During Movember, Peter Baker, Director of Global Action on Men’s Health, reflects on the state of men’s health in the UK and around the world.
Men’s health is problematic in the UK, in Europe and globally. In the UK, male life expectancy, while steadily improving, still lags four years behind female life expectancy. In the EU, the gap is 5.5 years and globally it is six years. There is also, of course, a marked social gradient in male mortality.
Recent UK data shows that life expectancy for newborn baby boys is highest in Kensington and Chelsea (83.3 years) and lowest in Blackpool (74.7 years). The social gradient for men is steeper than the gradient for women: deprivation and maleness are a particularly toxic combination.
The reasons for men’s poor health are a combination of risky behaviours (e.g. smoking, alcohol and drug misuse), sub-optimal use of primary care health services (not just general practice but also pharmacy, dentistry and optometry), low symptom awareness, and employment in hazardous occupations.
Men also tend to have limited social networks, especially when they are older, and are reluctant to discuss their health and wellbeing with others. This increases the risk of mental ill-health and makes it less likely that they will be advised or encouraged to seek help for any kind of health problem.
But there has as yet been little sustained effort made by policymakers or practitioners to tackle men’s health. Recent research by the Men’s Health Forum in England found that the majority of local authorities are not addressing the issues. Only 18% had a majority of measures in their JSNAs (Joint Strategic Needs Assessments) broken down by gender.
And there is a similar picture at the international level where, according to an analysis by Sarah Hawkes and Kent Buse of the policies and programmes of 11 major global health institutions (including WHO), a focus on the ‘prevention of and care for the health needs of men [is] noticeably absent.’ Only three governments – Australia, Brazil and Ireland – have introduced national health policies for men.
Primary care services have not taken steps to improve access by men. In the UK, the NHS Health Check programme, although inadequately delivered to both sexes in many areas, has not addressed men’s lower level of uptake.
The Bowel Cancer Screening Programme has not implemented measures recommended by the Men’s Health Forum and others to improve male participation. The specific symptoms of depression in men are not properly understood, leading to under-diagnosis and inadequate treatment, including a lower level of referrals to talking therapies.
The World Health Organisation and Professor Sir Michael Marmot, one of the world’s leading authorities on the social determinants of health, have argued that health policy and practice must take proper account of gender differences. Marmot has pointed out that ‘the social and economic roles of men and women have a significant effect on the health risks to which they are exposed over the life course’ and, in a recent report on health inequalities in the UK, he explicitly called for a greater policy focus on men’s health.
An increasing body of research shows that ‘gender-sensitive’ health interventions aimed at men can improve outcomes. We now know, for example, that sport is an effective medium for engaging men in lifestyle improvement programmes and that many prefer men-only weight management interventions.
A recent study by Leeds Beckett University found that the key factors for successful mental health promotion work with men include the use of safe and ‘male-friendly’ settings, adopting a ‘male-positive’ approach, and using male-oriented terms (e.g. ‘activity’ rather than ‘health’ and ‘regaining control’ rather than ‘help-seeking’). Men’s Sheds have shown the important role played by ‘shoulder-to-shoulder’ contact between men in the development of wider social networks for older men.
The UN has recently agreed 17 Sustainable Development Goals (SDGs) which aim to ‘end poverty, protect the planet, and ensure prosperity for all’. Goal 3 aims to ‘ensure healthy lives and promote well-being for all at all ages’ and includes the specific targets of reducing premature mortality from non-communicable diseases, promoting mental health and well-being, tackling alcohol and substance abuse, and cutting deaths and injuries from road traffic accidents.
Given men’s significantly higher level of premature mortality and higher rates of suicide, alcohol- and drug-related conditions and traffic accidents, it is difficult to see how these goals can be achieved without action that takes account of gender differences and men specifically.
The fatalistic beliefs that men’s poor health is inevitable for biological reasons and that men will never change their risky behaviours should be jettisoned forever. Governments and other health organisations, national and international, must follow the lead of Australia, Brazil and Ireland and address the health and wellbeing needs of men and boys alongside women and girls. Better health for all cannot be achieved if the problems facing men are left hiding in plain sight.