Editorials

The future of men and their health

Are men in danger of extinction?

It may seem incredible now, but up to just 25 years ago there was very limited research specifically targeted at women's health. The world seemed to assume that, except for issues related to reproduction, women's health problems, needs, and solutions were essentially the same as men's.¹ As a result of vigorous lobbying by women from all over the world, research on women's health needs mushroomed in less than three decades. Major studies are now generating increasing evidence on important differences between men and women, from the cellular to the societal level.²

Almost by default, the strong emphasis on women's issues (which we applaud and support) has revealed areas of men's health that require just as much attention. Perhaps one of the most puzzling is the difference in life expectancy between men and women. Despite having had most of the social determinants of health in their favour, men have higher mortality rates for all 15 leading causes of death³ and a life expectancy about seven years shorter than women's.⁴ Men's reluctance to embrace preventive strategies has also contributed to the spread of AIDS, particularly in Africa,⁵ and to an alarming rise in infections among young men, including other sexually transmitted diseases.⁶ Furthermore, there is a sustained increase in psychosocial disorders in men, including alcohol and substance abuse, mid-life crisis, depression, and domestic violence.⁷ Men's increasing aggression and autoaggression remain an unsolved health and societal problem. As you read this, over 30 wars and conflicts rage around the world, mostly created, maintained, and aggravated by men.

Can something be done to improve men's life expectancy? Are there effective and morally acceptable strategies to modify men's negative behaviour towards themselves and others? We hope that these questions and the need to answer them trigger a strong movement in support of more focused and stronger research on men's health.

Although there is still a long way to go in most societies around the world, it is clear that women can perform (and on most occasions outperform) pretty much all the tasks traditionally reserved for men. In most of the developed world women are starting to outnumber men in medical schools and making rapid gains in terms of equality in compensation and opportunities in the workforce. Will we see the gap in life expectancy between men and women widen as the gaps in social determinants of health become narrower? The answer is probably yes, unless women continue to adopt the same negative behaviours that characterise men today.

With the advent of sperm banks, in vitro fertilisation, sex sorting techniques, sperm independent fertilisation of eggs with somatic cells, human cloning, and same sex marriages, it is also reasonable to wonder about the future role of men in society. In a recent article a female Canadian journalist posed the question: "Are men the new women?" This question was motivated by the proliferation of magazines and television shows aimed at men with contents and formats that mirror what has been typically regarded as "women's stuff."⁸ What will be the implications of the redefinition of men's roles within the family, work, and society on their health? Will men be needed at all?

Are men and society prepared for the population explosion led by the Baby Boomers and by their "global ageing"? What will be the consequences of rapid fertility declines in the "post-Boomer" phase? Does hormone replacement therapy have a role in men? The Men's Health Report of Vienna 1999 and the World Health Organization report, Men, Aging and Health, published in 2000, provide a good starting point to look at the priorities and specific strategies that will be required to improve and maintain ageing men's health in a rapidly changing world. ^{9 10} There is an urgent need to advertise and promote men's health in a positive way. In addition, gender specific training of primary care workers must be supported.

We see this theme issue of the BMJ as a great opportunity to invite the international community to reflect about men's health and the opportunities it creates for transdisciplinary activities. These span from basic research on sex and gender differences to new strategies of public health and health promotion, targeting men of all ages, with special emphasis on life course, high risk periods, environmental factors, and risk factor epidemiology. We have selected articles that focus on clinical and population health issues related to men's health.

But this is not all: this issue coincides with the first World Congress on Men's Health in Vienna (www.wcmh2001.com), which will host the celebration of Men's World Day on 3 November 2001 (www.mensworldday.com) as well as the launch of the International Society for Men's Health and the European Men's Health Forum. We hope that these initiatives will act as strong platforms to support strategic and innovative research on men's health and the generation of strong commitment for collaborative work by researchers interested in men's and women's health, and the role of gender in society.

Siegfried Meryn, professor of medicine and chairman and president of the First World Congress on Men's Health. 

Center for Advanced Medical Education and Health Communication, Institute for Medical Education, Medical Faculty, University of Vienna, A-1090Vienna, Austria (siegfried.meryn{at}univie.ac.at)

Alejandro R Jadad, director, program in ehealth innovation. 

Department of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, ON M5G 2C4, Canada