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New men's health initiative at Vancouver General Hospital

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From the Vancouver Sun; November 16, 2009

By Larry Goldenberg and Barry Rich

 

In countries around the world, including Canada, a consistent pattern of life

expectancy has developed over the past century: Men die at an earlier age than

women.

Canadian men have a life expectancy of 76 and in British Columbia live on average

4.4 years less than women. But beyond length of life, more revealing statistics

relate to the age at which a person loses their good health (health expectancy)

and the numbers of years of life lost because of dying at an early age (Potential

Years of Life Lost). With an average health expectancy of 65 years, Canadian men

may experience 11 or more years of poor health and disability before they die.

And Canadian men have a 20-per-cent higher number of potential years of life

lost, as they are more likely to die at a younger age when struck by a stroke or

heart disease, or as a result of risk-taking behaviour, suicide or workplace

mortality.

Granted, these statistics are averages. Many men do better than this, living and

thriving well into their 90s. Other men do much worse; in lower socio-economic

sectors of our communities, male health expectancy will average 17 years less

than life expectancy. Factors beyond biology, such as risk-taking behaviour,

substance abuse, poor self-care, lack of awareness and societal and cultural

pressures clearly impact on gender differences in morbidity and mortality.

In 2005, 1,097 Canadians died in the workplace, 97 per cent of them were male.

Today, military deaths, which almost always involve young males, compound the

potential years of life lost.

Early male death through illness, accident or suicide has wide repercussions on

the broader family dynamic: The loss of a father's love and of a male role model

has huge impact on the normal development of children; almost 50 per cent of

women are widowed by age 65; more than one half of elderly widows living in

poverty were not poor before the death of their husbands; at age 95 women

outnumber men 8 to 1. A glance around any nursing or extended care home in the

country will confirm this observation.

In the past decade we have recognized the need to make men's health a distinct

and important issue. However, the science of male health is still in its infancy.

Many questions need to be asked and eventually answered on issues affecting all

the ages and stages of the male lifespan. In adolescent and young adult males we

need to investigate why violence, risk-taking, suicide rates, substance use and

abuse are so prevalent. Why at this age health concerns are generally "off the

radar"?

An important example is cancer of the testicle, which occurs mainly in this young

age group and are curable by modern treatments when found early. We simply need

to get the message to young men about self examination.

In middle-aged males, we need to teach about preventive strategies, nutrition,

risk assessment and how to "listen to one's body." As an example, diminishing

sexual function may be like the canary in the coal mine -- it may be the first

indication of problems elsewhere such as blockages in the coronary arteries of

the heart or the arteries to the brain, diabetes, high blood pressure or high

cholesterol. Middle-aged men are key role models for young boys and adolescents

so this is a time for them to assess their own health and teach the next

generation to do the same. In the older man, it seems that the more birthdays

that pass by, the more losses there seem to be to endure: Hormone loss, sexual

loss, hair loss, bone loss, muscle loss and loss of memory, prostate health, and

mental health. Clearly, many of these losses are a result of aging and will be

with us until we find the fountain of youth, but many of these can be predicted

at early stages and possibly delayed through appropriate education and public

health intervention in midlife years.

The modern women's health movement has been strong, vibrant and productive for

over 20 years. It is only in the past decade that world governmental and

nongovernmental organizations are beginning to address the issues of male

specific health.

The development of a men's health initiative in B.C. is timely -- building on the

expertise we currently have across multiple institutions and disciplines, we can

become global leaders in the field and develop a strong model of care, awareness,

education and research. We need to work with our government and community leaders

to coordinate a system that will better understand men's attitudes to health,

invest in male defined approaches to health care provisions, initiate health care

education early in life for boys and young men in schools and diverse

communities, and develop coordinated health and social policies based on the best

available standards of care. Together we can add 10 good quality years to the

middle of a man's life, postpone and perhaps decrease the inevitable losses of

aging, help men to grow older without growing old. The time is now.

Larry Goldenberg is the head of the department of urologic sciences at the

University of British Columbia and Barry Rich is a physician in Vancouver

specializing in vasectomies.

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