- Email: [email protected]
Masculinity is Dangerous to Your Health
Editorials
Masculinity is Dangerous to Your Health A surprising and rarely discussed health disparity in the United States is that between men and women. Studies report that women receive poorer quality care than men, are less likely to be the focus of research and have less access to health care professionals because of a lack of job provided insurance or inability to pay as a single parent.1,2 Thus, women are becoming effective advocates on behalf of their care and that of their children. Yet the current focus on women’s health fails to reconcile some disturbing aspects of gender disparity. On average men die 7 years earlier than women and surpass women in 9 of 10 categories for the leading causes of death.3 When indexed by race, African-American and Hispanic men have even higher mortality ratios relative to women. Winning the race to the grave is a competitive event at which men should not be eager to excel. Perhaps an even better measure of this health disparity between men and women regardless of race or socioeconomic status is “potential years of life lost.” A substantial portion of men die needlessly at an early age due to accidents compared to women which contributes to the overall earlier average mortality but premature death in risk taking young men tragically occurs decades before women. Researchers traditionally attribute this disparity in longevity to biological differences between men and women, citing the observation that females of nearly all species live longer than males. Previous parity for the average age of death in the early 20th century plus the tremendous variability in death rates between men and women throughout the world imply that potentially modifiable factors account in part for this disparity. Men die at alarming rates from male specific conditions such as prostate cancer and from male risk conditions such as cardiovascular disease, accidents and suicide. In this regard, an underused strategy to promote wellness would be a dual approach to reduce risk taking while promoting healthy lifestyles. The current health care system rewards diagnosis and treatment but not prevention. Urologists like other physicians tend to follow this paradigm. Unfortunately men are less likely than women to embrace preventive measures for reasons including de0022-5347/10/1846-2229/0 THE JOURNAL OF UROLOGY® © 2010 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
nial, feelings of invulnerability, lack of time and even fear of appearing less masculine. There are substantial barriers to saving the lives of men. Some barriers like violent or risk taking tendencies in young males are difficult to reverse. Others like re-tooling the mechanics involved with the delivery of health care and preventive education are more surmountable. Men visit health care providers a third less often than women. In 1999 men accounted for 135 million fewer office visits than women, and greater than 9 million men had not seen a doctor in more than 5 years. In a study published in the American Journal of Public Health the fact was highlighted that men are not socialized to see physicians in contrast to women who are because of their reproductive issues and as primary caregivers to children.4 Embarrassment begins with registration with a female receptionist for a “male” complaint. The same study reported that men hate waiting in the doctor’s office which averaged 20 minutes in the waiting room and 7 minutes in the examination room. Physicians’ offices also tend to be “feminized” as exemplified by furniture, decorating and reading material. A Harris Poll conducted in 2007 identified the top 10 excuses men give for not seeing a doctor. Top on the list was that they only go to the doctor if they are extremely sick, possibly due to fear or stoicism, followed by denial believing they are healthy, time constraints, lack of insurance, dislike of doctors and fear that something may be wrong. Pharmaceutical companies, in their direct to consumer marketing, target men in ads for prostate and erectile dysfunction medications, pleading them to “ask their doctor.” The problem is that often men do not have a physician or refuse to see one. Other nonurologists not recognizing the harbinger of cardiovascular disease such as erectile dysfunction or perhaps lower urinary complaints may dismiss these complaints as less important than issues such as lipid or blood pressure control. Many times urologists are the first physician in decades to see a man when problems below the beltline cause concern. We focus on the urological issue even if recognizing implications of genitourinary symptoms Vol. 184, 2229-2230, December 2010 Printed in U.S.A. DOI:10.1016/j.juro.2010.09.039
www.jurology.com
2229
2230
MASCULINITY IS DANGEROUS TO YOUR HEALTH
on overall health because of limited training. Recent expansion of the urology curriculum to include geriatrics spearheaded by the American Urological Association is a step in the positive direction. Conditioning to avoid medical care unless a severe sports or other injury occurs often begins in late adolescence when mothers no longer accompany their sons to the doctor and the culture of invulnerability begins. This pattern of women coercing men to see doctors continues throughout life, and the notion that only “the weak” see doctors or you only visit a physician when it is a matter of life or death permeates our society and is exacerbated by lack of insurance. Indeed, it is estimated that 80% of men refuse to seek medical care until women (spouse, girlfriend) plead with them to see a doctor. The additional health care costs of delayed diagnoses and unhealthy behaviors of men have prompted several governments to formally establish health campaigns that target men. Ireland, Australia and British Columbia are investigating ways to improve health care in men. Similar efforts in the United States are fragmented and are often more of a marketing campaign by physician practices to attract men to their offices. Urologists must be at the forefront of promoting men’s health. Counseling on smoking cessation and weight loss is a step in the right direction. In a fee for service environment care is often linked to tests or procedures to be financially viable without government or philanthropic support. Anti-aging clinics administering androgens or growth hormone are popular in certain locales, while impotence clinics may offer unnecessary testing and quick symptomatic fixes rather than preventive counseling or investigation of cardiovascular risks. A coordinated effort among medical and surgical specialists to identify, treat and prevent behaviors leading to sexual dysfunction, prostate problems, violence or substance abuse is lacking. It can be argued that any attempt to reduce health care costs in the United States is doomed to failure if men are not specifically targeted. Beyond the delivery of health care, the education of men about healthy behaviors has been sporadic, misdirected, error ridden and fraught with challenges. Magazines such as Men’s Health often focus
on sexual function, sports activities, diet and body sculpting. For more affluent or educated men the Wall Street Journal or institutional health briefs (Harvard, Johns Hopkins, New England Journal) offer knowledge and advice. In the 1970s a group of women in Boston recognized the lack of information on reproductive and sexual health or worse, wrong information was provided by health care professionals. This offshoot of the feminist movement resulted in the self-publication of the low cost pamphlet, Our Body Ourselves. This grass roots effort led to greater self-awareness of health issues among women. However, 2 challenges with a similar approach in men are 1) the lack of any masculine health movement and 2) men tend not to read or at least receive health care information in the same manner as women. Research on how men receive information about their health and strategies of how best to deliver medical advice is scant. Whereas men exceed women in total Internet use, women are more likely than men to search for health information via the Internet.5 Companies have marketed “male drugs” for sexual function or prostate conditions via sports sponsors such as NASCAR, MLB and the NFL. The American Urological Association Foundation relies on sports celebrities to campaign against prostate cancer. However, the distribution of health care materials at sporting or other male identified activities has not altered health care for men on a national level. Although discussion of targeting adolescent males for lifelong healthy behaviors is admirable, changing male behavior may be more challenging than altering the manner in which health care is delivered to men and providing information in a fashion that appeals to them. Taking a more nihilistic view, targeting women with male health care information who then deliver these messages to their sons, husbands, fathers or friends could even be considered. Thus, it appears that being a male is dangerous to your health. As the doctors for aging men urologists should lead the way to improve men’s health. William D. Steers Editor
REFERENCES 1. Turpin RS, Darcy LA, Weaver FM et al: Assessing health care delivery to male versus female veterans. Women Health 1992; 18: 81.
gov/owh/multidisciplinary/reports/GenderBased Medicine/Question1.cfm. Accessed September 1, 2010.
4. Williams DR: The health of men: structured inequalities and opportunities. Am J Public Health 2003; 93: 724.
2. U. S. Department of Health and Human Services Office on Women’s Health: Literature review on effective sex- and gender-based systems/ models of care. http://www.womenshealth.
3. Leading cause of death in males. CDC 2004. http:// www.cdc.gov/men/lcod/index.htm. Accessed September 1, 2010.
5. http://www.marketingcharts.com/interactive/nineof-10-women-online-seek-health-info-via-web-1656/ burst-media-health-information-internet-use-by-agegenderjpg/. Accessed September 1, 2010.
Masculinity is Dangerous to Your Health A surprising and rarely discussed health disparity in the United States is that between men and women. Studies report that women receive poorer quality care than men, are less likely to be the focus of research and have less access to health care professionals because of a lack of job provided insurance or inability to pay as a single parent.1,2 Thus, women are becoming effective advocates on behalf of their care and that of their children. Yet the current focus on women’s health fails to reconcile some disturbing aspects of gender disparity. On average men die 7 years earlier than women and surpass women in 9 of 10 categories for the leading causes of death.3 When indexed by race, African-American and Hispanic men have even higher mortality ratios relative to women. Winning the race to the grave is a competitive event at which men should not be eager to excel. Perhaps an even better measure of this health disparity between men and women regardless of race or socioeconomic status is “potential years of life lost.” A substantial portion of men die needlessly at an early age due to accidents compared to women which contributes to the overall earlier average mortality but premature death in risk taking young men tragically occurs decades before women. Researchers traditionally attribute this disparity in longevity to biological differences between men and women, citing the observation that females of nearly all species live longer than males. Previous parity for the average age of death in the early 20th century plus the tremendous variability in death rates between men and women throughout the world imply that potentially modifiable factors account in part for this disparity. Men die at alarming rates from male specific conditions such as prostate cancer and from male risk conditions such as cardiovascular disease, accidents and suicide. In this regard, an underused strategy to promote wellness would be a dual approach to reduce risk taking while promoting healthy lifestyles. The current health care system rewards diagnosis and treatment but not prevention. Urologists like other physicians tend to follow this paradigm. Unfortunately men are less likely than women to embrace preventive measures for reasons including de0022-5347/10/1846-2229/0 THE JOURNAL OF UROLOGY® © 2010 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
nial, feelings of invulnerability, lack of time and even fear of appearing less masculine. There are substantial barriers to saving the lives of men. Some barriers like violent or risk taking tendencies in young males are difficult to reverse. Others like re-tooling the mechanics involved with the delivery of health care and preventive education are more surmountable. Men visit health care providers a third less often than women. In 1999 men accounted for 135 million fewer office visits than women, and greater than 9 million men had not seen a doctor in more than 5 years. In a study published in the American Journal of Public Health the fact was highlighted that men are not socialized to see physicians in contrast to women who are because of their reproductive issues and as primary caregivers to children.4 Embarrassment begins with registration with a female receptionist for a “male” complaint. The same study reported that men hate waiting in the doctor’s office which averaged 20 minutes in the waiting room and 7 minutes in the examination room. Physicians’ offices also tend to be “feminized” as exemplified by furniture, decorating and reading material. A Harris Poll conducted in 2007 identified the top 10 excuses men give for not seeing a doctor. Top on the list was that they only go to the doctor if they are extremely sick, possibly due to fear or stoicism, followed by denial believing they are healthy, time constraints, lack of insurance, dislike of doctors and fear that something may be wrong. Pharmaceutical companies, in their direct to consumer marketing, target men in ads for prostate and erectile dysfunction medications, pleading them to “ask their doctor.” The problem is that often men do not have a physician or refuse to see one. Other nonurologists not recognizing the harbinger of cardiovascular disease such as erectile dysfunction or perhaps lower urinary complaints may dismiss these complaints as less important than issues such as lipid or blood pressure control. Many times urologists are the first physician in decades to see a man when problems below the beltline cause concern. We focus on the urological issue even if recognizing implications of genitourinary symptoms Vol. 184, 2229-2230, December 2010 Printed in U.S.A. DOI:10.1016/j.juro.2010.09.039
www.jurology.com
2229
2230
MASCULINITY IS DANGEROUS TO YOUR HEALTH
on overall health because of limited training. Recent expansion of the urology curriculum to include geriatrics spearheaded by the American Urological Association is a step in the positive direction. Conditioning to avoid medical care unless a severe sports or other injury occurs often begins in late adolescence when mothers no longer accompany their sons to the doctor and the culture of invulnerability begins. This pattern of women coercing men to see doctors continues throughout life, and the notion that only “the weak” see doctors or you only visit a physician when it is a matter of life or death permeates our society and is exacerbated by lack of insurance. Indeed, it is estimated that 80% of men refuse to seek medical care until women (spouse, girlfriend) plead with them to see a doctor. The additional health care costs of delayed diagnoses and unhealthy behaviors of men have prompted several governments to formally establish health campaigns that target men. Ireland, Australia and British Columbia are investigating ways to improve health care in men. Similar efforts in the United States are fragmented and are often more of a marketing campaign by physician practices to attract men to their offices. Urologists must be at the forefront of promoting men’s health. Counseling on smoking cessation and weight loss is a step in the right direction. In a fee for service environment care is often linked to tests or procedures to be financially viable without government or philanthropic support. Anti-aging clinics administering androgens or growth hormone are popular in certain locales, while impotence clinics may offer unnecessary testing and quick symptomatic fixes rather than preventive counseling or investigation of cardiovascular risks. A coordinated effort among medical and surgical specialists to identify, treat and prevent behaviors leading to sexual dysfunction, prostate problems, violence or substance abuse is lacking. It can be argued that any attempt to reduce health care costs in the United States is doomed to failure if men are not specifically targeted. Beyond the delivery of health care, the education of men about healthy behaviors has been sporadic, misdirected, error ridden and fraught with challenges. Magazines such as Men’s Health often focus
on sexual function, sports activities, diet and body sculpting. For more affluent or educated men the Wall Street Journal or institutional health briefs (Harvard, Johns Hopkins, New England Journal) offer knowledge and advice. In the 1970s a group of women in Boston recognized the lack of information on reproductive and sexual health or worse, wrong information was provided by health care professionals. This offshoot of the feminist movement resulted in the self-publication of the low cost pamphlet, Our Body Ourselves. This grass roots effort led to greater self-awareness of health issues among women. However, 2 challenges with a similar approach in men are 1) the lack of any masculine health movement and 2) men tend not to read or at least receive health care information in the same manner as women. Research on how men receive information about their health and strategies of how best to deliver medical advice is scant. Whereas men exceed women in total Internet use, women are more likely than men to search for health information via the Internet.5 Companies have marketed “male drugs” for sexual function or prostate conditions via sports sponsors such as NASCAR, MLB and the NFL. The American Urological Association Foundation relies on sports celebrities to campaign against prostate cancer. However, the distribution of health care materials at sporting or other male identified activities has not altered health care for men on a national level. Although discussion of targeting adolescent males for lifelong healthy behaviors is admirable, changing male behavior may be more challenging than altering the manner in which health care is delivered to men and providing information in a fashion that appeals to them. Taking a more nihilistic view, targeting women with male health care information who then deliver these messages to their sons, husbands, fathers or friends could even be considered. Thus, it appears that being a male is dangerous to your health. As the doctors for aging men urologists should lead the way to improve men’s health. William D. Steers Editor
REFERENCES 1. Turpin RS, Darcy LA, Weaver FM et al: Assessing health care delivery to male versus female veterans. Women Health 1992; 18: 81.
gov/owh/multidisciplinary/reports/GenderBased Medicine/Question1.cfm. Accessed September 1, 2010.
4. Williams DR: The health of men: structured inequalities and opportunities. Am J Public Health 2003; 93: 724.
2. U. S. Department of Health and Human Services Office on Women’s Health: Literature review on effective sex- and gender-based systems/ models of care. http://www.womenshealth.
3. Leading cause of death in males. CDC 2004. http:// www.cdc.gov/men/lcod/index.htm. Accessed September 1, 2010.
5. http://www.marketingcharts.com/interactive/nineof-10-women-online-seek-health-info-via-web-1656/ burst-media-health-information-internet-use-by-agegenderjpg/. Accessed September 1, 2010.