The longevity gap
Much has
changed in the US Society over the past 100 years. Medicine has evolved as much
as any field, with dramatic advances in diagnosis and treatment. Changing, too,
is the American lifestyle, with its new emphasis on healthier diets and regular
exercise and its declining dependence on tobacco.
As a
result of these developments, life expectancy is also changing, rising slowly
but steadily year after year. One thing, though, has not changed — the gender gap. People of both sexes are living longer, but decade after decade, women
continue to outpace men. In fact, the gap is wider now than it was a century
ago.
The
longevity gap is responsible for the striking demographic characteristics of
older Americans. More than half of all women older than 65 are widows, and
widows outnumber widowers by at least three to one. At age 65, for every 100
American women, there are only 77 men. At age 85, the disparity is even
greater, with women outnumbering men by 2.6 to 1. And the longevity gap
persists even into very old age, long after hormones have passed their peak;
among centenarians, there are four females for every male.
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. It's a
universal observation that suggests a basic difference between the health of
men and 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 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.
A lifelong gap
When it
comes to health, males are the weaker sex throughout life. But why? It's the million
dollar question, but there is no single answer. Instead, the gap depends on a
complex mix of biological, social, and behavioral factors.
Biological factors
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 appears to have some protective effect against heart disease, 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 than prostate cancer.
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.
Diabetes is a major problem for both sexes, and its prevalence is
increasing in both.
Like
diabetes, obesity is rapidly increasing across the US. More than two-thirds of
American adults are overweight or obese. 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.
Social factors
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. 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.
Behavioral factors
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 changed; when women began to smoke in large numbers, they
started to catch up to men in heart disease, lung cancer, and emphysema.
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.
Diet. In most
cases, women eat a healthier diet than men. 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. 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.
Closing the gap
Men
can't change their chromosomes and genes, and very few would change their
hormones. Still, men can catch up to women in some other areas. That doesn't
mean "going girly," though it does mean
Following are some simple rules. But will
men change their behavior?
An
incident reported in The
Wall Street Journal may help you decide about making changes.
In the 1960s, when Muhammad Ali was a brash and fearless boxing sensation still
known as Cassius Clay, he boarded a plane to fly to a big fight. While
preparing for takeoff, a flight attendant noticed that the boxer had not
fastened his seat belt. She asked him to buckle up, but he ignored her. When
she asked again, he replied, "Superman
don't need no seat belt." Her retort: "Superman don't need no airplane. Buckle up."
And he did.
Men who
think they are too tough to get sick are risking a medical crash-landing. To
stay healthy, we all need to follow the rules (including the one about seat
belts). Here are 10 tips to help you wing your way to a long and healthy life.
1. Avoid
tobacco in all its forms.
2. Eat
well. That
means eating more healthful foods and fewer harmful foods.
- Eat more: whole grains,
fruits, vegetables and legumes, fish, low- or non-fat dairy products, and
nuts and seeds.
- Eat less: red meat,
whole-milk dairy products, poultry skin, high-sodium (salty) processed
foods, sweets, sugary drinks and refined carbohydrates, and if you need to
lose weight, calories.
3.
Exercise regularly, including:
- At least 30 minutes of
moderate exercise nearly every day.
- Exercises for strength two
to three times a week.
- Exercises for flexibility
and balance according to need.
4. Stay
lean. It's
equally hard for men and women, but even partial success will help.
5. If
you choose to drink, limit yourself to one to two drinks a day,
counting 5 ounces of wine, 12 ounces of beer, and 1.5 ounces of liquor as one
drink.
6.
Reduce stress. Get enough sleep. Build social ties
and community support.
7. Avoid
risky behavior, including drug abuse, unsafe sex,
dangerous driving, unsafe firearm use, and living in hazardous household
conditions.
8.
Reduce exposure to toxins and radiation, including
sunlight and medical x-rays.
9. Get
regular medical check-ups, screening tests, and
immunizations. Listen to your body and report sounds of discord to your doctor.
10. Seek
joy and share it with others. Laughter is good medicine. Fun
and optimism improve health as well as happiness. And if you make changes 1 to
9 slowly, steadily, and reasonably, you will actually come to enjoy your
healthful lifestyle.
As
things now stand, men are from Mars, women from Venus. But
gents who get their planets aligned correctly can enjoy the best of both worlds
— and good health right here on Earth.
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