Men's health

Men's health refers to a state of complete physical, mental, and social well-being, as experienced by men, and not merely the absence of disease or infirmity.[1] Differences in men's health compared to women's can be attributed to biological factors (such as male genitalia or hormones), behavioural factors (men are more likely to make unhealthy or risky choices and less likely to seek medical care) and social factors (e.g.: occupations).[2] These often relate to structures such as male genitalia or to conditions caused by hormones specific to, or most notable in, males. Some conditions that affect both men and women, such as cancer, and injury, also manifest differently in men.[3] Men's health issues also include medical situations in which men face problems not directly related to their biology, such as gender-differentiated access to medical treatment and other socioeconomic factors.[4][5][6] Some diseases that affect both genders are statistically more common in men. Outside Sub-Saharan Africa, men are at greater risk of HIV/AIDS – a phenomenon associated with unsafe sexual activity that is often nonconsensual.[7][8]

A symbol of men's health

Definition

The concept of "men's health" is variously defined. A 2016 international literature review found seven different meanings, and proposed a definition based on the WHO general definition of health, that avoided male-specific disease and male stereotypes.[9]

Life expectancy

Despite overall increases in life expectancy globally, men's life expectancy is less than women's, regardless of race and geographic regions.[10][11] The global gap between the life expectancy of men and women has remained at approximately 4.4 years since 2016, according to the World Health Organization.[12] However, the gap does vary based on country, with low income countries having a smaller gap in life expectancy.[13] Biological, behavioural, and social factors contribute to a lower overall life expectancy in men, however the individual importance of each factor is not known.[14] Overall attitudes towards health differ by gender. Men are generally less likely to be proactive in seeking healthcare, resulting in poorer health outcomes.[15]

Global comparison of life expectancy of men vs women in different countries

Biological influences on lower male life expectancies include genetics and hormones. For males, the 23rd pair of chromosomes are an X and a Y chromosome, rather than the two X chromosomes in females.[11] The Y chromosome is smaller in size and contains less genes. This distinction may contribute to the discrepancy between men and women's life expectancy, as the additional X chromosome in females may counterbalance potential disease producing genes from the other X chromosome. Since males don't have the second X chromosome, they lack this potential protection.[11] Hormonally, testosterone is a major male sex hormone important for a number of functions in males, and to a lesser extent, females.[16] Low testosterone in males is a risk factor of cardiovascular related diseases.[17] Conversely, high testosterone levels can contribute to prostate diseases.[11] These hormonal factors play a direct role in the life expectancy of men compared to women.

In terms of behavioural factors, men have higher levels of consumption of alcohol, substances, and tobacco compared to women, resulting in increased rates of diseases such as lung cancer, cardiovascular disease, and cirrhosis of the liver.[11][18] These diseases influence the overall life expectancy of men. For example, according to the World Health Organization, 3.14 million men died from causes linked to excessive alcohol use in 2010 compared to 1.72 million women. Men are more likely than women to engage in over 30 risky behaviours associated with increased morbidity, injury, and mortality.[19][20] Additionally, despite a disproportionately lower rate of suicide attempts than women, men have significantly higher rates of death by suicide.[21][22][23]

Social determinants of men's health involve factors such as greater levels of occupational exposure to physical and chemical hazards than women.[15] Historically, men had higher work related stress, which negatively impacted their life expectancy by increasing the risk of hypertension, heart attack, and stroke.[11] However, it is important to note that as women's role in the workplace continues to be established, these risks are no longer specific to just men.[11]

Mental health

Stress

Although most stress symptoms are similar in men and women, stress can be experienced differently by men.[24] According to the American Psychological Association, men are not as likely to report emotional and physical symptoms of stress compared to women.[24] Men are more likely to withdraw socially when stressed and are more likely to report doing nothing to manage their stress.[24] In terms of causes of stress, men are more likely to cite that work is a source of stress than women (who are more likely to report that money and the economy are a source of stress).[24]

Mental stress in men is associated with various complications which can affect men’s health: high blood pressure and subsequent cardiovascular morbidity and mortality,[25] cardiovascular disease,[26] erectile dysfunction (impotence)[27] and possibly reduced fertility (due to reduced libido and frequency of intercourse).[28]

Fathers experience stress during the time shortly before and after the time of birth (perinatal period).[29] Stress levels tend to increase from the prenatal period up until the time of birth, and then decrease from the time of birth to the later postnatal period.[29] Factors which contribute to stress in fathers include negative feelings about the pregnancy, role restrictions related to becoming a father, fear of childbirth, and feelings of incompetence related to infant care.[29] This stress has a negative impact on fathers.[29] Higher levels of stress in fathers are associated with mental health issues such as anxiety, depression, psychological distress, and fatigue.[29]

Substance abuse

Substance and alcohol abuse can be defined as a pattern of harmful use of substance for mood-altering purposes.[30] Alcohol is one of the most commonly abused substances, and men are up to twice as likely to develop alcoholism than women.[31] Gender differences in alcohol consumption remain universal, although the sizes of gender differences vary.[32] More drinking and heaving, binge drinking occurs in men, whereas more long-term abstention occurs in women.[32] Moreover, men are more likely to abuse substances such as drugs - with a lifetime prevalence of 11.5% in men compared to 6.4% in women - in the United States.[33] Additionally, males are more likely to be substance addicts and abuse substances due to peer pressure compared to females.[33]

Risks

Substance and alcohol abuse disorders are associated with various mental health issues in men and women.[34] Mental health problems are not only a result from drinking too much alcohol, they can also cause people to drink too much.[33] A major reason for consuming alcohol is to change mood or mental state.[35] Alcohol can temporarily alleviate feelings of anxiety and depression and some people use it as a form of ‘self-medication’ in an attempt to counteract these negative feelings.[36] However, alcohol consumption can make existing mental health problems worse.[33] Evidence shows that people who consume high amounts of alcohol or abuse substances are vulnerable to an increased risk of developing mental health problems.[37] Men with mental health disorders, like posttraumatic stress disorder, are twice as likely than women to develop a substance use disorder.[38]

Treatment

There have been identified gender differences in seeking treatment for mental health and substance abuse disorders between men and women.[39] Women are more likely to seek help from and disclose mental health problems to their primary care physicians, whereas men are more likely to seek specialist and inpatient care.[40] Men are more likely than women to disclose problems with alcohol use to their health care provider.[41] In the United States, there are more men than women in treatment for substance use disorders.[41] Both men and women receive better mental health outcomes with early treatment interventions.[42]

Suicide
World Health Organization: Global Male-Female age standardized suicide rates (2015)

Suicide has a high incidence rate in men but often lacks public awareness.[43][44] Suicide is the 13th leading cause of death globally, with a disproportionate number of these deaths being men compared to women.[44][45][46] Despite the fact that women are significantly more likely to attempt suicide than men, men more frequently successfully commit suicide.[45][46] This is known as the gender paradox of suicidal behaviour.[45] The world-wide men to women ratio of age standardized suicide was 1.8 in 2016 according to the World Health Organization.[47] This means that nearly two times as many men as women die due to suicide worldwide. Looking at specific countries, the men to women ratio of suicide can vary, but the overall trend still exists. For example, the suicide rate of men is three times then that of women in the United Kingdom and Australia, and four times that of women in the United States, Russia, and Argentina.[48][49][50][51] In South Africa, the suicide rate amongst men is five times greater than women.[52] In East Asian countries, the gender gap in suicide rates are relatively smaller, with men to women ratios ranging from one to two.[53] Multiple factors exist to explain this gender gap in suicide rates, such as men more frequently completing high mortality actions such as hanging, carbon-monoxide poisoning, and the use of lethal weapons.[54][55] Additional factors that contribute to the disparity in suicide rates between men and women include the pressures of traditional gender roles for men in society and the socialization of men in society.[48][56][57]

Risk factors

Variations exist in the risk factors associated with suicidal behaviour between men and women which contributes to the discrepancy in suicide rates.[45][58][59] Suicide is complex and can not simply be attributed to a single cause, however there are psychological, social, and psychiatric factors to consider.[56][59][60] Mental illness is a major risk factor for suicide for both men and women.[60][61][62] Common mental illnesses that are associated with suicide include depression, bipolar disorder, Schizophrenia, and substance abuse disorders.[61][62][63] In addition to mental illness, psychosocial factors such as unemployment and occupational stress are established risk factors for men.[45][64][65] Alcohol abuse is a risk factor that is much more prevalent in men than in women, which increases risks of depression and impulsive behaviours.[66][67] This problem is exacerbated in men, as they are twice as likely as women to develop alcoholism.[31][68] Reluctance to seek help is another prevalent risk factor facing men, stemming from internalized notions of masculinity.[56][64][69][57] Traditional masculine stereotypes place expectations of strength and stoic, while any indication of vulnerability, such as consulting mental health services, is perceived as weak and emasculating.[56][64][69][57] As a result, depression is under-diagnosed in men and may often remain untreated, which may lead to suicide.[57][70]

Warning signs

Identifying warning signs is important for reducing suicide rates world-wide, but particularly for men, as distress may be expressed in a manner that is not easily recognizable.[54][71][72] For instance, depression, and suicidal thoughts may manifest in the form of anger, hostility, and irritability.[56][71] Additionally, risk-taking and avoidance behaviours may be demonstrated more commonly in men.[56][69]

Common conditions

The following is a list of conditions/diseases that have a high prevalence in men (relative to women).[73]

Cardiovascular conditions:

Respiratory conditions:

Mental health conditions:

Cancer:

Sexual health:

Other:

Organizations

In the UK, the Men's Health Forum was founded in 1994. It was established originally by the Royal College of Nursing but became completely independent of the RCN when it was established as a charity in 2001.[74] The first National Men's Health Week was held in the US in 1994. The first UK week took place in 2002, and the event went international (International Men's Health Week) the following year.[75] In 2005, the world's first professor of men's health, Alan White, was appointed at Leeds Metropolitan University in north-east England.

In Australia, the Men's Health Information and Resource Centre advocates a salutogenic approach to male health which focuses on the causal factors behind health. The Centre is led by John Macdonald and was established in 1999.[76] The Centre leads and executes Men's Health Week in Australia with core funding from the NSW Ministry of Health.

The Global Action on Men's Health (GAMH) was established in 2013 and was registered as a UK-based charity in May 2018. It is a collaborative initiative to bring together men's health organizations from across the globe into a new global network. GAMH is working at international and national levels to encourage international agencies (such as the World Health Organization) and individual governments to develop research, policies and strategies on men's health.[77]

See also

References
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