Women form the backbone of Europe's health and care systems, yet a new report from the World Health Organization (WHO) shows they earn on average 19% less per hour than their male colleagues. The finding underscores a persistent inequality in a sector that employs more women than any other across the continent.
The health and care sector is the fourth-largest employer in the WHO European Region, which spans 53 countries from Portugal to Uzbekistan. It is the single largest employer of women, accounting for 77% of its workforce, compared with 45% in all other sectors combined. Despite this dominance, women hold only 55% of the top-paying jobs in the sector.
“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.
Wage gap widens at the top
The gender pay gap in hourly earnings is not uniform. Among the lowest earners, the gap is just 2%, but it balloons to over 22% at the highest wage levels. This pattern mirrors broader labour market trends, where structural inequality intensifies with seniority and pay.
Globally, the health sector shows an even wider gap, with women earning on average 24% less than men. The European figure, while lower, remains a cause for concern given the sector's importance for women's employment: it represents almost 17% of all women's jobs in the region, compared with 5% for men.
The report's authors note that part of the gap can be explained by measurable factors such as age, education, whether the job is in the public or private sector, and full-time versus part-time status. Adjusting for these four factors reduces the hourly gap from 19% to 6%, and the monthly gap from 28% to 10%. But a significant unexplained portion remains.
“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.”
Structural undervaluation of care work
The WHO points to deeper structural factors, including the undervaluation of care work, occupational segregation, and potential discrimination in pay-setting practices. The more feminised an occupational category, the less it pays—a pattern that holds across managerial, professional, and technical roles. For instance, managerial jobs in health and care pay on average €22 per hour, compared with €24.70 for comparable roles in other sectors, even though these roles employ more women.
This pay gap has far-reaching consequences. Lower lifetime earnings translate into reduced pension entitlements, higher poverty risk for women in old age, and diminished returns on education. It also undermines sustainable economic growth, the report warns.
“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.”
The findings echo broader concerns about gender inequality in healthcare, such as a recent study showing that women receive less invasive care than men for the same conditions. They also align with ongoing debates in Brussels about gender pay transparency, as the EU has already introduced binding measures for large companies.
The WHO recommends targeted actions, including salary transparency, greater female representation in decision-making positions, and challenging gender norms and stereotypes. Closing the gap, the agency argues, is not only a matter of equity but also an investment in a stronger and more sustainable health workforce across Europe.
