WHY MEN DIE YOUNG

The extra longevity of women in our society is well established.  In fact, the difference in life expectancy for male and female infants born today is projected to be 80 years for females, but only 75 for males.  This five-year difference has commonly been attributed to genetic factors.  However, new evidence demonstrates that this discrepancy may be affected more by male behavior rather than genetic traits.

Men outrank women in all of the top fifteen causes of death except for Alzheimer’s disease.  Men’s death rates are twice as high for suicide, homicide, and cirrhosis of the liver.  In every age group, American males have poorer health and higher risk of mortality than do females.  Common increased risks include:

·         More men smoke than women.

·         Men are twice as likely to be heavy drinkers, or to engage in other risky behaviors such as abusing drugs and driving without a seatbelt.

·         More men work in dangerous settings than women, and men account for 90% of on the-job fatalities.

·         More men drive SUVs that are rollover prone, and suffer fatalities in motorcycle accidents.

Perhaps some of these increased risks are associated with deep-seated cultural beliefs about men’s bravely and machismo, which reward them for taking risks and facing danger head-on.  This “macho” attitude seems to extend to the care that men take of their own physical and mental health.  Women are twice as likely to visit their doctor on an annual basis and explore preventive medical treatments as are men.  Men are more likely to ignore symptoms and less likely to schedule check-ups or seek follow-up treatment.  Psychologically, men tend to internalize their feelings or stress or even self-medicated to deal with stress, while women tend to seek psychological help.  Almost all stress-related diseases are more common in men.

In the final analysis, men and women alike must be responsible for their own health and well-being.  By making sound choices regarding diet, exercise, medical care, and high-risk behaviors, both genders can attempt to maximize the full potential of their life expectancy.

DEFINITIONS OF HEALTH

By the time they reach college age, most Americans are familiar with the many ways in which health care is provided.  Here are easily recognizable examples, all of which serve to reinforce our traditional definitions of health.  As you will learn, these definitions are centered in the cure or management of illness and the extension of life.  Note the concerns over morbidity (pertaining to illness and disease) and mortality (pertaining to death) present in the descriptions that follow.

Episodic Health Care

The vast majority of Americans use the service of professional health care providers during periods (episodes) of illness and injury, that is, when we are “unhealthy”.  We consult providers seeking a diagnosis that will explain why we are not feeling well.  Once a problem is identified, we expect to receive effective treatment from the practitioner that will lead to our recovery (the absence of illness) and a return to health.  If we are willing to be compliant with the care strategies prescribed by our practitioner, we should soon be able to define ourselves as “health” once again.

The familiarity of episodic health care is evident in the 823.5 million times that Americans visited physicians during 2000.  Although some of these visits were for preventive health care (see discussion on page 5), the vast majority were in conjunction with illness.  When viewed by racial groups, Whites averaged 3.2 visits, Asians 2.9, Blacks 2.1 and Native Americans 0.8 visits during that year.

KEYS TO LONGER LIVING

Experts generally agree on basic lifestyle characteristics that support greater longevity and, hopefully, a higher quality of life.  Small adjustments that promote this improvement include:
·         Testing your cholesterol level regularly and taking a 30-minute brisk walk every day.

·         Wearing a seat belt in the car and a helmet while riding a bicycle, motorcycle, or while skating.

·         Substituting olive oil instead of butter.

·         Quitting smoking or at least reducing the amount of tobacco used daily.  Lung cancer is the most frequent cause of cancer-related death in the United States.

·         Avoiding sun exposure from 11 am until 2 pm when UV radiation is most dangerous.  Stay inside during those peak hours and always wear sunscreen outdoors.

·         Asking questions of your doctor or pharmacist about concerns, test results, diagnosis, or treatments.  It is often helpful to take someone with you to important appointments.

Don’t worry! Even if everyone was overly cautious, we would still not live in a risk free world – unnecessary worry can stress the mind and body.

Preventive or Prospective Medicine

Simple logic suggests that it takes more sense to prevent illness than to deal with it through episodic health (medical) care.  This philosophy characterizes preventive or prospective medicine.  Unfortunately, however, many physicians say they have little time to practice preventive medicine because of the large number of episodically sick people who fill their offices every day.

When physicians do practice preventive or prospective medicine, they first attempt to determine their patient’s level of risk for developing particular conditions.  They make this assessment by identifying risk factors (and high-risk health behaviors) with a variety of observational techniques and screening tests, some of which may be invasive (taking tissues from the body such as a biopsy or blood draw).  Additionally, an important tool in assessing risk is an accurate family health history, something that over one-third of all adults cannot adequately provide to their health care providers.

Once they have identified levels of risk in patients, health practitioners try to lower those risk levels through patient education, lifestyle modification, and when necessary, medical intervention.  Continued compliance on the part of the patients will result in a lower level of risk that will continue over the years.  Note that preventive medicine is guided by practitioners, and patients are expected to be compliant with the direction they are given.

Although preventive medical care appears to be a much more sensible approach than episodic care in reducing morbidity and mortality, third-party payers (insurance plans) traditionally have not provided coverage for these services.  Managed health care plans that earn a profit by preventing sickness, such as health maintenance organizations, or HMOs should be much more receptive to the concept and practice of preventive medicine.

HEALTH PROMOTION

Throughout the United States, YMCA/YWCA – sponsored wellness programs, commercial fitness club, and corporate fitness centers offer risk-reduction programs under the direction of qualified instructors, many of whom are university graduates in disciplines such as exercise science, wellness management, and health promotion.  Using approaches similar to those employed in preventive medicine, these nonphysicians  health professionals attempt to guide their clients toward activities and behaviors that will  lower their risk of chronic illness.  Unlike preventive medicine, with its sometimes invasive assessment procedures and medicine, with its sometimes invasive assessment procedures and medication-based therapies, health promotion programs are not legally defined as medical practices and thus do not require the involvement of physicians.  In addition, the fitness focus, social interaction, and healthy lifestyle orientation these programs provide tend to mask the emphasis on preventing chronic illness that would be the selling point of such efforts if they were undertaken as preventive medicine.  In fact, it is likely that people receiving health promotion in these settings do not recognize it as such.  Rather, they are only submitting to assessments and listening to health – related information as incidental parts of personal goals, such as losing weight, preparing for their first marathon, or simply friends for lunch hour basketball.

COMMUNITY HEALTH PROMOTION

In addition to the practices just described, a group – oriented form of health promotion is offered in many communities.  This approach to improving health through risk reduction is directed at empowering community groups, such as church congregations or a neighborhood association, so they can develop, operate, and financially sustain their own programs with little direct involvement of health promotion specialists.

The key to successful community – based health promotion is empowerment.  In the context of health, empowerment refers to a process in which individuals or groups of people gain increasing control over their health.  To take control over health matters, individuals and groups must learn to “liberate” themselves from a variety of barriers that tend to restrict health enhancement.

Empowerment programs have produced positive health consequences for individuals and groups that traditionally have been underserved by the health care system, such as minority populations.  Once such people are given needed information, inroads into the political process, and skills for accessing funding sources, they become better able to plan, implement, and operate programs tailored to their unique health need.  In many communities, empowered people have organized grassroots campaigns to prevent neighborhood violence, improve childhood nutrition, promote healthy lifestyle, or prevent drug use among youth.  When successful, these programs stand as excellent examples of the reality that people can make a difference when they become empowered. 

Healthy People 2000 and Healthy People 2010

To identify all of the health-related concerns identified by members of the health community would be a monumental undertaking far.  However, in 2003, the institute of medicine released a list of priority health concerns that they believed need particular attention.  Among these priority concerns are:

·         Treatment of asthma

·         Coordination if care for the 60 million persons with chronic health conditions.

·         Reduction in the development of diabetes.

·         Development of evidence-based cancer screening.

·         Enhanced rates of immunization, particularly for flu and pneumonia.

·         Improved detection of depression, which is now inadequately diagnosed and treated.

·         Aggressive promoted prevention of cardiovascular disease, presently the leading killer of American adults.

·         Concerted efforts to reduce the rate of nosocomial infections (infections that occur as a result of medical care) that kill an estimated 100,000 Americans annually.

·         Reduction of tobacco dependence through cessation and prevention of smoking.

·         Widened availability of prenatal care.

While improvements in these areas are greatly needed, the Institutes of Medicine have no specific programs in place at this time to address them.  In comparison, a well-established and ongoing program, Healthy People 2000, has established specific goals and objectives to improve the health of Americans in many of these areas.  A brief description of this ongoing program follows.

In 1991 a U.S government document titled Healthy People 2000: National Health Promotion and Disease Prevention Objectives outlined a strategic public.  The plan included 300 health objectives in twenty-two priority areas.  Forty-seven of the 300 objectives were defined as “sentinel ones, that particularly significant goals that could be used to measure the progress of the 1990s health promotion objectives.

Progress toward achieving the objectives was assessed near the middle of the decade and reported in a document titled Healthy People 2000: Midcourse Review and 1995 Revisions.  Although process was reported in some areas, little or no progress was reported in many.  Subsequently, a new plan, called Healthy People 2010: Understanding and Improving Health, was formulated, refined, and is now being implemented.

Healthy People 2010:  Understanding and improving Health is a health promotion program intended to be implemented at all levels, ranging from individual involvement through multinational cooperative efforts, including Health for All in the 21^st Century, a World Health Organization health promotion initiative.  Although the goals of healthy people 2000:  National Health Promotion and Disease Prevention Objectives and Healthy People 2010:  Understanding and improving health are similar, the later focuses on the projected needs of the United States during the first decade of the new century.  Newly emerging demographics, such as the increasing number of older adults, and technologies, including new vaccines and HIV antiviral drugs, are better addressed in Healthy People 2010: Understanding and Improving Health.

Central to the design of Healthy People 2010: Understanding and Improving Health are two paramount goals: 
(1) increasing quality and years of life, and 
(2) eliminating health disparities in areas such as gender, race, and ethnicity, as well as income and education level.  These goals in turn provide twenty-eight more focused objectives.  Progress in accomplishing these objectives is anticipated through the manipulation of the behavioral, biological, and environmental determinants of health as they relate to ten of the leading health indicators: 
(1) physical activity, 
(2) weight management, 
(3) tobacco use, 
(4) substance abuse, 
(5) responsible sexual behavior, 
(6) mental health, 
(7) injury and violence, 
(8) environmental quality, 
(9) immunization, and 
(10) access to health care.

The success of Health People 2010:  Understanding and Improving Health will not be known until nearer the end of the decade.  However, if its goals are ultimately reached, Americans can anticipate an improved quantity and quality of life.