NEWS & VIEWS HEALTH POLICY
Male health—a recent paradigm S. Larry Goldenberg and Alan White
During the month of November, the Movember Foundation challenges men to grow a moustache in an effort to raise vital funds and awareness for the often ignored health issues affecting the male population. Global healthcare delivery and policies, which have focussed on women’s, children’s and minority’s health for the past few decades, need now address these issues. Goldenberg, S. L. & White, A. Nat. Rev. Urol. 12, 15–16 (2015); published online 11 November 2014; doi:10.1038/nrurol.2014.306
During November, the Movember Founda tion aims to broaden awareness of men’s health issues in society by challenging men to grow a moustache, with the aim of spark ing conversation and raising vital funds and awareness for these often ignored health issues.1 Human health in general, and with it men’s health, has been improving measurably for more than a century, thanks to societal improvements including changes in labour laws, new safety legislation, smoking reduc tion, availability of seatbelts and environ mental campaigns. However, considerable proportions of our male population are still succumbing to avoidable premature death and morbidity. Although some of this morbidity can be explained by the impact of the Y chromosome and the influence of tes tosterone on human behaviours, part of the issue might be the fact that men, culturally, are not conditioned to see their health as a priority—unhelpful stereotypes of indepen dence, risk taking, and ‘the strong silent type’ can make it difficult to engage in positive health behaviours. Globally, gender medicine is seeing a big increase in activity as the impact of the differing biology and social factors between the sexes becomes more apparent. From the most basic of physiological processes, through to macro-level political activity, gender has an influence. Over the past three decades, improvements in women’s health have come about as a result of a concerted action to tackle antenatal complications and the most notable causes of premature death in women—breast cancer, sex-specific cancers and cardio vascular disease. Global efforts include pub lically funded women’s health offices and
national policies that support development of important and successful programmes. The pendulum has now begun to swing towards a focus on men and boys with the realization that blindness to the impact of gender has had a negative effect on the male population. Average life expectancy is lower for men than for women in nearly all countries (Table 1), and rates of Potential Years of Life Lost (PYLL) are higher. In the majority of countries in the EU27, less than 13% of total female deaths occur in the 15–64-year age range, whereas over 26% of total male deaths occur in this age range.2 Although biological, environmental and social reasons might explain these differ ences, it is time to address the major causes of PYLL in men and bring men back into the picture—of health.
The economic argument for having a stronger focus on preventing premature death and chronic illness in men is clear. Current estimates for the cost of the health disparities between men and women in America show that the federal, state, and local government costs are in excess of US$142 billion annually. The cost to indus try stands in excess of $156 billion annu ally in direct medical payments and lost productivity, and an additional $181 billion annually in decreased quality of life.3 Much of the effort and success of medicine over the centuries has been to find the cure for specific illnesses, yet male-specific illnesses based on the genitourinary system remain remarkably under-researched and underexplored. Testosterone, considered the most powerful yet possibly most misunderstood hormone in biology, ‘colours the fabric’ of the male persona and underlies every psycho logical, biological and social manifestation of male health. We have much to learn about the impact of testosterone on young male behav iour and illness. Multiple schools of thought exist regarding the links between testosterone and metabolic syndrome, cardiovascular and mental health. Is low testosterone a cause of, or the result of, illness? Is testosterone replace ment appropriate and safe? How testosterone decline in later life should be managed is controversial and contested. And controversy still exists as to the best way of detecting and
Table 1 | Global life expectancy Country
Year
Life expectancy (years) Women
Men
Gap (years)
Guinea-Bissau
2010–2015
50
47
3
Democratic Republic of the Congo
2010–2015
51
47
3
Afghanistan
2010–2015
49
49
0
Lesotho
2010–2015
48
50
–2
Botswana
2010–2015
51
54
–2
Russian Federation
2010–2015
75
63
12
China
2010–2015
76
72
4
United Kingdom
2010–2015
82
78
4
United States of America
2010–2015
81
76
5
Canada
2010–2015
83
79
5
Israel
2010–2015
84
80
5
Japan
2010–2015
87
80
7
Permission obtained from the United Nations Statistics Division © http://unstats.un.org/unsd/demographic/products/ socind/default.htm (2012).
NATURE REVIEWS | UROLOGY
VOLUME 12 | JANUARY 2015 © 2015 Macmillan Publishers Limited. All rights reserved
NEWS & VIEWS managing the most prevalent of male cancers, that of the prostate. The impact of a man’s sex and gender extends well beyond the discipline of urology. The greater prevalence of obesity in men than in women, with the metabolic impli cations of the ‘android’ visceral fat distribu tion, higher levels of lethal cancer in men, earlier and more aggressive cardiovascular health problems and a greater propensity to successfully commit suicide, are just some of the challenges facing men. So PYLL from young deaths account for the gap in average life expectancy between genders that has existed for many decades. Both men’s and women’s life expectancies are improving, but that is because we are getting better at keeping the older alive for longer, not because we are reducing premature mortality.4
‘‘
…the Movember movement is prompting men to wake up to the importance of their health…
’’
If men are suffering from ‘heavy impact’ illnesses (that is, illnesses that are more likely to end in premature death, such as cardiovas cular disease) in their earlier years, we should be acknowledging that fact and seeking solutions that target at-risk groups. Men are also more vulnerable to the social determinants of health, with increasing poverty, unemployment rates, lower rates of educational attainment and higher rates of incarceration having more detrimental effects on their physical and mental health and wellbeing. This finding led to the State of Men’s Health in Europe report conclud ing that the “variability [between men and women and also between men in differ ent countries and localities] demonstrates clearly that men’s health disadvantage is an issue of inequity and not biological inevita bility and highlights the impact of the social environment in which men find themselves”.2 The most serious gap in the whole picture lies in the social sphere: the awareness of men’s health as an important issue in society
JANUARY 2015 | VOLUME 12
as a whole, and the cultural challenge of widening our focus beyond medical informa tion to the facilitation of a social movement to connect men to medical information in such a way that they can truly hear it, absorb it and act on it. The Movember Foundation is one initiative that has been improving the aware ness among men about health issues in many countries worldwide. Although biology is a dominant force, communication research is vital to help the medical world create the proper conditions (the receptive, retentive and unprejudiced audience) for the health messages to actually take hold. We can no longer claim ignorance of the health needs of men. Many countries now have equality legislation in place, which covers gender as well as age and ethnicity. This should be used as a legislative tool to seek services to consider men’s needs with regard to their physical and emotional health and wellbeing. Reports on men’s health have now been completed across the globe, includ ing the European Commission State of Men’s Health in Europe,2 three reports from Brit ish Columbia,5–7 the Australian Health of Males reports,8,9 the Asian Men’s Health Report10 and reports from a number of other countries. An International Consultation on Men’s Health and Infertility report is under way to create an internationally recognised statement on the health needs of men. As socially responsible physicians and health-care providers, today is our opportunity to establish a new social movement aimed at making health awareness a part of everyday fabric of life for boys and men. Ultimately, the reason for promoting better health among men is that it leads to a better world, a better society, better families, better communities and even better economies. Men’s health advocates seek to collaborate and cooperate with anyone and everyone who shares this goal. Worldwide, the Movember movement is prompting men to wake up to the importance of their health and this type of social pressure should clarify for health professionals and policy makers the reality that this issue is one that needs to be addressed today.
Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada (S.L.G.). Centre for Men’s Health, Institute for Health & Wellbeing, Leeds Beckett University, Calverley 512, Portland Way, Leeds LS1 3HE, UK (A.W.). Correspondence to: S.L.G. [email protected] Competing interests The authors declare no competing interests. 1.
The Movember Foundation. Movember [online], http://www.movember.com (2014). 2. White, A. et al. The State of Men’s Health in Europe: Extended Report. European Commission [online], http://ec.europa.eu/ health/population_groups/docs/ men_health_extended_en.pdf (2011). 3. Brott, A. et al. The economic burden shouldered by public and private entities as a consequence of health disparities between men and women. Am. J. Mens Health 5, 528–539 (2011). 4. White, A. et al. An examination of the association between premature mortality and life expectancy among men in Europe. Eur. J. Public Health 24, 673–679 (2014). 5. Bilsker, D., Goldenberg, L. & Davison, J. A roadmap to Men’s Health: current status, research, policy & practice. Aboutmen.ca [online], http://www.aboutmen.ca/ mens-health/resource-centre/reports (2010). 6. Saewyc, E. et al. The XY Factor: The state o boys’ and young men’s health in BC. Aboutmen.ca [online], http:// www.aboutmen.ca/mens-health/ resource-centre/reports (2012). 7. Bowering, D. Where are the Men? Chief Medical Health Officer’s Report on the Health and Wellbeing of Men and Boys in Northern BC. Aboutmen.ca [online], http:// www.aboutmen.ca/mens-health/ resource-centre/reports (2011). 8. Australian Institute of Health and Welfare. The health of Australia’s males: from birth to young adulthood (0–24 years). Australian Government [online], http://www.aihw.gov.au/ publication-detail/?id=60129543995 (2013). 9. Australian Institute of Health and Welfare. The health of Australia’s males: 25 years and over. Australian Government [online], http://www.aihw.gov.au/publication-detail/ ?id=60129543994 (2013). 10. Tan, H. M., Ng, C. J., Ho, C. C. K. & Teo, C. H. Asian Men’s Health Report. Foundation for Men’s Health [online], http:// foundationformenshealth.org/ educational_resources/PDF/ Asian_Mens_Health_Report.pdf (2013).
www.nature.com/nrurol © 2015 Macmillan Publishers Limited. All rights reserved
Male health—a recent paradigm S. Larry Goldenberg and Alan White
During the month of November, the Movember Foundation challenges men to grow a moustache in an effort to raise vital funds and awareness for the often ignored health issues affecting the male population. Global healthcare delivery and policies, which have focussed on women’s, children’s and minority’s health for the past few decades, need now address these issues. Goldenberg, S. L. & White, A. Nat. Rev. Urol. 12, 15–16 (2015); published online 11 November 2014; doi:10.1038/nrurol.2014.306
During November, the Movember Founda tion aims to broaden awareness of men’s health issues in society by challenging men to grow a moustache, with the aim of spark ing conversation and raising vital funds and awareness for these often ignored health issues.1 Human health in general, and with it men’s health, has been improving measurably for more than a century, thanks to societal improvements including changes in labour laws, new safety legislation, smoking reduc tion, availability of seatbelts and environ mental campaigns. However, considerable proportions of our male population are still succumbing to avoidable premature death and morbidity. Although some of this morbidity can be explained by the impact of the Y chromosome and the influence of tes tosterone on human behaviours, part of the issue might be the fact that men, culturally, are not conditioned to see their health as a priority—unhelpful stereotypes of indepen dence, risk taking, and ‘the strong silent type’ can make it difficult to engage in positive health behaviours. Globally, gender medicine is seeing a big increase in activity as the impact of the differing biology and social factors between the sexes becomes more apparent. From the most basic of physiological processes, through to macro-level political activity, gender has an influence. Over the past three decades, improvements in women’s health have come about as a result of a concerted action to tackle antenatal complications and the most notable causes of premature death in women—breast cancer, sex-specific cancers and cardio vascular disease. Global efforts include pub lically funded women’s health offices and
national policies that support development of important and successful programmes. The pendulum has now begun to swing towards a focus on men and boys with the realization that blindness to the impact of gender has had a negative effect on the male population. Average life expectancy is lower for men than for women in nearly all countries (Table 1), and rates of Potential Years of Life Lost (PYLL) are higher. In the majority of countries in the EU27, less than 13% of total female deaths occur in the 15–64-year age range, whereas over 26% of total male deaths occur in this age range.2 Although biological, environmental and social reasons might explain these differ ences, it is time to address the major causes of PYLL in men and bring men back into the picture—of health.
The economic argument for having a stronger focus on preventing premature death and chronic illness in men is clear. Current estimates for the cost of the health disparities between men and women in America show that the federal, state, and local government costs are in excess of US$142 billion annually. The cost to indus try stands in excess of $156 billion annu ally in direct medical payments and lost productivity, and an additional $181 billion annually in decreased quality of life.3 Much of the effort and success of medicine over the centuries has been to find the cure for specific illnesses, yet male-specific illnesses based on the genitourinary system remain remarkably under-researched and underexplored. Testosterone, considered the most powerful yet possibly most misunderstood hormone in biology, ‘colours the fabric’ of the male persona and underlies every psycho logical, biological and social manifestation of male health. We have much to learn about the impact of testosterone on young male behav iour and illness. Multiple schools of thought exist regarding the links between testosterone and metabolic syndrome, cardiovascular and mental health. Is low testosterone a cause of, or the result of, illness? Is testosterone replace ment appropriate and safe? How testosterone decline in later life should be managed is controversial and contested. And controversy still exists as to the best way of detecting and
Table 1 | Global life expectancy Country
Year
Life expectancy (years) Women
Men
Gap (years)
Guinea-Bissau
2010–2015
50
47
3
Democratic Republic of the Congo
2010–2015
51
47
3
Afghanistan
2010–2015
49
49
0
Lesotho
2010–2015
48
50
–2
Botswana
2010–2015
51
54
–2
Russian Federation
2010–2015
75
63
12
China
2010–2015
76
72
4
United Kingdom
2010–2015
82
78
4
United States of America
2010–2015
81
76
5
Canada
2010–2015
83
79
5
Israel
2010–2015
84
80
5
Japan
2010–2015
87
80
7
Permission obtained from the United Nations Statistics Division © http://unstats.un.org/unsd/demographic/products/ socind/default.htm (2012).
NATURE REVIEWS | UROLOGY
VOLUME 12 | JANUARY 2015 © 2015 Macmillan Publishers Limited. All rights reserved
NEWS & VIEWS managing the most prevalent of male cancers, that of the prostate. The impact of a man’s sex and gender extends well beyond the discipline of urology. The greater prevalence of obesity in men than in women, with the metabolic impli cations of the ‘android’ visceral fat distribu tion, higher levels of lethal cancer in men, earlier and more aggressive cardiovascular health problems and a greater propensity to successfully commit suicide, are just some of the challenges facing men. So PYLL from young deaths account for the gap in average life expectancy between genders that has existed for many decades. Both men’s and women’s life expectancies are improving, but that is because we are getting better at keeping the older alive for longer, not because we are reducing premature mortality.4
‘‘
…the Movember movement is prompting men to wake up to the importance of their health…
’’
If men are suffering from ‘heavy impact’ illnesses (that is, illnesses that are more likely to end in premature death, such as cardiovas cular disease) in their earlier years, we should be acknowledging that fact and seeking solutions that target at-risk groups. Men are also more vulnerable to the social determinants of health, with increasing poverty, unemployment rates, lower rates of educational attainment and higher rates of incarceration having more detrimental effects on their physical and mental health and wellbeing. This finding led to the State of Men’s Health in Europe report conclud ing that the “variability [between men and women and also between men in differ ent countries and localities] demonstrates clearly that men’s health disadvantage is an issue of inequity and not biological inevita bility and highlights the impact of the social environment in which men find themselves”.2 The most serious gap in the whole picture lies in the social sphere: the awareness of men’s health as an important issue in society
JANUARY 2015 | VOLUME 12
as a whole, and the cultural challenge of widening our focus beyond medical informa tion to the facilitation of a social movement to connect men to medical information in such a way that they can truly hear it, absorb it and act on it. The Movember Foundation is one initiative that has been improving the aware ness among men about health issues in many countries worldwide. Although biology is a dominant force, communication research is vital to help the medical world create the proper conditions (the receptive, retentive and unprejudiced audience) for the health messages to actually take hold. We can no longer claim ignorance of the health needs of men. Many countries now have equality legislation in place, which covers gender as well as age and ethnicity. This should be used as a legislative tool to seek services to consider men’s needs with regard to their physical and emotional health and wellbeing. Reports on men’s health have now been completed across the globe, includ ing the European Commission State of Men’s Health in Europe,2 three reports from Brit ish Columbia,5–7 the Australian Health of Males reports,8,9 the Asian Men’s Health Report10 and reports from a number of other countries. An International Consultation on Men’s Health and Infertility report is under way to create an internationally recognised statement on the health needs of men. As socially responsible physicians and health-care providers, today is our opportunity to establish a new social movement aimed at making health awareness a part of everyday fabric of life for boys and men. Ultimately, the reason for promoting better health among men is that it leads to a better world, a better society, better families, better communities and even better economies. Men’s health advocates seek to collaborate and cooperate with anyone and everyone who shares this goal. Worldwide, the Movember movement is prompting men to wake up to the importance of their health and this type of social pressure should clarify for health professionals and policy makers the reality that this issue is one that needs to be addressed today.
Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada (S.L.G.). Centre for Men’s Health, Institute for Health & Wellbeing, Leeds Beckett University, Calverley 512, Portland Way, Leeds LS1 3HE, UK (A.W.). Correspondence to: S.L.G. [email protected] Competing interests The authors declare no competing interests. 1.
The Movember Foundation. Movember [online], http://www.movember.com (2014). 2. White, A. et al. The State of Men’s Health in Europe: Extended Report. European Commission [online], http://ec.europa.eu/ health/population_groups/docs/ men_health_extended_en.pdf (2011). 3. Brott, A. et al. The economic burden shouldered by public and private entities as a consequence of health disparities between men and women. Am. J. Mens Health 5, 528–539 (2011). 4. White, A. et al. An examination of the association between premature mortality and life expectancy among men in Europe. Eur. J. Public Health 24, 673–679 (2014). 5. Bilsker, D., Goldenberg, L. & Davison, J. A roadmap to Men’s Health: current status, research, policy & practice. Aboutmen.ca [online], http://www.aboutmen.ca/ mens-health/resource-centre/reports (2010). 6. Saewyc, E. et al. The XY Factor: The state o boys’ and young men’s health in BC. Aboutmen.ca [online], http:// www.aboutmen.ca/mens-health/ resource-centre/reports (2012). 7. Bowering, D. Where are the Men? Chief Medical Health Officer’s Report on the Health and Wellbeing of Men and Boys in Northern BC. Aboutmen.ca [online], http:// www.aboutmen.ca/mens-health/ resource-centre/reports (2011). 8. Australian Institute of Health and Welfare. The health of Australia’s males: from birth to young adulthood (0–24 years). Australian Government [online], http://www.aihw.gov.au/ publication-detail/?id=60129543995 (2013). 9. Australian Institute of Health and Welfare. The health of Australia’s males: 25 years and over. Australian Government [online], http://www.aihw.gov.au/publication-detail/ ?id=60129543994 (2013). 10. Tan, H. M., Ng, C. J., Ho, C. C. K. & Teo, C. H. Asian Men’s Health Report. Foundation for Men’s Health [online], http:// foundationformenshealth.org/ educational_resources/PDF/ Asian_Mens_Health_Report.pdf (2013).
www.nature.com/nrurol © 2015 Macmillan Publishers Limited. All rights reserved
