Men Are Reluctant Patients

At the turn of the 20th century, men born in United States had a life expectancy of 46.3 years. Women generally lived to the ripe, old age of
48.3 years. The difference was real but small. But throughout the century it widened, peaking at seven years in 1990. By the mid-2000s men were still shedding their mortal coils five years earlier than women.

And then came COVID-19.

Of the more than 1 million American lives lost during the height of the pandemic, 62% were men. COVID-19’s effect on U.S. male mortality is reflected in the February 2023 life expectancy report from the Centers for Disease Control and Prevention. Male life expectancy is now almost six years shorter than female life expectancy (73.2 versus 79.1).

COVID-19 aside, there are several factors that contribute to men expiring more than half a decade earlier than women. Men are bigger risk takers. They have a significantly higher rate of completed suicide. Men are almost three times more likely to die in a traffic accident than women, according to the Insurance Institute for Highway Safety.

Henry says, boys and girls receive different messages about healthcare. Many girls form a lifelong connection to the healthcare system beginning with visits to a gynecologist as adolescents. Aside from childhood vaccinations, injuries or physicals needed to play sports, boys don’t have strong reasons to see a doctor.

How it factors into mortality and health is complicated, but men are also reluctant users of healthcare. A 2020 Cleveland Clinic survey of 1,174 men age 18 years and older found that 77% preferred shopping with their wife or domestic partner to going to the doctor. Some statistics show that women are twice as likely to get routine health exams as men.

Traditional work life and hours may be factor. “A guy working in a factory 8 a.m. to 4 p.m. — well, those are exactly the hours a doctor is open,” says Ronald Henry, president of Men’s Health Network, which was founded years ago to raise awareness about men’s health.

Connection to healthcare

“How” may be addressable. It’s the “why” part of men ignoring their healthcare that Henry and other men’s health advocates are working to change. Changing that mindset really means redefining decades (centuries?) of society’s ingrained image of what it means to be a man.

“Guys are supposed to be strong, supportive, protective, carrying the load, which makes it harder for guys to get engaged with medical care,” comments Henry. “They are told to shut up, be strong and silent. Go suck it up and deal. It is harder for a guy to acknowledge that he has a problem.”

From early in life, Henry says, boys and girls receive different messages about healthcare. Many girls form a lifelong connection to the healthcare system beginning with visits to a gynecologist as adolescents. Aside from childhood vaccinations, injuries or physicals needed to play sports, boys don’t have strong reasons to see a doctor.

“We have a much better way of connecting young people to the healthcare system for women than we have for men,” Henry says.

Counteracting the dated ideas of men as strong and not needing care is part of the mission of Henry’s organization. But the organization’s reach is limited. What would help, Henry says, is if the government, media, health insurers and the healthcare system would start promoting and encouraging men to start taking care of themselves.

“Healthcare promotion, when you look around, is women, women, women,” he says. “How often does anybody talk to guys about, ‘You need to get connected with the healthcare system’? How many people are speaking to men’s health? Look inside the federal government. Why do they have eight to 10 offices of women’s health? There are zero for men.”

Neglected women’s health

Henry is perhaps overstating things a bit. The Office on Women’s Health, created in the Department of Health and Human Services (HHS) in 1991, does oversee 10 agencies focused on the health and well-being of women, but children are also often included. Plus, the focus on women’s health was a reaction to prior neglect and blind spots. Women were underrepresented in clinical trials and breast cancer was neglected. There was little research into how heart disease might differ in women.

Men held sway over reproductive health issues and services — and still do in important respects. This is to say nothing of what had been the male domination of the upper ranks of the healthcare professions and organizations. That is changing. More than one-third (37.1%) of the active physician workforce in the United States is male, although there are certain specialties, such as orthopedic surgery, that are still male bastions.

Henry argues, though, that there are no federal offices for male health and precious few at the state level. While a few states have offices of men’s health, there currently are zero federal offices. Rep. Donald M. Payne Jr. introduced legislation in 2021 that would create an Office of Men’s Health in HHS. Henry also sees health insurers as part of the problem: the more men who have health insurance but don’t use medical services, the less money insurers must pay out. But his organization wants to drive home to the tried-and-true prevention message. “It’s a lot better to treat high blood pressure than it is to treat a stroke, and it’s a lot better to change a diet than deal with diabetes,” he says.

Even when men go to a doctor, they aren’t always forthcoming about their health issues. It’s something David Shusterman, M.D., encounters every day.

“Guys don’t express themselves well,” says Shusterman, a New York board-certified urologist. “You ask them, ‘How are you peeing?’ and they say, ‘Great, no problems,’” he says. “And then I look at the questionnaire and they have serious problems.”

Often Shusterman gets a better physical history from his patient’s wife or significant other writing things down or being at the appointment. “A lot of women are always pushing the men into action versus men not really wanting to go to the doctor,” he says. “When men need procedures, for example, when they have a rise in (prostate-specific antigen) and need a biopsy, they try to get out of doing it. Their wives are the ones that needle them to get the biopsy.”

Both Henry and Shusterman believe while younger men are more health conscious, there is still a great deal of progress that could bemade.

“Younger guys do seem to be more attuned to that, and that reinforces what we’ve been talking about in terms of social messaging and support,” Henry says. “We certainly are seeing it in an increased commitment to fitness, exercise, healthy lifestyle and healthy diet. They get a lot of encouragement to exercise and to watch what they eat. They don’t get a lot of encouragement to go see the doctor.”

Robert Calandra is an independent journalist in Philadelphia and a frequent contributor to Managed Healthcare Executive.