Women outlive men almost everywhere — but the gap runs from about one year to ten

The female advantage in life expectancy is one of the most consistent patterns in population data. In the WHO Global Health Estimates for 2021, female life expectancy at birth exceeds male life expectancy in 184 of the 185 countries covered. What that sentence hides is how unequal the advantage is: it is 1.0 years in Mauritania and 10.1 years in Belarus, with a median of 4.7 years.

A gap that ranges by a factor of ten across countries is not behaving like a fixed biological constant. Biological differences between the sexes may contribute to it, but variation on that scale between countries has to be coming from somewhere else. That is the story worth telling, and it is the one the country-by-country numbers can actually support.

One country in the dataset does not follow the pattern

In Israel, the same WHO release puts male life expectancy at birth at 82.4 years and female life expectancy at 82.1 years — a difference of 0.3 years in the opposite direction. It is the only such case among the 185 countries here.

The two estimates are separated by three-tenths of a year. The honest reading is not that men outlive women there, but that this is the one place in the dataset where the usual advantage does not appear at all and the two figures sit level with each other. It is worth naming rather than rounding away, because it is the clearest evidence that the advantage is not a fixed constant.

Where the gap is widest, and where it nearly disappears

The widest gaps in the dataset cluster in Eastern Europe and parts of Latin America. The narrowest sit mostly in North and West Africa and South Asia. Notably, the widest gaps are not found in the longest-lived countries: several of the countries with the highest life expectancy overall have gaps close to the median.

The pattern is not a ranking of how well countries treat women. A narrow gap can mean women and men both live long lives, or that both live short ones. Mali and Mauritania have narrow gaps and low life expectancy for both sexes; Israel has effectively no gap and high life expectancy for both. The size of the difference and the level it sits at are two separate questions. Compare a country and sex in the explorer.

What the life tables can establish, and what they cannot

Everything above comes from one kind of evidence: national life tables built from mortality rates. That evidence can establish the pattern, its size and its geography. It cannot, on its own, establish why the pattern exists. For that, the explanations have to come from studies designed to look at causes, and they are cited separately below.

The explanations researchers actually test

Historical demography puts a useful constraint on any biological explanation. Beltrán-Sánchez, Finch and Crimmins, analysing cohorts born across the nineteenth and twentieth centuries in a set of high-income populations, found that the large excess of adult male mortality is a relatively recent development: it emerged in cohorts born after about 1880, as overall death rates fell, and was concentrated in cardiovascular deaths. A difference that grew that quickly cannot be explained by biology that did not change.

The most heavily studied contributor is smoking. Janssen's analysis of European populations attributes a substantial share of the sex difference in mortality to smoking, and finds that the share has been falling as male and female smoking histories converge. Because smoking's effect on mortality follows decades behind smoking behaviour, countries move through this in sequence rather than together — which is one reason the gap widens and then narrows at different times in different places.

In the countries with the widest gaps, alcohol is prominent in the research literature. Zaridze and colleagues, following 151,000 adults in three Russian cities, reported very high mortality among men reporting heavy vodka consumption, with deaths concentrated in causes plausibly related to alcohol. Trias-Llimós and colleagues estimate that alcohol-attributable mortality accounts for a meaningful part of the East–West mortality difference in Europe, and more of it among men.

• Behaviour and exposure: smoking histories, alcohol, occupational risk, road injury and violence, all of which differ by sex and differ far more between countries than biology does.
• Biology: sex differences in cardiovascular disease onset and in hormonal and immune profiles, and higher male mortality at the youngest ages, which behaviour is unlikely to explain.
• Health systems and care-seeking: differences in when people present for treatment and how conditions are managed, which vary by country as much as by sex.

A biological contribution is plausible, and the cardiovascular findings above are consistent with one. But no biological account explains a ten-year gap in one country and effectively none in another, in the same year, measured the same way. The variation across countries is where the modifiable part shows itself.