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SA scores on gender health equality but otherwise at the bottom of world ranking analysis

An analysis of health data from 156 countries across 10 categories found that South Africans are the world’s unhealthiest, with both men and women coming in last place in the global rankings due to low life expectancy and high incidences of workplace accidents, alcohol abuse and cancers.

On the upside, South Africa is one of only two nations globally (alongside Guatemala) and the only G20 country to have a perfect score for gender health equality, according to Manual, the wellbeing platform for men.

According to the World Health Organisation, men are living healthier and longer lives than ever before but are still more likely to be burdened by illness and are outlived by women in every country. Scientists are even reporting a coronavirus risk gap. Despite the infection rate being relatively equal between the sexes, the death rate for men is estimated to be 2.8%, compared with 1.7% in women.

With this in mind, Manual, the wellbeing platform for men, has analysed health data* for 156 countries worldwide across 10 categories – including life expectancy, rates of diseases such as diabetes, cancer and obesity, mental health disorders and daily alcohol intake – to find out where has the largest gender health gaps.

Out of the 156 countries studied, men face greater health risks in 58% and women face greater health risks in the remaining 41%.

South Africa is one of only two nations globally (alongside Guatemala) and the only G20 country to have gender health equality (0). Other G20 countries which have near gender equality include Turkey (-8), Australia (6) and the US (8).

The data reveals the men’s health gap is largest in Russia (-50) and South Korea (-39). Four further G20 countries in Asia follow this trend – Japan (-27), India (-26), Indonesia (-24) and China (-23).

But it isn’t all good news for South Africa despite boasting gender health equality.

Citizens of South Africa are the world’s unhealthiest, with both men and women coming in last place in the global rankings (156/156) due to low life expectancy and high incidences of workplace accidents, alcohol abuse and cancers.

A widening economic gap between the rich and poor could be to blame, with obesity and physical inactivity among the upper classes coexisting with malnutrition in urban townships.

In particular, South African men rank below average for mental wellbeing (98/156). Whereas, South African females rank in the bottom 20 for physical activity (140/156).

That said, South Africa scores positively for its low daily tobacco use among both sexes (men 56/156 and women 58/156), with less than 19% of the total population being classed as smokers. According to WHO, tobacco kills half of its users and is considered one of the biggest public health threats across the world.

Globally, the Netherlands has the largest women’s health gap (-62) with higher rates of cancer, mental health disorders and tobacco use than men. Surprisingly, many other countries in Northern Europe follow this trend.

In comparison, the world’s largest men’s health gap is in Georgia (-84). Women in Georgia have higher positive scores across all health and wellbeing factors. As a result, Georgian men find themselves 84 places (108/156) behind their female counterparts (24/156) in the global health rankings.

George Pallis, CEO of Manual commented on the findings: “It really is eye-opening to see the differences between genders when it comes to health. Of the 156 countries studied, 41% and over half of the G20 have healthier men than women. But the fact remains that a greater percentage (58%) have healthier women.

“It’s important to remember, however, women are more likely to seek healthcare support, disclose symptoms and therefore receive a diagnosis. This could mean female gender health gaps aren’t as high in reality and why they live longer in every country.

“In any case, everyone no matter their gender, age or background, should own their health and happiness by accessing the support available to them and speaking to a medical professional as soon as symptoms appear.”

A Healthline report notes that more men are dying from COVID-19 worldwide than women, and the potential reasons run the gamut from biology to bad habits. A Frontiers in Public Health study reported that men and women were equally likely to contract the novel coronavirus. However, the researchers also reported that men are significantly more likely to suffer severe effects of the disease.

The Chinese researchers said that in one large subset of COVID-19 patients, more than 70% of those who died were men. They said they found similar results when they examined research from the 2003 outbreak of severe acute respiratory syndrome (SARS).

The report says the study was backed up by other figures released since the COVID-19 pandemic began. The WHO has reported that 63% of deaths related to COVID-19 in Europe have been among men. And among Italians hospitalised for the novel coronavirus, 8% of men died compared to 5% of women.

In New York City, men have been dying of coronavirus at almost twice the rate of women. The city’s health department reported in early April that 43 COVID-19 deaths for every 100,000 men, compared with 23 deaths for every 100,000 women.

The report says the US Centres for Disease Control and Prevention (CDC) currently isn’t reporting COVID-19 deaths by gender, but experts see no reason the trend would differ elsewhere in the country. “Some of the underlying reasons why COVID-19 may be more deadly for men than women may include the fact that heart disease is more common in elderly men than in elderly women,” Dr Stephen Berger, an infectious disease expert and co-founder of the Global Infectious Diseases and Epidemiology Network (GIDEON), is quoted in the report as saying. “Studies also find that high blood pressure and liver disease are more prevalent in men and these all contribute to more negative outcomes with COVID-19.”

Genetics may also play a big role,” Berger said. “Women, because of their extra X chromosome, have a stronger immune system and response to infections than men.” “You can’t get away from biology and genetics,” agreed Dr Salvatore J Giogianni, a pharmacist and senior science advisor for the Mens Health Network, which advocates for the health of men and boys. The phenomenon actually prompted the launch of two clinical trials in the US. In these trials, scientists are giving men with COVID-19 sex hormones such as oestrogen to see if that will help them recover from the illness.

Males are culturally conditioned to think of themselves as strong, Giorgianni said int eh report, but “women are not the ‘weaker sex’ when it comes to immunity.” Moreover, he noted, men have higher rates in 9 out of 10 of the leading causes of death in the US. That means they’re more likely to have pre-existing conditions that can make COVID-19 more dangerous.

Behaviours that impact lung health, such as smoking, also may play a role in the disease’s deadly impact on men. “In China, for example, smoking is largely a male habit, resulting in many men suffering from chronic lung disease,” Berger said. “This puts men at a much greater disadvantage should they get COVID-19.”

High-risk occupations deemed “essential” under pandemic emergency orders — notably first responders — also may be “disproportionately jobs men traditionally do,” Dr Derek M Griffith, director of the Institute for Research on Mens Health at Vanderbilt University in Tennessee, said.

Higher rates of death among men in pandemics is not new, the report says. Research on the worldwide flu of 1918, for example, found that non-elderly adult males died at a much higher rate than women, possibly because more men had a history of lung-damaging tuberculosis.

Male behaviour during the pandemic also could be increasing their exposure to the novel coronavirus. A Gallup poll taken between 2-13 March found that women were more concerned about COVID-19 than men were (by a 62% to 58% margin). “It’s possible that men are more at risk because they tend to expose themselves more to larger crowds and social exchanges, including things like handshaking and sporting events,” Berger said. “There are men with invincibility syndrome that underpins a lot of behaviours, and they tend to be less compliant” with pandemic-related restrictions such as physical distancing, Giorgianni said. For other men, he said, the issue isn’t so much a cavalier attitude as simply being conditioned “to think of health as ‘not their job.’”

COVID-19 prevention messages aimed at men should focus on these traditional male roles, “not ignore millions of year of biology and natural selection,” Giorgianni said. “Guys are very concerned for their families, so tell them don’t do it for yourself, do it for those who love you,” he said. “Even if they feel like they’re in good shape and can fight it off, they can still be a carrier can cause the death of their spouse or daughter or their dad.”

Griffith cautioned, however, that much remains unknown about COVID-19, including its different impact on men and women. “It’s worth considering these factors, but it’s a little premature,” he said. “Most of these statements seem to assume we know more about this disease than we do.”

The report says that one thing that is well-proven, however, is that men tend to delay seeking healthcare and ignore or dismiss symptoms of illness. “Many men see self-care as an admission of weakness,” David Ezell, CEO of Darien Wellness, a mental health group in Connecticut, said. “We are taught to be self-sufficient and there for everyone but ourselves. That results in ignoring tell-tale symptoms of not only COVID but any life-threatening condition.”

Dr Deborah Birx, the COVID-19 response coordinator for the Trump administration noted at a 9 April briefing that 56% of people who have been tested for the illness are male compared to 44% female. Of the men who were tested, 23% were positive for COVID-19, compared to 16% of women. “It gives you an idea about how men often don’t present in the healthcare delivery system until they have greater symptomatology,” Birx said. “This is to all of our men out there, no matter what age group: If you have symptoms, you should make sure that you are tested.”

[link url="https://www.manual.co/mens-health-gap/"]Manual study[/link]

[link url="https://www.healthline.com/health-news/men-more-susceptible-to-serious-covid-19-illnesses#Taking-symptoms-seriously"]Full Healthline report[/link]

[link url="https://www.frontiersin.org/articles/10.3389/fpubh.2020.00152/full"]Frontiers in Public Health study[/link]

[link url="https://news.gallup.com/poll/295505/coronavirus-worries-surge.aspx"]Gallup poll[/link]

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