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EDITORIALS: Peter Baker The international men's health movement BMJ 2001; 323: 1014-1015 [Full text]

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Health of men in developing countries

Luis Benavente   (7 November 2001)

Men becoming extinct? Far from it!

C K Connolly   (10 December 2001)

Health of men in developing countries 7 November 2001
Luis Benavente, Asoociate Director, Maternal and Child Health Project HOPE Headquarters, Virginia, USA Send response to journal: Re: Health of men in developing countries	Sir: although our international programs are usually focused on mothers and children, we included adult men in a survey in the Amazon Basin. Anemia prevalence rates were much higher among men than among women. But iron supplementation was available only to women. Since anemia is associated with low productivity, it could be expected that by preventing anemia among men, men could bring more food to the table. Men's health has an impact in the health if the entire family, thus interventions based in the assumption that adult men are a low-risk group should be revised.
Men becoming extinct? Far from it! 10 December 2001
C K Connolly, Ret (PNT Cons Physician Darlington) Richmond N Yorks DL11 7tp Send response to journal: Re: Men becoming extinct? Far from it!	Editor In their introduction to your issue devoted to Men’s’ health Professor Meryn and Drs’ Jadad and Baker do not address the real paradox that has to be explained if their argument that men are in danger of extinction is to be sustained. The latest mortality figures show that during the period in which they commend the approach to women’s health the longevity of men actually increased more than that of women, at least in the UK. If the present trend of a reduction in difference of about one and a half years per generation continues, in one hundred years time men, far from being extinct, will be living as long as women. This trend is unlikely to be a statistical anomaly, but could reflect a progression already underway preceding the cultural changes described by the authors. Nevertheless, it is legitimate to look to the reasons why this trend continues in the recent decades of increasing attention to women’s health and disease, which the authors so commend. It is accepted that the long- standing reason for the greater survival of women than men is by no means clear. It has been suggested that it is associated with men’s’ lifestyle and levels of aggression. It could be argued that over the period concerned the lifestyle of women has come closer to that of men and the consequent disadvantage has not been fully compensated by improvements in the approach to women’s health. As interventions aimed at early diagnosis or primary prevention have little potential for return in the average healthy individual, their benefit must necessarily be lower to that individual than treatment or secondary prevention instituted if and when the disease occurs. Could it be that the global benefit from these primary interventions is more than counterbalanced by the morbidity associated with the worry involved and undesired effects of any intervention prescribed? The latter might be very subtle, e.g. the effect of beta blockers on exercise levels. This is not an argument against population based health promotion. Indeed observation suggests that men might have benefited more than this from women over the period concerned if the recent smoking habit of young women is to be a guide. Whilst the propositions put forward in this letter are entirely speculative, they are at least, unlike your leading articles, not entirely incompatible with the observed trends in mortality. May be doctors in clinical medicine should concentrate on what they are trained to do and best at; that is treating the sick and instituting secondary prevention measures, eschewing most primary preventative measures, whose real benefit to the healthy are often unproven, and leave others to focus on health promotion and population based approaches. The evidence suggests that this approach should be considered before large sums of money are diverted towards primary preventive medicine in men which, as in women, may prove to be subtly counterproductive and so hinder improvements in mortality and certainly reduce men’s feelings of health by fostering a disease focussed culture. Yours faithfully CK Connolly PN Trewby Consultant Physicians References: Baker P The international men's health movement BMJ 2001; 323: 1014-1015. Meryn S and Jadad AR The future of men and their health BMJ 2001; 323: 1013-1014. National population projections: 1998-based. ONS Series PP2 no. 22. London: The Stationery Office(2000) available on www.