While men in most societies enjoy greater privileges and power than women, they tend to fall behind when it comes to health
“Men are a stubborn lot,” said Prof Datuk Dr Zulkifli Md Zainuddin. “In my practice, I notice that they see hospitals as a last resort measure. They’ll try everything else first, like swallowing tongkat ali or whatever their friends recommend. By the time they come to us at the clinic, it’s only because the situation has got so bad that their wife is threatening to leave them.”
Being the head of the urology unit at Universiti Malaya, Prof Zulkifli is erectile dysfunction – not exactly the kind of topic many Malaysian men may feel comfortable talking about.
Speaking at ‘WTF of Sexual Habits, an event organised by Pfizer Malaysia in June to highlight issues in male sexual health, Prof Zulkifli offered a candid view of the behaviour of patients seeking treatment at his clinic. While sharing a particularly graphic picture of an anonymous patient’s inflammed and painful-looking nether regions, he said it was unfortunate that men would rather take matters into their own hands than pay a visit to the doctor. “I mean, it is disturbing to think that they’re more comfortable letting some guy inject them with silicone, or force themselves into metal rings, than receive simple medical treatment,” he said.
The other speaker at the session, Dr George Lee, a consultant urological surgeon ay Gleneagles Kuala Lumpur, also noted that men had a tendency to shy away from making a visit to the doctor. “Erectile dysfunction is a very common and treatable condition; but I suspect men feel embarrassed talking about it, because it’s so interlinked with how we perceive masculinity,” he said.
“I do think younger men are more willing seek professional help, thanks to the internet. When they go online, they can talk about these issues anonymously, and since there is access to information, they know enough to come and see a real doctor.”
While erectile dysfunction is obviously a very male problem, the two doctors also revealed a gender difference that plays out for men across all sorts of diseases and conditions – the way they perceived the need for medical attention. Globally, studies and research has shown that men tended to shy away from going to the doctor, delaying treatment until they were seriously ill.
Are men less healthy?
Local studies suggest on average, men die five years younger than women. Estimates as of 2015 say that men are expected to live to about 72 years of age, while women are expected to live till they are 77 years old.
Men have higher mortality for most diseases, including cardiovascular diseases, cancers, infections, suicide and injuries. This is despite the fact that men are often stronger socioeconomically and have more opportunities to access health care than women.
In Malaysia, the main causes of death in men are non-communicable diseases and injuries. According to the Malaysian Burden of Disease and Injuries Study in 2000, cardiovascular diseases were the leading types of diseases found in men. Hypertension is also prevalent, followed by hypercholesterolaemia and diabetes. For most of the Malaysian men with hypertension and hypercholesterolaemia, they were not aware of their deteriorating blood pressure and cholesterol level until a definite diagnosis was given.
Local researchers also mention that many of diseases tend not to be diagnosed early or go unreported as men seem less likely to undergo health screenings. The Health Ministry in 2015 for instance, found that only 3% of men had gone for a health screening while the prevalence of undiagnosed hypertension was 18.6%. The ministry also found that men aged 15 to 65 are twice as more likely to prematurely die compared to women.
According to researchers at Universiti Malaya’s Men’s Health Research (UMMHR), there is a combination of genetic and environmental factors that could explain why men’s health status is poorer than women. Men tend to take more risks, including health risks, and delay in seeking help when they are ill. In addition, seeking help from the doctors might be perceived to be a sign of weakness by their peers and the society.
Not enough men seek healthcare
Prof Dr Tong Seng Fah, who is part of the research team at UMMHR, notes that many men seemed to be unaware of their health problems. With diabetes for instance, women have a higher chance of receiving medical help earlier as they are usually screened for the disease during their antenatal checkups. “Men are not privy to such opportunities,” he shared. “Our studies have shown that many men were also unaware of their hypertension and hypercholesterolaemia status.
Furthermore, women have a higher self-reported prevalence of mental disorders compared to men, but men have higher death rates due to self-inflicted injuries. This suggests that men may not recognise or report their mental problems but may rather allow their illness to progress before seeking help.”
While attitudes may be shifting with the younger generation, it appears that in contrast to women, men are less aware of the importance of health screenings. A UMMHR study on the issue, published earlier this year, revealed that while young men were aware of the importance of exercise, a healthy diet and adequate sleep, they did not view regular health screenings as a part of disease prevention. “This lack of understanding could be due to lack of awareness of men’s health and the fact that current health campaigns often target women. When men are targeted, older rather than younger men are often the focus,” the study notes.
Interestingly, the respondents of the study say they would be open to screenings if recommended by their doctors, but still balked at the idea of mental health screenings. The researchers found that men who conformed more strongly to traditional ideas of masculinity were less likely to seek help with mental health issues. “Depression conflicts with the masculine norm such as stoicism; it may also increase self and societal stigma, which may explain why these men disfavour mental health screening. Efforts should be taken to address the negative impact of conforming to the masculine norm and to encourage men to be screened and to seek help for depression in view of the high suicide rate among men,” the study adds.
Gender equality includes men too
The UMMHR is currently tasked with a relatively unique proposition – to help implement the Health Ministry’s National Men’s Health Action Plan to ensure equal treatment in the health services is provided to men. Malaysia is currently one of the four countries in the world to develop a comprehensive health programme targeting men, joining the ranks of Australia, Brazil and Ireland.
As men conventionally tend to be seen as those occupying positions of privilege and power, policymakers worldwide tend to assume that paying more attention to gender in healthcare matters means focusing primarily – and sometimes exclusively – on women. However, gender stereotypes can affect both sexes negatively. Rather than catering mostly to women, programmes that are designed to address male gender roles and promote more gender-equitable relationships as a whole, tend to be more effective for both men and women.
In a World Health Organisation report on the issue of engaging men in addressing health inequalities, the authors offer the example of how the way view masculinity can be damaging for young men – and by extension, young women. “In some settings, for example, being a man means being tough, brave, risk-taking, aggressive and not caring for one’s body. Men’s and boys’ engagement in some risk-taking behaviour, including substance use, unsafe sex and unsafe driving, may be seen as ways to affirm their manhood. Norms of men and boys as being invulnerable also influence men’s health-seeking behaviour, contributing to an unwillingness to seek help or treatment when their physical or mental health is impaired,” the report states.