Death: The Male Minefield
By Stewart Schultz
Women live longer than men, have fewer fatal accidents, suffer fewer violent deaths, and are outnumbered by men in suicide by a ratio of three to one. - Susan Brownmiller, Against Our Will: Men, Women, and Rape
In the US and most developed countries, a man's probability of dying over the next year is nearly twice that of a same-aged woman. Only 70 years ago, however, this probability was the same. The reason for the present difference is the greater care given women by the medical establishment, according to Baltimore Commissioner of Health John DeHoff, M.D. Because of the tremendous advances in obstetrics and gynecology, women die during childbirth and from reproductive cancers far less frequently now than at the turn of the century, when deaths primarily from these causes were common enough that the average life span was the same in men and women (in 1900 there were 96:100 men:women over 75). The causes of death, however, were just as different then as now, and presumably have been for centuries.
One way to lower men's death rates, without compromising women's health, is to establish a new or expanded medical specialty for men analogous to gynecology, according to DeHoff. In the process, it is also important to legitimize men's health needs, since gains are obstructed by the fact that "Public concern for the health of men generally has been limited to the economical maintenance of effective work forces."
These arguments are best seen in the U.S. mortality statistics:
U.S. Mortality Statistics
|Age in Years||Mortality rate M:F|
E.g., a 30-year-old man is 3.13 times as likely to die in the next year as a 30-year-old woman.
The net effect over all ages is the 7-year "longevity" advantage of women, though this is not longevity in the strict sense. The longevity gap peaked in 1975 at 7.8 years, but is now back down to 6.9, where it is expected to hold steady at least until 2010. In several states, the gap approaches 9 years.
What factors are most responsible for higher male death rates? The most important are the following, which are responsible for 50% of all annual US deaths:
Factors most responsible for higher male death rates
|Bronchitis, emphysema, and asthma||3.1|
|Motor vehicle accidents||2.8|
|All other accidents||2.8|
|Chronic ischemic heart disease||2.4|
|Acute myocardial infarction||2.4|
|Cirrhosis of the liver||2.2|
At least 75% of the overall sex difference in mortality is due to cultural factors, according to Ingrid Waldron Ph.D., U. of Pennsylvania. The most important are smoking and coronary prone behavior, followed by violence (accidental or intentional) and alcoholism. Coronary disease is a major category because smoking is more common in men (although this is slowly changing) and because men "more often develop the competitive, aggressive Coronary Prone Behavior Pattern."
What's the solution to this apparent social inequity? DeHoff proposes that the field of andrology, which already focuses on narrow fertility problems, be expanded "beyond the genitals" to encompass the major male-specific mortality causes that are medically addressable. This would include coronary disease, lung cancer/emphysema, urological disorders, and stress-related illnesses. Broadly defined, stress may be an important element in most of the categories, since it contributes to cancer, suicide, and substance abuse as well as coronary death; the substances of choice in our culture are alcohol and tobacco. Occasional, episodic stress of course is not the problem, but rather chronic anxiety coupled with hostility and depression that often accompany the ethic of competitive career success/achievement, which carries with it substantial risk, pressure, responsibility, and alienation from home and family.
The spectacular improvements in women's health over the last 50-100 years (and hence the mortality gap) have been due largely to the incorporation of women's primary needs under a single umbrella, gynecology/obstetrics, and the legitimization of an annual physical examination (including the pelvic exam) in the average woman's medical education and insurance. Men currently enjoy neither. While most of a woman's health needs are addressed by a single specialist, with whom she often develops a close relationship over the years, a man's specific needs cannot be met by less than three separate doctors, none of whom are consulted frequently enough for a close relationship to develop. One reason for lower male visitation rates is that, unless he's an airline pilot or has a similar high-profile job, a man's insurance fails to allow an annual physical without an explicit diagnosis of illness (in the US).
Much of the chivalry ethic and the gender roles are understandable as a contract negotiated between the sexes to compensate the high odds a woman had of dying from pregnancy complications. The equal death rates in 1900 show that a rough balance had been in effect. However, the situation is now reversed, and though it has been for at least the last 50 years, men still shoulder the lion's share of external risks, and the gender dance has yet to catch up with science.
While equalizing the sex roles is a distant fantasy, the immediate short term needs are the consolidation of men's health concerns under a single specialty, and their legitimization in standard insurance policies. The above statistics make a strong case for a new ethic of compassion for a man's physical well-being. A new medical specialty is just the push needed to establish it, and once established, it will perhaps pave the way for increased reproductive, domestic, and other rights. Is it too naive to hope that a genuine concern for a man's untimely death occupy a priority position in equality debates?
DeHoff, J.B. 1981, Andrology beyond or above the genitals, Maryland State Medical Journal 30: 57-61
Harrison, J.B. 1984, Warning: the male sex role may be dangerous to your health, Men's Reproductive Health, Springer: New York.
Little, B., 1989, The sin of pride: research in obstetrics and gynecology, Am. J. of Obstetrics and Gynecology 160: 771-81
U.S. Department of Commerce, 1990, Statistical abstract of the U.S. 1990. U.S. bureau of Census.
Waldron, I. 1976, Why do women live longer than men? J. Human Stress 2: 1-29
Parts of an Andrology: On Representations of Men's Bodies, Lawrence R. Schehr
The Prostate: A Guide for Men and the Women Who Love Them (A Johns Hopkins Press Health Book), Patrick C. Walsh, Janet Farrar Worthington
Symptom Solver: Understanding and Treating the Most Common Male Health Concerns (Men's Health Life Improvement Guides), Alisa Bauman
The Testosterone Solution: Increase Your Energy and Vigor with Male Hormone Therapy, Aubrey M. Hill
Men's Health Concerns Sourcebook (Health Reference), Karen Bellenir (Editor)