Men’s Health Week 2017: Tackling a global issue
Thursday, June 8th, 2017 |
Men’s Health Week 2017 kicks off very soon (on 12 June) and is a fantastic opportunity for men’s health organisations around the world both to engage men and to make the case for systematic action to tackle the many problems they still face.
At the global level, it is very clear that many key health outcomes are worse for men than for women. In 2015, average male life expectancy at birth was 69 years compared to 75 years for women. In 1980, male and female life expectancies were 60 and 64 years respectively. The ‘sex gap’ has therefore increased from four to six years over the past 40 years.
Male death rates are higher than for females for most causes globally. The overall age-standardized cancer incidence rate in 2012 was almost 25% higher in men than in women and the mortality rate was over 50% higher. A recent study of data for 26 countries found that, in 2010, coronary heart disease mortality was, on average, about four times higher in men than in women aged 30–60; the ratio declined to two times higher at ages 75–80.
This excess burden of male mortality is in part explained by the health practices of men. Worldwide, in 2015, five times as many men smoked than women. Total pure alcohol per capita consumption in 2010 was, on average, 21 litres for males and nine for females.
The under-utilisation of primary care services by men is a problem in many countries. In the European Union, infrequent use of, and late presentation to, such services has been associated with men experiencing higher levels of potentially preventable health conditions and having reduced treatment options.
Men tend to be less well-informed than women about health issues, including the symptoms of potentially life-threatening diseases. Women are more likely than men to recognise a range of common cancer symptoms, according to a study in England. In Uganda, research found that under half (46%) of men had heard of prostate cancer and only 10% had a good knowledge of the symptoms.
Men are not a homogenous group, however, and it is important to be aware of differences between men in different countries as well as between men within the same country. Male life expectancy varies hugely around the world, from 49 years in Sierra Leone to 81 years in Switzerland, a difference of 32 years. Smoking rates range from under 10% in Ethiopia to about 60% in Russia.
The proportion of professional men in the UK with four lifestyle risk factors was half that of unskilled manual men. Men who conform to ‘traditional’ masculine norms are more likely to take part in unhealthy behaviours, such as a poor diet and excessive alcohol consumption, and to have poorer mental health. In the USA, the life expectancy of a white boy born in 2014 was 77 years, about four years longer than that of a black or African American boy. There are also disparities for gay and bisexual men who, in the USA, are more likely to report severe psychological distress, heavy drinking and moderate smoking than heterosexual men.
There has not, as yet, been a strategic response to the health problems facing men either globally or in the overwhelming majority of countries. Only four states – Australia, Brazil, Iran and Ireland – have developed national men’s health policies. An analysis of the policies and programmes of 11 major global health institutions, including WHO, found that they did not address the health needs of men. A complementary study of 18 Global Public Private Partnerships for Health (e.g. GAVI, Global Road Safety Partnership and TB Alliance) reached similar conclusions. The European Commission did publish a major report on the state of men’s health in 2011 but it omitted any recommendations for action and has not yet led to any observable changes in policy or practice.
The World Health Organisation has adopted a human rights-based approach to health. Its Constitution enshrines ‘the highest attainable standard of health as the fundamental right of every human being’. There is therefore a clear ethical case for measures to improve the health of men as well as women. The UN’s Sustainable Development Goal 3 seeks ‘to ensure health and well-being for all, at every stage of life.’ This Goal specifically includes specific commitments to reducing by one third premature mortality from non-communicable diseases (NCDs), promoting mental health and well-being, strengthening the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol, and halving the number of global deaths and injuries from road traffic accidents. None of these goals can be achieved without taking account of the health of men.
Healthier men would reduce the economic costs of lost productivity and health treatments. Men’s premature mortality and morbidity has been estimated to cost the United States economy approximately USD 479 billion annually. An assessment of the cost-savings that would accrue in Canada if there was a 1% annual relative reduction in the proportion of middle-aged men who smoke tobacco, consume hazardous or harmful levels of alcohol and have excess weight in the period 2013-36 found that there would be a cumulative reduction in the country’s economic burden of over CAD 50.7 billion.
There is increasing evidence that appropriate action to address men’s health can make a difference. A review of Ireland’s national men’s health policy found that, although it was not successful in every aspect, real progress was made in increasing the focus on men’s health research, developing health promotion initiatives that support men to improve their health, tackling social isolation and disadvantage in men through community development work and developing men’s health training for health and other professionals.
The importance of gender-sensitivity in the design and delivery of health services to men has been highlighted in a study of the Football Fans In Training (FFIT) initiative in Scotland. The researchers concluded that FFIT demonstrated that ‘an evidence-based programme, gender-sensitised in context, content, and style of delivery, offers one strategy to support weight loss in men.’ The success of FFIT has led directly to the roll-out of a similar programme, EuroFIT, across 15 top-flight football clubs in Portugal, Norway, the Netherlands and UK supported by European Union funding of almost EUR 6 million.
During Men’s Health Week 2017, there will be a wide range of activities in many countries that will demonstrate the value of targeting men. Global Action on Men’s Health has also taken the opportunity to write to the new World Health Organisation Director-General, Dr Tedros Adhanom Ghebreyesus, to make the case for WHO addressing men’s health. As a first step, GAMH suggests that WHO convenes an expert symposium on men’s health followed by a report analysing the problems and recommending a range of solutions at the global as well as the national levels.
The case for action is clear as are many of the solutions. All that is missing is the political will to make a difference and it is therefore vital that men’s health advocates around their world continue their work, during Men’s Health Week and after, to demand action from practitioners, policymakers and politicians. Their failure to respond would leave too many men at risk of unnecessary suffering and would be unethical, unfair and unjustifiable.