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.
Diet and physical activity
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:
- changing diets, reflecting an environment that promoted the over-consumption of energy-dense foods and drinks
- to a lesser extent, reduced habits of strenuous physical activity.
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.
Use of health services
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.
Suffering in silence
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.