Although Men’s Health does include urology based health problems such as benign or malignant prostate disease and erectile problems, it is about much more than just physical fitness, physique and urology.
The mention of “Men’s Health” for many people brings to mind images of washboard abs, bulging biceps and bedroom tips on keeping partners happy! Others (often in an older age group) think of Men’s health as pertaining to difficulties with bladder emptying, prostate cancer and erectile dysfunction. It would be nice to think we can all achieve the physique that usually adorns the magazine of the above name, and although Men’s Health does include urology based health problems such as benign or malignant prostate disease and erectile problems, it is about much more than just physical fitness, physique and urology.
We are lucky enough in Australia to have among the highest life expectancy in the world and we are lucky to live at a time when life expectancy is higher than at any other time in history.
However, since records began in the late 19th century, women have enjoyed longer life expectancy than men and in 2013 the difference was a whopping 4 years (1)! What’s more, Australians don’t enjoy universally high life expectancy, as those outside our cities and in particular Aboriginal and Torres Straight Islanders, have significantly lower life expectancy due to poorer overall health.
The reasons for this are many and complex, but it is worth considering some of the underlying causes of this gender differential as well as some of the imbalances in the delivery of medical care to men and women. As a cancer specialist, I have a particular interest in the differences in incidence and mortality of various cancers between men and women. Whilst women are not at risk of prostate cancer(!), more men are diagnosed with and more men die from prostate cancer each year than women from breast cancer. In fact, men are more likely to be diagnosed with or die from just about every non-gender specific cancer as well. Overall, 1 in every 2 men will be diagnosed with some form of cancer before the age of 85, compared to 1 in 3 women (1).
But the higher rates of cancer are not the only contributing factor, as men are more likely to suffer from heart disease, lung disease and are more likely to be diagnosed with chronic medical conditions such as diabetes and high blood pressure (1). Although the gap is narrowing, men are still more likely to smoke and drink to excess than women (2). Men are also more likely to engage in risky behaviour and the vast majority of workplace injuries and deaths occur to men(2).
Although even my two year old daughter can identify the external differences between men and women (“You have a penis Daddy and I have a ‘gina!”), there are fundamental differences between men and women on the inside that contribute to gender health imbalances. Whilst being overweight is a health risk for both men and women, men carry excess weight differently to women and this appears to increase the health risks for overweight men. When I operate on patients with kidney cancer, I find the differences in fat distribution quite striking. Women carry most of their excess weight in the subcutaneous tissue (just below the skin), whereas men tend to carry their excess weight around their internal organs, including the kidney. This is profoundly unhealthy and increases the risk of many chronic illnesses such as diabetes and heart disease.
We just can’t change our biology, but we can change our behaviour. And it’s important to remember that incremental change in the right direction can be easier to achieve and easier to maintain than sudden big changes. So rather than quitting bad habits (such as smoking), embarking on major dietary change and starting a rigorous exercise program all in one go, try approaching these goals one by one. Men should see their GP for a routine yearly check-up from the age of forty, including blood pressure, a cholesterol check and other basic blood tests. Identifying little problems early, (such as high blood pressure or cholesterol), can prevent big problems in the future (like a heart attack or stroke).
Screening for prostate cancer with a simple blood test and examination should also be discussed, particularly if there is a history of prostate cancer in the family. Most prostate cancers detected in this way are curable, whilst those presenting with symptoms from prostate cancer almost universally have advanced disease. (Bladder symptoms, such as poor flow and dribbling are usually due to benign conditions of the prostate).
Women have played a tremendous role in advancing their own health and have provided the framework for promoting health awareness. They have also played a fundamental role in advancing Men’s health and often initiate contact with health services for their male partners. We should congratulate their successes in this regard and aim to emulate for Men’s health that which has been achieved for Women’s health. Most importantly, let’s start talking about Men’s Health, because change starts with awareness.