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: gjcardiol@talk21.com

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