Men’s health: the case for global action
Monday, June 25th, 2018 |
Men’s health has for too long been a problem hiding in plain sight at both the global and national levels. Men’s poor outcomes, not least in terms of premature mortality, are obvious but have not been addressed effectively by either policymakers or practitioners. There are now, at last, some signs of change – but are they enough to make a difference?
The scale of the challenge is clear. Globally, in 2015, average male life expectancy at birth was 69 years, according to WHO data. Sierra Leone had the lowest life expectancy for males at 49 years and another 29 countries, almost all in Africa, had a life expectancy below 60 years. By comparison, average global life expectancy for females was 74 years. The difference in life expectancy between men and women globally has widened by about 30% since 1970.
Men are more likely than women to die from cancer, cardiovascular disease, suicide, road traffic accidents, and other major causes of death. They are more likely to smoke, drink alcohol excessively, and eat a poor diet. In many countries and for many diseases, men use primary care services less effectively than women.
The irrefutable human-rights-based case for addressing men’s health aside, there is a very powerful economic case for doing so. Men’s premature mortality and morbidity has been estimated to cost the US economy alone approximately US$479 billion annually.
Improving men’s health would also affect women’s health, most obviously in the case of sexual health. High male mortality rates adversely affect women, especially in lower-income households and countries, through the loss or incapacity of the primary breadwinner, usually a man. Addressing men’s alcohol and drug misuse would contribute to a reduction in male violence against women as well as against children and other men.
The recently-published 2018 Global Health 50/50 Report, which looked in detail at 140 global health organisations, found that fewer than one-third define gender in a manner that is consistent with global norms (ie, relevant to men as well as women). None of the 40 NGOs in the sample focused exclusively on the health of men and boys; this, the report’s authors comment, “speaks to the need for organisations to truly adopt a gendered approach to programmes and strategies in realising the right to health for everyone”.
Blind spot, a UNAIDS report published on World Aids Day 2017, showed that, globally, men are less likely to take an HIV test, less likely to access antiretroviral therapy and more likely to die of AIDS-related illnesses than women.
The report urges HIV programmes to make services more easily available to men by extending operating hours, using pharmacies to deliver health services to men, reaching men in their places of work and leisure, including sports clubs, and developing new communications technologies, such as mobile phone apps.
The potential role of gender-sensitivity in the design and delivery of health services to men has been demonstrated by the Football Fans in Training (FFIT) weight-loss initiative in Scotland, the first large-scale men’s health programme evaluated by a randomised controlled trial. The success of FFIT has led directly to the roll-out of a similar programme, EuroFIT, across 15 top-flight soccer clubs in Portugal, Norway, the Netherlands and the UK.
Prompted by the Sustainable Development Goals and their focus on non-communicable diseases and gender equality, WHO-Europe is currently developing its first men’s health strategy. This is due in September 2018 and, although it is not binding on the 53 member states in the region, it could act as a catalyst for action both within and beyond Europe.
The strategy will hopefully call for the development of national men’s health policies; currently, these exist in just four countries (Australia, Brazil, Iran, and Ireland). A review of the Irish policy showed that its impact had been considerable.
In the UK, Leeds City Council has shown what is achievable at the local level following a needs assessment and a range of actions to improve men’s use of services.
Whether or not more governments introduce men’s health policies, a more systematic approach to gender and men’s health is now needed. All health policies must be gender-proofed, data sex-disaggregated, men’s needs more fully researched, professional training enhanced, and services reconfigured to ensure maximum accessibility. Attention must be paid to intersectionality to help identify groups of men at particular disadvantage, such as homeless men, migrants and some ethnic communities.
Non-governmental organisations and men’s health advocates can be engaged through multi-disciplinary local and national networks; lay people must also be involved, for example as local men’s health champions. The Lancet and other major journals must pay more attention to men’s health and also to women’s health.
Anything less will leave too many men around the world at continued risk of an unnecessarily unhealthy life and an untimely death.
This blog was first published in The Lancet Global Health on 17 April 2018.