Women dominate Europe's health workforce but earn 19% less per hour, WHO warns

Women in healthcare in Europe — a sector where they dominate— earn 19% less per hour than men on average, the World Health Organization (WHO) warns in a new report.

The health and care sector is the fourth-largest employer and the single largest employer of women in the WHO European Region. Women account for 77% of the workforce in healthcare, compared with 45% in all other sectors combined. However, they make up only 55% of the sector’s top earners.

“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 Natasha Azzopardi Muscat, director of the Division for Health Systems, at WHO Europe.

The gender pay gap — the difference in average wages between men and women who are engaged in paid employment — in hourly pay is widest at higher wage levels, ranging from a 2% gap among the lowest earners to over 22% at the top of the wage distribution.

The sector is especially important for women’s employment, the report found. It represents almost 17% of all women’s employment, compared with 5% for men.

These findings follow the same pattern documented across the wider labour market: heightened structural inequality that intensifies at higher wage and seniority levels.

Globally, the health sector mirrors Europe, with women earning on average 24% less than men — a wider gap than in many other industries.

What is behind this difference?

The authors noted that some of the healthcare sector’s pay gap can be explained by differences in work-related factors such as age, education, sector of employment — public versus private and employment type — full-time versus part-time.

Adjusting for those four factors brings the hourly pay gap down from 19% to 6% and the monthly pay gap down from 28% to 10%.

However, the remaining pay gap can’t be explained by anything measured in the data.

“Most of this gap isn’t down to women working fewer hours, being younger or working in different parts of the sector," Azzopardi Muscat explained. “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.”

According to WHO, the report points to deeper structural factors, such as the undervaluation of care work, occupational segregation and potential discrimination in pay-setting practices.

The more feminised an occupational category is, the less it pays — a pattern that holds across managerial, professional and technical roles alike. Managerial jobs in health and care, for instance, employ more women than management roles in other sectors and pay less for it: €22 per hour on average, against €24.70 in comparable roles elsewhere.

The broader cost of the gap

The gender pay gap remains one of the most persistent forms of labour market inequality, the WHO noted.

Considering how many women work in health and care, this gap can have important economic and social consequences.

The report noted this inequality may lead to lower lifetime earnings and pension entitlements, increase women’s risk of poverty, reduce returns to education and undermine sustainable economic growth.

“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,” said Azzopardi Muscat.

“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.”

Closing gender pay gaps is therefore both an equity imperative and an investment in a stronger and more sustainable health workforce, the international health agency noted.

To that end, they suggest targeted actions, from ensuring salary transparency and facilitating female representation in decision-making positions to addressing gender norms and stereotypes.