Men's Health - Closing the Gender Gap

by Roger S Kirby and Michael G Kirby

Shorter lives

Men live on average 5 years less long than women.  Currently the average expectation of life in the UK is 74.5 years for men compared with 79.7 years for women.  This difference has been termed the gender gap.  For many years this phenomenon has been attributed to some intrinsic difference in overall disease susceptibility between the sexes.  Of late, however, it has become apparent that at least some of the difference in life expectancy between the sexes reflects the fact that men look after themselves much less well than women.

Greater susceptibility

Men's greater susceptibility to heart disease has generally been ascribed to a lack of the protective effects of oestrogens.  Yet, most of the preventable risk factors for myocardial infarction or stroke, such as smoking, central obesity and hypertension, are considerably more common in men than women.

Men in the UK visit their doctor on average four times less often than women and are, as a result, less likely to have their hypertension or diabetes diagnosed and treated.

Men everywhere read fewer magazines and watch health programmes on TV less frequently than women and are consequently less frequently exposed to information which encourages healthy choices in diet and lifestyle.

Reduced awareness amongst men of the malignant diseases to which their bodies are prone may also be a factor.  Lung cancer can largely be prevented by abstinence from smoking, a habit much more commonly and more heavily indulged in by men.  Colon cancer, especially in those with a positive family history, can be detected early and cured with little morbidity by the use of faecal occult blood testing and flexible colonoscopy.  Prostate cancer, which also has a familial link in about 9% of cases, can be detected early by means of PSA testing, combined with digital rectal examination and cured by surgery or radiotherapy.

Although far less common as a cause of death than either cardiovascular disease or malignancy, mortality from trauma, as a result of accidents or violence, contributes significantly to the total loss of anticipated life years because they so often involve young people.  Here again men are very much more susceptible than women; risk-taking behaviour is predominantly the province of young men and could potentially be reduced by focused education programmes.  Suicide rates among young men have quadrupled recently and many of these premature deaths must be preventable.

What steps should be taken to improve the health of men-folk?

A campaign of public information seems appropriate, targeted particularly at those less socially and financially advantaged: young men aged 20-24 years in social class five experience the same mortality as men twenty years older in social class one.

All men should be actively encouraged to adopt a healthier lifestyle, in terms of both diet and exercise, and strongly exhorted to give up smoking.

An arranged visit to the practice could reinforce those messages and include a health check for cardiovascular disease, when enquiries should be made about rectal bleeding as well as lower urinary tract symptoms.  A physical examination could include a cardiovascular check, testicular palpation and advice on self-examination, as well as a digital rectal examination of the prostate.  In men with lower urinary tract symptoms, it seems appropriate to counsel men about the pros and cons of PSA testing, as well as perform a dipstick examination of the urine.  Transitional cell carcinoma more commonly occurs in men, especially those who are heavy smokers, and may present as microscopic haematuria.  Erectile dysfunction is associated with significantly reduced quality of life, and can now be safely and effectively treated; therefore discreet enquiry should be made about this symptom.

Regular health checks not only allow the detection of diseases at a stage when they can be treated effectively, but also provide an opportunity for men to be educated on the way to make healthier choices, stay fit as well as to discuss their own particular health concerns.

Men (as opposed to women) have a much greater tendency to bury their heads in the sand with regard to health matters, often hiding behind the excuse that they do not want to bother the doctor.  Their mind-set needs to be changed from that of "if it ain't broke don't fix it" mentality, to a more proactive one that accepts "if you look after it, it doesn't break".

Much remains to be done to confirm that these preventative strategies are effective, but while more men are dying prematurely every year there seems no better time than the present to encourage men of all ages to live healthier, happier and longer lives.,