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Friday, July 29, 2011

The Health-Survival Paradox and Life Expectancy

Men are physically stronger than women and have fewer disabilities, but they also have a higher mortality rate (or lower life expectancy) than women, at every adult age.
Women just live longer around the world. It doesn’t matter if it’s a large, rich country or a small, poor one. In Russia, women live 12 years longer than men on average; but in Bangladesh they only live two years longer, BUT it’s still longer. In the United States the spread is five years. For years demographers have been at a loss to say why. Academia calls it the “Male-Female Health-Survival Paradox”
Fundamental biological differences, such as hormones or disease patterns, play a part but much of the difference is caused by behavior. Men take greater risks. We aren’t talking about mountain climbing here, but in a man’s behavioral reluctance to seek medical attention when it is needed; either for injury or disease.
So what explains why women have gained the edge on life expectancy and men have fallen behind? Consider these phenomena.
1. Throughout most of human history, women lived shorter lives, suffering a higher mortality rate. In Europe about 600 years ago things began to change. Males began to experience a mortality rate that was higher than females.
2. Women began to marry at a later age which led to fewer pregnancies. Their earlier, higher mortality rates were chiefly a result of death in childbirth.
3. The access to food and rudimentary health care became more equal between the sexes.
4. Populations became more urbanized and inter-cultural trade increased. Men had always been more vulnerable to infections and parasites; and increased trade and migration negatively impacted them more than females.
5. With a higher concentration of men in new urban locations, the competition for mates caused males to increase their risk taking behavior. This is a phenomenon that exists among several primate species, not just man.
Historical and social stressors, environmental stressors, communicable diseases, increased risk taking behavior, even atmospheric changes, can force changes on an entire population, but men seem to be more vulnerable. Examples are:
Political stressors include regime changes, division or reunification of countries (the reuniting of Germany in the 1990’s, even though it was a good thing, caused widespread stress).
Famines, drought, severe heat, or any kind of deprivation is especially impactful on children (unrest in Africa is a prime example).
Migrations of large populations can be accompanied by long term stress (freed slaves leaving the South for northern cities after the Civil War).
Urban lifestyles can result in accumulated stress over time (smoking, drinking, narcotics, and even driving in traffic).
Stress during one’s earlier years has especially long lasting effects (prisoners of war, concentration and internment camp experiences, exposure to mass destruction scenarios such as natural disasters or atomic weapons).
Researchers have concluded that these stressors are having long lasting impacts on health and mortality. “What doesn’t kill you, makes you stronger” has pretty much been proven wrong.
The stressors referred to above have only a marginal correlation to mortality rates across the entire American society. Political changes are usually mild and slow. Famines and drought have been slight. People have not been confined in camps in the last 60 years (excluding criminal confinement). Exposure to mass destruction is remote (exceptions are occasional hurricanes, tornadoes). The urban stressors of alcohol, tobacco, and narcotics are only somewhat correlated to high mortality at the total population level (although they certainly are at the individual level).
There are two major categories of stressors that DO have a statistical correlation to widespread higher mortality rates. They are cultural pressures and poverty.
Cultural pressures: Heightened competitiveness and pressure to achieve.
These cultural stressors are more difficult to quantify because the theorized effects on mortality are just now being realized. But one example may be women’s entrance into a highly-pressurized labor market over the last two generations that is beginning to show the same negative effects on them that we have seen in males for some time.
Effects of poverty: Poverty is usually accompanied by a lack of access to health resources, substandard food and housing, and a higher incidence of disease.
The correlation between poverty and life expectancy in the U.S. may be easier to quantify. And that correlation also seems to be extending to geographic regions. Looking at the three separate geographic regions below, their mortality rates, and their poverty rates indicates a correlation between these factors.

(These 2000 statistics come from the Population Reference Bureau; www.prb.org)
Interestingly, the states with the highest and lowest life expectancies are not part of these regions at all. Life expectancy for men is highest in Hawaii (77.1) and lowest in the District of Columbia (68.5). Life expectancy for women is highest in Hawaii (82.5) and lowest in the D.C. (76.1). Also, the percent of population living in poverty was lowest in New Hampshire (6.5%) and highest in D.C., again (20.2%).
Some people may argue that this comparison is not valid - the regions are subjectively grouped, there may be age differences between the regions (affecting poverty), and recent migrations in and out may affect the numbers. But it’s hard to ignore these significant variations.
During the latter half of the 20th Century improvements in vaccines, refrigeration, water filtration, and other interventions have mediated the effects of stressors.
Public health interventions in the past primarily benefitted the poor most. In the future, experts see better medical care and disease prevention having a larger role. Unfortunately, these may not be available to all tiers of our society as there is an economic cost to their access.

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