Is the life expectancy gap between males and females a result of social issues that need to be addressed?

Question

Many people simply assume that the life expectancy gap is due to biology, but is the gap also a result of social polices, attitudes, values and beliefs?

Answer 1

Biology

In the modern Western world, males have a lower life expectancy for two important biological reasons. Women in the past who died before old age died in child birth, which is now a rare event.

The death rate for women giving birth plummeted in the 20th century. The historical level of maternal deaths is probably around 1 in 100 births.[19] Mortality rates reached very high levels in maternity institutions in the 1800s, sometimes climbing to 40 percent of birth giving women (see Historical mortality rates of puerperal fever). At the beginning of the 1900s, maternal death rates were around 1 in 100 for live births. Currently, there are an estimated 275,000 maternal deaths each year.8 A hugely disproportionate number of maternal deaths occur in sub-Saharan Africa and South Asia

In the United States, the maternal death rate averaged 9.1 maternal deaths per 100,000 live births during the years 1979-1986

So most females expect a long life. Two, most advances in life expectancy in the last 60 or 70 years have been minor and most gains have been in lower infant mortality. Males are conceived at a rate of 170 to 100 to females, which is explained as being due to their increased biological likelihood of death and born at a rate of 105 to 100 to females.

The sex ratio at birth is commonly thought to be 107 boys to 100 girls,2 though this value is subject to debate in the scientific community. The sex ratio for the entire world population is 101 males to 100 females.3 typical range of 1.03 to 1.07, The value for the entire world population is 1.01 males/female, with 1.07 at birth, 1.06 for those under 15, 1.02 for those between 15 and 64, and 0.78 for those over 65

Male infants are more prone to genetic diseases and have reaped fewer of these gains, shown as the declining sex ratio for children under 15.

Males are typically more prone to die from most forms of illness, including infectious disease.

Men accounted for 76% of all adults and adolescents living with HIV infection at the end of 2010 in the United States. (Centers For Disease Control) In most settings, tuberculosis incidence rates are higher for males at all ages except in childhood, when they are higher in females. (World Health Organization)

As the doctor points out the largest gains have been made in this area but biologically there is still a gap.-

Data from the UK

Leading causes of death in men, England and Wales, 2012 Rank Leading cause of death No. of men Percentage of men 1 Heart disease 37423 15.60% 2 Lung cancer 16698 7.00% 3 Emphysema/bronchitis 14378 6.00% 4 Stroke 14116 5.90% 5 Dementia and Alzheimer’s 13984 5.80% 6 Flu/pneumonia 11063 4.60% 7 Prostate cancer 9698 4.00%

8 Bowel cancer 7841 3.30% 9 Lymphoid cancer 6301 2.60% 10 Throat cancer 4603 1.90%

Leading causes of death in women, England and Wales, 2012 Rank Leading cause of death No. of women Percentage of women 1 Dementia and Alzheimer’s 29873 11.50% 2 Heart disease 26741 10.30% 3 Stroke 21730 8.40% 4 Flu/pneumonia 15075 5.80% 5 Emphysema/bronchitis 14155 5.50% 6 Lung cancer 13575 5.20% 7 Breast cancer 10311 4% 8 Bowel cancer 6600 2.50% 9 Urinary disease 5570 2.10% 10 Heart failure 5065 2%

The top ten first factors for death in any given society account for 50-75% of deaths. Males are being attributed with higher rates for everything, excepted flu/pneomenia, breast cancer and urinary disease. From the table, some things stand out. Heart disease kills 5% more men. Lung cancer kills 2% more men. Most other things kill about 1% more men.

Modern medicine has been able to close this gap actually. It was much more pronounced in the 1960s and 70s. I'm uncertain of the exact reasons, but we have better antibiotics and treatments for cancer and heart attacks now, for instance. Also, [the common use of alchohol and tobacco, usually something more men did than women, is less socially acceptable for middle age people][2 ] It is likely that the best hope to continue to increase the life expectancy of males is to improve medical advances for all illness and to provide education about medical illnesses so that risk factors can be avoided. Estimates show that life expectancy for males is increasing faster that women in developed nations and that the gap may be closed by 2030..

Now, there are still some social and policy reasons for the discrepancy and ones that might can be addressed. The first is violent death. Males die from all forms of violent death much more commonly than women: car accidents, suicide, military conflict, gang violence, work place accidents.

Violence Most of these have been the subject of public health campaigns already, but efforts can always be made to lower their effects. Gang violence is the one I don't see much effort being placed into, but I do know that there was a successful public health campaign that convinced American gang members to switch from using guns to other less lethal means to settle disputes. The death rate for gang members went down significantly. Unfortunately there is not much public support for such a program at this time.

Male suicide is a huge problem, especially among elderly males. They are not the target of many public health campaigns. Young people are usually the target. China does have a higher suicide rate for females, so this is a socially determined phenomenon. Suicide goes up mainly as a result of economic hardship, although I suppose that's not always the case. Lowering the rate might be most effective by lowering poverty rates and improving the economy.

Homelessness

The second issue is homelessness. Women actually have a much higher poverty rate, especially women with children, but they have much more support from their families and the government. So males have a much higher homelessness rate. 76% of the homeless are single adult males according to the National Coalition of the Homeless. The homeless are at increased risk of violence from the police or people in their community, which is why they may have early death rates. The National Coalition for the Homeless (NCH) catalogued almost 1300 incidents of anti-homeless bias violence from 1999 to 2011. As well, about half don't have proper access to medical care, so they will not get the proper diet or medication needed to prevent death from diabetes, heart disease or any illness they might have. Homelessness is highly associated with severe drug abuse and mental illness, both of which are problems the US offers little support for.

Persons with severe mental illness represented about 26 percent of all sheltered homeless persons (Annual Homeless Assessment Report to Congress, 2008) Among surveyed homeless people 38% have an alcohol problem, and 26% report problems with other drugs (National Health Care for the Homeless Council).

Policy changes to provide long term free rehab and job training for drug abusers and different long term facilities to meet the needs of the mentally-ill would prevent these problems. Homelessness is also associated with prior criminal convictions. The US should decrease the number of people it puts in prison and provide assistance to people after they are released to decrease the homelessness rate, especially if the criminal is mentally-ill, which a large percentage of people in US prisons are. I'm of the opinion, this would also reduce recidivism.

At midyear 1998, there were over a quarter of a million mentally ill people incarcerated in prison or jail. An estimated 283,800 inmates -- or 16 percent of all incarcerated individuals -- reported either a mental condition or an overnight stay in a mental hospital, and were identified as mentally ill Half of the mentally ill inmates in state and federal facilities reported having three or more prior sentences

Additional Reading: The World Bank

Answer 2

Gender gap is discussed in the second half of this post.

This summarizes part of my term paper for a public health course:

Life expectancy changes and shift in mortality causes

Prior to the early 1900s, neither gender lived long enough to begin to see the significant pathophysiology differences between genders. Chronic diseases were far less common than infectious diseases and accidents.

Public health triumphs such as improved sanitation, increased safety regulations, and widespread vaccination reduced the infectious disease burden and accident mortality dramatically. (Look at the statistics and you'll that public health interventions were far more influential on improving disease and death from infectious disease than even the advent of antibiotic use!) Life expectancy in the U.S. increased by 62%, from 47.3 years in 1900 to 76.8 in 2000. Then, as we began to live longer, we began to see much more of the chronic diseases of aging: heart disease, cancer, stroke, dementia, etc.

This is an excerpt from my paper, with citations:

In their paper “Health Promotion and Disease Prevention: A Historical Perspective,” McLeroy and Crump in 1994 discussed “the epidemiologic transition” in the primary cause of death across history. Where it used to be primarily due to infectious disease, it has transitioned to be primarily due to chronic disease.

They cited a paper written by Omran in 1974 that described three epochs in the epidemiologic transition of health. The first was the age of pestilence and famine, lasting until the early 20th century. There were high death rates, high infant and maternal mortality, chronic malnutrition, many endemic diseases, and outbreaks of rampant infectious diseases without understanding of etiology nor transmission - let alone any means to cure them. The second was the age of declining pandemics; with fewer epidemics there was a decline in the early death rate, and we saw endemic infectious diseases become the primary cause of death. Still, infectious diseases were three of four leading causes of death. The third epoch in the 20th century finally saw a dramatic decline in the morbidity and mortality from infectious diseases, and more people stayed alive long enough to die from chronic non-infectious diseases.

Males

Many of the socioeconomic reasons for higher death rates in males have been discussed, primarily higher accident, violent, and (successful) suicide rates. Higher poverty rates in men was an issue mentioned by a previous poster that I have seen in literature as well. Also, alcoholism and smoking rates have historically been both higher in men, leading to higher liver and lung diseases and cancers.

Medically, males develop atherosclerosis (hardening of arteries due to cholesterol plaques on artery walls) more rapidly than females

[> As you get older, your risk for atherosclerosis increases. Genetic or

lifestyle factors cause plaque to build up in your arteries as you age. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms. In men, the risk increases after age 45. In women, the risk increases after age 55.]9

and on average have higher blood pressure than women (that is up until around age 65, when the female average rises higher than men). It is believed that much of this is due to the cardio-protective effects of estrogen during reproductive years.

Answer 3

Some of the gap could be attributed to social issues, but that may not account for the entire gap. Male life expectancy is lower because of a few risk factors that women don't have. Making a person live longer has less of an affect on life expectancy than a person dieing at a young age, so this answer will focus on things that tend to kill men at younger ages.

• The most obvious is military service, the dangerous front line positions are male dominated and the most likely to be killed in war times, which can drastically lower life expectancy when large numbers of men are being killed.

• Young men are also disproportionally representative of gang violence which is another source of early death primarily for males.

• Men also make up the majority of risky jobs which are more likely to result in death or injury that will lower life expectancy.

• Finally men are a larger percentage of the poor, who might not be able to afford proper nutrition, healthcare, or may be exposed to more unsafe living conditions.

Answer 4

In some countries, i.e. Saudi Arabia, the gap is very small, about 2 years. This indicates that there is no biological difference in natural life expectancy and the most difference is due to social issues.

AFAIK the largest gap of about 15 years is in Russia where men and women enjoy totally different quality of life and this is supported by the state propaganda and law. For example the child support may reach 70% with 50% of income is typical. There is also a lower limit on child support, so the person has to pay it at any cost even if having no income source. Those who fail to pay go to penal labor.

Women are virtually never required to pay child support both because the courts leave children to the mothers in 98% cases (there is no shared custody in Russia) and because women can anonymously refuse a newborn child without informing the father via a baby-box (which a father cannot do).

Russia is also known for harsh conditions in army, prisons and street violence. Men are expected not to report violence against them to police (the image of so-called "true man who does not complain"), even if reported, the police is less likely to take action compared to the case of women. Also men are expected to solve conflicts by fighting (the so-called "men's conversation", "to talk as true men do"), while any violence against women is strongly condemned. Men are also expected not to attend medics unless under very serious danger.

At the same time men in Russia usually bear all expences during mating with women, expected to give them expensive gifts, feed in expensive restauraunts, pay for apartments and vacations. This requires men to work significantly more than women. If you look at the Black Sea resorts in summer, you will see that the majority of the vacationeers are young women. Some men have no choice other than to commit crimes to please their women and gain sex.

Women also receive pension earlier than men, until recently the ages of retirement were 55 years for women compared to 60 for men (now they were rised, but the disparity remains). Given lower life expectancy for men, the average period of enjoying pension under the old law was for women 19 years against -1 years for men (most men do not reach the age of pension). In the case of retiring for pension at the same age, 60 years, women's pension would be 1.5 times greater than men's under otherwise similar conditions.

Only men are conscripted into the military, which is known in Russia for harsh violent bullying and all forms of other abuse.

The punishment for the same crimes is stronger for men than for women: only men can receive death sentence (although it is not practiced recently), only men can be put in prison, only men can be put into strict and special regime penal colonies, only men can be sentenced to imprisonment for life. Women with children are often exempted from criminal punishment or released earlier. This is by law, but in case the law has no distinction, the judges usually punish the women lighter.

Among the homeless in Russia there is 4 times more men than women.

Recently the president Putin said in an official address "our attitude towards the women is special, caring".