Why Men Die Young

Lik

e most doctors, I'm painfully aware that women live longer than men — five years longer, on average. I used to accept the disparity, assuming it was part of our collective genetic inheritance, more nature than nurture. But a new study published in the current issue of the American Journal of Public Health suggests that men's behavior may also be to blame.

According to David Williams, a senior research scientist at the University of Michigan's Institute for Social Research and the main author of the study, men outrank women in all of the 15 leading causes of death, except one: Alzheimer's. Men's death rates are at least twice as high as women's for suicide, homicide and cirrhosis of the liver. Men don't just have more accidents, they are accidents waiting to happen.

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"At every age," Williams reports, "American males have poorer health and a higher risk of mortality than females." More of them smoke (26% compared with 22%, although women are catching up quickly); they are twice as likely to be heavy drinkers and far more likely to engage in behaviors that put their health at risk, from abusing drugs to driving without a seat belt.

As if that weren't enough, men tend to work in more dangerous settings than women, and thus account for 90% of on-the-job fatalities, mostly in agriculture. And men drive more rollover-prone SUVs (contributing to last year's 42,850 traffic deaths, the highest since 1990, according to the National Highway Traffic Safety Administration) and suffer more motorcycle fatalities (up sharply over the past five years, thanks in part to the repeal of state helmet laws).

These reasons alone would certainly contribute to a shorter life span for men, but the problem may be even more profound. Williams blames deep-seated cultural beliefs — a "macho" world view that rewards men for taking risks and tackling danger head on. Men are twice as likely to get hit by lightning or die in a flash flood, according to a report delivered last week in Atlanta at a meeting sponsored by the Centers for Disease Control and Prevention. In low-lying flood zones, says Thomas Songer of the University of Pittsburgh School of Public Health, men are more likely to drive around barricades and drown in high water.

That macho attitude seems to extend to the care men take of their bodies. Women are twice as likely as men to visit their doctor once a year and more likely to explore broad-based preventive health plans with their physician. Men are less likely to schedule checkups or to follow up when symptoms arise. "Men also tend to internalize" and "self-medicate" their psychological problems, says Williams, while women tend to seek professional help. Virtually all stress-related diseases — from hypertension to heart disease — are more common in men.

Although medical research has traditionally concentrated on men, the emphasis seems to have shifted. We hear a lot more public-service announcements these days about breast cancer, for example, than we do about prostate cancer. Ultimately, however, men have to take responsibility for their own health. "Being a man should not only mean taking care of your family," says Williams, "but also taking care of yourself." Good advice. I think I'll take it and finally go see someone about my back.

Dr. Gupta is a neurosurgeon and CNN medical correspondent