Unequal returns to effort? Gender differences in health status and lifestyle

Equality of opportunity suggests that observed differences in an outcome of interest should only reflect factors within individuals' control, namely effort, and not circumstances beyond their control, such as their parent's level of education or longevity. In the health field, lifestyles are typically considered as individual effort and are viewed as legitimate sources of health inequality. However, it remains unclear to what extent these effort-related factors contribute to gender differences in health status. Using data from the Survey on Health Ageing and Retirement, we examine differences in health and lifestyles related to physical exercise and fruits and vegetables intake between men and women. We use a Shapley decomposition and generate a multidimensional health score based on a set of health-related outcomes. Interaction terms between gender and lifestyles suggest that insufficient physical activity is more strongly associated with poorer health in men than in women, whereas infrequent consumption of fruits and vegetables is more strongly associated with poorer health in women than in men. Finally, the decomposition shows that family socio-economic background is the main contribution of heath inequalities among women, while the frequency of physical exercise is the main contribution of health inequalities among men. Our results encourage gender-specific prevention policies to improve population health.