Sex differences in mortality at the local level: An analysis of Belgian municipalities

Explanations for the consistent female mortality advantage have ranged from the biological, through the behavioural to the social, but we are still far from a satisfactory explanation. The current mortality advantage, which women enjoy in almost all societies and age groups, is not a historical universal. Indeed, it may even be a unique development of the 20th century. Even if this is the case, however, this does not make it a necessary corollary of low mortality. Human mortality reflects the pattern of social relationships, standards of living, living arrangements, and patterns of power and inequality in the society, and although mortality levels are similar for men and for women, they nonetheless display important differences. These differences, in their turn, reflect the pattern of relationships between men and women in the society. The present analysis looks at mortality levels and differences between men and women in Belgium. We focus on aggregate effects at the municipality level (the smallest level of local government), and show that mortality is negatively associated with high standards of living; familial solidarity; immigrant concentration and a stable, locally born, population. It is positively associated with a high tendency to cohabitation. Male mortality is more sensitive to social conditions than is female mortality so that as conditions improve the female mortality advantage declines. We also show that net of these conditions there remains a mortality disadvantage in Wallonia, and this can only partly be explained in terms of social differences between the two major regions of the country.