Men in the United States die, on average, five years younger than women.
At a cultural moment when men and women are sharing the child-rearing burden more than ever, working in comparable professional environments, and facing the same health risks, why are men still dying so much younger?
“Guys don’t care about health; they care about performance. So unless it’s a problem in the bedroom or the golf course or with their job, they man up and they don’t come to the doctor,” said Dr. William Steers, chair of the UVA Department of Urology.
But that explanation isn’t enough to quell Steers’ burning interest in a fundamental question that has shaped his life. He deals everyday with men dying of prostate cancer. His father died young from cancer caused by smoking.
“My father was an All-American athlete in high school and a runner in college. I saw him gain weight, eat too much, probably drink too much, not exercise, have a four-way coronary bypass at age 48 and then die of a cancer. Not good,” he said.
In the U.S., though, where men have better insurance than women, they are three times less likely to go to the doctor and 1.5 times more likely than women to die from heart disease, cancer, and chronic respiratory diseases, according to the Centers for Disease Control and Prevention. The life-expectancy gender gap is even wider in Europe and wider still in the developing world.
During the day, Steers looks down the barrel of the men’s health problem as an expert in mitigating the ravages of prostate and testicular cancer. He sees the risky behaviors (one guy came in with a pet snake in his urethra), he sees the reluctance to seek care (most men don’t seek treatment until they are ravaged by the disease), and he sees the effects of long-term bad habits, like the ones that killed his father.
An Editor of the Journal of Urology and President of the American Board of Urology, Steers has pushed his own clinical career to its limits, pioneering robotic surgery and earning a prominence in his field that made him an early reviewer of the sexual dysfunction drug Viagra.
A lifetime spent treating men’s health issues has spurred Steers to fixate on the root causes of the gender mortality gap. Clearly the problem isn’t purely medical; it’s psychological, cultural, sociological, maybe even genetic. High-risk behaviors, attitudes towards to treatment, and disorders like depression and addiction are huge parts of the equation.
In 2004, Steers founded the Charlottesville Men’s Four-Miler as a way to bring visibility to the issue of prostate cancer, but the race has never gained the status of the Women’s Four-Miler, which raises awareness for breast cancer. Is it possible that men just don’t care as much about their health as women do?
Steers’ firsthand experience with the second sexual revolution that drugs like Viagra engendered over the past decade has given him some insight into what men do care about, namely sex. He has mixed feelings about the way sexual dysfunction has influenced male attitudes towards healthcare, in large part because he feels the central health message has been obscured by the marketing frenzy.
“Your sexual health is really a barometer of your overall health,” Steers said. “Erectile dysfunction is the highest predictor of a heart attack if you have high cholesterol. How many guys know that?”
Steers feels like drugs have become such a central character in the conversation about men’s health that they’ve obscured the rest of the discussion. As the father of a professional cyclist, he rues the missed opportunity that Lance Armstrong’s fall from grace has had on men’s health. But he hasn’t given up hope that he can find a way through male indifference and the stigma of sequential controversies surrounding performance enhancing drugs and high-profile athletes.
“The NIH is not going to spend money on men’s health. The money is dwindling and they’re focused on life threatening disorders. Plus men’s health has the negative cache of e.d. drugs, testosterone, and overtreatment of prostate cancer,” Steers said.
He sees inspiration in David Sedaris’ humorous account of life attached to a Fitbit in his New Yorker story “Stepping out: Living the Fitbit life.”
“Why should you care? Because of the tremendous explosion of knowledge in genetics, genomics, biometrics, and technology, we can improve it. I think the fear is that we’re running out of money in health care to do the right thing.”
So what would it take to find the root causes of the gender mortality gap? Exactly the type of prevention-focused, multidisciplinary effort that’s impossible to find funding for these days.
“If you put together multidisciplinary clinic with an endocrinologist, a psychiatrist, a dietician, a weight trainer, a urologist, and a cardiologist, you’ve covered about 90 percent of what takes guys out,” Steers said. “But that group is never in the same room. That’s what we’re trying to figure out.”
Want to help Dr. William Steers fight to level the gender mortality gap?
Call +1 (434) 924-9107 or e-mail asc9d@virginia.edu