They are less likely to go to the doctor. They eat less fruits and vegetables. They are more likely to smoke, die in alcohol-related accidents, and engage in other activities that can lead to traumatic brain injury. By almost every known measure, men fall short of women when it comes to taking care of themselves.
And for months, to the surprise of few in the medical community, men have consistently lagged behind women in getting a COVID-19 vaccine. By mid-November, 57% of men and boys in the US had been fully vaccinated, compared to 61% of women and girls.
The man’s reluctance to seek medical attention is so well documented and talked about so extensively that it has become a punch line. And that can make solutions difficult, said James Leone, a health professor at Bridgewater State University in Massachusetts.
“The reason why men often live sicker and die earlier is that we allow it,” he said. “As a society, we don’t go beyond the surface, and just say, ‘Oh, that’s a shame. What’s wrong with guys?’”
But there’s nothing funny about men living sicker and dying earlier than women — especially when the decisions they make about their health can have medical and economic consequences for their families, as has become apparent during the COVID-19 pandemic. More than 40,000 children have lost a parent to COVID-19, and many more have faced food or housing insecurity after their parents lost their jobs or were unable to work.
So what’s going on with men and their health?
Doctors, psychologists, evolution theorists seem to agree that it all comes down to men having a higher risk tolerance. But untangling the cause is complicated. Some researchers think the trait is a genetic inheritance from ancient times, when men who engaged in aggressive, risky behavior were able to outdo their peers for mates and food. Others say that men’s higher risk tolerance is primarily a learned trait fostered by social and cultural norms of masculinity.
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While women can take risks, too, on average the difference is undeniable, said Daniel J. Kruger, an evolutionary psychologist at the University of Michigan’s Institute for Social Research. Whatever combination of nature and nurture is at work, these characteristics have been deeply ingrained in our society over the centuries. Public health campaigns are exploring new ways to make their messages resonate with men, but changing such ingrained behavior will take significant and concerted effort.
“This goes way back in our evolutionary history,” he said. “It doesn’t determine our behavior, but it certainly influences it.”
During the pandemic, the gap between men and women became clearly visible.
Since 2018, researchers from Indiana University Bloomington have been conducting a long-term survey of 250 opposite-sex couples, questioning them about a range of what Jessica Calarco, an associate professor of sociology at Indiana University, called “loaded topics” for new parents. . – including breastfeeding, childhood vaccines, co-sleeping and when both partners return to work.
When COVID-19 hit, Calarco and her colleagues added pandemic themes to the mix.
One of the key findings: Two-thirds of the couples disagreed about what level of risk was acceptable for their families. In most cases where the man and woman disagreed, it was the woman who was more risk averse and more diligent about safety guidelines, such as wearing masks and maintaining social distancing.
“Because women were the ones who took the more risk-averse positions, they were also pressured to be the peacekeepers when this escalated into conflict,” Calarco said. “Women felt a responsibility to resolve the conflict or prevent it from escalating.”
They did that by taking on the burden of ensuring the safety of the family itself — and in many cases taking extra precautions to protect children or elderly relatives from their spouse’s riskier behavior, she said.
“This is not a function of biological differences, but the pressure placed on women to be caregivers, to think about themselves and everyone else around them,” Calarco said. “Being pushed into that worrisome role in their family or community makes them more aware of risk than men.”
In other words, women make decisions — including health decisions — based on what they think is best for themselves and everyone else they care for, ultimately leading to more conservative choices. Men are more likely to base decisions solely on their personal risk tolerance, leading to riskier choices, Calarco said.
Leone calls it “normative satisfaction.”
“It’s kind of a self-fulfilling prophecy,” he says. “Men and boys are going to do things that are bad for their health and we just accept that as part of our culture. It’s almost like we’re giving the social ticket to men and boys to just run off and come to us if you have a problem.”
Cultural norms aside, biology ultimately sets the stage, said Michigan’s Kruger. While the differences between men and women are not black and white, studies have nevertheless suggested that genetic predisposition plays a role in their differing propensities for risk.
The phenomenon dates back to our ancestors centuries ago, when men had to compete for mates in a way that women didn’t. Most women had children, but only the strongest men had a partner. They used their physical strength to establish powerful leadership positions within their communities and prevent other males from mating, he said.
“There was a lot of incentive for competition, to get into those high status, powerful positions where you can attract and keep partners,” Kruger said. “There’s a risk of dying without reproducing and a greater motivation to take risks to get there.”
Our physical and social environment has of course changed drastically. No one was scheduling doctor’s appointments or getting vaccines at the time, and the survival of a modern American man doesn’t depend on his ability to physically fend off competitors and hunt large animals for dinner. But the mindset that comes from that genetic inheritance, he said, is still there.
When public health officials have tried to encourage public acceptance of vaccines, masks and other pandemic safeguards, few, if any, of the messaging initiatives have been created with gender in mind.
But evidence from other health contexts shows it’s possible to make men more health-conscious, said Leone, who studies methods to improve health outcomes in low-care communities.
One possibility is terminology.
The term ‘women’s health’ is often linked to the issues surrounding reproductive health and the health of the offspring, while ‘men’s health’, insofar as it pays any lip service, stands in its own silo. The more inclusive term “family health” would send a message to men that they too should take care of themselves, Leone said.
But how do you get the message across? It may sound simple, Leone said, but it can help get men in the same room and talk about health topics they may have shied away from in the past.
In Australia, for example, men are encouraged to join community organizations called “barns,” where they discuss healthy behaviors while participating in activities such as woodworking and beekeeping.
In the US, some health care providers have shown success meeting men where they are, such as barbershops or sporting events, Leone said. Blood pressure tests at football games and car shows, for example, are becoming more common in many states. Or a community breakfast combined with cancer screenings, with catchy names like Pancakes & Prostates.
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A big part of the strategy is simply to get men to form new habits, Leone said.
Girls are taught to be proactive about their health, and young women are encouraged to schedule routine gynecological exams. Young men, meanwhile, may have very little reason to see a doctor, as long as they’re healthy, he said. But if they start a relationship with a trusted health care provider, men can get started on lifestyle changes that can reduce the risk of chronic disease years into the future.
Modeling behavior and social influence can also be powerful in shaping health behaviors, Indiana’s Calarco said — especially for men, who may be less threatened by exposing what they see as a weakness if someone else does the same.
For example, research has shown that when male executives don’t take advantage of their company’s parental leave policies, neither do new fathers who are lower in the organization.
“The more other people do it, the more inclined you are to do it,” she said. “If you have high-status men who engage in that behavior, it could be a signal that it’s okay for other men to exhibit that behavior as well.”
Will any of these work with the highly politicized topic of COVID-19? Hard to say, though vaccine mandates can make the question moot in many cases.
What is clear is that men and women often have different minds when it comes to taking care of themselves, but it is an issue that affects all of us.