Women top the health issue agenda as men die

A recent Irish Times report of a conference on women's health, hosted in Dublin by the Irish College of General Practitioners…

A recent Irish Times report of a conference on women's health, hosted in Dublin by the Irish College of General Practitioners and the Women's Health Council, cited a female English GP as stating that "more women than men die from diseases of the circulatory system". The implication, in the context of a conference entitled "Women Taking Control of their Health" was that there is an imbalance in health matters which adversely affects women compared to men.

Dr Ann McPherson's statement was factually true. But as an example of the distance that sometimes lies between fact and truth, it would be hard to beat. Most years, more women than men do die from diseases of the circulatory system. However, most of the female deaths occur after the age of 75, when the average man has shoved up more daisies than he ever had hot dinners. In the long run, we'll all be dead of something or other.

In an average year, roughly 35-40 per cent more women than men die from cerebrovascular disease and other diseases of the circulatory system, and about three-quarters of these female deaths occur past the age of 75. Only about 60 per cent of the men who succumb to these diseases survive past the age of 75. In every other age group, significantly more men die from these diseases.

But the pattern is significant only in that the gender margins are less marked than is the case with other diseases; Dr McPherson made mention of the condition which comes closest to implying that women's health is a more pressing issue than men's. But the opposite is true. Men die younger and more frequently from almost anything else you might think of.

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It is difficult to imagine there could exist a disease which tended to affect women significantly more adversely than men, without this being alluded to at every possible opportunity. As a matter of fact, no such condition exists: all serious conditions which are capable of affecting both genders tend to strike down men much earlier in life . We hear much about the "glass ceiling" affecting female opportunities in the workplace, and little or nothing about the clay ceiling - six feet thick and finished in the finest oak - which bears down upon men long before their time.

There are some diseases - breast cancer, for instance - which affect women exclusively, and these are seldom off the news agenda. There are, by the same token, diseases - prostate cancer springs immediately to mind - which affect men exclusively, and these rarely rate a mention in public debate. Yet prostate cancer affects men almost to the same extent as breast cancer affects women. Women are encouraged, through publicly-funded advertising, to watch for early signs of breast cancer. Most victims of prostate cancer will never have heard of the disease until they have become seriously ill.

Heart disease provides the most striking example of the stark reality of this society's relative levels of concern about the health of males and females. If, without specialist knowledge, you were to get a question in the course of, say, a pub quiz, about which of the genders suffers most from heart disease, you might be forgiven for answering that both males and females were equally prone to the condition.

After all, discussion of the disease in this society gives little indication that the situation is otherwise: men and women get heart attacks, and sometimes die as a result. Indeed, in broad statistical terms, men and women are more or less equally prone to death from heart disease - except that, again, men tend to die in their youth and middle-age, whereas women tend to die from heart failure in their 70s and beyond. You would never guess this from the way heart disease is discussed in the media.

There is a quite extraordinary degree of evasion, both at official and public discourse levels, of the staggering statistical gap that exists between the physical well-being of men as compared to women. Two years ago, the Department of Health produced an impressive-looking book, Reflections on Health, to mark the 50th anniversary of its existence, which contained a number of excellent essays about various aspects of health in Ireland. There were chapters on child welfare, health policy for women, services for the elderly, people with disabilities, the health service, etc. etc. One group, however, was noticeably absent from the book, the group most prone to premature death from all of the main causes of death.

The approach of virtually all agencies charged with monitoring or protecting public health, throughout the western world, is to avoid mention of the gap between males and females in respect of early death from major diseases. A typical quote is the following, from the World Health Organisation: "Irish men and women have the highest rate of death before the age of 65 from coronary heart disease (CHD) in the European Union - in 1993, 59 deaths per 100,000 population compared to the EU average of 32".

This is true, in as far as it goes, but what it omits is that the vast bulk of these fatalities are male. Women under 65 die from heart disease at roughly a quarter the rate of men.

A recent survey by the British Office of Health Economics, using the same World Health Organisation figures for 1993, placed Ireland fourth in the world for premature death from coronary heart disease. In that year, Ireland had 310 deaths per 100,000 males between the ages of 45 and 64, and 82 deaths per 100,000 for females in the same age bracket. (These proportions, because they relate to a smaller, maximum-risk age-segment, are obviously much higher than the overall figure for under-65s quoted above.)

To elicit this particular crumb of information from the media reports of the survey, however, you would have been better starting at the final paragraph and working back. The emphasis was again on the fact that Ireland now has the highest incidence of "premature death from heart disease in under-65-year-olds in the EU". The fact that most of the fatalities were males was a minor element of the story. It is women, we are led to believe, who suffer disadvantage and discrimination in our society and men who run our public institutions, including our media and our health service, allegedly for the benefit of themselves and other males.

Why, then, are the dangers to men's health not highlighted in the same way as dangers to the health of women? There is no Men's Health Council. Conferences about men's health are on a par with flying pigs. In Ireland, as elsewhere in the western world, women's health is close to the top of the agenda for funding, research and public education; men's health is a non-issue.

For all these reasons, everyone with a genuine interest in equality will welcome the publication this week of Men's Health - the Common-Sense Approach (Gill & Macmillan) by my colleague, Joe Armstrong.

John Waters can be contacted at jwaters@irish-times.ie