We take it for granted that women live longer than men. This is the case in over 98 percent of countries in the world. In the United States, average life expectancy is over five years more for women than for men.
But why is this the case? Why is it that for every major cause of mortality that affects both men and women, men die faster?
Are men genetically programmed to die sooner then women? Is it determined in our genes that men develop cancer and heart disease more often than women? Men have a 60 percent higher chance of developing cancer and a 40 percent higher chance of dying from cancer than women, even when you leave out gender-specific cancers like breast, cervical and prostate cancers.
In fact, men have an increased risk of mortality at all ages. Of the top 10 causes of death in the United States, men are winning in nine of them.
This difference in life span between men and women has been relatively unexamined because it has been assumed to be based on biology. But this does not appear to be the case. For one, the extent of the gender gap in life expectancy changes across time and across countries. In the United States, the gap is narrowing, from 7.8 years in 1979 to just 5.2 years in 2006. This is thought to be due to women increasingly taking on stresses and habits of men such as smoking, drinking alcohol and working outside the home. The gender difference is much larger in African countries where AIDS strikes men at higher rates than women and in countries of the former Soviet Union. Clearly there is more to the gender gap than our genes.
Perhaps masculinity itself is killing us. It seems that doctor-avoidance, risk-taking behavior and stress may be the best explanations for the gender gap. It is true that men just don't go to the doctor. Men are twice as likely as women to say they do not have a usual source of health care, and men attend half as many preventive care visits. This leads to half the opportunities to screen men for high blood pressure, obesity, high cholesterol, high blood sugar, substance abuse, cigarette smoking and depression or anxiety. Lack of identification of such risks leads to fewer chances to intervene in a disease process. Heart attacks, strokes, diabetes and cancer then present more often and in more advanced stages than among those who are diagnosed or treated sooner.
Male gender roles may play a part in making men feel that they should deal with symptoms or illness on their own. Just as men typically don't ask for directions when lost, the male may feel it is not "masculine" to seek help for potentially serious medical symptoms. It remains to be seen whether the metrosexual movement will improve the rate at which men seek care for potentially dangerous conditions. However, to the extent that higher mortality can be explained by avoidance of the health care system, it is incumbent upon creators of health policy and providers of health care to make such services more attractive and accessible to men.
Men's habits and roles also impact their rates of disease incidence, While women are taking on more and more professional roles previously held by men, in the US, 95 percent of workers in the 10 most hazardous occupations are still men. Men die in workplace accidents at much higher rates as women, even excluding combat deaths, which were the leading cause of occupational deaths in the US when last reported in 2005.
Then there are non-occupational risks that men take. Men have an increased risk of heart disease and increased risk of alcoholism, suicide and homicide.
Men drive faster and are more likely to eat an unhealthy diet. Men report higher levels of stress and lower rates of stress-reducing activities like meditation and yoga. Well, then, one might say that men deserve to die younger. However, when disparities are found in risk-taking among ethnic or socioeconomic groups, the usual response is not to blame the group at risk. The socially responsible response is to take a hard look at how the educational and health care systems may have failed that group and what can be done to change that, which promotes risk-taking and avoidance of self-care.
Social policy also impacts the rate at which men access the healthcare system. There are fewer programs that target men as specifically as women. Men are less likely to be insured and are less able to qualify for public insurance, such as Medicaid, than women with children.
It is dangerous to assume that the gap in life expectancy between men and women is biological. Such an assumption stops us from examining social, economic, behavioral, or public health policies that may be contributing to higher mortality among men. In the United States, Men's health is largely neglected when looking at health policy. This is not as much the case in Europe and Australia, where entire departments of Andrology exist at many academic and governmental health institutions. Such departments include anthropologists and sociologists, policy advisors and health service researchers. Women have strongly advocated for their own health, leading to increased research, public policies favorable to women's health concerns and health care delivery approaches that specifically address women's health issues. Men need to do the same, not to take away such programs for women, but to add years to the lives of their fellow men.
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