Gender Equality in Health: Its Measurement, Determinants, and Long-Run Evolution

Abstract

Gender inequality remains one of the most persistent and consequential forms of social disparity worldwide, yet its long-run development and determinants are poorly understood. Existing gender equality indices are often limited to contemporary data and depend on administrative sources that are unavailable for most historical and pre-literate societies. This dissertation develops and applies a long-run measure of gender equality in health using adult stature as a proxy. Height reflects cumulative net nutrition and disease exposure during early childhood. After isolating the biological component from the height gap between males and females, the remaining variation captures gender-discriminatory differences in intrahousehold resource allocation and can be used as a measure for gender equality in health. This measure is validated through comparisons with the Gender Development Index and relative life expectancies and applied to three different historical and geographic contexts to analyze the development and determinants of gender equality in health. The first study addresses whether socialism improved gender equality using a sample of 88 countries in Europe and Asia for the period from the 1910s to the 1980s. Regression analysis reveals a significant and positive relationship between socialist governance and gender equality in height. The results are paralleled by improvements in gender equality in education. Robustness checks using staggered difference-in-differences estimation and instrumental variable estimation, using distance to Moscow as an instrument, confirm the positive effect. The second study analyses the long-run development of gender equality in health and the role of subsistence systems relying on male and female height estimates for precolonial America spanning several thousand years. Two-way fixed effects regressions indicate that subsistence systems influenced the development of gender equality. A specialization in maize cultivation, compared to mixed agriculture, had an initially positive relationship with gender equality; in the later period, when population pressure intensified competition for resources within households, the relationship turned negative. Similar trends are observed for hunting. Overall, the results suggest that women’s contribution to subsistence mattered for the development of gender equality. The third study examines how European settlement reshaped gender equality in health among Indigenous populations in the Americas. The dataset from the previous study is expanded to the post-contact period and restricted to the last 2,000 years, combining bioarchaeological evidence with historical anthropometric sources. Exploiting variation in settlement timing and location, two-way fixed effects regressions indicate that European settlements negatively influenced gender equality among Indigenous populations. The results are robust to controlling for subsistence systems, climate, land use, and population density. The relationship is heterogeneous across colonial activity types and institutional environments, consistent with differential disruptions to Indigenous access to land and labor.