this, there are some standard measures we can look at, although none of them on their own tells the whole story.

The worst health outcome, ultimately, is death, so life expectancy is one simple way of expressing the risk of death that people face throughout their lives, as Dr Dattini suggested. On this measure, females are generally less likely to die than males at almost every age, in almost every country.

There can be big differences in the health of people who are still alive, however. Another standard measurement can help to capture this—health-adjusted life expectancy, or HALE, which measures how many years a person spends in good health.

On this measure, it’s clear that females can also expect to live for more years in good health than males in almost every country in the world. This is also true in the UK, according to data from the IHME and the WHO.

Looking at IHME data for 2021, women in all 19 countries in the G20 have higher health-adjusted life expectancy than men. Women in the UK have the ninth-highest, at 69.3 years, while men have the eighth highest, at 68.2. The gap between them in the UK, at 1.15 more years of healthy life for women, is the third smallest after Saudi Arabia and Germany.

Using these measures, therefore, it appears that women are healthier than men in most countries of the world. But you could also look at essentially the same data in a different way, by considering how many years people can expect to live in poor health, or indeed what proportion of their life they can expect to spend in poor health.

From this point of view, women can expect to live more years, and a higher proportion of their lives, in poor health. Higher values on these measures are not necessarily “worse” than lower ones, however, as someone who lives an entirely healthy but short life may not be “better off” than someone who lives a long one that includes some unhealthy years. In general, according to the IHME data, women in poorer countries tend to live fewer years in poor health than women in richer countries. Where the unhealthy proportion is concerned, the picture is more mixed.

In England and Wales, we also have data on people’s state of health according to their own subjective assessment. This shows that women in England can expect to live slightly more years in good health than men, although the reverse is true in Wales. Males and females both report worse health, on average, at different ages.

Full disclosure: Full Fact has received funding from Google and Google.org, Google’s charitable foundation. We disclose all funding we receive over £5,000; you can see these figures here. Our funders have no input into our editorial content.