Guest editorial: Men’s health, Part 1: Why we need a comprehensive strategy in British Columbia

The health risks associated with men’s gender or mascu­linity have remained largely unproblematic… Left un­ques­tioned, men’s shorter lifespan is often presumed to be natural and inevitable.[1]

One hundred years ago men and women had equal average lifespans. But over the past century a consistent pattern has developed in countries around the world, including Canada: males experience higher mortality rates than females across the spectrum of life, from conception to old age. 

In BC average male life expectancy is currently 4.4 years less than female life expectancy. This difference is at­tributable to potential years of life lost (PYLL), calculated as life expectancy minus the age at death. 

In an analysis of BC data, three causes of PYLL for men were identified as cardiovascular disease, suicide, and motor vehicle accidents.[2] Over 95% of workers in the 10 most hazardous jobs are men, and over 90% of occupational deaths occur in men. In 2005, 97% of the 1097 Canadians who died in the workplace were male. Today, military deaths, which almost always involve young males, compound the PYLL.
 
In the past decade we have recognized the need to make men’s health a distinct and important issue—the “final piece of the puzzle” of family health. The early loss of a father, either through illness, accident, or suicide, has wide repercussions: the broader family is affected profoundly; almost 50% of women are widowed by age 65 and more than 50% of elderly widows living in poverty were not poor before the death of their husbands; at age 100 women outnumber men 8 to 1. 

The loss of a father’s love and a male role model has a huge impact on the normal development of children. One cannot but agree that fathers are possibly the world’s most undervalued and underutilized natural resource.

The modern women’s health move­ment has been strong, vibrant, and productive for over 20 years. It is only in the past decade that world governmental and nongovernmental organizations have formed to address the issues of male-specific health. Australia and Ireland have been the leaders in this field, with formal national policies on men’s health. 

Only three endowed academic research chairs in men’s health exist internationally, one of them established in Ottawa in 2010. We now have the opportunity to develop a men’s health strategy in British Columbia. By building on the expertise we currently have across multiple institutions and disciplines, as the Men’s Health Initiative of BC (MHIBC) has begun to do, we can become global leaders and develop a strong model of male health care, awareness, education, research, and advocacy. 

We need to work with our government leaders to coordinate a system that will better understand men’s attitude to health, invest in male-sensitive ap­proaches to health care provision, initiate health care education early in life for boys and young men in schools and diverse communities, and develop coordinated health and social policies based on the best available standards of care to promote men’s health. 

One example can be seen in the Northern Health Authority, where Chief Medical Health Officer Dr David Bowering recently initiated a multistakeholder collaborative venture to address men’s health needs by re­designing primary health care services in six communities. This initiative recognizes that meaningful change will happen only when there are concerted efforts to engage men and boys across the many settings where they spend their time.[3]

This two-part theme issue contains articles about a diverse group of men’s health concerns. In Part 1 we begin with an article by me and Dr Robert MacMillan, a primary care physician and urologist by training, that looks at men’s health from the primary care perspective and presents some novel ideas regarding group therapy and preventive care. 

Dr Richard Bebb, an endocrinologist and expert in testos­terone, then discusses the epidemiology, diagnostics, and therapeutic measures available today for managing hypogonadism in men of all ages. 

Dr Stacy Elliott, a sexual health expert, completes Part 1 by reviewing erectile dysfunction, focusing on the link with cardiovascular and lower urinary tract health, as well as the serious efforts being made in the field of penile rehabilitation following pros­tate cancer therapy.
  
In Part 2, we’ll consider three other important topics for men’s health: suicide, osteoporosis, and cancer.
—S. Larry Goldenberg, CM, OBC, MD, FRCSC
Professor and Head
Department of Urologic Sciences
University of British Columbia

References

1. Minino AM, Heron M, Murphy SL, et al. Deaths: Final data for 2004. Hyattsville, MD: National Center for Health Statistics; 2007. Accessed 2 August 2011. www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf. 
2. Bilsker D, Goldenberg L, Davison J. A roadmap to men’s health: Current status, research, policy and practice. Vancouver, BC: Men’s Health Initiative; 2010. Ac­cessed 2 August 2011. www.aboutmen.ca/application/www.aboutmen.ca/asset/upload/tiny_mce/page/link/A-Roadmap-to-Mens-Health-May-17-2010.pdf.
3. Bowering D. Where are the men? Prince George, BC: Centre for Healthy Living; 2009. Accessed 2 August 2011. www.northernhealth.ca/Portals/0/Your_Health/MensHealth/northen-health-mens-health-report.pdf.