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By: Robert M. Califf, MD, Commissioner of Food and Drugs

As I described in my previous blog, the trajectory of men’s health in the U.S. is headed in a negative direction. As we develop approaches to reversing these trends of declining life expectancy, excess chronic disease and disproportionate risk taking, it behooves us to examine the potential underlying reasons for this decline. 

Three key parts of the men’s health puzzle relate to income, employment and education, which paradoxically have evidence of both cause and effect in this context. As I discussed in my previous blog, male labor force participation has dropped from 80% in 1970 to 68% in 2020. While this is partly due to the fact that men disproportionately work in fields impacted by automation, poor health also plays a significant role: 26% of men of prime working age report being unable to work because of sickness, compared to 18% of women. Men are also falling behind in educational attainment: In 1972, the proportion of men to women receiving bachelor’s degrees favored men by 12 percent but by 2021, only 4 in 10 college students were men. This gap, which is also widening globally, is even greater for Black and Hispanic men in the U.S. These changes are occurring as our country, and indeed much of the world, is undergoing a transition to economies driven by knowledge and high technology. 

Work and education are inextricably tied to health, and healthier people fare better in education and work, creating a self-reinforcing cycle. Income, for example, is one of the strongest correlates of health across the population, and many have argued that “zip code trumps genetic code” in overall health status. Employment is tied to private health insurance – having health insurance is yet another major determinant of health. Men also have disproportionate representation in professions that pose higher risk for injury on the job – such as logging, fishing and roofing – which are overwhelmingly occupied by men. Education, in turn, affects type of employment but also directly impacts health outcomes given its strong association with health literacy. Men have lower health literacy than women, and people who have less knowledge about their health have worse medical outcomes, including a greater frequency of being admitted to the hospital, needing to go to the emergency room, and even death. The cumulative and interconnected regression in education, employment, income and health among men presents a composite picture that portends continued amplification of the gap between men and women in health status and longevity. 

Multiple studies have demonstrated that men often fail to pay attention to their health, particularly in their younger or middle-aged years, and are more likely to take risks. Of course, taking risks is not always a bad thing. People who choose to take risks that come with service to country or community, or that are inherent to vital industries or professions, deserve society’s gratitude and respect. But when risk-taking serves only to harm their own health, or the health of those around them, it is no longer a beneficial tradeoff. For example, men are more likely to smoke than women despite all we know about the clear and present danger that smoking presents both from direct- and secondhand smoke. Men are also more likely to have unhealthy diets. One major threat to health is food that has an excess of unhealthful components and a dearth of important nutrients, consumption of which is generally higher and rising faster among men than women. 

Another important issue is the rise of medical misinformation and mistrust in the U.S. and around the world. Misinformation about vaccines dominates the conversation, and unfortunately, men are less likely to be vaccinated against COVID-19 even though they have a much higher risk of death from COVID-19 infection. Incorrect information has also been propagated about treatments for heart disease and cancer, and about the effects of diet on our health to name a few additional areas. Although it’s currently unclear why men may be more susceptible to misinformation, related factors such as lower health literacy and greater reliance on social media for information gathering may increase men’s susceptibility to online misinformation.  

Given these observations, I believe the first and perhaps most important thing we can do now is to generate awareness about this evolving and concerning situation. While continuing to also emphasize the deficits and need for action for women’s health and the many other sources of disparities in health outcomes in our society, the public health community, the health system, policy makers, and society at large should have a focus on understanding the drivers of men’s declining health. We will all benefit from learning how those factors interact and reinforce each other and creating strategies and interventions for reversing this trend.

Catch up with you next time.