Peter Baker

A recent study of British dental patients found that men are more likely than women to be hospitalized due to severe dental disease. Why? Because men delay seeking help at earlier disease stages when their condition would be easier to treat.

While it’s a myth to assume that all or even most men do not use, or largely avoid, primary care, there is nevertheless good evidence that services are under-utilized by many. In one Australian study, 70% of men say they delay or avoid visiting a medical professional to address their health concerns at least some of the time. Other studies have shown that men also make less use of community pharmacy services.

As a consequence, too many male health problems remain undetected or untreated. Men from several countries in central and eastern Europe have the highest blood pressures in the world. Among those with raised blood pressure, only 22–66% (depending on the country) have had their problem diagnosed by a healthcare worker and only 8-35% of men with raised levels are actually receiving treatment.

Globally, and mainly because of a lack of engagement with primary care services, 25% of men with HIV are unaware of their status, 45% of men with HIV are not receiving anti-retroviral treatment, and 53% do not have a suppressed viral load. There is a similar picture for men with tuberculosis and for common mental health conditions, such as depression and anxiety.

There are two main barriers to men’s effective use of primary care. First, some men see help-seeking as undesirable because it feels challenging to traditional notions of masculinity. The gender norms that inhibit men include their need for independence and control, as well as their unwillingness to show vulnerability or “weakness.” Many men endure pain and downplay symptoms in order to adhere to masculine norms.

One study that looked at psychological help-seeking found the gender gap in help-seeking attitudes is entirely due to masculinity beliefs. And further, men’s view that reproductive health is “women’s business” has been identified in Uganda as a barrier to their involvement in contraceptive uptake and use of family planning services.

The second barrier is more practical: relatively few services are actually targeted at men or delivered in a way that meets men’s needs. Men often find conventional primary care services difficult to access. For example, appointments may not be available at times that are possible because of work commitments, and many men may subordinate healthcare because of their roles as financial providers for their families.

But there are solutions. Primary care services can be made more accessible to men by removing obstacles, such as broadening open hours, and by utilizing digital technologies for making appointments and accessing information, advice, and consultations. Services can be delivered in settings where men feel more comfortable, such as workplaces and faith, sports, and other leisure venues.

Creating a more male-friendly ambience within traditional settings could also make a difference, which may include things like providing male-interest magazines and male-targeted health information. The nurse-led AHEAD project in the United Kingdom showed that identifying and specifically reaching out to men can lead to a significant uptick in health appointment attendance. Pregnancy could provide another good entry point for men in countries where they are encouraged to attend antenatal services with their female partners. While there, men can be offered preventative health and screening services.

In the longer-term, action is needed to improve men’s health literacy and to challenge the traditional gender norms that impact on health behaviors. Schools have an important role in communicating information about health risks and help-seeking to boys, but this must be reinforced by consistent exposure to health communications that take full account of gender.

Community-based men’s health champions—persons trained to talk with their male peers about health issues and also direct to services when appropriate—could help to normalize conversations about health and help-seeking. Male role models, including “ordinary” men (not just celebrities) who are willing to share their experiences, could make a contribution here as well.

Men’s health outcomes are far worse than they need to be. Poor health impacts on workplaces, places greater demands on health services, and is financially costly. The development of a more gender-responsive approach to health, including in primary care, would go a long way towards relieving this burden.

This blog was first published by Havard Medical School’s Center for Primary Care on 5 May 2021.

The COVID-19 pandemic has refocused attention on many health inequalities, not least those related to gender. Globally, men and women are thought to be infected with COVID-19 in roughly equal numbers. But, overall, men are 40% more likely than women to die from COVID-19 and almost three times more likely to require admission to an intensive treatment unit.

Men of colour and men in lower-income groups have suffered particularly high mortality rates. Men’s mental health and wellbeing has suffered in many countries and, at the same time, non-governmental organisations that focus on engaging and supporting men have experienced funding pressures that may lead to reduced services.

Of course, highlighting the impact of COVID-19 on men does not mean that the many gendered dimensions of the pandemic which affect women disproportionately can be ignored. Women are at the forefront of efforts to tackle the pandemic, representing the vast majority of health and social services staff globally. They also consistently carry the primary responsibility for caregiving and other unpaid work at home. Gender-based violence has increased during the pandemic and women may be more susceptible than men to long COVID.  The reporting of such outcomes is often poor in many countries.

There is a clear and urgent need for gendered policy responses to ensure that the specific needs of men, women and people of diverse genders are not overlooked. Relatively early in the pandemic, in May 2020, WHO published an advocacy brief on gender and COVID-19. This encouraged member states to conduct a gender analysis of data and to invest in gender-responsive research on the potentially differential adverse health, social and economic impacts of COVID-19 on women and men. The brief stated that ‘the findings of such analys[es] should be used to fine-tune response and recovery policies.’

We are unaware of any government that has actually followed WHO’s advice and developed policy and practice in respect of COVID-19 that takes full account of the position of all genders. The Sex, Gender and COVID-19 Health Policy Portal’s recent analysis of 76 countries found that less than one-third (31%) of policies identified the beneficiaries by sex or gender, that most of the policies that did identify a beneficiary focused on women and that only 3% mentioned interventions targeting men.

The WHO itself has not yet established a gender and COVID-19 working group, despite a public commitment from the Director-General in September 2020. The Biden administration’s National Strategy for the COVID-19 Response and Pandemic Preparedness rightly highlights the impact of the pandemic on women’s health, but its one-dimensional approach to gender is revealed by the complete omission of men.

This lack of action is despite calls for a properly gendered policy response from many advocates in the men’s and women’s health fields, including Women in Global Health, GENDRO and Global Action on Men’s Health (GAMH). A paper published by the Centers for Disease Control and Prevention (CDC) emphasised the importance of addressing men’s vulnerability to COVID-19 in the policy response to the pandemic, particularly for men who are marginalized or disadvantaged because of their race, ethnicity, sexual orientation, or status as incarcerated or homeless. However, despite its provenance, even this analysis has not succeeded in stimulating any concrete activity in the USA or elsewhere.

The absence of a gendered policy response to COVID-19 is set in the context of the longstanding failure to address gender adequately in broader health policy. This is especially pertinent for men’s health. An analysis of 35 national health policies in the WHO European Region member states, for example, found that the term ‘men’s health’ appeared once. Globally, just four states – Australia, Brazil, Iran and Ireland – have developed national men’s health policies along with one city, Quebec.

Men’s higher mortality from COVID-19 can in part be explained by biology (males have a weaker immune response to the virus than women) but their outcomes could still be improved by both short- and long-term gendered policy responses. Action  to improve COVID-19 prevention and help-seeking which are influenced by gender norms is needed. A few potential  areas are compliance with mask-wearing, handwashing and social distancing, addressing workplace health and safety risks, facilitating testing and self-isolation, and maximising vaccination uptake.

The underlying conditions (eg. hypertension, chronic lung disease, diabetes) that disproportionately affect men and which contribute significantly to their poor COVID-19 outcomes – as well as having a broader impact on their life expectancy – must also be tackled.

Many have said that our societies must ‘build back better’ as part of the recovery plan from the pandemic. This cannot succeed through a ‘gender-blind’ approach that overlooks men’s health. The opportunity to achieve the long-overdue leap forward in gender-transformative policy and practice that will make a real difference to the lives of men – as well as women – around the world must now be seized.

About the authors

Peter Baker, Director, Global Action on Men’s Health (UK)

Clara Alemann, Director of Programs, Promundo (USA)

Stephen Burrell, Assistant Professor (Research), Department of Sociology, Durham University (UK)

Derek M. Griffith, Director, Center for Research on Men’s Health, Vanderbilt University (USA)

Shirin Heidari, Founder and President, GENDRO (Switzerland)

Jasmine Kelland, Lecturer in Human Resource Studies/Leadership, Plymouth University (UK)

Arush Lal, Vice-Chair, Women in Global Health (USA) and LSE Department of Health Policy (UK)

Sushmita Mukherjee, Director – Gender, Project Concern International (India)

All the authors are members of Gender and COVID-19 Working Group (Men and COVID-19 Sub-Group).

This blog was first published by BMJ Global Health on 24 April 2021.

Gambling, especially problem gambling, is more common in men than women. 45% of men and 40% of women gambled in some way in 2020, according to Gambling Commission data. There is a much bigger sex gap when it comes to problem gambling – 0.6% of men are defined as ‘problem’ gamblers (those ‘who experience negative consequences and a possible loss of control’) compared to a statistically insignificant proportion of women. Twice as many men as women (1.3% vs 0.6%) are ‘moderate risk’ gamblers (those who ‘experience a moderate level of problems leading to some negative consequences’).

Men’s excess burden of mortality from COVID-19 seems clear. In the USA, the CDC’s COVID Data Tracker reported that, by 6 July, 54% of all deaths were male. In some countries, including The Netherlands, Denmark, Dominican Republic and Romania, around twice as many men as women have died. Globally, the WHO has stated that 58% of deaths are male. Applying this proportion to the number of deaths shown on the WHO’s Coronavirus Disease Dashboard suggests that, by 7 July, around 310,500 men had died directly as a result of the pandemic.

This is not to imply that COVID-19 is solely or primarily an issue for men. COVID-19 is a profound and unprecedented human crisis on a global scale; almost every country, every family and every individual has been impacted in some way. The consequences for women have of course been huge, and not just in terms of illness and death. Those on low incomes, with caring responsibilities, at risk of violence or in need of sexual and reproductive health services have been especially affected.

Vulnerability

But men’s particular vulnerability to serious COVID-19 disease and death demands urgent attention. There has been considerable discussion about the role of male biology (chromosomes, hormones and immune systems) as well as their propensity for risk-taking behaviours such as smoking, excessive alcohol consumption, sub-optimal compliance with recommendations on handwashing and mask-wearing, and delayed help-seeking. 

Underlying serious illnesses which affect men disproportionately, including liver disease, ischaemic heart disease and chronic kidney disease, have also been implicated. Research leading to a better understanding the causes of male mortality will help the development of interventions that could help to reduce the risks. But we already know enough to justify the immediate introduction of male-targeted health promotion messaging about the importance of basic infection prevention measures.

Gender-responsiveness

In the longer-term, gender-responsive strategies and programmes to tackle other risk-taking behaviours and the prevalence of serious underlying conditions in men would also help. In fact, the need for such an approach has been called for by men’s health advocates repeatedly over many years pre-COVID-19.

There is an increasing quantity of robust evidence of what programmes work with men in a variety of settings – local communities, digital, sports venues, workplaces, and elsewhere – although policymakers and practitioners may still require practical guidance about their implementation.

Equity lens

A ‘equity lens’ is additionally needed to focus on those groups within the male population most at risk from the pandemic. Men who are most socially and economically disadvantaged have much higher mortality rates, as do men from black and ethnic minority communities. In England, black men are over 3.5 times more likely, and Asian men more than twice as likely, to die as white men. There are also additional risks for prison and homeless populations, most of whom are male. An approach to COVID-19 based on ‘proportionate universalism’ – resourcing and delivering universal services at a scale and intensity proportionate to the degree of need – should be an essential part of the public health response.

Mental health

There are a plethora of COVID-19 spin-off risks for men that also require action. Men’s social support networks, generally smaller than women’s and often linked to the workplace, are likely to be affected by lockdowns and the trend towards home-working. This could have significant mental health and wellbeing impacts for many. It is likely that financial hardship and unemployment will lead directly to increases in male suicide rates. This has certainly been the case in previous recessions. At the same time, many organisations that can help to mitigate these problems are unable to expand their services because of funding problems or to continue to deliver face-to-face activities because of social distancing rules.

The future

So far, gender-responsive actions on COVID-19 by governments have been minimal, not least for men. This is ‘par for the course’ given that most countries have historically overlooked men’s health. Just four countries – Australia, Brazil, Iran and Ireland – have national men’s health policies. An analysis of 35 national health policies in the member states of the WHO European Region found that the term ‘men’s health’ appeared just once.

Global Action on Men’s Health has recently published a report, From the Margins to the Mainstream, that aims to highlight the steps needed for successful advocacy on men’s health policy. It identifies a range of drivers for men’s health policy development. In addition to COVID-19, these include the generally increasing visibility of men’s health, helped by events like Movember, Men’s Health Week and disease-specific awareness-raising campaigns, including on prostate cancer and mental health, the growing acceptance of human rights-based approaches to health which, clearly, apply to each and every person whatever their sex and gender, and the Sustainable Development Goals (SDGs). 

A 30-year old man has a 150 per cent greater risk of dying from any of the four major non-communicable diseases (NCDs) before the age of 70 than women. It follows that the SDG commitment to reduce premature mortality from NCDs would be, if successfully implemented, particularly beneficial to the health of men and boys; equally, it cannot be optimally realized without an approach that takes account of the specific health needs and health behaviours of men and boys.  

The pandemic has shone a cruel but very bright light on health inequities in general and, from a men’s health perspective, revealed the need for systematic action on a problem that has for far too long been hiding in plain sight.  

This blog was first published on 27 July 2020 by the Gender and COVID-19 Working Group.

COVID-19 has very starkly laid bare the poor state of men’s health. Although men and women have roughly the same rate of infection, men are more likely to die in almost every country for which there is data. In several, men are about twice as likely to die. Read the rest of this entry »

Men’s risk of death from COVID-19 appears to be much greater than women’s. A major factor could be that men are more likely to be affected by one of the underlying NCDs that are known to increase mortality, such as hypertension, diabetes, cardiovascular disease and chronic obstructive pulmonary disease. Read the rest of this entry »

Men are much more likely than women to become seriously ill and to die as a result of COVID-19. The data from about 40 countries is stark: while infection rates are broadly similar between men and women, men are up to twice as likely to die.  Men account for 69% of deaths from COVID-19 in Italy and Ireland, 67% in Denmark, 65% in Germany, and 64% in China. Read the rest of this entry »

At long last, men’s health has edged on to the global health agenda – and not a moment too soon for those who have spent years calling for more attention to be paid to the health and wellbeing of men and boys. Read the rest of this entry »

Humen, the men’s mental health charity, has recently produced a short but very powerful video. It’s called ’20 Men 1 Question’. In it, 20 men are asked when they last cried. Many had not done so for years. Not talking about or expressing emotions, Humen suggests in the video, is linked to the high rate of suicide in men. Read the rest of this entry »

British men have died at a younger age than British women since at least the time of Queen Victoria’s accession and they will continue to do so for the foreseeable future. This is not some strange peculiarity of these islands: the pattern is repeated throughout every region of the world. There is not a single country where men outlive women. In both the UK and globally, there is currently a four-year difference in life expectancy between the sexes. Read the rest of this entry »