Healthwise, women are the stronger sex!

It seems obvious: Men are generally bigger and more muscular than women. They can run faster, lift heavier load, and throw things farther. Indeed, men rule on the playing field, but when it comes to health, men are the weaker sex! 

The longevity gap

Much has changed in the field of medicine over the past 100 years. There had been tremendous advances in diagnosis and treatment.  As a result, life expectancy has also changed. One thing though has not changed — the gender gap.  People of both sexes are living longer, but decade after decade, women continue to outpace men. In fact, the gap is wider now than it was a century ago. 

In the United States, for example, the longevity gap is producing striking demographic characteristics in older people.  More than half of all women older than 65 are widows, and widows outnumber widowers by at least three to one.  And this longevity gap persists even into very old age, long after hormones have passed their peak.  Among centenarians, there are four females for every male.

The gender gap is not unique to America.  In fact, every country with reliable health statistics reports that women live longer than men.  And this longevity gap is present both in industrialized societies and in developing countries.  It’s a universal observation that suggests a basic difference between the health of men and women everywhere.

The health gap

Men die younger than women, and they are more burdened by illness during life.  They fall ill at a younger age and have more chronic illnesses than women.  For example, men are nearly 10 times more likely to get inguinal hernia than women, and five times more likely to have aortic aneurysms.  Men are also about four times more likely to contract AIDS or be hit by gout; they are more than three times more likely than women to develop kidney stones, to become alcoholics, or to have bladder cancer.  And they are about twice as likely to suffer from emphysema or duodenal ulcer.

The lifelong gap

The health disparity between males and females actually begins during fetal life and continues from cradle to grave. About 115 males are conceived for every 100 females, but males are much more likely to die before birth, so there are only 104 newborn boys for every 100 newborn girls. Boys are about 60 percent more likely to be born prematurely, to have conditions related to prematurity such as neonatal respiratory distress syndrome, and to suffer birth injuries.  Boys are about 18 percent more likely to die before their first birthday than girls.

So, when it comes to health, males are really the weaker sex throughout life. But why? That’s the $64,000 question, but there is no single or simple answer.  The gap is most probably the result of a complex mix of biological, social, and behavioral factors.

Biological factors

• Genes and chromosomes. Males and females are different from the moment of conception.  Each has 23 pairs of chromosomes, which carry the body’s 20,000 to 25,000 genes. Twenty-two of these pairs are present in both males and females, but the 23rd separates the sexes.  The final pair contains the sex chromosomes, but in men, one is an X and the other is a Y. 

The Y chromosome is only about a third as large as the X and contains far fewer genes than the female sex chromosomes.  Some of these genes may be linked to diseases that contribute to the excess male mortality throughout life.  In addition, if a woman has a disease-producing gene in one of her X chromosomes, it may be counter balanced by a normal gene on the other X, but if a man has the same bad gene on his X chromosome, he lacks the potential protection of a matching gene.

• Hormones.  Hormones don’t seem to account for the lion’s share of the gender gap, but they do play a role.  Estrogen raises HDL (“good”) cholesterol levels, perhaps explaining why heart disease typically begins about 10 years later in women than in men.  On the other hand, testosterone also fuels diseases of the prostate, both benign and malignant. Even so, the testosterone-prostate connection cannot account for the longevity gap, since there are more deaths from breast cancer than prostate cancer.

Both sex hormones keep bones strong but here, men actually have the edge.  As men age, testosterone levels decline slowly, about one percent per year, but estrogen levels drop abruptly at menopause, boosting the risk of osteoporosis.

• Metabolism. Cholesterol may account for some of the health gap. Males and females have similar LDL (“bad”) cholesterol levels, but women have substantially higher levels of HDL (“good”) cholesterol.  HDL cholesterol protects against heart disease, but triglycerides may increase risk and men usually have higher triglyceride levels than women.

Obesity is rapidly increasing around the world, especially in the more developed nations. As compared to men with healthy weight, an average 40-year-old male nonsmoker will lose three years of life to overweight and almost six years to obesity.  Although the prevalence of obesity is slightly higher in women, excess weight is more of a problem in men.  That’s because women tend to carry excess weight on their hips and thighs (“pear shape”) while men add it to their waistlines (“apple shape” or “beer belly”).  Excess body fat is never a good thing, but abdominal obesity is much riskier than lower body obesity, sharply increasing the risk of heart attack and stroke.

Although obesity is often classified as a metabolic problem, it usually results from unwise health behaviors, another major misfortune in males.  In fact, although metabolic, genetic, and hormonal factors may explain part of the health gap particularly very early in life, social and behavioral factors play a larger role in adults.

Social factors

• Work stress and hostility. The stereotype of a harried, hard-driving, overworked male executive has a basis in fact, and work stress can increase the risk of hypertension, heart attack, and stroke.  In fact, in Japan, “karoshi” is a recognized diagnosis.  Type A behavior, stress, hostility, and anger have all been implicated as heart disease risk factors, and these traits tend to be higher in men than women. 

• Social networks and support.  It’s true: People are good medicine. Strong interpersonal relationships and support networks reduce the risk of many health problems. In contrast, social isolation has been identified as a heart disease risk factor. In general, women are more in touch with their feelings and with other women, and they have a remarkable ability to express their thoughts and emotions.

Women may not really be from Venus anymore than men are from Mars, but strong relationships and good communication seem to help explain why women live longer on earth!

Behavioral factors

Biological factors account for part of the gender gap.  But from adolescence onward, male behavior is the main reason that men fall ill sooner and die off faster than women. 

• Risky behavior.  Whatever the cause — whether it’s genetic, cultural norms, or daredevil role models — from boyhood on, males take more risks than females, and they often pay the price in terms of trauma, injury, and death.  Simple precautions like wearing seat belts and bike helmets can help, but more complex measures involving education about alcohol, drugs, firearms, and safe sex are also essential.

• Smoking. It’s the riskiest of all health habits, and that includes secondhand smoke.  Smoking is a terrible hazard for both men and women, young and old.

• Alcohol and substance abuse.  Like smoking, drinking and drug abuse are traditionally male problems that are increasingly threatening to women as well.  Still, males dominate in these self-destructive habits.

• Medical care.  According to a major health survey, three times as many men as women had not seen a doctor in the previous year.  In general, men who have the most traditional, macho views about masculinity are the least likely to get routine check-ups and necessary medical care.

Closing the gap

Men who think they are too tough to get sick are risking a medical crashlanding.  To stay healthy, we all need to follow certain health rules and practices.  Here are 10 steps to help you swing your way to a long and healthy life:         

1.  Avoid tobacco in all forms.

2.  Eat well.  Eat more: whole grains, fruits, vegetables and legumes, fish, low- or non-fat dairy products, and nuts and seeds.  Eat less:  red meat, whole-milk dairy products, poultry skin, high-sodium (salty) processed foods, sweets, sugary drinks, refined carbohydrates, trans fats and, if you need to lose weight, calories.

3. Exercise regularly, including 30 minutes of moderate exercise nearly every day; exercise for strength two to three times a week; and exercise for flexibility and balance according to need.

4.  Stay lean.  It’s equally hard for men and women, but even partial success will help.

5. If you choose to drink, limit yourself to one to two drinks a day, counting 5 ounces of wine, 12 ounces of beer, and 1.5 ounces of liquor, as one drink.

6.  Reduce stress. Get enough sleep. Build social ties and community support.

7.  Avoid risky behavior, including drug abuse, unsafe sex, dangerous driving, unsafe firearm use, and living in hazardous household conditions.

8. Reduce exposure to toxins and radiation, including sunlight and medical x-rays.

9.  Get regular medical check-ups, screening tests, and immunizations.

10. Seek joy and share it with others.  Laughter is good medicine.  Fun and optimism improve health as well as happiness. And if you make changes 1 to 9 slowly, steadily, and reasonably, you will actually come to enjoy your healthful lifestyle longer — whether you are a man or a woman!

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Source:  www.health@harvard.edu.