Leave No Man Behind

Monday, June 13th, 2016 |

Many health outcomes indicators are worse for men than women but men’s health is often overlooked by global and national health organizations. In this blog, I argue that there is a strong ethical, economic and social case for new approaches that address the needs of men and justify their inclusion in the dialogue about the implementation of the new Sustainable Development Goals.

Men’s health is a global health issue that few organizations and activists seem ready to discuss. This is despite a mass of readily-available evidence showing the health burden borne by men. Recent WHO data shows that, globally, there is a five-year life expectancy gap between the sexes (69 years for men, 74 for women) and there is not one country in the world where men outlive women. The gap between the sexes has actually widened since 1970 and is expected to increase further by 2030 – by then, male life expectancy could well be seven years shorter than female life expectancy. Africa is the WHO region with the lowest male life expectancy at 58 years. Sierra Leone has the poorest life expectancy for men in the world at 49 years. There are 27 countries in the world with male life expectancy below 60; 26 of these are in Africa (the only non-African country is Afghanistan).

Men fare poorly on a wide range of health measures. The global age-standardised cancer incidence rate for men is 205 per 100,000 and the male mortality rate is 126; the respective figures for females are 165 and 83. The global suicide rate in men is almost twice that in women; the European region has the biggest male: female ratio (4:0). Male smoking rates are higher than female with the biggest sex gaps in low- and middle-income countries. In Indonesia, 76% of men smoke compared to 4% of women. Men make up about 90% of road traffic fatalities in urban areas in Bangladesh, a country with one of the highest road death rates in the world. There are similar figures in other low- or middle-income countries, although, of course, in some societies this reflects restrictions on the ability of women to leave their homes.

But the problems facing men have not been addressed by most national governments or international health organisations. Only Australia, Brazil and Ireland have introduced national men’s health policies. Most other governments have been largely silent on the issue and, as Sarah Hawkes and Kent Buse have shown, ‘global health policies and programmes focused on prevention of and care for the health needs of men are notably absent.’ The UN’s new Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) has been criticized for overlooking boys – ‘boys matter too and are in danger of being left behind’, said a Lancet editorial – and at the recent G7 Summit in Japan world leaders made important commitments to improving women’s health but did not mention men.

This approach has been evident in the global response to the HIV epidemic. Although about 50% of those living with HIV and 60% of AIDS-related deaths are male, insufficient action has been taken to tackle men’s later presentation to HIV services, their lower rates of HIV testing and their poorer compliance with antiretroviral treatment.

There are several reasons for the neglect of men’s health. Since it is clear that women face many significant health problems, along with other, multiple social disadvantages, they have understandably been seen as a global health priority. I believe that men may also have forfeited sympathy because of the role of many in perpetrating gender-based violence and other forms of discrimination against women, including often denying them access to healthcare.

But there is not a simple binary choice to be made between addressing men’s and women’s health. This need not be a zero sum game. In any event, improving men’s health would also be good for women’s health. In lower-income households and countries in particular, the loss or incapacity of the primary breadwinner, usually a man, can have a hugely detrimental effect on partners and children. They may have to take on caring responsibilities, limiting employment and educational opportunities and reducing current and future income.

The Sustainable Development Goals concerning health – which include smoking, road traffic accidents and substance misuse – are unlikely to be achieved without taking men into account. Men’s premature mortality and morbidity costs the United States economy some GBP £335 billion annually while the economic burden associated with smoking, excess weight, alcohol and physical inactivity in Canadian men has been estimated at about GBP £18 billion a year. Tackling men’s health therefore makes good economic sense too. Overlooking men’s health burden is, moreover, a contravention of the basic human rights set out in the WHO Constitution.

These arguments are now being made by men’s health organizations working in Europe, North America, Southern Africa and Australasia. Many of these are now members of the Global Action on Men’s Health, a new NGO which seeks to raise the profile of men’s health with both national governments and international health organizations. These groups have highlighted the increasingly robust evidence-base for gender-sensitive interventions that can reduce men’s risk-taking, improve their use of health services, enhance their mental health and wellbeing, and encourage them to be more actively involved in the health of their partners and children.

The case for action on men’s health at a global level will be highlighted during International Men’s Health Week (13-19 June 2016). Men’s health organizations and activists will be hoping that WHO and other global health agencies will soon decide to pay due attention to a problem that has for too long been hiding in plain sight.

This blog was first published by IHP on 10 June 2016.

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