Have You Looked Under Your Hood?

Many men would rather diagnose the roar of their muffler than the rasp in their throat; they'd sooner talk about what's going on with their engine's fuel injection system than about their own cardiovascular health.

Those are sweeping generalizations, of course, but they are borne out by 33 years of experience working as a primary-care internist at Massachusetts General Hospital in Boston. Women, I have discovered, tend to pay attention to their own health and the health of other family members, while men busy themselves keeping everything running -- in the garage, in the office and in the house. Everything, that is, apart from their own bodies.

Those tendencies are reflected in some troubling statistics about men's health. Men are not likely to live as long as their wives and sisters. While the average American woman has a life expectancy of 80.4 years, American men lag more than five years behind, at just over 75 years. And if you are black and male, the odds are stacked even more heavily against you: Black men can't even expect to reach the biblical milestone of three score years and 10; they have a life expectancy of about 69 years. Living in poverty and often with less access to routine preventive care, as many black men do, exacerbates the male disadvantage.

There are many reasons for those statistical discrepancies, based in both biology and behavior, but if men want to close the health gap and live longer, we should learn to live more like women: We have to gain a better understanding of our bodies, take better care of ourselves and get the medical care we need. We need to pay more attention to our health.

Many of us, both men and women, fail to have regular checkups with our primary-care physicians. But women typically make annual appointments with their ob-gyns who, by default, become their primary-care physicians. (How many men see a urologist every 12 months?) Women also tend to be the ones to take the children to the pediatrician, who will sometimes discuss issues of importance to the health of the whole family; they still often cook family meals and oversee the household's nutrition; they talk among themselves about health-related topics and report feelings of ill health to their doctors; and they tend to read health-related magazines and newspaper sections like this one.

And, oddly enough, they don't usually obsess about the car in the driveway.

The health gap between men and women is not just a longevity issue. For every year of their life from the moment they are born, American males have a higher death rate than American females. They die younger than women and have more chronic diseases than women. And when it comes to our five leading causes of death -- heart disease, cancer, stroke, chronic lung disease and accidents -- men die at rates 40 percent to 220 percent higher than women do.

Check out these numbers: American men are almost four times as likely to contract AIDS; they are more than three times as likely as women to develop kidney stones, to become alcoholics or to have bladder cancer. And they are about twice as likely to suffer from emphysema, a duodenal ulcer or a heart attack.

Why? A complex mix of biological, social and behavioral factors is at play. Here are some possible contributors: