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Improving men's health: successful initiatives and barriers to progress

13 June 2019
Volume 28 · Issue 11

Abstract

Peter Baker, Director, Global Action on Men's Health (peter.baker@gamh.org), discusses initiatives to encourage men to take care of their health and examines the barriers that prevent men from seeking help

Men's Health Week 2019, which began on 10 June, is not just an opportunity to highlight the many problems facing men and boys. It is also a time to celebrate what is going well. And there is some genuinely good news to share, not least that men are living significantly longer and healthier lives than was the case 25 years ago. Life expectancy for men in the UK in 1992–1994 was 74 years; by 2015–2017, it had increased to 79 years (Office for National Statistics (ONS), 2018a).

Cigarette smoking, cardiovascular disease and cancer mortality rates among men have steadily declined in the UK. There has also been a marked decline in alcohol consumption in young men (Ng Fat et al, 2018). Men can now access national screening programmes for bowel cancer, chlamydia and abdominal aortic aneurysms, as well as NHS Health Checks. Later this year, the national human papillomavirus (HPV) vaccination programme will be extended to adolescent boys, thereby protecting them against the cancers caused by HPV as well as genital warts.

There is now a variety of well-established initiatives aimed at men in the UK. These include Football Fans in Training in Scotland, Men's Pie Club in north-east England, Man v Fat, and Campaign Against Living Miserably (CALM). Around 500 Men's Sheds bring together mainly older men to pursue practical interests and build social capital with wider health benefits (Foster et al, 2018). The Queen's Nursing Institute (QNI) has published a report highlighting a wide range of men's health community projects led by nurses and funded by the Burdett Trust for Nursing (Baker, 2018).

But many serious problems with men's health remain, not least premature mortality. In England and Wales in 2017, 19% of all male deaths were in age groups under 65 years and 38% were in age groups under 75 years (ONS, 2018b). There are also stark inequalities in outcomes between different groups of men. In 2014–2016, life expectancy at birth in men living in the most deprived neighbourhoods in England was 73.9 years, compared with 83.3 years for men in the least deprived (ONS, 2018c).

There are some other specific groups of men who experience particularly poor health outcomes, including prisoners, gay men and homeless men. Suicide and self-harm rates are higher than average among gay men in the UK and these issues are associated with the stress experienced by men as a result of homophobia (Marwa and Davis, 2017). A recent study found that the mortality rates of homeless men in Dublin are 3–10 times higher than those of the general population (Ivers et al, 2019).

‘Expectations to be self-sufficient, to act tough, to be physically attractive, to be heterosexual … and to use aggression to resolve conflict encourage men to take risks with their health’

Men generally have less healthy diets than women, with lower consumption of fruits, vegetables, nuts/seeds and wholegrains; they are also more likely to drink alcohol or smoke. Thirty-nine per cent of male deaths in the UK are due to health behaviours, according to the Institute for Health Metrics and Evaluation (IMHE, 2019). Men also generally have lower health literacy levels than women, and are less familiar with common symptoms of serious diseases. They underuse primary healthcare services, including GPs, pharmacies, dentists, optometrists and health checks or screening, and are particularly reluctant to seek help for mental health problems.

Australia, Brazil and Ireland have responded to these challenges by establishing national men's health policies; they are the only countries that have so far done so. The UK Government is among the majority which have shown no interest in the idea. At the local level, men's health is also notable for its absence in strategic planning. Leeds City Council, which commissioned a comprehensive men's health report (White et al, 2016) whose findings it has begun to implement, currently stands alone.

Most health services continue to be offered on ‘a one-size-fits-all’ basis and make no attempt to take account of male gender norms. These norms—expectations to be self-sufficient, to act tough, to be physically attractive, to be heterosexual, to have sexual prowess, and to use aggression to resolve conflict (Heilman et al, 2017)—encourage men to take risks with their health and to avoid seeking help. The more closely men identify with ‘traditional’ masculinity, the more likely they are to exhibit damaging lifestyle behaviours (Sloan et al, 2015) and avoid services (Wong et al, 2017).

A recent report by Global Action on Men's Health, Who Self-Cares Wins: A global perspective on men and self-care, highlights the range of ‘gender-responsive’ actions that are needed if men's health is to be improved (Baker, 2019). The measures recommended include health policies (including national men's health policies) that recognise the needs of men, measures to improve men's health literacy, reconfiguring health services to make them more accessible to men (eg taking more services to male-friendly venues such as workplaces and sports stadiums), better training in men's health for professionals, and the publication of better practical guidance for policymakers and practitioners.

The benefits of better men's health would not be confined to men. The burden of male morbidity and mortality on health expenditure is significant and investment in measures to improve outcomes would prove cost-effective (Brott et al, 2011). Better men's health would also contribute to better health for women. Safer sex practices by men would clearly prevent the transmission of a wide range of infections and their consequences. Addressing men's mental health issues, including alcohol and drug misuse, could also help to reduce male violence against women, children and other men.

Men's Health Week was launched 25 years ago in the USA. It must be hoped that it will not take another 25 years for the issues it highlights to be systematically addressed.