A boy born today will be over 20 per cent more likely to die of a heart attack than a girl - and almost 30 per cent more likely to get diabetes. Photo / 123RF
A boy born today will live nearly four years less than a girl born in the room next door. One in four won't live to retire. What are the biggest killers of Kiwi men – and what can we do about it? For Mens Health Week, Jamie Morton looks at four troubling statistics.
Prostate cancer: 1 in 8 men diagnosed
It might not be the deadliest cancer among men – but prostate remains the most commonly diagnosed one, with around one in eight Kiwi males developing it within their lifetimes.
Each year, more than Kiwi 3000 men learn they have it – about 80 per cent of diagnoses are among men aged over 60 – and around 600 die from it.
While the incidence of prostate cancer is increasing in New Zealand - largely due to better outcomes from early diagnosis and improved treatments available - its causes still aren't fully understood.
Unlike with other cancers – like lung cancer and smoking - there does not appear to be clear and specific measures men could take to prevent prostate cancer.
What is clear, however, is that men have a much better chance of successful treatment if they're diagnosed early.
Prostate Cancer Foundation chief executive Peter Dickens said it was crucial for men who'd had prostate cancer to tell their families about that.
"If you have a first-degree relative who'd had a diagnosis of prostate cancer, then you yourself are twice as likely to be at risk of the disease than someone in the general population," he said.
Because prostate cancer often doesn't produce symptoms until the condition is quite advanced – it's typically found after treatment is sought for problems with urinary function – doctors can't stress enough the need for men over 50, or over 40 if they have a family history, to get tested.
And all of these tests – whether PSA, physical examination or ultrasound testing – are painless, simple and easy to get underway.
"Just like you get your warrant of fitness for your car, go and see a health professional each year and get checked out."
Heart disease: 20 per cent more likely
One in three of us will die of heart attack or stroke – and males born today happen to be 20 per cent more likely to be killed by heart disease than women.
Cardiovascular diseases are the main cause of death, followed by strokes which happen when an artery in the brain is blocked or leaks, and remain the largest cause of disability in adults here.
The latest research shows that men are also at greater risk of stroke than women - and that more than 170,000 Kiwis live with heart disease every day.
Some of the risk factors for the most common type of heart disease, coronary artery disease or CAD, can't be avoided – and these range from age and ethnicity to family history.
Yet many other factors – think smoking, obesity, high blood cholesterol and pressure, and a lack of exercise - are indeed preventable.
Another big danger is diabetes – and perhaps one in four Kiwis might be in danger of developing type 2 diabetes.
Again, experts tell us that lifestyle change can help prevent or delay its onset.
Cardiologist and Heart Foundation medical director Associate Professor Gerry Devlin said New Zealand's mortality rate from heart disease had fallen by around 75 per cent from a peak in the late 1960s and early 1970s, when one in two Kiwis smoked.
Yet rates hadn't come down nearly low enough – given annual hospital admissions from heart attacks hadn't dropped far below a new baseline of around 15,000 cases over the last decade.
"New Zealanders might be living longer – but we're also living longer with heart disease and other conditions, and I think it's important for us to recognise and respond to that."
Why men appeared to be more at risk wasn't straightforward: biology could be a factor, but so too were known lifestyle traits.
"Blood pressure, to me, is the one that we really need to do better with," Devlin said.
"A million New Zealanders are living with hypertension. A 5mm [by Hg] reduction in systolic blood pressure reduces your chances of having a heart attack or stroke by 10 per cent.
"That's pretty powerful intervention, no matter how you get that done, either by lifestyle or pharmacotherapy."
People should seek regular heart and diabetes checks if they have a family history of heart problems, or are over certain ages: that's 45 and 55 for European men and women respectively, and 30 and 40 for Māori, Pacific and South-Asian men and women respectively.
As well, they should get their blood pressure checked once a year: and know the signs of heart attack.
Mental health: 444 lives lost
Sam O'Sullivan has seen the "deep end" of New Zealand's mental health crisis.
While working as a clinical psychologist in an inpatient hospital, he noticed the bulk of patients were men – while many of the women there were the victims of violence from men.
"It became pretty clear to me that there was a pattern with gender: and when you're in the deep end of mental health, you begin thinking, why are these people showing up?"
Again, mental health is an issue far from exclusive to men – and women in New Zealand are more likely to experience and report depression, anxiety and mental distress.
But men appear less likely to recognise the problem and do something about it.
Rather than talk about what they're going through, they're more likely to discuss the physical signs of depression, such as feeling tired all of the time.
They're also more likely to take their own lives: in 2020, there were 444 suspected male deaths by suicide, compared with 147 among women.
O'Sullivan said he'd been shocked to see men battling mental health problems journey through the health system without sharing their emotions – and often choose outlets such as drinking, anger and violence instead.
A sense among men of needing to preserve masculinity was a common theme he'd seen in his work in the sector – and also through his travelling documentary series, Tough Talk.
"It's sort of humbleness about being a Kiwi," he said.
"They certainly don't want to be seen as weak – and there's also this idea of success, and not wanting to be seen as unattractive to partners or potential partners."
In sad contrast, studies have linked male masculinity norms to higher mental health risk, alcoholism and violence.
One 2018 report investigating the building sector's high suicide rate – something the national programme Mates in Construction is now trying to tackle - singled out a culture of toxic masculinity.
O'Sullivan pointed out that Māori men – particularly younger ones – also had higher suicide rates than other ethnic groups, and he saw a need for Pākehā to recognise and address how colonisation had played a harmful role.
"We can improve some of those outcomes – because we're all affected by it."
What could men do to improve their own mental health?
Clinicians recommend eating well-balanced diets, staying physically active, avoiding turning to drugs and alcohol, staying connected and talking with loved ones – and perhaps most importantly, always asking for help.
Life expectancy: 73 years for Māori men
If we ever needed a glaring reminder of the higher health burden that Māori and Pasifika communities carry, the Covid-19 crisis has provided it.
A disproportionate rate of coronavirus-linked deaths have involved Māori and Pasifika people, who, even after taking age and pre-existing conditions into account, were respectively two and half and three times more likely to need hospital level care for Covid-19.
Among men in particular, Māori males have a life expectancy of just 73 years, and Pacific men 74.5 years, compared with about 80.3 years for their non-Māori counterparts.
While cancer remains the major cause of death - Māori men are 1.7 times more likely to die from it than non-Māori - heart disease is the second biggest killer, and deaths among Māori and Pacific men happen to occur five to 15 years earlier.
In all, Māori are two-and-a-half times more likely to die from diseases that were potentially preventable with timely and effective health care.
None of these appalling statistics are at all surprising to Adrian Te Patu – the first indigenous person appointed to the World Federation of Public Health Associations.
"We know an unfair burden of unwellness is carried by 20 to 25 per cent of the population in this country – and that's not a political statement," the Māori health advocate said.
"It's just the fact that Maori and Pacific men, in particular, lead shorter, sicker lives than their Pakeha cousins."
The reasons for these disparities are complex – and often span well beyond lifestyle factors.
Māori and Pacific people live with higher co-morbidities, but also face inequity and structural racism within the health system, and, as Covid-19 vaccination rates have illustrated, have poorer access to care.
That's on top of factors like higher poverty, unemployment, poorer education and inadequate housing.
Even today, Māori on average earn two thirds of the average European income while home ownership rates are less than half of the national average of over 64 per cent.
Given this, Te Patu didn't blame many Māori for moving across the Tasman to Australia, where they could earn higher incomes, enjoy better health services and raise tamariki in warmer, drier homes.
He thought it worrying that New Zealand was having to pour tens of millions of dollars into providing care for preventable diseases like diabetes, which accounts for about six per cent of Māori deaths.
But he added that arresting the root causes would take much longer than one or two political cycles.
"Better educational outcomes, better access to healthcare, warmer, dry housing – all of those things are going to help."
• For information, visit the Men's Health Week website.
