Gender, COVID-19 and NCDs: Illuminating men’s neglected vulnerability
Friday, May 15th, 2020 |
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.
It was clear well before the advent of COVID-19 that any serious attempt to tackle the burden of NCDs cannot ignore men’s health. Globally in 2016, the risk of a 30-year old dying from one of the four major NCDs before reaching 70 was 22% for men and 15% for women, according to WHO data.
Male physiology has a part in this, but health behaviours are a more significant factor. Globally, about one-third of men smoke, almost six times the proportion of women. On average, men consume over three times as much alcohol each year, and the male mortality rate from suicides is twice as high. Men also tend to underuse health services and seek help less frequently.
These behaviours are, in turn, heavily influenced by male gender norms. Although masculinity takes different forms in different times and places, there are some widely-shared key characteristics, sometimes referred to as ‘The Man Box’. Men are typically expected to be independent, self-sufficient, physically strong, and heterosexual; to have sexual prowess, to act tough, and to use aggression to resolve conflicts. Those men who are most firmly in the ‘Box’ are much more likely to put their own health at risk.
A gendered response to NCDs
The gendered nature of NCDs requires a gendered response. Some important one-size-fits-all ‘gender blind’ solutions – such as tobacco control measures – benefit men disproportionately because they are affected most by the health behaviours being targeted. But interventions that take account of male gender norms are also essential.
There is now a good evidence-base pointing to the effectiveness of gender-based interventions aimed at men, whether they are delivered online, at workplaces, in local communities, or via sports stadia. Football Fans in Training is a good example of a ‘lifestyle’ programme – in this case, weight management – which uses soccer to target men specifically. Based at Scottish professional football clubs, it has achieved significant participation and resulted in a range of positive outcomes.
At the structural level, action is needed to improve men’s health literacy through the school curriculum, media and targeted information campaigns. Men’s use of services can be improved by changes that align them better with men’s lives, for example by introducing more flexible opening times for primary care services that make it easier for full-time workers to attend. Professional training in gender is also essential.
Men’s health policies can also focus attention and have a catalytic effect on service development for men’s health. So far, four countries (Australia, Brazil, Iran and Ireland) have introduced national men’s health policies and WHO’s Regional Office for Europe has published a men’s health strategy for its 53 member states. Policies are not a panacea, but the evidence points to positive impacts. An analysis of Brazil’s policy found that the promotion of paternity and prenatal consultations as entryways to engage men has been particularly effective.
Building a culture of promoting men’s health
As yet, initiatives to improve men’s health in relation to NCDs, as well as more widely, are far from mainstream. A recent analysis of the gender-related policies and practices of around 200 global health organisations found that none focuses specifically on men. If the Sustainable Development Goal on health and wellbeing is to be met, the international public health community must pay greater attention to men, especially those sub-groups of men who, because of their location, income, race, sexuality or other indicator of disadvantage, have the poorest health outcomes.
COVID-19 has illuminated many stark inequities in health, including men’s experiences of NCDs. The health problems affecting men can no longer be overlooked. But the need for action on men’s health must not detract from parallel efforts to improve women’s health, nor from the continuing need to recognise and tackle the many areas of public and private life where men remain privileged and dominant. Both sexes have an inalienable right to the best possible health and to gender equality.
This blog was first published on 20 April 2020 by the NCD Alliance.