When It Comes to Health
by andrew l. yarrow
(and Maybe Economics) …
Men Are the Weaker Sex
andrew l. yarrow, a former New York Times reporter, is the author of the new book, Look: How a Highly Influential Magazine Helped Define Mid-20th-Century America.
Published December 8, 2021
Men are (by tautology) the manlier sex. But it’s long been understood that, by most every metric other than average physical strength, they are also the weaker sex. And the ongoing pandemic has only highlighted this reality; as of late October 2021, about 75,000 more American men than women had died of Covid-19. The 1.2-year drop in life expectancy for U.S. males in 2020 is 3 months greater than that for females.
Indeed, men are the more likely victims for nine of the 10 leading causes of death in the United States. The virus, alas, is just one of them. Visit a nursing home or assisted-living facility, and the gender gap in longevity is readily apparent. Among the 85-and-older set in America, the old Jan and Dean song, “Surf City,” is demographically on the mark: “two girls for every boy.”
Indeed, a broader statistical overview of the risks that men face is decidedly a downer. Men account for nine out of 10 workplace deaths, six out of seven alcohol-related fatalities, four out of five murder victims and at least three out of four suicides.
Moreover, while rates of heart disease, cancer, respiratory diseases and AIDS among men have all declined in the 21st century, the XY gender has hardly turned a corner on chronic disease. The frequency of diabetes, liver disease and obesity among men has increased. And then there are what the economists Anne Case and Angus Deaton called “deaths of despair.” In 2020, as the death toll of opioid and other drug overdoses climbed to nearly 100,000 in the United States, 70 percent of those who died were men.
All told, life expectancy was 5.7 years shorter for American men than for women in 2020. This number may come as no surprise — I’m hardly the first to raise the alarm. What’s been missing, though, is public discourse on why the male-female gap is so large and so persistent, and why what ought to be labeled a crisis receives so little attention.
Out of Sight …
It’s not that we lack hypotheses regarding the gender gap. For one thing, we know that men lack the hormonal protection from heart disease that women enjoy before menopause. For another, men seem less inclined to avoid risks in work and lifestyle. Then there are some important but less tangible factors: men are less socially connected than women and, not coincidentally, less willing to reach out for help.
Being tough may have been helpful for hunting mastodons 15,000 years ago, but it doesn’t appear beneficial for men who have lost jobs or suffered other life reversals. Although self-acknowledged rates of depression are higher among women, men tend to avoid talking about sadness and are much less likely than women to seek help from friends — or from psychotherapists.
The seamier side of American particularism, the side that includes perverse pride in the idea that everybody takes care of themselves and that we are not all in this together, seems to be at work here.
Whereas girls and women are socialized to cultivate close relationships, boys and men traditionally are expected to be more self-reliant. In adulthood, this translates into fewer friendships. Surveys have found that as many as two in five adult men feel lonely (and these are the ones who admit it), a significantly higher percentage than among women. In a time of declining marriage rates, it also doesn’t bode well that men are also more likely to call their spouse their “best friend.”
“Masculine gender socialization is hazardous for men’s health, posing a double whammy of poorer health behaviors and lower use of health care,” said Ronald Levant, a former president of the American Psychological Association.
In recent decades, while women have successfully drawn public and policymaker attention to women’s health, Jimmy Boyd, director of the Men’s Health Network, notes that “no other health problem that affects so many Americans has suffered from as much benign neglect and for so long as male health.”
Sal Giorgianni, chair of the Men’s Health Caucus of the American Public Health Association, thinks that some of the neglect stems from a belief that “it’s all men’s fault — they just don’t care about their health.” There is both a “snarkiness” and a fair amount of truth to such beliefs, he added, since “men aren’t acculturated to take their health seriously.”
When it comes to self-care, men are clearly the second sex. Only three-fifths of men bother with annual physicals, and just 63 percent can identify a primary-care practitioner as “their doctor,” compared to 81 percent of women. A Cleveland Clinic survey found that more than two-fifths of men see doctors only when they think they have a serious medical condition, and half of men said that health isn’t something they talk about. The failure to treat conditions early not only increases mortality but also makes care more costlydown the road.
Traditional gender norms do suggest that masculinity really can be toxic, but the health care system and public policy could also do better when it comes to mitigating the impact. Giorgianni argues that men “are made to feel less welcome” in health care, stemming from subtle factors ranging from health advertising that’s geared to women to doctors’ waiting rooms filled with women’s magazines.
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Since the Milken Institute Review largely focuses on issues of economic policy, this is the place in the piece you might expect to find a back-of-the-envelope estimate of the cost of the neglect of men’s health and perhaps some basics on how much cheaper it would be to plow the resources into solving the problem than letting it fester. There is, indeed, evidence that the cost in terms of health care and lost productivity — not to mention the human cost of premature morbidity and mortality — is far greater than the cost of extending the social safety net to include mental health and preventive medicine. But I would argue there’s another point worth making here, too.
The neglect of a societal problem so vast would be almost unthinkable in other high-income social welfare states. But the seamier side of American particularism, the side that includes perverse pride in the idea that everybody takes care of themselves and that we are not all in this together, seems to be at work here. And one has to wonder whether we have the will to deal with the toxic consequences.