Background <p>Physical health disparities between male and female constitute a significant yet underexplored manifestation of gender inequality, a challenge increasingly exacerbated by climate shock.</p> Methods <p>This paper explores the gender inequality in the impact of climate shock on physical health and its spillover effect. We develop a theoretical framework of intra-household resource allocation, and employ micro-level panel datasets matched with a climate physical risk dataset to estimate the impacts of climate shock using panel fixed-effect models.</p> Results <p>We find that climate shock significantly reduces the activity of daily living and health expenditure, with female disproportionately affected. In male-preferred households, the deterioration of male’s activity of daily living generates negative spillovers that further undermine female’s activity of daily living, whereas in households without a strong male preference, this spillover is attenuated. Channel analysis shows that climate shock impairs the activity of daily living through reduced exercise and social participation. Heterogeneity analysis reveals that the physical health-reducing effects of climate shock are more pronounced among rural, low-educated, unmarried and unretired subgroups. Improving access to local employment opportunities and healthcare resources is effective in enhancing health adaptation to climate shock.</p> Conclusions <p>These findings underscore the need for gender-responsive adaptation strategies that prioritize equitable access to healthcare resources to strengthen physical health resilience under escalating climate risks.</p>