It has been well documented and universally understood that coronavirus discriminates against the elderly and those with underlying health conditions. What hasn’t been so high profile is the extent to which it discriminates by gender.
Whilst men and women are fairly equally likely to contract the disease – analysis from the Office for National Statistics found: ‘Males had a significantly higher rate of death due to COVID-19.’ [1] It has been reported from the very beginning of the pandemic, back in Wuhan, that men have suffered more severely – with one initial analysis finding the fatality rate of men was 2.8%, compared to just 1.7% in women. [2] This pattern has continued in varying degrees around the world, causing this year’s ‘Men’s Health Week’ – perhaps unsurprisingly – to focus on ‘Taking Action on Covid-19’.
Could it be that there is more to the notion of ‘man flu’ than exaggerated symptoms and wimpy reactions? Are genetics and biology predisposing men to an immunological inferiority – or are their behaviours more to blame? We take a look at some of the reasons men’s health might be more at risk – not just from Covid-19.
Initially in China there was an assumption that it was men’s habits – rather than their biology – that was causing the disproportion in Covid-19 deaths. 50% of men there smoke, compared to just 2% of women. Smoking not only leaves the lungs vulnerable, but it was thought the habit of smoking itself might have also contributed to the likelihood of contracting the disease in the first place – as they are more likely to touch their lips or share cigarettes. Whilst the gender smoking-gap is much smaller in the UK, male smokers still outweigh female, with 16.5% of men smoking compared to 13% of women [3]. Men are also likely to drink more alcohol, with 28% men saying their average weekly alcohol consumption was more than 14 units compared to 14% women. They’re also more likely to be overweight or obese according to the NHS Health Survey for England 2017 [4]. All these factors can be to blame for weaker immune systems and have also been connected with higher rates of cancer and cardiovascular disease in men too.
Previous research by Sabra L. Klein would suggest that biology may also be playing its part. He investigated how; ‘Sex influences immune responses to viruses’, and when researching the effects of HIV and Hepititis C viruses found that; ‘The intensity and prevalence of viral infections are typically higher in males’. He says; ‘Their immune systems may not initiate an appropriate response when it initially sees the virus’. [5]
When it comes to immunity, it seems two X chromosomes are better than one. There are a number of genes located in the X chromosomes, which are important for immunity and give women a helping hand. Other research has also suggested that the female sex hormones oestrogen and progesterone have been known to boost the immune system.
Men’s attitude to risk taking also comes into question as a potential contributing factor. Whilst obviously generalised and sweeping – it is fairly widely acknowledged that men would be less likely to wash their hands or take the other necessary precautions to distance themselves from potential routes of infection.
A 2016 study found that “women are more than twice as likely to be cautious about risk than men”. The data, based on a psychological assessment of risk personality suggests that ‘gender plays a major hand in our appetite for risk’. [6] Author of the study Geoff Trickey claims the gap was shaped by evolution and it ensured the survival of our ancestors. A risk taking nature was beneficial to a hunter-gatherer, whilst a more cautious approach from women served the family better.
Women are much more likely to have frequent contact with health professionals throughout their lives – due to seeking contraception or during pregnancy and raising children. They are also invited regularly for screening for cervical and breast cancer and generally have more opportunities for education and reporting symptoms. In addition to this though, the stereotypical male reaction – to burry their heads in the sand and tough it out – almost certainly plays its part. Men’s reluctance to visit the doctor has been attributed as a key factor to cancer death rates being a third higher in men. It also means more men could be suffering from underlying conditions they are unaware of, making it more difficult for them to tackle the virus.
It seems the gender bias witnessed with Covid-19 deaths is not isolated to this virus, but rather it’s a small part of a much bigger picture surrounding men’s health and attitudes to healthcare. One in five men will die in the UK before they reach retirement age at 65 [7]. Those that do make retirement age still have a life expectancy of three years less than women.
Let’s hope that we can take this opportunity to collectively learn to look out for the men we treasure in our life, to encourage them to go against deep-rooted instincts and to prioritise their health and be proactive about protecting it. Perhaps it might be time to lay off the ‘man flu’ jokes too!
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[4] https://files.digital.nhs.uk
[5] https://www.ncbi.nlm.nih.gov