Men belong to a privileged class. They make more money than women for equal labor, they are less likely to be assaulted, and they disproportionately occupy top executive positions. But in one key area (perhaps the most important sector) women have an edge: life expectancy.
Women live an average of seven years longer than men worldwide, and 67 percent of 85-year-olds in the U.S. are female. Biology and genetics cannot entirely explain the disparity. Experts suspect that men die younger in large part because society conditions them to take greater risks in their youth, and stoically ignore declining health as they age. And the U.S. federal government has shown little interest in closing the longevity gap. At least a dozen offices in the federal system are charged with promoting women’s health, but none exist exclusively to protect men.
“We’re accepting the fact that guys live sicker and die younger without raising an eyebrow,” Michael J. Rovito, health sciences professor at the University of Central Florida and chairman of the non-profit Men’s Health Initiative, told Fatherly. “It has just become the norm.”
At the federal level, The National Cancer Institute spends $500 million per year on breast cancer research and throws $177 million at uterine, ovarian, and cervical cancer. The budget for fighting prostate cancer, the third leading cause of cancer death in the U.S. (which may account for as many deaths per year as breast cancer), is only $250 million. Similar disparities exist within the National Institutes of Health. $700 million for breast cancer; $250 million for prostate cancer.
“It’s almost as if they’re telling men that they matter a little less,” James Leone, professor at Bridgewater State University and member of the Men’s Health Initiative, told Fatherly. “We still have this chivalrous, paternalistic instinct to protect women and children. And who’s going to do the sacrificing that comes with that protecting?”
The situation is not much better at the state and local levels. While there are certainly clinics and healthcare providers for men—even Planned Parenthood, associated with women’s health in the public imagination, offers free testicular cancer screenings—there just isn’t the same sort of investment in men’s health issues. Dedicated women’s clinics are pervasive, compared to a mere handful clinics for men, and local marathons for breast cancer research seem to resonate more than comparable efforts to fight prostate cancer. After a state-of-the-art women’s hospital opened near Rovito’s home, he reflected on the disparity. “I challenge anybody to point me toward a hospital dedicated solely for guys,” he says. “That would never exist. It’s not allowed to exist.”
True, we cannot blame the longevity gap solely on lack of government attention. There are a handful of biological and genetic forces conspiring against men. The male sex hormone testosterone has been shown to increase both risky behavior and cholesterol. Estrogen, the female sex hormone, is associated with a healthy lipid profile. Even in utero, female fetuses fare better thanks to a spare X chromosome that can compensate for certain genetic mutations. And male mortality is 30 percent greater than female mortality among infants in their first year of life.
At the same time, “some of these sex differences work against women,” Shervin Assari, professor at the University of Michigan Institute for Healthcare Policy, told Fatherly. Maternal deaths are the second biggest killer of women of reproductive age, according to the World Health Organization, and 287,000 women die each year due to complications from pregnancy and childbirth—99 percent of them in developed countries. “Men don’t have that risk, so there’s a sex difference that should give men the advantage,” Assari says. “But still, men die earlier.”
It follows that social and behavioral conditions are likely to blame, rather than genetics. “Biology loads the chamber,” Leone says. “But masculinity and social constructs pull the trigger.”
Part of the problem is occupational. Men dominate many of the riskiest fields, including firefighting, mining, logging, and fishing. “Those professions alone cut down quite a few guys in the prime of their lives,” Leone says. Men are more likely to die from unintentional injuries and, while they’re less likely to be depressed or express suicidal ideation, they’re far more likely to kill themselves. “We may be biologically wired to take more risks but, again, social masculinity and cultural context weighs heavily on whether you literally take the jump,” he says.
Even apparently biological causes of death are partly attributable to gendered behaviors, Leone adds. We tend to assume that heart disease is purely biological, and that men die of it more often than women because their high levels of testosterone promote poor cholesterol. But that’s only part of the story. “Heart disease doesn’t just happen,” Leone says. “We have to look at the decisions that were engineered by the man, his culture, and his occupation, to get him to that point.” For instance, society often tolerates men who are overweight or smoke cigarettes—two major risk factors for heart disease that social norms may selectively push women to avoid. “If I were to assign a percentage, I’d say about 80-20 in favor of social determinants,” Leone says.
Still, men may be partly to blame for their own predicament. Most men are woefully oblivious when it comes to their health, and seldom notice problems until they interfere with their daily functions and job performance (“which means it’s too late,” Assari says). And once men drag themselves to the doctor they can be coy about their symptoms, unlike women who tend to be open with healthcare providers. “Men are terrible at that,” Assari says. “Not only do they approach the doctor late, they don’t share the information the doctor needs to make the diagnosis.”
Assari demonstrated this in his own research, by asking 1,500 older adults about their own health, and then following them for three years. The results, published in 2016, suggest that a woman’s perception of her failing health is a poor predictor of whether or not she’ll die in the coming years. But when a man says he’s on his way out, he means it—and he tends to die shortly thereafter. “Clinicians should take a poor health response of men much more seriously than women,” Assari says. “By the time a man says ‘I’m not doing great’, it’s because he realizes it’s too late.”
It’s no wonder, Assari says, that governments and local organizations ignore men’s health. Women are asking for help; men are not. “To me, it makes sense,” he says. “At the individual level, women take more control of their health. So at the policy level, more attention is given to the health of women.” Similarly, Assari does not consider the existence of women’s hospitals and clinics indicative of disparity. “This is a consequence of being the more privileged gender,” he says. “Men don’t need a hospital just for them because they are the dominant group. You don’t have a hospital for whites, but there are hospitals that try to reach minority groups and LGBT people.”
Rovito takes a more moderate approach. “It could be self-driven or systematic, probably a mix of both” he allows. “We’re not really the best consumers, so why would they offer us the product?”
Unfortunately, it’s easier to identify the longevity gap and its motivating factors than it is to close it once and for all. One solution would be for the federal government to start taking men’s health seriously, even if men do not. “We have to lead from the front,” Rovito says. “We need a national office. That we don’t have a men’s health office says that it’s important, but not that important.”
Broad gestures, however, would be next to worthless if not followed by better funding for men’s health clinics and men’s health research. “Talk is great, but money speaks,” Leone says. “I’m begging the government, these politicians (that are largely men) to pay attention. This is what is going to lead to a stronger population, a stronger economy, and a well-adjusted nation.”
But change happens slowly, and governments, funding, and societal expectations aren’t changing fast enough to save lives. In the meantime, Rovito and Leone say it falls to parents and educators to change the narrative and teach the next generation to reject masculine norms that put men in harm’s way. We need to change how we talk about sexual health so that it’s no longer taboo, and stop telling boys to “walk it off” after injuries, they add. For dads, that means modeling healthy behaviors. If you don’t go to the doctor until you’re nearly dead, if you don’t take a sick day unless you can’t stand, and if you are uncomfortable talking about your health—your sons will notice.
Interestingly, one of the best ways for men to buck gender norms and improve their odds of living to see 80 without letting go of their masculinity, is to simply reinvest in fatherhood. Studies have shown that involved dads are more health conscious, and there’s nothing more masculine than throwing your kids in the air or maintaining a monopoly on shoulder rides. “Parenting has a negative correlation with many undesirable, unhealthy behaviors,” Assari says. “Anything that gives fathers incentive to be more involved in the household will help reduce harmful behaviors.”
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