Question

Males across societies share a common pattern of dying at higher rates than their female counterparts, especially in industrialized countries. What is one reason researchers have suggested for this differential in mortality?

Answer 1

Inequalities between men and women in morbidity and mortality show a contrast, which has been called gender paradox. Females showed a longer life expectancy in almost every human society in the world in the last decade of the 20th century, though the size of the advantage varied greatly.

The differences in life expectancy between females and males are higher in high-income countries than low-income countries. Causes of disparities in mortality among males and females in different countries are also different. Communicable diseases, injuries and maternal conditions contribute most to differences in life expectancy between females and males in low-income countries, whereas noncommunicable diseases (NCDs) contribute most to life expectancy differences in high-income/industrialized/developed countries.

Disparities in life expectancy are more evident if we look at the life expectancy of males and females in different countries and compare the differences. In the U.S. male life expectancies are nearly 76.1 years for males and 81.1 years for females, a difference of 5 years, whereas in France difference is of 5.9 years and in the U.K. 3.5 years. The discrepancy was much greater in some countries, with the difference in Russia reaching more than 12 years, but in others, such as Bhutan 0.6 years, Pakistan 2 years or niger 1.9 years, all having a much less than developed countries.

According to WHO, the incidence rate of TB was 1.7 higher in men than in women globally in 2017. In 2016, the probability of a man aged 30 years dying from an NCD before 70 years of age was 1.44 times higher than for a woman aged 30 years. Globally in 2016, suicide mortality rates were 1.75 times higher in men than in women. Death rates from road injury were also more than twice as high in men as in women from age 15 years.

There are many causes of sex difference in mortality which can be broadly categorized into two groups:

· Biological factors

· Behavioral and social factors

Biological factors

Women have certain biological advantages that allow them to live longer. The biological advantage of the female sex in terms of mortality rates can be seen is from the very beginning of life. During infancy (the first year of life, in the absence of any outside influence which could differentiate mortality between the sexes) also mortality rates are higher in boys than girls in most parts of the world. According to WHO in 2017, male children were 11% more likely to die than female children before the age of 5 years, compared with only 6% in 2000, indicating that the decline in under-5 mortality rate since 2000 has been faster in females than in males. Given that boys generally have a higher under-5 mortality rate than girls for biological reasons

This has been explained by sex differences in genetic and biological makeup, with boys being biologically weaker and more susceptible to diseases and premature death.

The genetic advantage of females is evident. Females have two X chromosomes, and when a mutation of one of the genes of the X chromosome occurs, females have a second X to compensate. Whereas all genes of the unique X chromosome of males express themselves, even if they are deleterious because they have only one X chromosome.

The genetic difference between the sexes is also associated with better resistance to biological aging later in life. Furthermore, female hormones and reproduction have been also associated with greater longevity. For example Studies have shown that estrogen (a female sex hormone) affects almost every tissue or organ system, including the heart and blood vessels. Estrogen’s known effects on the cardiovascular system include increases HDL cholesterol (the good kind), decreases LDL cholesterol (the bad kind), promotes blood clot formation, relaxes smooth muscles, dilates blood vessels so blood flow increases and protects from free radicals.

While testosterone, (a male sex hormone) on the other hand, has been linked to violence and risk-taking.

Other than these hormonal influences, the female body has to accommodate the needs of pregnancy and breastfeeding. So it is better able to cope with stresses and to handle adversities.

Social and behavioural factors

The diversity in worldwide longevity alone indicates that the difference in mortality between the sexes is not purely biological and that there are intervening social factors.

Women have not only survived better due to their biological advantage but also because they tend to engage in fewer unhealthy behaviors than men do. So it puts them in a position to take better profit from current advances in health care like preventive health care, early screening, and improvement in living conditions.

Negative behavioral or environmental factors affect men more than they do women. This is because of the fundamental difference in lifestyles that allows women to better benefit from the progress technological advancements and improvement in the health care system. According to WHO, the age-standardized prevalence of tobacco smoking was five times higher in men than in women in 2016 Globally, per capita alcohol consumption was almost 4 times higher in men than in women in 2016.

Economic and social progress that has occurred in 18 th and 19th century has dramatically reduced social differences between men and women.

If we analyze the causes, higher male mortality in industrial countries could be explained by the rise of so-called "man-made diseases," which are more typically male. The causes include cancer, heart diseases, stroke, chronic respiratory diseases, violence ( intentional and unintentional injuries).

The factors predisposing to these conditions include exposure to the hazards of the workplace in an industrial context, chronic stress, alcoholism, smoking and road accidents, which have indeed increased considerably throughout the 20th century.

Today particularly in industrialized countries women are also increasingly engaging in unhealthy behavior like smoking and drinking, they are also moving out of home for work and exposed to stress but still, studies have shown that their engagement is still under control, for instance, male smokers tend to smoke more cigarettes than female smokers do, and men drive more recklessly than females drivers. Although the majority of women in industrialized nations are working, most of the time their nature of jobs, roles and professional activities are different from males, on average less prejudicial to their health.

Also, by nature, females relate to their bodies and health in a much different way than males do. They often seek beauty while men seek strength and power. Thus, for a woman, her body must remain young, good looking and healthy as long as possible, whereas from a man’s perspective body must be submitted to risks and challenges from an early age which results in engaging in risky behavior. Hence, women, being more inclined to take care of their bodies and their needs, practice lifestyle/ activities that are healthier and often seek professional help when needed. So they are better able to glean greater profit from modern medical and technological advances by getting diagnosed early, resulting in appropriate and timely treatment leading to lower risk for mortality and morbidity from sickness.

In general men are generally exposed to increased occupational risks, and have a higher prevalence of tobacco use and higher per capita consumption of alcohol. In many settings, men use health services less than women, even after taking into account reproductive-related consultations. The health gap between men and women is widest in high-income countries

Males are on the opposite end, are ignorant of their health, postponed/delay appointments and show poor adherence to treatment resulting in higher rates of mortality and morbidity from illnesses.

All these factors result in higher mortality rate for males than females in industralized nations.