Despite the growing number of women in healthcare, the gender-based pay gap remains. A recent World Health Organization (WHO) Regional Office for Europe report found that women in the health and social care sector earn 19% less per hour than men and 28% less per month.

The report analyzed data from 43 countries and found that women account for nearly 77% of the health and social care workforce in the WHO EU Region. The pay gap also widens substantially at higher-income levels. In lower-paying positions, women earn approximately 2% less per hour than men, whereas in higher-paying positions, the gap approaches 23%. Although women’s education and experience would theoretically qualify them to earn slightly more than men in higher-paying positions, they earn less in practice.

The report also found that women hold a greater share of management positions in health and social care than in other sectors, but these positions pay less. Managers in health and social care earn an average of €22 per hour compared with €24.70 per hour for managers in other fields.

In Spain, the charts in the report show an average gender pay gap of approximately 20%-30%. This is similar to the gap in Portugal, but considerably larger than the gaps in France, Italy, and Greece. By comparison, the average pay gap across other economic sectors is substantially smaller, at approximately 10%-15%.

A Global Problem

Although the WHO report focuses on Europe, the gender-related pay gap in healthcare is not confined to this region. A study published in December in the JAMA Network Open using Canadian data found that medical specialties with larger increases in the proportion of women over time experienced smaller increases in median total payments. This pattern was observed across the physician workforce as a whole and among women physicians, but not among men.

Similarly, in the US, an earlier study published in Health Affairs Scholar found that although women hold 77% of healthcare jobs, gender inequality affects their earnings and career advancement. The adjusted gender pay gap is wider among highly qualified healthcare professionals, including physicians and advanced practice providers, although it has narrowed substantially over the past 20 years. In contrast, the gender pay gap has stagnated or widened in some lower-skilled occupations.

Why Does the Gender Pay Gap Persist?

The WHO report also examined possible explanations for the disparity. However, much of the gender pay gap remains unexplained after accounting for factors such as age, education, working hours, and sector.

In a press release, Natasha Azzopardi Muscat, MD, PhD, director of the Division of Health Systems at the WHO Regional Office for Europe in Copenhagen, Denmark, said, “Most of this gap is not down to women working fewer hours, being younger, or working in different parts of the sector. It comes down to how the sector values women’s work. Age, education, working hours, and public versus private sector employment only helps explain some of it.”

Although the WHO report highlighted differences in management positions and traditionally women-dominated fields, such as nursing and obstetrics, a 2026 study published in the International Journal of Nursing Studies highlighted the limitations of relying on unadjusted pay differences alone. The study concluded that “raw pay gaps alone are insufficient for understanding inequality in these highly feminized occupations, underscoring the importance of robust, context-sensitive analytical approaches. Where pay gaps persist after adjustment, they point to structural and institutional factors related to wage-setting and progression.”

Far-Reaching Consequences Call for Action

The WHO warned that the consequences of the gender pay gap extend beyond a person’s earnings during their working life. “Women make up the majority of the people who keep Europe’s health systems running, yet they’re paid less than their male counterparts, a gap that compounds over a lifelong career,” said Azzopardi Muscat. “It means lower pensions, less financial security in older age, and a higher risk of poverty for women who’ve spent their working lives caring for others. This isn’t a coincidence, and it isn’t about qualifications. Women are being paid less for the same work and passed over for the roles that pay more.”

The report proposes several measures to address these disparities. These include requiring national reports on the gender pay gap; collecting and publishing wage data broken down by gender, occupation, race, and ethnicity, instead of reporting only by age and sector; strengthening equal pay legislation and enforcing it effectively; and removing structural barriers that limit women’s access to higher-paying leadership positions, including unequal access to mentoring and unequal caregiving expectations.

According to the report, “Closing gender pay gaps in the health and care sector calls for sustained action across several fronts, in line with existing global and regional commitments already in place. By tackling both the observable drivers of pay gaps and the structural factors, Member States across the WHO EU Region can make measurable progress on improved workforce motivation and retention.”

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.