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Mind the (gender) gap
When travelling on the underground or overground
in London, as the train pulls into the station the
refrain is a consistent ‘Mind the gap between the
train and the platform – mind the gap’. It is a gap
clearly identified and the alert allows travellers to
reflexly ‘bridge the gap’ and arrive safely. It is the
same degree of awareness we need to bring to the
gender gap whereby deaths from all causes are higher
for men than women and women on average live at
least 4 years longer than men (1).
The cause or reason for the gender gap has been
and remains a subject of debate, generating high
quality papers and discussion at the 7th Men’s
Health World Congress (28–30 October 2010) with
an expected similar academic and practical input at
the 8th World Congress in Vienna from 5 to 8 Octo-
ber 2011 (http://www.ismh.org/worldcongress). A
recent paper by McCartney and colleagues (funded
by the Medical Research Council – MRC) adds sig-
nificantly to our knowledge base, highlighted also in
the December edition of IJCP which focused on
Men’s Health and a previous editorial with key refer-
ences (2–5).
The MRC study compared the gender gap with
regard to all-cause mortality in 30 European coun-
tries with special reference to smoking and alcohol-
related deaths. Addressing the social causes rather
than accepting biological ⁄ hormonal differences con-
firmed that smoking is the most important cause of
gender differences in mortality across Europe. Smok-
ing was found to be responsible for 40–60% of the
gender gap in all countries except Denmark, Portugal
and France where it was lower (38%) and Malta
where it was higher (74%). In the United Kingdom,
smoking-related diseases (most commonly coronary
disease and lung cancer) led to 60% of excess male
deaths. The argument in favour of social causes of
the gender gap is reinforced by the all-cause mortal-
ity gap varying among countries with, for example,
225 excess male deaths each year per 100,000 popula-
tion in the UK and 188 in Iceland, compared with
942 per 100,000 in the Ukraine and 833 in Lithuania.
All countries with a mortality gender gap over 400
per 100,000 were Eastern European. Alcohol-related
deaths accounted for an average male excess in all-
cause mortality of 20% across Europe, but again the
proportion was higher in Eastern Europe. Comparing
smoking with alcohol, smoking-related mortality
contributing to all-cause mortality was greater in
every country.
The accumulation of social factors was studied in
the United States where men were found to be more
likely to drink alcohol regularly and to excess, and
smoke more heavily than women and, in turn, be
less likely to quit (6).
It is self-evident, though perhaps not to politi-
cians, that we need to raise awareness of the impor-
tance of preventing cardiovascular and metabolic
disease as well as cancer and this requires a major
public health initiative. Though we cannot pick our
parents, we can pick a lifestyle that benefits our chil-
dren – what better motive to live a healthy lifestyle
than help our children be part of a healthy family
tree.
We need to get away from seeing ‘healthy’ as ‘the
absence of illness’ and view it positively with the clo-
sure of the gender gap as the fundamental objective.
Disclosures
Co-President 7th & 8th Men’s Health World
Congress.
Graham JacksonEditor
Email: [email protected]
References1 Barford A, Dorling D, Davey Smith G, Shaw M. Life
expectancy: women now on top everywhere. BMJ
2006; 332: 808.
2 McCartney G, Mahmood L, Leyland AH, Batty GD,
Hunt K. Contribution of smoking-related and alco-
hol-related deaths to the gender gap in mortality:
evidence from 30 European countries. Tobacco Con-
trol 2010; doi: 10. 1136/tc.2010.037929.
3 Rosenberg MT. Men’s health: more than just plumb-
ing. Int J Clin Pract 2010; 64: 1728–30.
4 Alford L. What men should know about the impact
of physical activity on their health. Int J Clin Pract
2010; 64: 1731–4.
5 Jackson G. Men’s health left hung out to dry: why
men die earlier and suffer more. Int J Clin Pract
2009; 63: 1669.
6 Pinkhasov R, Shteynshlyuger A, Hakimian P, Lindsay
GK, Samadi DB, Shabsigh R. Are men shortchanged
on health? Perspective on life expectancy, morbidity,
and mortality in men and women in the United
States. Int J Clin Pract 2010; 64: 465–74.
doi: 10.1111/j.1742-1241.2011.02659.x
ED ITORIAL
ª 2011 Blackwell Publishing Ltd Int J Clin Pract, April 2011, 65, 4, 375–385 375
Smoking was
found to be
responsible for
40–60% of the
gender gap