By Craig Rinder, MD

It has been well known for years that the life expectancy of men is less than that of women. According to a 2013 report from the Nation Center for Health Statistics, the life expectancy for males born in 2011 is 76.3 years versus 81.1 years for females. In fact, in every country in every region of the world for which statistics are available (with the sole expectation of the tiny state of Qatar). Men have shorter life expectancies than women. And yet, there has been little understanding of why this should be so.

The Assumption in the past was that biological differences between men and women were sufficient to account for the shorter life expectancy of men but new evidence indicates that this may not be the case. Until recently, our understanding of health issues affecting men specifically has been hampered by the lack of systematic scientific inquiry into the unique ways that health and disease affect men.

Craig Rinder, MD
Craig Rinder, MD

That began to change with the publication in 2011 of the European Union’s comprehensive report on The State of Men’s Health in Europe. The report details life expectancy, causes of death and the prevalence of important chronic health conditions in 34 European countries. It includes statistics on various cancers, alcohol and tobacco use. The authors found significant disparities in health between men and women, among men in different countries and among men in different groups within the same country. Many of these differences can be traced to specific behaviors and lifestyle choices. They concluded that, “This variability demonstrates that men’s health disadvantage is not biological inevitability.” The greatest contributor to the disparity between the life expectancies of men and women in the EU report was premature death in working age men (15-64 years) with 630,000 men in this group dying annually compared to 300,000 women. Cardiovascular disease was the greatest single cause of premature and this was largely due to preventable causes such as smoking. Men were much more likely to die of heath attacks and developed heart disease at an earlier age.

With regard to cancer, men were found to develop cancers earlier that should affect men and women equally, such as cancer of the lung, bladder and colon. As with cardiovascular disease, this is largely due to lifestyle and behavioral differences between men and women. Male cancer survival was also worse, 47% versus 56% for women.

The report found that men are more likely to smoke, drink more alcohol, eat a less healthy diet and engage in other risky behaviors than women. For example, men were, on average, 50% more likely to smoke than women and twice as likely to have chronic liver disease caused by excess alcohol consumption. 82% of deaths due to drug overdose occurred in men and men were four times as likely to commit suicide. Men are three times more likely than women to die in motor vehicle accidents.

In Europe, as in the US, obesity has been increasing and this, in turn, has been associated with increasing rates of hypertension, hyperlipidemia and diabetes as well as fat-associated cancers such as prostate bowel, liver and kidney. The authors noted that 46% of men between 25 and 34 years of age were overweight or obese versus 25% of women.

The higher rates of preventable deaths in men have impacts that go far beyond the loss of life. Many premature deaths are preceded by many years of chronic illness during which the affected individual may experience limitations on their ability to work and their quality of life. Because, in many countries, men are still the main breadwinners in families, their chronic illness, disability and early death can result in financial hardship and poverty for their families. Their illness can prevent a heavy emotional burden for the family both while they are ill and after they have died.

The challenge for physicians and policymakers has been to convince men to make the behavioral changes that can result in a healthier lifestyle. Men overwhelmingly avoid seeing doctors as long as they perceive themselves to be healthy. Consequently, physicians rarely have the opportunity to counsel men about issues such as smoking, obesity and alcohol consumption. Women by contrast, often have regular contacts with physician during their twenties, thirties and forties, generally in the context of obstetrical care, at a time when they are uniquely receptive to advice and counseling around health issues. A man’s first contact with a physician is more likely to occur when he first experiences the symptoms of an illness, heath disease, for example, that may have been progressing silently for decades. By the time he arrives in the emergency room with chest pain, it is already too late to start counseling him about the harms of smoking or to screen for high cholesterol; the damage has been done.

To address this problem, organizations concerned with men’s health issues have begun to develop creative strategies to try to reach their target audience. At Stanford University, pediatric urologists collaborated with design students to develop a promotional campaign to encourage male students to perform testicular self-examination for early identification of testicular cancer, the most common cancer in men between 15 and 35. Social media, graphic design and simple clever messages posted in areas of the campus frequented by male students were used to more effectively raise awareness of this issue. Several organizations such as the Men’s Health Network and The Men’s Health Initiative of BC offer accessible information about a variety of men’s health issues to promote wellness and health awareness among younger men.

New information about the causes of premature illness and death in men and the insight that most, if not all, of these causes are preventable has already begun to change the way we think about men’s health. As governments, health care providers and the public becomes increasingly aware of these issues, opportunities for outreach, prevention and early intervention will arise that have the potential to dramatically improve outcomes and reduce the medical, social, and economic burden of preventable disease in men.

Craig Rinder, MD, is a board-certified urologist and Director of the Men’s Health program at Brattleboro Memorial Hospital. He can be reached at 802-251-8720.

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