December 19, 2024
7 min read
Key takeaways:
- Men face a higher risk for mortality than women in almost every phase of life.
- Healio spoke with experts to learn more about the decline in men’s health and what physicians can do to help.
Men’s health has been declining for years in the United States, and health literacy may play an unexpectedly large role, according to experts.
Historically, in most societies, men have typically had shorter average lifespans than women, Robert M. Califf, MD, commissioner of the FDA, told Healio. But recently in the U.S., that lifespan gap has broadened, and men now face a higher risk for mortality in almost every phase of life.
“This is really ranging from teenage years, where the rate of suicide now is four times higher in males than females, … and then as you get older, you get into the chronic diseases that are caused mostly by repetitive, unhealthful behaviors, and men seem to be much more prone to those behaviors,” Califf said. “In the U.S., we’re now almost in last place among high-income countries in life expectancy overall. And one of the many differences that one can talk about is that men are living shorter lives than women, with the gap now widening.”
According to mortality data from the CDC, in 2022, life expectancy for men was 74.8 years, compared with 80.2 years for women. In 2018, life expectancy for men was 76.2 years compared with 81.2 years for women. Califf previously wrote in a blog that this inequity “is further widened among men, as Black men, Indigenous men, and men living in rural communities have the lowest life expectancy among all groups.”
It is possible that the public’s “recognition of how suboptimal” men’s health is “finally catching up with reality,” According to Russell W. Kohl, MD, FAAFP, a family physician and the speaker of the American Academy of Family Physicians Congress of Delegates.
“There’s the classic stereotypical situation of men who just don’t seek care; that stoic, stubborn, ‘I have other things to do. I don’t need help,’ sort of thing, [but] I think that is changing,” Kohl told Healio. “Men’s mental health, I think that’s another area where, historically, we would have said it didn’t exist, but the reality is, no, a lot of these problems were there. I think we’re finally just recognizing that they’re there and doing something about it.”
Possible factors
There are many factors that could be contributing to men’s health issues, according to Califf and Kohl.
“When it comes to self-care and what you might call health executive function — that is the ability to forgo early gratification for later benefit — men are not as good as that, on average,” Califf said.
Additionally, women make “the vast majority” of health care decisions for families, “including the men in those families,” he said.
“In my practice as a cardiologist, it was very common to have no idea what was going on with the man coming to clinic until you got the wife or the girlfriend and asked, ‘What’s really going on here?’” Califf said. “And then you get the facts. That’s my personal experience.”
Data also show that men are less likely to have a healthy diet and more likely to vape, use tobacco products or use illegal drugs, Califf added, and these gaps are also increasing.
“Now there’s a new phenomenon that some people are talking about … it does appear that there’s an epidemic of loneliness going on in young men,” he said. “Wrapped up in that is also this issue that, as women have been treated better by society, among people under age 30, females are, in many cases, out-earning men, and that’s calling into question the traditional role of the male.”
In another previous blog, Califf wrote that three key parts of this puzzle are related to education, employment and income, “which paradoxically have evidence of both cause and effect in this context.”
“This is very hard to talk about because it gets into really complex issues,” he said. “The vast majority of valedictorians and students in the top part of their class are dominated by women now, which is a big change.”
Califf said that he recently visited veterinary schools because of the avian influenza outbreak in cows, and someone mentioned an exceptional level of male applicants at 15%.
“In medical schools now, well over half are female in terms of the entrance,” he said. “ This combination of education in an education-oriented society, the income and status that comes with that is a bit of an issue. … Again, it’s hard to talk about, because when I was growing up, it was exactly the opposite. It’s happened in a relatively short period of time, and I think we’re all adapting to it.”
Health literacy and mistrust
Social determinants of health are also potential contributing factors, as they “have huge impacts on your education level, which directly affects your health literacy,” Kohl said.
“Do you fully understand what it is that’s going on with your health? Is your [primary care provider] taking the time to make sure that you actually understand why these things are important and what they mean to you personally?” Kohl added. “One of our main jobs as a family physician is to customize the care that we give … and so we have to understand all of those different drivers that are affecting that particular person.”
He said informed consent — “one of the fundamental concepts of all of medicine” — is “purely health literacy.” It is a key aspect of success in all health, but Kohl believes this has been ignored with respect to men’s health while receiving more attention in other areas.
For example, Kohl said that patients like the parents of small children or women looking into reproductive health typically ask more questions to ensure they understand everything about their situation.
“There’s a whole lot more of ‘Okay, doc, I got it,’ in men’s health; that may be a sign of not great health literacy around a particular topic,” he said.
But with growing levels of mistrust in health care, that can become even more challenging.
In a study recently published in Frontiers, researchers found what they believed was relatively low trust in government health agencies.
They analyzed 5,842 responses to the Health Information National Trends Survey, and found that just 70% had high trust in government health agencies for health information and 84% had high trust in scientists. The participants who reported feeling that expert recommendations do not often change expressed a higher likelihood to have high trust in government agencies (82%) compared with those who felt recommendations often change (65%).
However, the researchers also reported that 95% trusted physicians for health information and wrote that “patients look to their physicians to act in their best interest,” so “emphasizing physician-patient relationship is essential for maintaining public trust in health experts and ensuring the effective dissemination of health recommendations.”
Care continuity
Continuous care with a PCP can help improve trust, health literacy and prevent chronic diseases.
“One of our most important roles as a family physician is in customizing care to a person, recognizing that our effectiveness is in empowering them to care for themselves, and that’s where health literacy comes into it,” Kohl said. “How do we recognize and help them understand what’s important to them?”
When looking at chronic disease prevention, longevity and functional status, “the best solution, whether it’s men or women, for the problems we’re having in the U.S., is to have a successful primary care system,” Califf said.
“What we’re seeing in other societies is when a good primary care system is put into place, people really have better health status, even if they’re not wealthy,” he told Healio. “I would point to countries like Costa Rica and Thailand that have now passed the United States in life expectancy at a fraction of the cost, and they would say it’s mostly because they have primary care clinics in all the neighborhoods. And here, I think it’s also important that it be a human being, not just a computer.”
Califf said the “key is human interaction.” After all, only human interaction can offer what Kohl called ‘doorknob moments.’
“In family medicine, we often joke about the hand on the doorknob moments,” Kohl said. “You’ll have a 15-minute appointment with somebody, discuss everything in the world — you think — but the actual reason they showed up comes only when you put your hand on the doorknob to leave the room, and they go, ‘Hey, one more question.’”
Issues that are more sensitive or require more trust in a provider are “almost always a doorknob sort of question,” and it’s important for PCPs to anticipate these, Kohl said.
“Bring the doorknob questions up yourself as the physician before you get to the end of the visit,” he said. “I think that’s particularly true around men’s sexual and reproductive health, around men’s mental health issues and around substance use, particularly with regard to alcohol.”
Kohl cautioned that physicians should not wait until they are about to leave the room to ask men those important health questions.
“Make that a proactive part [of the visit],” he said. “If you are not doing that proactively, you will get the classic, ‘Thanks, doc, we’re good,’ and you’ll miss those opportunities to actually improve their life, their health and their wellness.”
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