Men’s health has been less widely discussed than women’s health – both professionally and by interest groups, in New Zealand and internationally. There has been a lack of attention to some important preventable causes of death and disease in New Zealand men. For instance, it was not until the 2000s that public discussions took place on prostate cancer, an issue specific to men.
The health of men in New Zealand has slowly improved. Further health gains for New Zealand men will come through prevention of the major causes of premature death, disease and injury throughout the life course, and addressing ethnic and social inequalities.
Life expectancy measures the average age that someone can expect to live to, at a particular age. The life expectancy of a male born in 2012–14 was 79.5 years; a female had a life expectancy of 83.2 years. In the 1990s, male life expectancy increased steadily and at a faster rate than that of females. It rose by 5.1 years between 1995–97 and 2012–14, a remarkable improvement. The corresponding increase for females was 3.5 years; as a result, the gender gap in life expectancy decreased from 5.3 years to 3.7 years over the period. Internationally, New Zealand men’s life expectancy ranked eighth out of 36 OECD countries in 2013.
In New Zealand in 2012–14, the life expectancy of non-Māori males (80.3 years) was 7.3 years higher than that of Māori men (73). This gap had slowly decreased since the late 1990s. Pasifika men had a life expectancy of 74.5 years – closer to the Māori rate than the non-Māori. Asian men had the highest life expectancy, 84.4 years.
There were striking differences in life expectancy at birth by measures of social and economic status. Low-income men experience higher risks of dying at every age than their more advantaged counterparts. Mortality rates have been falling for all income groups for several decades, at much the same rate.
An important feature of the increase in male life expectancy is that most of the extra years gained have been in relatively good health. Independent life expectancy (the number of years that a person can expect to live without needing assistance) for men increased from 63.8 years to 65.2 years between 1996 and 2013; three-quarters of the life years gained in this period were in good health.
Around two-thirds of life-expectancy improvements have been through the prevention of major causes of death. The rest are due to improvements in the efficacy of health services for ill men.
The leading cause of death for men in 2013 was heart disease, followed by stroke and lung cancer. The causes of death were in the same order as for women, but the rate of heart disease among men was almost twice that of women. Death rates were considerably higher for Māori than non-Māori. Diabetes was an especially important cause of death in Māori men (the second highest death rate, over four times higher than in non-Māori men).
The death rates for all leading causes of death are declining in New Zealand men. The rate of decline has been particularly rapid for heart disease and stroke, due to a combination of improved prevention and better health-care services.
Both transport accidents and suicide are significant causes of death among men, especially younger men. The male rate for these in 2013 was almost three times the rate for women.
Prostate cancer, an exclusively male condition, was the fourth most significant cause of men’s death in 2013 – a rate similar to breast cancer among women.
The major causes of sickness in New Zealand men mirror the leading causes of death, with the addition of mental health problems, which are prevalent but rarely lethal. Depression is the leading cause of mental ill-health in New Zealand men; it is a greatly under-appreciated cause of disability. Mental illness among male prisoners is a major issue.
From 2006, former All Black John Kirwan fronted an advertising campaign talking about depression, funded by the government’s suicide-prevention strategy. After the advertisements were screened, the Mental Health Foundation received an unusually large response from men.
As the population ages, various forms of dementia are likely to become more common. Gambling is also an increasingly important cause of adverse social, economic and health effects, especially among disadvantaged men.
In terms of sexual health, considerable attention has been given to HIV/AIDS, at least partly because of the successful advocacy of non-government organisations. In New Zealand in 2014, 190 men (89% of all cases) were diagnosed with HIV, almost three-quarters acquired through sex with men and most of the rest through heterosexual sex. In the same year, 22 men developed AIDS. Over half had acquired the virus through sex with men, and most of the rest through heterosexual contact. Fortunately, because of the impact of modern therapies, HIV/AIDS is now a very rare cause of death in New Zealand, responsible for the deaths of about 10 men each year.
In the early 21st century there was much attention in popular literature and advertising to men’s erectile dysfunction. Men’s clinics and several commercially available pills have emerged to treat the problem.
The immediate risk factors for the major causes of death and disease in New Zealand men are well known and preventable: tobacco smoking, unhealthy diet, physical inactivity and excessive alcohol consumption.
Tobacco use is the most readily preventable cause of death and disease in New Zealand men. In 2014/15, 18% of men and 15% of women aged 15 and over were cigarette smokers. Smoking rates were significantly higher among Māori and Pasifika men, at 34% and 27% respectively. Māori women had even higher rates.
The smoking rate in the most economically deprived areas was 3.1 times the rate in the least deprived areas. Compared to other OECD countries, New Zealand’s smoking levels among males are relatively low. Smoking prevalence has been falling slowly in New Zealand men of all ethnic groups since the 1990s.
Unhealthy diet and physical inactivity are important causes of the epidemics of chronic diseases in New Zealand men – cardiovascular diseases, cancer, and especially obesity and diabetes. In 2014/15, the obesity prevalence rate (defined as a Body Mass Index of more than 30) for males aged 15 and over was 29%. This was a notable increase from the 1997 rate of 19%. The major drivers of the increase in obesity rates were:
There are large differences in the prevalence of obesity by ethnicity. Among the population aged 15 and over in 2014/15, Pasifika men were almost 2.5 times and Māori men 1.6 times more likely to be obese than men in the total population, while Asian men had a significantly lower rate of obesity. These differences were also apparent among boys aged 5–14. The prevalence of obesity was higher in relatively deprived neighbourhoods. Compared with other OECD countries, New Zealand had high levels of obesity.
Alcohol abuse can damage men’s physical and mental health. Alcohol also contributes to death and injury due to traffic accidents, drowning, suicide, assaults and domestic violence.
The 2014/15 New Zealand Health Survey found that 25% of male drinkers aged 15 and over had a potentially hazardous drinking pattern (a score of at least 8 in the World Health Organization’s Alcohol Use Disorders Identification Test), more than twice the proportion of women. Hazardous drinking among men had dropped between 2006/07 and 2013/14 but increased in 2014/15. Almost half of males aged 18–24 had a potentially hazardous drinking pattern, but the rate declined with age. Māori and Pasifika men were significantly more likely to have a hazardous drinking pattern, while Asian men were less likely to drink to excess. Problem drinking was significantly more common in the most economically deprived areas than in other areas.
Men used health services less frequently than women, perhaps because of reluctance to acknowledge their need for help. A study of visit records in 246 New Zealand doctors’ practices in 2001/2 showed that men visited an average of 5.4 times in the year and women 6.3 times. The difference was not explained by women’s gynaecological problems or childcare responsibilities. Improvements in access to, and quality of, health care for disadvantaged and marginalised men could substantively reduce health inequalities.
In the 2014/15 New Zealand Health Survey, 76% of men had visited a GP in the last 12 months, compared to 84% of women. This gap was only present in the 15–64 age group – older men and women saw GPs equally often.
One older man who participated in a men’s health focus group remembered, ‘I have a few uncles who were farmers. One or two of them popped off with bowel cancer ‘cos their idea of when it was time to go to the doctor was by the time you were bleeding from the rear orifice and in considerable pain … They were just brought up that you don’t groan, a bit of aches and pain, a bit of blood – so what.’1
Various attributes of male culture are important underlying drivers of New Zealand men’s health. Historically, many New Zealand men were injured or lost their lives fighting in wars. A macho culture of risk-taking among men, especially young men, encourages them to drive cars fast and indulge in dangerous sports, leading to accidents and injuries. Excessive alcohol intake also contributes to traffic accidents and encourages fighting, which can result in injuries and occasionally death.
Men's well-being can also be at risk as a result of taking part in traditionally male sporting activities such as rugby and boxing. Contact sports can cause spinal and brain injuries. The costs of injuries to amateur rugby players who made accident compensation claims rose significantly between 2011 and 2015, reaching $75 million. Players experience concussion, sprains, fractures and dislocations that can have long-term effects.
Young men, especially Māori and Pasifika men, are at higher risk of unemployment, and their imprisonment rates are extraordinarily high; both factors are associated with poor health. High levels of suicide among young men are also linked to such factors. Mental illness among male prisoners is a major issue.
The health of New Zealand men is slowly improving, and is relatively high by international standards. Men’s health advocates argue that further improvements can be made through:
Although ethnic and socio-economic inequalities in male death, disease and injury rates are no longer increasing, they remain a serious challenge.
The continuing ageing of the male population has important implications, as increasing age is an important risk factor for chronic diseases and dementia.
In September 2009 the Prostate Cancer Foundation gave a presentation to men on the Chatham Islands. At least 40 men were there, and Joe Tapara, a member of the Chatham Islands Māori Community Health Care group, explained why: ‘The wives and the partners were the reason why so many men turned up. Without them nagging, I’m not sure how many would have bothered.’
Women’s health has made notable gains, for example with screening programmes for cervical and breast cancer, partly through the work of women’s non-government health organisations. There have been fewer men’s health groups. One example is the Prostate Cancer Foundation, which in 2016 had 28 support groups nationwide and worked to raise awareness of prostate and testicular cancers. From 2008 the Cancer Society and Mental Health Foundation combined to promote Movember, in which men grew moustaches in November to draw attention to – and raise funds for – men’s health issues, specifically prostate cancer and depression.
The MENZSHED movement developed in the 2010s as a way of bringing men together through practical tasks such as woodwork or carpentry in ‘sheds’ – places where they could share skills and establish friendships. The movement also shares information on issues such as testing for prostate cancer. MENZSHED members are mainly middle-aged or retired.
The challenge for New Zealand men is to build a sustainable and evidence-based movement for promoting their health which addresses the underlying determinants of premature death and disease.
Baldwin, Dave. Healthy bastards: a bloke’s guide to being healthy. Auckland: Random House, 2009.
Worth, Heather, Anna Paris and Louise Allen (eds). The life of Brian: masculinities, sexualities and health in New Zealand. Dunedin: University of Otago Press, 2002.