Peter Baker

My Review of Ireland’s National Men’s Health Policy 2008-13 is now available. The Review was commissioned by the Health Service Executive.

Ireland was the first country in the world to adopt a national men’s health policy (followed by Australia and Brazil). Given the relatively recent emergence of ‘men’s health’ as an important public health issue, the Irish government’s recognition of the need to address it at the strategic policy level was clearly a very far-sighted and significant step and has been widely recognised as such.

In brief, I found that:

• Male life expectancy at birth in Ireland is improving and has risen faster for men than women since 1991.
• There are major inequalities in outcomes between different groups of men. Men living in deprived areas or who are homeless, Travellers, gay, farmers or agricultural workers generally do worse.
• Further work in the field of gender-specific policy and practice is needed if progress in improving the health outcomes of men and boys is to be maintained.
• There is now a widely-shared view among men’s health researchers and advocates around the world that health policies and practices that take account of sex and gender differences are more likely to lead to improvements in outcomes. Many also take the view that dedicated national men’s health policies can achieve additional improvements.
• There was a consensus among those consulted during the course of the Review that, overall, the National Men’s Health Policy (NMHP) made a significant and far-reaching contribution to making the issue of men’s health more prominent and providing a framework for action. However, its impact has been stronger in some areas of activity than others and very weak in some.
• Most progress has been towards achieving three of NMHP’s 10 Strategic Aims:

1. Promoting an increased focus on men’s health research in Ireland.
2. Developing health promotion initiatives that support men to adopt positive health behaviours and to increase control over their lives.
3. Building social capital within communities for men.

• There has also been good progress in the development of men’s health training for health and other professionals.
• Less progress has made in achieving these seven Strategic Aims:

1. Developing appropriate structures for men’s health at both national and local level to support the implementation of the policy and to monitor and evaluate its implementation on an ongoing basis.
2. Developing health and social services with a clear focus on gender competency in the delivery of services (with the exception of the development of training).
3. Supporting the development of gender-competent health services, with a focus on preventative health.
4. Targeting specific men’s health policy initiatives in the home that accommodate diversity within family structures and that reflect the multiple roles of men as husbands/partners, fathers and carers.
5. Developing a more holistic and gendered focus on health and personal development in schools, out-of-schools settings and colleges within the context of the Health Promoting School and college models.
6. Targeting the workplace as a key setting in which to develop a range of men’s health initiatives that are based on consultation and partnership-building with employers, unions, workers and other relevant statutory bodies.
7. Increasing the availability of and access to facilities for sport and recreation for all men and safe social spaces for young people.

• Key areas of difficulty were inter-Departmental collaboration, funding, and the sheer number and scope of the specific policy recommendations and action points (there were 118 action points in total).
• The specific issue of men’s health is absent from Healthy Ireland (the new public health policy) and there is no significant discussion of gender differences in the sections of the policy addressing health inequalities or elsewhere.
• The Review found very strong support for the continuation of a dedicated national policy on men’s health.
• Most men’s health advocates, as well as government officials and others, also take the view that men’s health must be addressed within the Healthy Ireland.
• Healthy Ireland has the high-level political support and the governance and implementation structures that make it much more likely that it will successfully achieve its goals through co-ordinated cross-sectoral activity.

Recommendations

• The Department of Health (DoH) and the Health Service Executive (HSE) should commit themselves to the joint development of a Men’s Health Action Plan.
• Men’s health must be addressed not only in a separate document but also within other policy areas under the Healthy Ireland umbrella.
• The Men’s Health Action Plan should focus on a relatively small number of specific and achievable priorities that are aligned with the wider priorities of Healthy Ireland.
• The implementation of the Men’s Health Action Plan should be accountable to the governance structures for Healthy Ireland.
• A senior official in DoH’s Health and Wellbeing Programme team should have lead responsibility for men’s health policy. At least one full-time staff post within HSE should have executive responsibility for implementing the Men’s Health Action Plan.
• HSE should institute a transparent and ring-fenced annual budget to support a range of local and national activity on men’s health, including the development of Men’s Health Forum in Ireland (MHFI). The Men’s Development Network (MDN) should also continue to be funded by HSE and other organisations to deliver its men’s health programmes.
• DoH should develop a business case to support inter-Departmental implementation of the Action Plan.
• A Men’s Health Action Plan Implementation Group should be established with a diverse and inclusive membership from all sectors, including DoH and HSE.

Ireland was the first country to adopt a distinct national men’s health policy. It now has an opportunity to continue its leadership in this field by being the first to mainstream men’s health throughout the comprehensive approach to improving public health embodied in Healthy Ireland.

My Review did not comment on possible lessons for other countries but I am certain that national men’s health policies, if backed by sufficient resources, robust implementation structures and political will, have the potential to create a vision and an identity for men’s health’ and act as a blueprint and a resource for practitioners and continuing health policy and practice development.

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