A “fair innings” between the sexes: are men being treated inequitably?

Abstract

In most modern developed communities, women are known to live longer than men. A less known fact is that in many statistics reporting differences in life expectancy between socio-economic classes, on average women in the worst-off social class live as long as men in the best-off social class, if not longer. It is true that women tend to have higher morbidity, or lower health-related quality of life, especially at advanced age, but this female disadvantage does not offset the life expectancy advantage sufficiently to lead to the conclusion that men and women enjoy comparable lifetime health prospects in these communities. Although there is much public and policy discussion about the inequity of health inequalities between the social classes, there is relatively little discussion about such inequalities between the sexes. The paper first discusses the applicability of the fair innings argument to the issue of inequality in health between the sexes. It critically examines six arguments concerning why inequality in health between the sexes may or may not be an inequity. Next, special attention is given to the argument that it is wrong to judge the fairness or unfairness of health inequalities in isolation, but that this judgement should be made only after considering other inequalities relevant to overall human well-being, many of which are believed to work to the disadvantage of women. An analytical framework based on the Gender-related Development Index (a supplementary index to the Human Development Index) is taken as a starting point, to address the issue of health and overall well-being. But this is found wanting, and suggestions are made as to how its conceptual and empirical properties could be improved. Meanwhile we conclude that a prima facie case has been made that the current distribution of health in most countries does not give men a “fair innings”, but the broader question about general well-being remains unresolved.