Gender Differences in Health
The Harvard Medical School (reference below) has summarized the extent and implications of gender differences in health.
The article notes:
“The gender gap is not unique to America. In fact, every country with reliable health statistics reports that women live longer than men. The longevity gap is present both in industrialized societies and in developing countries (see Table 2). It’s a universal observation that suggests a basic difference between the health of men and women.
“Men die at a faster rate than women; the overall mortality rate is 41% higher for men than for women, and it’s also higher for men for eight of the 10 leading causes of death (see Table 3). In addition, American men are 2.1 times more likely to die from liver disease, 2.7 times more likely to die from HIV/AIDS, 4.1 times more likely to commit suicide, and 3.8 times more likely to be murder victims than women.
“Men die younger than women, and they are more burdened by illness during life. They fall ill at a younger age and have more chronic illnesses than women. For example, men are nearly 10 times more likely to get inguinal hernias than women, and five times more likely to have aortic aneurysms. American men are about four times more likely to contract AIDS or be hit by gout; they are more than three times more likely than women to develop kidney stones, to become alcoholics, or to have bladder cancer. And they are about twice as likely to suffer from emphysema or a duodenal ulcer. Although women see doctors more often than men, men cost our society much more for medical care beyond age 65.
“The health disparity between males and females begins during fetal life and continues from cradle to grave. About 115 males are conceived for every 100 females, but males are much more likely to die before birth, so there are only 104 newborn boys for every 100 girls. Boys are about 60% more likely to be born prematurely, to have conditions related to prematurity such as neonatal respiratory distress syndrome, and to suffer birth injuries. Boys are about 18% more likely to die before their first birthday than girls.”
Table 2: The international longevity gap
Overall life expectancy
Gap (in years)
|Source: CIA World Factbook (2009 estimates)|
Table 3: America’s 10 leading killers
Male-female death rate ratio
|1. Heart disease||1.5|
|4. Chronic obstructive lung disease||1.3|
|7. Alzheimer’s disease||0.7|
|8. Influenza and pneumonia||1.4|
|9. Kidney disease||1.4|
|10. Septicemia (blood infection)||1.2|
|Source: National Center for Health Statistics|
Contributors to the gender differences in health
The remainder of this page is copied from the referenced article.
Genes and chromosomes. Males and females are different from the very moment of conception. Each has 23 pairs of chromosomes, which carry the body’s 20,000 to 25,000 genes. Twenty-two of these pairs are present in both males and females, but the 23rd separates the sexes. This final pair contains the sex chromosomes. In women, both members of the pair are X chromosomes, but in men one is an X and the other a Y.
The Y chromosome is only about a third as large as the X and contains far fewer genes than the female sex chromosome. Some of these genes may be linked to diseases that contribute to the excess male mortality throughout life. In addition, if a woman has a disease-producing gene on one of her X chromosomes, it may be counterbalanced by a normal gene on the other X, but if a man has the same bad gene on his X chromosome, he lacks the potential protection of a matching gene.
Hormones. It used to be so simple: testosterone got the blame for premature heart disease in men, while estrogen got the credit for protecting women. The theory was based on the observation that athletes who abuse androgens — male hormones — develop unfavorable cholesterol profiles and suffer an increased risk of cardiovascular disease. But research shows that in physiologic doses, testosterone neither impairs cholesterol levels nor damages the heart. In fact, small studies suggest that testosterone treatment may even help some men with heart disease. Moreover, women who take estrogen well beyond menopause, when their natural levels plummet, experience an increased risk of heart attacks, strokes, and blood clots.
Even if hormones don’t account for the lion’s share of the gender gap, they do play a role. Estrogen raises HDL (“good”) cholesterol levels, perhaps explaining why heart disease typically begins about 10 years later in women than men. On the other hand, testosterone may contribute to the risk-taking and aggressive behavior that causes problems for many young men. And testosterone also fuels diseases of the prostate, both benign and malignant. Even so, the testosterone-prostate connection can’t account for the longevity gap, since there are more deaths from breast cancer (about 40,000 a year in the U.S.) than prostate cancer (about 27,000).
Both sex hormones keep bones strong, but here, men actually have the edge. As men age, testosterone levels decline slowly, about 1% a year, but estrogen levels drop abruptly at menopause, boosting the risk of osteoporosis.
Reproductive anatomy. Many men view the prostate gland as a vulnerability. That may be, but reproductive factors actually hold down the health gap between men and women. The number of new prostate and breast cancers are closely matched, but women are about 45% more likely to die from their disease. Add malignant and benign diseases of the uterus and the perils of pregnancy and childbirth, and you’d suppose that women are the more fragile sex. Since they’re not, males must have important problems in other areas.
Metabolism. Cholesterol may account for some of the health gap. Males and females have similar LDL (“bad”) cholesterol levels, but women have substantially higher levels of HDL (“good”) cholesterol (60.3 milligrams per deciliter, or mg/dL, versus 48.5 mg/dL on average). HDL cholesterol protects against heart disease, but triglycerides may increase risk — and American men average 158 mg/dL, while women come in at only 135 mg/dL.
Diabetes is a major problem for both sexes, and its prevalence is increasing in both. But this metabolic risk factor affects a somewhat higher percentage of men (11%) than women (10%).
Like diabetes, obesity is rapidly increasing in the United States. More than two-thirds of American adults are overweight or obese. As compared to men with a healthy weight, an average 40-year-old nonsmoker will lose three years of life to overweight and almost six years to obesity. The prevalence of obesity is slightly higher in American women than men; still, excess weight is more of a problem for males. That’s because women tend to carry excess weight on their hips and thighs (the “pear shape”), while men add it to their waistlines (the “apple shape,” or “beer belly”). Excess body fat is never a good thing, but abdominal obesity is much riskier than lower body obesity, sharply increasing the risk of heart attack and stroke. Aesthetics aside, women are shaped better.
Although obesity is often classified as a metabolic problem, it usually results from unwise health behaviors, another major misfortune for males. In fact, although metabolic, genetic, and hormonal factors may explain part of the health gap, particularly very early in life, social and behavioral factors play a larger role in adults.
Work stress and hostility. It’s a common explanation for excess male mortality, and there may be something to it. Indeed, the stereotype of the harried, hard-driving, overworked male executive has a basis in fact, and work stress can increase the risk of hypertension, heart attack, and stroke. In fact, karoshi, “death from overwork,” is a recognized diagnosis in Japan, and it triggers compensatory payments to survivors. Type A behavior, stress, hostility, and anger have all been implicated as heart disease risk factors, and these traits tend to have a higher prevalence in men than women.
Work-related stress and heart-breaking personality factors may contribute to male vulnerability. But as more women enter the workplace and add financial obligations to their traditional roles at home, they may have the dubious honor of closing the gender gap by moving in the wrong direction.
Social networks and supports. It’s true: people are good medicine. Strong interpersonal relationships and support networks reduce the risk of many problems, ranging from the common cold and depression to heart attacks and strokes. In contrast, social isolation has been identified as a heart disease risk factor.
Women have much larger and more reliable social networks than men. A study by the New England Research Institute found that 28% of women but only 9% of men report they can rely on friends for support, and men were 2.5 times more likely than women to lack social supports.
Some 400 years ago, poet and pastor John Donne proclaimed, “No man is an island.” In 21st century America, though, many men seem very insular indeed. There is more than a germ of truth in the quip that two men can’t take a walk together unless one is carrying a ball. In general, women are in touch with their feelings and with other women, and they have a remarkable ability to express their thoughts and emotions. Women may not really be from Venus any more than men are from Mars, but strong relationships and good communication seem to help explain why women live longer on Earth.
Biological factors account for part of the gender gap, social factors for another portion. But from adolescence onward, male behavior is the main reason that men fall ill sooner and die off faster than women.
Risky behavior. Is it nature or nurture, the Y chromosome and testosterone, or daredevil role models and cultural norms? Nobody knows, but the answer is not likely to be either/or but all of the above. Whatever the cause, from boyhood on, males take more risks than females, and they often pay the price in terms of trauma, injury, and death. Simple precautions like seat belts and bike helmets can help, but more complex measures involving education about alcohol, drugs, firearms, and safe sex are also essential. More than ever before, young males need role models who demonstrate that common sense and prudence are manly traits.
Aggression and violence. These are extreme forms of risky behavior, and they all have many of the same root causes. But there is a difference between risk taking and aggressive or violent behavior. A man who takes risks places himself in harm’s way, but his unwise choices may not endanger others. Violent behavior, though, directly threatens the health and well-being of others, both male and female. A man is nearly four times more likely to die from homicide or suicide than a woman, but women are much more likely to be victims of domestic violence. Men need to learn self-control and anger management if they are to close this portion of the gender gap. Understanding that real men have feelings and that strong emotions are best expressed with words, not acts, is also important.
Smoking. It’s the riskiest of all health habits, and since secondhand smoke is dangerous to others, it’s also a form of undercover hostility.
In the old days, men smoked but women didn’t. Those were good old days for women, but not for men. Times are changing; when women began to smoke in large numbers, they started to catch up to men in heart disease, lung cancer, and emphysema. Now, at last, both sexes are trying to break the habit, but more men (24%) than women (18%) are hooked on cigarettes. And since 30% of male and 21% of female high school students use tobacco, smoking is likely to continue fueling the gender gap for years to come.
Smoking is a terrible hazard for men and women, young and old.
Alcohol and substance abuse. Like smoking, drinking and drug abuse are traditionally male problems that are increasingly threatening to women as well. Still, males dominate in these self-destructive habits.
Small to modest amounts of alcohol (one to two drinks a day) appear to protect a man’s health, reducing his risk of heart attack and the most common type of stroke. But larger amounts shorten life by increasing the likelihood of hypertension, heart failure, liver disease, various cancers, accidents, and traumatic death. Alcoholism also takes a terrible toll on employment, personal happiness, and family life. Men are twice as likely as women to be binge drinkers and to become dependent on alcohol. Alcohol is responsible for about 85,000 American deaths annually; that’s 85,000 too many.
Illicit drugs claim about 17,000 lives a year. It’s a tragedy for both sexes, but males are 80% more likely to abuse drugs than females.
Diet. Meat is bad, veggies are good. It’s an oversimplification, but it may help explain why women are generally healthier than men: in most cases, they eat better. In a Massachusetts survey, for example, women were about 50% more likely than men to meet the goal of eating at least five servings of fruits and vegetables a day. The masculine ideal of meat and potatoes should give way to vegetables, fruits, grains, and fish.
Exercise. When human survival depended on physical work, both men and women got plenty of exercise. As men moved behind desks, women who continued to haul groceries, climb stairs, scrub, and wash continued to get the many health benefits of physical activity. But as modern appliances replace muscles at home and women join men in sedentary jobs, American women have fallen slightly behind in exercise. It’s small comfort to men, though, since most men don’t come close to getting the exercise they need for health.
Medical care. Women think about health, and they do more about it. Women are more likely than men to have health insurance and a regular source of health care. According to a major survey conducted by the Commonwealth Fund, three times as many men as women had not seen a doctor in the previous year; more than half of all men had not had a physical exam or cholesterol test in the previous year; among men over 50 years of age, 41% had not been screened for prostate cancer, and 60% had not been screened for colon cancer in the previous year; and 25% of men said they would handle worries about health by waiting as long as possible before seeking help. In general, men who have the most traditional, macho views about masculinity are the least likely to get routine check-ups and necessary medical care.
Call it the ostrich mentality or the John Wayne Syndrome; by any name, men who skip tests and treatments, minimize symptoms, and disregard medical advice are asking for trouble. Men who look under the hood every time the engine coughs should be as quick to get help when they cough.
It is hard to know why men make such poor patients; busy work schedules and competing responsibilities and interests may play a role, but the macho mentality appears to be the chief culprit. Who can blame men for wanting to be John Wayne? But by following the example of that quintessential American he-man, men fail to take the simple steps that can protect them from heart disease and lung cancer – the very same illnesses that plagued John Wayne before his death at age 72.
Atlas topic, subject, and course
Harvard Medical School (2010), Mars vs. Venus: The gender gap in health, at http://www.health.harvard.edu/newsletter_article/mars-vs-venus-the-gender-gap-in-health, accessed 13 March 2017.
Page created by: Ian Clark, last modified 13 March 2017.
Image: University of British Columbia, School of Population and Public Health, Gender, sex, and occupational health, at http://pwhs.ubc.ca/research/determinants-of-work-injury-and-illness/gender-sex-worker-injury-and-successful-return-to-work/, accessed 13 March 2017.