- Email: [email protected]
What about Men’s Health? A Chair of Women’s Health perspective
Editorial
What about Men’s Health? A Chair of Women’s Health perspective Donna E. Stewart
Donna E. Stewart, MD (Professor and Chair of Women’s Health) University Health Network, University of Toronto, 657 University Ave, ML 2-0004, Ont., Toronto, Canada, M5G 2N2 E-mail: [email protected]
Online 12 May 2004
20
A gender-blind approach to health and healthcare serves neither men nor women well! Over a decade ago, increasing attention began to be paid to women’s health throughout North America and Europe and as a result, enormous advances have been made in women’s health research, policy and services [1]. Requirements have since been put in place in the United States, which mandate the participation of women, and ethnic minorities in government funded health research [2]. Guidelines for clinical trials for new drugs and devices encourage the inclusion of adequate numbers of women to conduct appropriate gender analyses [2]. Numerous vital gender differences in health behaviors, symptoms, response to therapy and prognoses have been described in the last decade [1]. Examples of these include gender differences in smoking initiation and cessation, symptoms associated with acute ischemic cardiac disease, responses to pharmacologic therapies and prognoses for cardiovascular diseases and lung cancer [1]. Many of these differences illustrate the point that women’s health should never be about ‘‘them versus us,’’ but rather ‘‘what are the gender differences in health and healthcare and how might we best address these to better serve both sexes?’’ Accordingly, this new focus on men’s health is welcomed and I hope your path will be a little smoother as a result of our work on the importance of sex and gender in health. Many women’s health researchers compared both sexes and sometimes discovered salient findings about men’s health. At
Vol. 1, No. 1, pp. 20–21, May 2004
times, the process has been memorable for me, as for example when a senior male physician thundered, ‘‘women’s health; what about men’s health?’’ He continued to insist that he would not allow his male patients, ‘‘to be used as controls for women.’’ After reassurance, he allowed the study to proceed and subsequently expressed some surprise that the symptoms and outcomes in male and female acute myocardial infarction patients were different. Only 3 years later I was amused to hear him state in a lecture that, ‘‘we have known for many years that there are important gender differences in the presentation and outcomes of myocardial infarction.’’ Another striking example occurred on my first day as Chair of Women’s Health in a large university hospital when a senior surgeon presented me with a coffee cup labeled ‘‘Save the Males.’’ He went on to assert that, ‘‘there is only one kind of health, human health, and all this political correctness in studying gender differences in health is a waste of time and money.’’ To his credit, he reversed his position a few years later, and recruited many of his patients for studies we were conducting on information needs and decisional preferences for various medical and surgical treatments [3,4]. Clearly, many healthcare professionals are beginning to understand the usefulness of sex (biological) and gender (sociocultural) aspects of health and are now incorporating some of these findings into their research, services and practices for both men and women. My colleagues and I recently undertook the first comprehensive analysis and publica-
ß 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.
Editorial tion of health and disease among Canadian women, which provided updated information and statistics on factors affecting the health status and health outcomes of the population [5]. We conducted comparisons between men and women, and between women themselves across the life course for a wide variety of health issues. Among the most surprising findings was that women’s longer life expectancy was primarily due to better health behaviors and not biology. In fact, the avoidable causes of death (such as, accidents, smoking–related deaths, HIV and AIDS) accounted for the majority of the difference in life expectancy between men and women, thereby defying the myth that women are by nature healthier than men [5]. Of course, what the report could not answer is why these differences in health behaviors exist, though it seems highly likely that biological, social, psychological and behavioral variables interact to produce many important gender differences. For example, the high rates of male death through violence throughout the world cry out for studies to better understand the multiple determinants of risky and aggressive behaviors. Interesting differences and similarities between men and women in their preferences for health information, medical decision-making and health services have also been identified. For example, we have found that women with acute myocardial infarction want more information about hypertension than they currently receive from their
physicians, and men cardiac patients have sexual issues which they feel are inadequately addressed [6]. In the case of men and women suffering from prostate and ovarian cancer respectively, we found both genders wanted extensive information, but men preferred less detailed information about their disease than women [3,4]. These age-controlled gender differences in information needs were not however reflected in strong preferences for shared or autonomous roles in medical decision making with their physicians [3,4]. There are unlimited opportunities to explore sex and gender differences in health and health care ranging from subcellular to health systems approaches. However we must remember that the life context of both genders, including our relationships with each other, will be critical in most considerations of health. I am delighted to serve on the editorial board of this new Journal of Men’s Health and Gender and look forward to working and learning together to help solve the many health issues that afflict both men and women. These will also undoubtedly include conditions that are sex specific, such as genital cancers, as well as those which show gender differences such as violence, sexual problems, depression and substance abuse. My heartfelt hope is that this new journal will enlighten and expand the vision of health for both genders, and that the men we know and love will also receive the health and healthcare they deserve.
References [1] Wizemann TM, Pardue M. Exploring the biological contributions to human health: does sex matter? Institute of Medicine. Washington, DC: The National Academy Press; 2001. [2] NIH guidelines on the inclusion of women and minorities as subjects in clinical research. Federal Register 1994;59:492B(a)(1). [3] Stewart DE, Wong F, Cheung A, Dancey J,
Meana M, Cameron J, et al. Informational needs and decisional preferences among women with ovarian cancer. Gynecol Oncol 2000;77:357–61. [4] Wong F, Stewart DE, Dancey J, Meana M, McAndrews MP, Bunston T, et al. Men with prostate cancer: influence of psychological factors on informational needs and decision making. J Psychosom Res 2000;49:13–9.
[5] DesMeules M, Stewart DE. Women’s Health Surveillance Report: a multidimensional look at the health of Canadian women. Canadian Institute for Health Information; 2003. [6] Stewart DE, Abbey S, Shnek Z, Irvine J, Grace S. Gender differences in health information needs and decisional preferences in patients recovering from an acute ischemic coronary event. Psychosom Med 2004;66(1):42–8.
Vol. 1, No. 1, pp. 20–21, May 2004
21
What about Men’s Health? A Chair of Women’s Health perspective Donna E. Stewart
Donna E. Stewart, MD (Professor and Chair of Women’s Health) University Health Network, University of Toronto, 657 University Ave, ML 2-0004, Ont., Toronto, Canada, M5G 2N2 E-mail: [email protected]
Online 12 May 2004
20
A gender-blind approach to health and healthcare serves neither men nor women well! Over a decade ago, increasing attention began to be paid to women’s health throughout North America and Europe and as a result, enormous advances have been made in women’s health research, policy and services [1]. Requirements have since been put in place in the United States, which mandate the participation of women, and ethnic minorities in government funded health research [2]. Guidelines for clinical trials for new drugs and devices encourage the inclusion of adequate numbers of women to conduct appropriate gender analyses [2]. Numerous vital gender differences in health behaviors, symptoms, response to therapy and prognoses have been described in the last decade [1]. Examples of these include gender differences in smoking initiation and cessation, symptoms associated with acute ischemic cardiac disease, responses to pharmacologic therapies and prognoses for cardiovascular diseases and lung cancer [1]. Many of these differences illustrate the point that women’s health should never be about ‘‘them versus us,’’ but rather ‘‘what are the gender differences in health and healthcare and how might we best address these to better serve both sexes?’’ Accordingly, this new focus on men’s health is welcomed and I hope your path will be a little smoother as a result of our work on the importance of sex and gender in health. Many women’s health researchers compared both sexes and sometimes discovered salient findings about men’s health. At
Vol. 1, No. 1, pp. 20–21, May 2004
times, the process has been memorable for me, as for example when a senior male physician thundered, ‘‘women’s health; what about men’s health?’’ He continued to insist that he would not allow his male patients, ‘‘to be used as controls for women.’’ After reassurance, he allowed the study to proceed and subsequently expressed some surprise that the symptoms and outcomes in male and female acute myocardial infarction patients were different. Only 3 years later I was amused to hear him state in a lecture that, ‘‘we have known for many years that there are important gender differences in the presentation and outcomes of myocardial infarction.’’ Another striking example occurred on my first day as Chair of Women’s Health in a large university hospital when a senior surgeon presented me with a coffee cup labeled ‘‘Save the Males.’’ He went on to assert that, ‘‘there is only one kind of health, human health, and all this political correctness in studying gender differences in health is a waste of time and money.’’ To his credit, he reversed his position a few years later, and recruited many of his patients for studies we were conducting on information needs and decisional preferences for various medical and surgical treatments [3,4]. Clearly, many healthcare professionals are beginning to understand the usefulness of sex (biological) and gender (sociocultural) aspects of health and are now incorporating some of these findings into their research, services and practices for both men and women. My colleagues and I recently undertook the first comprehensive analysis and publica-
ß 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.
Editorial tion of health and disease among Canadian women, which provided updated information and statistics on factors affecting the health status and health outcomes of the population [5]. We conducted comparisons between men and women, and between women themselves across the life course for a wide variety of health issues. Among the most surprising findings was that women’s longer life expectancy was primarily due to better health behaviors and not biology. In fact, the avoidable causes of death (such as, accidents, smoking–related deaths, HIV and AIDS) accounted for the majority of the difference in life expectancy between men and women, thereby defying the myth that women are by nature healthier than men [5]. Of course, what the report could not answer is why these differences in health behaviors exist, though it seems highly likely that biological, social, psychological and behavioral variables interact to produce many important gender differences. For example, the high rates of male death through violence throughout the world cry out for studies to better understand the multiple determinants of risky and aggressive behaviors. Interesting differences and similarities between men and women in their preferences for health information, medical decision-making and health services have also been identified. For example, we have found that women with acute myocardial infarction want more information about hypertension than they currently receive from their
physicians, and men cardiac patients have sexual issues which they feel are inadequately addressed [6]. In the case of men and women suffering from prostate and ovarian cancer respectively, we found both genders wanted extensive information, but men preferred less detailed information about their disease than women [3,4]. These age-controlled gender differences in information needs were not however reflected in strong preferences for shared or autonomous roles in medical decision making with their physicians [3,4]. There are unlimited opportunities to explore sex and gender differences in health and health care ranging from subcellular to health systems approaches. However we must remember that the life context of both genders, including our relationships with each other, will be critical in most considerations of health. I am delighted to serve on the editorial board of this new Journal of Men’s Health and Gender and look forward to working and learning together to help solve the many health issues that afflict both men and women. These will also undoubtedly include conditions that are sex specific, such as genital cancers, as well as those which show gender differences such as violence, sexual problems, depression and substance abuse. My heartfelt hope is that this new journal will enlighten and expand the vision of health for both genders, and that the men we know and love will also receive the health and healthcare they deserve.
References [1] Wizemann TM, Pardue M. Exploring the biological contributions to human health: does sex matter? Institute of Medicine. Washington, DC: The National Academy Press; 2001. [2] NIH guidelines on the inclusion of women and minorities as subjects in clinical research. Federal Register 1994;59:492B(a)(1). [3] Stewart DE, Wong F, Cheung A, Dancey J,
Meana M, Cameron J, et al. Informational needs and decisional preferences among women with ovarian cancer. Gynecol Oncol 2000;77:357–61. [4] Wong F, Stewart DE, Dancey J, Meana M, McAndrews MP, Bunston T, et al. Men with prostate cancer: influence of psychological factors on informational needs and decision making. J Psychosom Res 2000;49:13–9.
[5] DesMeules M, Stewart DE. Women’s Health Surveillance Report: a multidimensional look at the health of Canadian women. Canadian Institute for Health Information; 2003. [6] Stewart DE, Abbey S, Shnek Z, Irvine J, Grace S. Gender differences in health information needs and decisional preferences in patients recovering from an acute ischemic coronary event. Psychosom Med 2004;66(1):42–8.
Vol. 1, No. 1, pp. 20–21, May 2004
21