A decade ago at the annual meeting of the Public Health Association of B.C., I gave a talk on health inequalities.
In the discussion period, a member of a women’s health centre pointed out that I had said nothing about gender inequality. I agreed, but my response, although factually correct, was probably not what was expected.
I noted there was a significant gender inequality in that men had shorter life expectancies than women. We needed to do a better job of improving men’s health and reducing the gender gap, I suggested.
The women’s-health movement has done a great job in identifying and addressing the inequalities in life circumstances that have health consequences for women. But the inequality in health that is experienced by men is not widely understood, nor has it been a focus of concern, until recently.
In fact, the male health gap is considerable. A 2011 European Commission report on the state of men’s health noted that the gap in life expectancy at birth experienced by males “ranges from 11.3 years for Latvia to 3.3 years in Iceland.” Moreover, this difference “persists across the majority of conditions that should, on biological grounds, affect men and women equally.”
In the 27 countries of the European Union, the EC report also noted, “the death rate is higher for men in all age ranges.” In particular, it is more than twice as high in the 15-64 age range and 50 per cent higher among those 65 and over.
We see the same pattern in Canada, according to a 2013 report from Statistics Canada. Life expectancy at birth for males for the 2009-11 period, at 79.3 years, was 4.3 years less than for women. (However, the gap has been narrowing; in Canada it was 6.4 years in 1990-92.)
In B.C., where life expectancy for males is a bit longer, at 80.3 years, the gap is 4.4 years. Further, “there were more male than female deaths [in Canada] at all ages until age 83.” In 2009-11, men were 2.5 times more likely to die in their early 20s than women.
The two obvious questions we should ask are why does this gap exist, and what can be done about it? A 2011 report from B.C.’s Northern Health Area reports that according to Susan Phillips “male gender roles, as manifest by risky behaviour around drinking, driving and sex, account for virtually all excess male mortality below age 45, and approximately 50 per cent of the excess below age 60.”
The NHA report suggested a number of other reasons, including that “men often grow up relatively unaware of their bodies and ignore symptoms of trouble” and that there are “societal expectations of men to be stoic and uncomplaining of pain or other physical symptoms.”
Couple all this with a reluctance to take time off work, either because of loss of income or because work is a key part of their lives, and the result is that men access needed medical care — and preventive services — much less than women.
The men’s-health movement is still fairly new, but is beginning to develop responses. The NHA report suggests engaging men around health issues starting with boys in school, and including men at work, at play and at home.
One interesting approach developed in Australia is the concept of the Men’s Shed. Building on the common experience of the “shed in the backyard,” the Men’s Shed provides “a safe and friendly environment where men are able to work on meaningful projects at their own pace in their own time in the company of other men,” according to the Australian Men’s Shed Association.
However, the explicit subtext is that such an environment is intended to “advance the well-being and health” of the members.
The website of the Men’s Health Research network at the University of British Columbia notes that this approach “is recognized as a health-promotion tool, particularly for men at risk of social isolation, low income and/or those living in rural or remote areas.”
Canada’s first Men’s Shed was launched in Manitoba in 2011, and the University of Manitoba is using Movember funding to start a national website. So check it out, guys!
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.