Courtesy - Sunday Observer By Nilma DOLE
The Sri Lankan male mentality is such that they think they’re invincible to disease and the culture of patriarchy has given rise to the male perception of being ‘strong’. The problem is by having this kind of mentality, it means that they hardly go to the doctor and only seek medical attention once it’s too late. Regular checkups are not part of the routine with Sri Lankan men as they hardly have any relationship with their doctor and more often than not, some don’t even go to a doctor.
As a result, men have become more prone to conditions such as diabetes, obesity, heart ailments and cancer which affects them badly in the late stages.
Prof. Lakshman Dissanayake of the Department of Demography at the Colombo University told the Sunday Observer that addictions such as smoking, alcohol consumption in addition to unhealthy eating habits have contributed to Sri Lankan men living much less than women. “The sad plight is the loss of husbands contributing to a long widowhood in women and children losing their fathers at an early age. So we should aim to increase the longevity of men so that elderly couples can age gracefully together,” said the professor.
Life expectancy at birth for men was 32.7 and women was 30.7 in the 1920s but in 2002, female life expectancy at 77.2 years surpassed the male life expectancy which was 68.8 years.
The projected figures show that male life expectancy is expected to reach 72.3 years while female life expectancy will be 82.5 years by 2026 (Gunasekera, 2008).
According to the professor, the total as well as average annual gain in life years was more than double for females. Therefore, men seem to be increasingly exposed to high risk mortality factors.
“In relation to the diseases of the circulatory system, nervous system, respiratory system, endocrine, nutritional and metabolic diseases and external causes of morbidity and mortality, men are in a more hostile position in promoting their survival chances,” said the doctor.
Although most of these causes are amenable to medical intervention, sex differentials of mortality can be attributed to factors other than such interventions.
The research paper titled, ‘Avoidable mortality and men’s health status in Sri Lanka’ done by Prof. Dissanayake has stated that the focus on men’s health in Sri Lanka is rarely visible and can be regarded as a largely neglected health aspect. “Although there are general discussions about the gender gap in life expectancies, a serious attempt has not been taken so far to provide a rational explanation for such a significant difference.
Therefore, an awareness of the actual disparity that exists with men’s health still remains ignored,” he said.Age and sex-specific death rate due to diseases of the circulatory system show that there is a considerable difference of its prevalence between men and women, especially after 40 years of age.
After the age of 40, the death rate of men than women is higher at each age and the gap becomes wider, especially between 60 and 75. Among the diseases of the circulatory system, ischemic heart diseases, other heart diseases, hypertensive diseases and cerebrovascular diseases are the greatest killers of men during those ages in Sri Lanka.
According to the professor, the proportion of male deaths to total deaths of all these four causes during the ages 50 to 74 demonstrates that these causes constitute 56 percent of total deaths due to the diseases of the circulatory system.
He said, “It is quite interesting to observe that the widening gap between the sexes emerges only after the menopause is reached and hence women no longer have the same immunity like what they experience during the childbearing years against these diseases.
In such a situation, we need to expect that the morbidity status of both men and women to be not different if other factors affecting are equal.”
Therefore, the only theory that can rationally explain these statistics is that metabolic syndrome, mental depression and smoking are related to behaviourial patterns which are determined by factors outside the medical care system.
“This causes the difference of the prevalence of diseases of the circulatory system between men and women,” said the professor.
About 71 percent of the change in temporary life expectancy between men and women can be attributed to the difference in deaths due to these diseases. Different occupational conditions and specific lifestyle patterns have played key roles in making a significant difference between life expectancies of men and women.
“Health awareness given to women through exceptionally successful maternal and child health program available throughout Sri Lanka have played a key role in making women more health conscious than their male counterparts,” said Prof. Dissanayake.
Public health midwives or family health workers in the country play a significant role in addressing reproductive health related issues which also suggests that women are in a more beneficial position to be health conscious during and also even after child-bearing span.
Deaths due to malignant neoplasm of lip, oral cavity and pharynx recorded highest number of deaths among neoplasms category and it accounted for 9.3 percent of all deaths in that group.
It is a commonly known fact that tobacco and alcohol consumption are the two leading risk factors for those diseases and thus linked to specific lifestyle patterns.
According to Prof. Dissanayake’s study, the selected causes for this study are significant as Sri Lanka could have added 2.8 years to men’s life expectancy between birth and 75 years of age if those diseases were prevented at least to the levels of women’s mortality.
“In Sri Lanka, these risks are related more to men than women since prevalence of smoking and drinking is higher among men,” said the professor.
“Sri Lanka’s maternal and child health program could have had a significant impact on the reduction of women’s overall mortality level because of their more awareness of health issues,” said Prof. Dissanayake.
Lack of special programs for men’s health unlike the former together with cultural beliefs about masculinity may also have had considerable effect on deterioration of men’s health.
He said that an additional effort has to be taken to improve the health status of men to be par with women in order to advance their health standing and thus diminution of their vulnerability position to the above causes of death.
So, healthy lifestyles for men should be promoted in addition to eating right food plus regular checkups and healthy relationships with doctors should be promoted to make the Sri Lankan man live longer.
According to the professor, preventive programs are needed to decrease both morbidity and mortality due to such causes.
“One way of tackling this major public health issue would be introduction of successful interventions from the developed world,” said the professor.
As outlined in the methodological section of his paper, a life table analysis was performed in order to find the contribution made from each cause of death category to the gap between life expectancies of men and women. Such an analysis provides a unique opportunity to understand the relative significance of each cause of death category in the reduction of survival chances of men.
The total difference between temporary life expectancies of men and women were four years in 2006. Prof. Dissanayake said, “When major causes of death categories selected for this study are adjusted for both men and women, the difference becomes 2.8248 years.”
He said that this shows that if both sexes are not exposed to the six categories of causes of death, the difference is reduced by 1.1752 years.
“This research will allow us to examine how much contribution that each cause of death category made for men to have 2.8248 life years less than women.