What men can learn from women

Tough-guy attitude leads to gender health disparity

They are icons of American masculinity.

The athlete, banged and bruised, who plays through pain. The soldier, wounded and bedraggled, who battles on, spurning entreaties to seek help. The male driver, lost and confused, who refuses to ask for directions.

But for the mortal man - cigarette dangling, tummy bulging, arteries choking - stoicism and denial can prove dangerous, even deadly.

"In American society, what does a real man do? A real man doesn't show weakness," said David R. Williams, a medical sociologist at the Harvard School of Public Health. "It leads a lot of men to not take preventive action for their health, to deny pain and seek medical attention only when the problem is much more severe."

A richly detailed portrait of Bay Staters' health, released earlier this month, proves the point - and provides stark evidence of a persistent divide between the genders. In category after category, women do a better job of taking care of their health. They smoke less and drink less, and they're less likely to be overweight. They eat more fruits and vegetables. They have their cholesterol tested more regularly.

One especially telling finding: While men more frequently reported being diagnosed with high blood pressure, they were actually less likely than women to take drugs to tame it.

The annual survey by the Massachusetts Department of Public Health - more than 21,000 adults answered questions over the telephone in 2007 - jibes with broad national trends as well as the experience of doctors and public health specialists.

And it opens a window into American society, and the contribution of gender roles and social stigma to a disparity in health that is only now beginning to receive wider attention. Much as doctors and policy makers have embarked on campaigns to address racial and ethnic disparities in health, disease prevention specialists called for strategies to bridge gender inequity.

"Men can learn a lot from women," said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital. "We know that some of our health awareness campaigns about the risk of smoking and the risk of binge drinking have to do a better job of being gender-specific."

That could translate into initiatives centered in the workplace that, perhaps, promise lower insurance premiums for men - and women - who adopt healthy behaviors. And, at home, families could be encouraged to exercise together and share healthier meals.

There is hope that as traditional gender roles continue to shift - as more men, for example, assume family responsibilities historically associated with women - the gender divide will narrow.

Often, that will be a good thing: If men become more engaged in the well-being of their families, specialists said, it stands to reason that they will recognize the importance of attending to their own health.

Some believe there needs to be a commitment to men's health akin to campaigns in the late 20th century that encouraged women to regularly visit gynecologists, starting during their teen years - visits that intensify as women become pregnant.

"Some of the most successful gynecologic practices have transitioned to provide holistic care," said Salvatore Giorgianni, science adviser to the Men's Health Network, an advocacy association. "No one in the medical world has taken up that gauntlet for men.

"It has to become cool for men to be healthy, and it has to start when they are young."

Sometimes, though, the gap between the sexes is closing in ways that suggest women are adopting the dangerous habits of men: In Massachusetts, while men are more likely to drink to excess by a 2 to 1 margin, the divide was even greater at the start of this decade.

To be sure, the gap between men and women varies in magnitude, depending on what's being measured. It's fairly narrow when it comes to tobacco use, with 17.3 percent of men identifying themselves as current smokers, compared with 15.5 percent of women. But men are dramatically more prone to report problems with weight and alcohol use.

Specialists attribute the differences in behaviors - both those that help and those that harm - to a tangle of social, biological, and medical forces, with roots both ancient and modern. But the consequences are undeniable: In a 2003 report in the American Journal of Public Health, Williams found that among the 15 leading causes of death in the United States, men have a higher death rate than women in all categories except for Alzheimer's disease.

"I'm assuming that men are equally aware as women that fruits and vegetables are good for you, that you need to get your cholesterol checked, that being overweight is bad for you," said Dr. Lauren Smith, the Department of Public Health's medical director. "The question is, why have we not recognized the barriers to men incorporating that into their lives?"

Maybe, said a behavioral specialist at the National Institutes of Health, it's because there's something deeply ingrained in men, something to do with their historic role as hunters, spurred by testosterone as they jousted with tigers.

"If you think about evolutionary history, men had to take more risks of a particular form than women did," said Christine A. Bachrach, acting director of the NIH Office of Behavioral and Social Sciences Research. "But unpacking these things, it's complex, because behavior is complex."

Maybe, said medical sociologist Raymond Hyatt, men are responding to what they see - or, more precisely, don't see - when they browse the neighborhood bookstore.

There's magazine after magazine aimed at women and their health. But for men, the pickings are slim.

"That helps convey the message to men that health is not about them," said Hyatt, of the Tufts University School of Medicine.

"It reinforces the idea that men, we're stronger than depression, we're stronger than alcoholism, we're stronger than cancer or heart disease - or we should be," he said.

Williams, the Harvard professor, has a suggestion for one way to reach men: enlist a sports hero and have him offer testimony about the value of good health habits and getting help when it hurts. His nominee for the role: Tom Brady.

Stephen Smith can be reached at stsmith@globe.com.