Men in the United States live around five years less than women. And over the past several years, men have died at higher rates than women from 14 of the top 15 causes of death.
What does it take to encourage men to seek preventative care or prompt evaluation for symptoms? On Cincinnati Edition, we speak with doctors about how to change the trajectory of mens' health outcomes.
Guests:
- Helen Ouyang, emergency room doctor and contributing writer at the NYT Magazine
- Adam Raskin, co-medical director, Mercy Heart Institute
Beginning at noon, call 513-419-7100 or email talk@wvxu.org to have your voice heard on this topic. You can catch a recorded replay at 8 p.m.
A transcription of this conversation is below.
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This episode was transcribed using a combination of AI speech recognition and human editors and has been lightly edited for clarity. It may contain errors. Please check the corresponding audio before quoting in print.
Men in the US live on average five years less than women, and in recent years men have died at higher rates than women from 14 causes of death. What will it take to close that health gap? This is Cincinnati Edition on WVXU. I'm Lucy May. Joining me now to discuss this are Mercy Heart Institute co-medical director Dr. Adam Raskin, and emergency room physician and contributing writer for The New York Times Magazine, Dr. Helen Ouyang. Thank you both for being here.
Dr. Ouyang, there's this common perception that men don't go to the doctor nearly as much as women. Does that, does the data bear that out?
Dr. Ouyang: Yes, that's certainly true. Men go to the doctor a lot less than women. They are far less likely to have a primary care doctor. In fact, women make roughly 80% of medical decisions in American households, and they're also twice as likely as men to have received a checkup in the past year.
Wow, Dr. Raskin, what do you think are some of the common reasons men avoid care or delay seeking care?
Dr. Raskin: It's a great question, and I think it's because we got to be tough, you know, it's cliche, but it's probably true. And unfortunately, the most common thing that happens is we wait till we have symptoms, whether or not we recognize it and we know what it is, but when we wait that long, it's typically too late, and a lot of things that we talk about is preventative medicine and identifying things long before you have symptoms, but when someone feels I've got to work hard, I've got to be in the office all day, I got the kids to take care of, and the family to worry about, sometimes your health is left on the back burner, or it's the last thing you kind of worry about, and then, quote unquote, well, I'm fine, it'll go away, it's not a big deal, and then it's a little too late.
So, Dr. Raskin, does this idea of kind of manhood and people's thoughts about masculinity play into this? I mean, this kind of walk it off attitude.
Dr. Raskin: I think it does. I think that's how a lot of young boys are raised. Are you hurt or are you injured? Those kinds of conversations that you have playing sports as a little kid, and that just continues as we get, as we grow up, and this idea of it's not going to happen to me, I'm totally fine. Those are misconceptions, and the disease can start very early. The disease takes decades, and for most people are asymptomatic, despite this process happening, and it could be prevented years earlier, years if not decades earlier.
Yeah, and when you say the disease, I guess you're talking about heart disease specifically, or all kinds of things.
Dr. Raskin: So obviously in what I specialize in is cardiovascular disease, but that's a big word, and it means lots of things. The most common thing people think about is heart disease, or coronary artery disease, but in our space that means carotid disease, peripheral arterial disease, aortic disease, all these things contribute to the number one killer of men in this country, cardiovascular disease.
Dr. Ouyang, can you dig a little deeper into the psychology of why men might be more inclined not to take care of themselves? I know that's something you wrote about for the New York Times Magazine.
Dr. Ouyang: Yeah, I mean, it comes from all directions. First of all, I think the healthcare system is set up so that women are seeking care throughout their entire lives. We have gynecology appointments that we go to from adolescence on, and then we continue that into breast cancer screening from 40 and up for men, there's not clear guidelines like that. So, after they leave the pediatrician's office, they often don't seek care throughout their 20s, 30s, 40s, even their 50s. Prostate cancer screening is more complex, it's more personalized, there's not a straightforward guideline like there is for mammograms, and I think that often leaves men out of the healthcare system. They don't end up seeking care like women do. I think also to your point about men feeling like they're tough, they don't want to seek care. Well, they did a survey, and 86% of American men feel that providing for their family is the number one definition of being a man, so you can imagine if you are busy or you have to work and you don't feel well, you're really not going to seek care until it's too late.
Well, especially for men who don't have paid. Sick time, that's a, that's lots of, a lot of people work in jobs like that. Dr. Ouyang, I mentioned at the top of our conversation, that in recent years men have died at higher rates than women from, I think, it's 14 of the leading 15 causes of death. What are some of those causes? Dr. Raskin just mentioned cardiovascular disease. What are some of the other things we're talking about here?
Dr. Ouyang: Yeah, basically everything except Alzheimer's disease, so heart disease, cancers, all them men are dying at higher rates, and the thinking behind all this is that part of the reason women die more frequently of Alzheimer's disease is because they simply live longer. So really, 14 out of 15 causes are experienced much higher by men than women.
Does biology influence men's health outcomes Dr. Ouyang?
Dr. Ouyang: Yeah, definitely. I mean, I think we think that's what was happening during COVID, X-linked genes give women a little bit of advantage in terms of their immune systems. Testosterone is also thought to lower the immune system slightly, so that's why men were dying of COVID at 60% the rate that women were. In addition, estrogen is thought to be cardio protective in some sense, so definitely, at least before menopause, women had that cardio protection from estrogen that women don't. So there definitely is some biology involved, but biology is not destiny in this day and age.
Dr. Ouyang, I want to ask you this, because you addressed this in your article too. Some people might think, hey, men have all these advantages in other aspects of life. They typically earn more than women, they can hold more powerful positions in government, jobs, all those sorts of things. Why doesn't that translate to better health outcomes?
Dr. Ouyang: Yeah, I mean, I think that is what makes this so complicated, because after all, men do have all these advantages in society, and even in terms of health, women weren't even mandated to be included in NIH funded studies until 1993 so there definitely already is this advantage that men seem to have, but I think some of those advantages also affect their healthcare-seeking behavior. So, for instance, there were these University of South Florida psychology professors, they did these really interesting experiments on manhood, and they found that in the US this concept of manhood is like really strong and affects men, even if you don't believe in it, because it affects how society views them and affects how they're perceived as their jobs, and they did these experiments where they found that when men did a more feminine activity, or they were told they were more feminine, their response was to be more aggressive, and somehow that aggressive response sort of alleviated that anxiety about feeling less of a man, and they carried this out into the healthcare space. They surveyed these countries, 60 plus countries, and they found that male life expectancy is nearly seven years shorter in countries where these beliefs are stronger about manhood, and they controlled for wealth, they controlled for gender equality, equality, and even the number of physicians, and in the US, especially, we rank really high in this idea of strong manhood beliefs, and American men die younger.
Yeah, Dr. Raskin, you are a doctor, but you are also the man in this conversation, so I want to get your thoughts on that. I mean, there's a lot of talk about how women fall behind, and a lot of these metrics, earning, and things like that, but this, these health outcomes are so different. Do you have thoughts on why that is?
Dr. Raskin: You know, one of the things that came to mind is with all these advantages, the mental health piece, the stress piece, right? So, the chronic stress, what does that mean? Everyone's stressed, but the higher incomers, the more responsible jobs, the more you move up, and the more stress that comes along with it. It's not the stress itself, I believe it's how do you deal with that stress. Who, after a stressful day, goes home and has a cigarette? Who goes home and sits on the couch? Who's got the sedentary lifestyle as their response to the stress, as opposed to who goes to the gym after a stressful or long day, who goes and meditates or takes care of their mental health as their response to the stress. Who goes to the bar? Who has a drink after work as their response to that, as opposed to who goes home and has a protein shake and a bottle of water and. And gets a good night's sleep, so that environmental or your answer to how you deal with these additional responsibilities directly relates to your heart health, you know, and I feel really strongly about that, that if you're going to go outside and you need a break and you have a cigarette, that is why you're not going to do well compared to someone who doesn't, so it's how you treat these stressors that we all deal with every single day will directly relate to your long-term health.
Well, it seems to me how you deal with those stressors, those are conversations that a lot of people might have with a primary care doctor when they ask you those questions, but if you're not seeing a primary care doctor regularly or ever, then you maybe don't have the tools or you don't have that information.
Dr. Raskin: One of the most important parts of going to see your physician is having that conversation, not because you feel bad, you wait till you feel bad. Kind of how I started this, it's too late. You should be going to have a conversation. How do I adjust my risk? How do I reduce my risk? Is the lifestyle that I'm living appropriate or not? They're difficult questions to ask, but they're very, very important. And it starts with your primary care doctor, and then immediately goes to the specialist. There's no reason not to, if you're concerned, have a conversation with a cardiologist, a specialist in this field who do everything they can to evaluate your risk and determine what you could do to make small lifestyle changes that'll benefit you for decades to come.
Yeah, and Dr. Ouyang, that those kind of lifestyle changes that Dr. Raskin was talking about, those certainly could have positive impacts for lots of other diseases and health issues too. Right?
Dr. Ouyang: Yeah, certainly we know stress and inflammation affects pretty much every disease, so exactly as Dr. Raskin said, if people everywhere, including men and women, can address their stress, get that under control, that would help for all diseases, and probably increase life expectancy.
We do have a caller on the line. Hey there, thanks so much for calling. What's your call? Question or comment.
Caller: So, my question was, I heard earlier talked about me and going home and being couch potatoes and things like that. Typically, when I deal with stress, I go home and play video games, usually cooperative video games with voice chat, where we have to strategize with each other. I was curious if there was any research or any comments around that, and if that's healthy or unhealthy.
No, that's a great question. Thanks so much for calling, Dr. Raskin. What do you think about that?
Dr. Raskin: Do you want the good news or bad news?
Probably both. Probably both.
Dr. Raskin: I'm glad that the good news is that that is not terrible for you. The bad news is it's definitely not good for you. The level of cardiovascular activity is not going to be enough. You need to, and I tell patients all the time, the simplest thing: break a sweat. If you're breaking a sweat, it's probably a great start. You got to get up, go for a walk after you've finished your long day played some games before the night's over. Go for a little walk. That, that to me, is a great start. You got to move as much as possible. I never tell people they have to get on a treadmill, sometimes that's miserable, but it's got to be something you enjoy. But I would not recommend that type of stress reliever being of cardiovascular help.
Okay, well, thanks so much for that call. We sure appreciate it. Thanks for listening. Let me ask you this, Dr. Ouyang, we're talking about the role that men play in their own health care, but what about the healthcare system itself? I mean, are there ways the system could be improved to encourage, you know, better behaviors and outcomes for men?
Dr. Raskin: Yeah, definitely. As I said earlier, I think it's really difficult to get men to engage with the healthcare system after they've aged out the pediatrician's office, and in response, one hospital system in Ohio is trying this really innovative approach. The Cutler Center is part of university hospitals. It's located about 20 minutes outside of Cleveland's center, that's for men, and what they're doing is trying to, well, first of all, design a space that is really appealing to men, and from all angles, there's a lot of obviously sports themes in the space, there's pool table, foosball, there's sports on these big TVs, but there's also another space where men can relax, there's music, there's records, and they make the space really appealing to men to get them into the center, and the point isn't that when they are waiting for an appointment that they can do some enjoyable things. The point is that they will come to the center and hang out, so the center also does a lot of fun events, social events for men. As Dr. Raskin said earlier, depression is a huge problem among men. Men die of suicide four times the rate of women, so the point is to increase your social interactions at some of these events, which I attended, and by doing all this, men have more and more touch points with the healthcare system. They also have these patient navigators, which they call Joes, and they're dressed in athletic wear, and they really engage with the men, not only on health coaching, but helping with all the annoying aspects of healthcare that we all don't want to do, such as making appointments, follow-up press, getting results back, all of that they do for these men. When I witnessed it, I was like, I want this for myself. I also don't want to wait on the phone to make my appointments, so it's really, really innovative what they're doing over there.
Yeah, sounds like it reduces that friction and builds that trust. Well, thank you. We have another caller on the line. Hi, Teresa. Thanks so much for your call. What's your comment or question?
Caller: I just want to talk about the healthcare situation. My husband died last year of esophageal cancer. Thank you. He was 71 His father also died of esophageal cancer. He had his last endoscopy was in 2003 and I could not get him to go get one after that, his answer to me was, well, I don't have acid reflux anymore, so I just want the listeners to know, or the men, how important it is to go for their appointments and have those things checked out, because they, you know, by the time we found it, it was already in his liver, and he lived a year from the day they diagnosed it.
Oh, I'm so sorry, Teresa. Well, thank you for calling in and sharing that.
Dr. Raskin: Listen to your wife, listen to your spouse, listen to your significant other. It's not just saying it to say it, they notice certain things. When I see patients in the office and I'm talking to the patient, I'm talking to the husband, as an example. Oh, I'm fine. And then I look at her, is he fine? What is he doing when he walks up the steps? Is he taking an extra breath? Is he not quite himself? And then sometimes you'll get a different, completely different answer. It's so very, very important to listen to your significant other.
Yeah, thanks so much, Teresa. Thanks for listening. Thanks for calling. So, Dr. Raskin do you have advice for how to address this kind of stubborn behavior that some men have, and here I want to make a disclaimer: my husband is great about going to the doctor, so if he's listening, this is not about you, honey, but what about addressing that behavior that some men have? I mean, it can be next to impossible to get some men to go to the doctor, as poor Teresa found out with her husband.
Dr. Raskin: The system, and again, I know we kind of talked about it. The availability is very important. People work very long hours, busy days, they can't take off work, you can't take off, leave in the middle of the day to go get checked out. So the availability, whether it's off hours, weekend hours, the ability to get a routine stress test, so you don't have to take off from work, I think, and also alleviate some of some of those issues, so that's really important from the system's perspective to be available, you can't just get to the doctor from nine to four. Or you have that, I think, is it would alleviate some of that issue, but just to remember that, and it's sad to say, but after you have a stroke, you can't take care of your family. After you have a heart attack and have congestive heart failure, and then you can't take two steps, you're not going to be able to take care of your family. And we have these difficult conversations, and people who have gotten further along in their disease, and are not taking care of themselves, you know. You look at, they'll bring their, their child to the office, and we'll have an emotional conversation. Do you want to walk your daughter down the aisle? Do you want to see your grandkids get older? You have to have those real conversations to get people to kind of open up their eyes and be like, you know what, if I'm going to give my all for my family, you have to also give your all for yourself. And once people have those sort of realistic conversations, and it really kind of hits home, you know, I might not be able to see my grandkid go up, I might not be able to be at a wedding, I might not be able to be at a family event, a graduation. Then the conversation gets very different, and it's okay, you know what, you're right. Let me just get a routine blood test, that's all it is, and a lifetime of memories will be available to you with very, very small, simple things much, much earlier.
Yeah, we got an email from Bob. Bob writes, "I recently moved to California two years ago, and noticed a striking difference in terms of attitudes and opportunities for fitness going back to the Midwest, periodically everybody looks way too heavy." This is Bob's opinion. "How much of a factor is where you live to men's and women's and children's fitness?" Dr. Ouyang, do you have thoughts about that?
Dr. Ouyang: Well, it's funny that Bob mentions that, because when my mother moved to California a few years ago, just for a couple years, to help my brother take care of his kids, she was outside walking around in the parks for hours a day, something she rarely was doing when she was living in New Jersey. So I think to his point, what people do around you really affects what you do, so if you are living in an area where people are more active outdoors, where the weather is nice, and you see them doing that, or your social circle becomes more active, then you might be drawn up into that as well. So, I think there is a point in that. However, I do think that we can be active wherever we are, including in the Midwest, so I do encourage that.
Sure, we have a caller on the line. Hey Robert, thanks for your call. What's your question or comment?
Caller: Thank you for taking my call. My, I had a very quick observation. I had a primary care physician that I saw for a good amount of time, a little over 12 years, but then as soon as they retired, I found it a little bit challenging getting someone else, because all the recommendations I kept getting were women physicians, and I had that feel being seen by a female doctor because of how intrusive some of the procedures would be, and I want to see if there's a way how I could navigate that I haven't been able to see a doctor in over two years now because of that fear, and on top of that, I'm a black man, and I'm really struggling finding black physicians around town. I not strongly feel that that could be another reason why men just don't feel comfortable trying to see to seek out that the care that we would often badly need, so I wanted to see if the panel could talk, talk on that.
Yeah, I think that's a great point, Robert. I personally like to see women doctors, because I'm a woman, so I totally understand that. Dr. Raskin, do you have any thoughts on that?
Dr. Raskin: That's a great point, and I think people want to have a connection with the person that they're. Are talking to, and be a little bit more personal. This is a national problem. There's a national shortage of primary care. There's a national shortage of family practice. The amount of graduates from medical schools going into internal medicine and family practice has come down across the country, and that's for various reasons, whether it's access and the location of their work, and the payment models, and the lifestyle, and the loans that we have to pay back. So, there's lots of different reasons that that is a shortage, but it's a, it's a realistic problem. And I wish I had a great solution for it, which I don't. But I would say to the gentleman on the call, if you leave your information, I'll get you in immediately, that's without a question. You should be seen, you should be seen. You should be able to have a conversation with somebody, should feel comfortable, and get checked out.
Yeah, Robert, if you want to send more your contact information to our email at talk@wvxu.org we'll put you in touch with Dr. Raskin. So, thanks so much for calling and raising that important point, I want to ask you, Dr. Ouyang, about what you hear in the emergency room. I mean, you're an emergency room doctor, you're seeing people who have gotten to a point where something's gotten out of hand because they have to go to the ER. What do you hear from people? Why do they explain why they haven't been to the doctor in so long. How do they explain that?
Dr. Ouyang: Yeah, certainly. I mean, just to go along with what the last caller said, I see so many patients in emergency room who their doctors have retired and they have not been able to find a new one. I often see men that are sort of at the end stage of their disease, and I always think, if you have come in earlier, if you had gotten care earlier, you might be cured, you might not be here in emergency room with me. Oftentimes, I meet men, and they say I'm really healthy, I haven't seen a doctor in five years, they're proud of it, not recognizing that preventative care is really the cornerstone of medicine, so that often happens, and then oftentimes, as Dr. Raskin said, these men are not able to find appointments during a time they can go, they work during the day, so then they end up coming into the emergency room, they come in when they're really desperate, when all the people around them, oftentimes women keep urging them to go, and they finally come in, and I just see them so often at such a late stage. It's really tragic.
We got a call from Matt, who wanted to comment about how much of a factor access to affordable care is for him and many other people. I mean, Dr. Raskin, that's a huge problem, isn't it?
Dr. Raskin: Huge. Everyone's worried about what will be the financial risk to them, to their family, whether they have insurance or don't have insurance, and it keeps people away. And there's no question that a significant percentage of people use the emergency room as their primary care, that's their first source of access, which by then it's definitely too late. You're very limited in what you could do. They're going to treat you for your emergency and send you home. But we're talking about chronic diseases. We're talking about diseases that have been evolving for years and will continue to create issues for years to come, and they need to be seen on a regular basis, and you can't use the emergency room for that.
Yeah, Dr. Ouyang, you know, Dr. Raskin earlier said, "Listen to your partner, listen to your spouse, because they might be noticing things about your health that you are not, and if they tell you go to the doctor, you should go. What are some other things doctors and researchers and advocates are urging, what do they want to see to ensure men have better health outcomes?
Dr. Ouyang: Well, unfortunately, no matter how much the healthcare system does, a lot of what determines a person's health happens outside the walls of a hospital or a clinic, so we need to do everything in our society to help men get healthier. That includes reducing stress, reducing loneliness, helping with depression, all of these things that happen outside the walls of a medical center. So it's a starting point to make it into the hospital or the clinic, hopefully the clinic first, but we need to create a healthier environment for men when they're not here as well.
I've been talking with Mercy Heart Institute co-medical director Dr. Adam Raskin, and emergency room physician and contributing writer for The New York Times Magazine, Dr. Helen Ouyang, thank you both so much for your time today.