Survival Skills
It is no exaggeration to say that men's health has become a growth industry in this country over the past decade or so. And not just for doctors. Scholars in psychology, sociology, and other disciplines now specialize in male health issues, attend meetings dedicated to the topic, and publish in an array of journals that focus on men and medical matters. There are websites devoted to discussions of the topic. And medical consultants specialize in advising every institution from labor unions to the insurance industry on how to improve the health of American men by improving their behavior. For there is a growing awareness that men don't take very good care of their bodies and minds. Indeed, they are killing themselves by ignoring their medical needs and acting in destructive ways that simply make their health problems much, much worse.
Of course, women can be self-destructive, too, but the strong consensus among healthcare providers is that it's men, far and away, who are taking the most health risks.
There is no doubt that such risks exact a big toll. A study published in a recent issue of the Journal of the American Medical Association demonstrated that while the overall death rate in the United States has declined dramatically over the past 30 years, this trend masks increases in certain specific death rates, such as those from diabetes and an all-too-common lung ailment known as chronic obstructive pulmonary disease. Both of these disorders are strongly linked to unhealthful behaviors--a bad diet leading to obesity in the case of diabetes, and smoking in the case of lung disease. Men smoke too much and eat too carelessly, and that leads to trouble. For example, the death rate among men due to the lung problem is much higher than it is for women.
All this leaves unanswered the question of just why men are so self-destructive. What is the underlying psychological dynamic driving so many men toward poor health? Theories vary from a Freudian "death wish" to genetics and brain chemistry. Most experts today, however, tend to emphasize basic evolutionary biology and modern social norms. "Women were wired early on to care, and to care about their bodies because that is where people come from," says Jerry Kaiser, a California-based healthcare consultant who coaches CEOs on health matters and is writing a book on doctor-patient relationships. "Men, by contrast, are attuned to their musculature, because they're still basically hunters and warriors and that's where food and protection come from. They tend not to pay attention to things that are invisible and internal. If there is no clear external stimulus, there's no response."
Rough and ready. Michael Addis, a psychologist at Clark University, takes a slightly different view, emphasizing the ubiquitous social messages people receive. "Men and women both learn what makes a good man," he says, "and the message is that a good man is always independent. Anything else is weakness." Somewhat whimsically, Addis notes that the timeworn cliché that men, when lost, refuse to ask for directions is really a mundane appearance of this risky male pattern: Asking is weak. More seriously, this message of manly independence includes placing a high value on such traits as ruggedness and such behaviors as fast driving and participation in contact sports. Men view their bodies as machines, not things in need of caring, Addis says.
This would help explain men's attitudes toward their doctors. If they have a doctor, that is: A survey in 2002 showed that a quarter of men ages 45 to 64 don't even have a physician. Again, this probably has to do with resistance to conceding that one is vulnerable, flawed in some way. But it also may reflect a certain arrogance. Kaiser, who consulted with labor unions for years, recalls talking with a factory worker, a smoker, who dismissed the idea of going to a doctor with this comment: "I am not going to have some snot-nosed kid running my life." Whether the cause is stoicism or anger, many men are probably leaving very treatable disorders undiagnosed because they avoid doctors' offices until their bodies are in some kind of crisis.
So how to change this? Altering men's perilous attitudes and lifestyles is difficult but not impossible, says Will Courtenay, founder of Men's Health Consulting in Berkeley, Calif. The first step, he says, is to get out the message--especially to medical practitioners and HMOs--that they cannot expect men to behave like women. Women seek out and gobble up any information offered them about their health, while men will accept the pamphlets and toss them in the nearest trash bin as soon as they leave the doctor's office.
But that's the macho indoctrination talking. In fact, says Courtenay, many men, despite being socialized to think help-seeking is uncool, secretly are very concerned about being healthy and living for a long time. What is needed is an ambitious social marketing campaign--like the successful anti-binge-drinking campaign on college campuses--to get out this message: that men's devil-may-care attitude can be changed. "But it's not enough for doctors to leave a copy of Sports Illustrated in the waiting room," Courtenay says. "We need to really convince men that health is manly."
Dying Like a Man
Almost 1.2 million U.S. males die each year. The five leading reasons account for more than half of that total, and guys could do a lot to reduce it.
[chart labels]
Number of deaths per year (top causes)
Heart disease 340,933
Cancer 288,768
Unintentional injuries 69,257
Stroke 62,622
Chronic obstructive pulmonary disease 60,713
Source: Centers for Disease Control and Prevention, 2004
USN&WR
More information about heart disease, cancer, and other health matters can be found at www.usnews.com/health
This story appears in the September 26, 2005 print edition of U.S. News & World Report.