Men’s Health – an overlooked global health inequality

Thursday, August 16th, 2018 |

Men’s health – one of the biggest health inequalities but one of the least talked about. Globally, in 2016, average male life expectancy at birth was 70 years, according to WHO data.  Lesotho had the lowest life expectancy for males at 51 years and Switzerland had the highest at 81 years, a difference of 30 years or almost 60%. 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.

Some groups of men are particularly susceptible to health problems, such as men who are gay or bisexual, transgender, migrants, prisoners, homeless or living on a low income. Men who are from certain ethnic groups are also more vulnerable. In the USA in 2016, non-Hispanic black males had an age-adjusted death rate of 1,081 per 100,000, almost 25% above the rate for non-Hispanic white males (880 per 100,000). Men from indigenous populations (e.g. in Australia, Canada and New Zealand) are also at particular risk.

Men are generally 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.

Women’s health is, of course, far from perfect and major investment is needed in interventions that will help. But a complementary effort is also required for men in order to tackle the particular challenges facing them.

Men’s health problems are caused, in large part, by gender role norms. Men have been socialised to view health and well-being as ‘women’s issues’ and therefore not for them. Risk-taking is seen by many as a way of demonstrating maleness. In rural India, for example men’s use of tobacco is closely linked to their perception that a ‘real man’ should be daring, courageous and confident and able to demonstrate his manliness by smoking. A study of men in Russia suggested that heavy drinking of strong spirits ‘elevates or maintains a man’s status in working–class social groups by facilitating access to power associated with the hegemonic ideal of the real working man.’ Asking for help and acknowledging vulnerability can feel shameful. There is also an expectation that men will undertake particularly hazardous work such as mining, construction and military service.

There is a parallel assumption by health policymakers and practitioners that men’s risky behaviours are somehow unpreventable and that men are simply incapable of accessing services appropriately. There is also a belief that men’s health and women’s health are binary opposites and that, when it comes to investment and effort, a choice between the two must be made as if they are in a zero sum game. In fact, they are completely interdependent and it is clear that improving men’s health will significantly benefit women by limiting sexually transmitted infections, reducing men’s dependency on female carers, improving family incomes and impacting on violence linked to mental health problems and substance misuse.

There is also a strong human rights case for addressing men’s health – the WHO constitution says ‘the highest attainable standard of health’ is ‘a fundamental right of every human being’ – and it would be very cost-effective for health systems and the wider economy. One estimate puts the annual cost of male morbidity and mortality at USD 479 billion for the USA alone.

There is growing evidence of how health services can be designed and delivered ways that engage men. In Scotland, for example, the Football Fans in Training programme, evaluated by means of the gold-standard tool of a randomised controlled trial, found that diet and physical activity programmes delivered through top-flight soccer clubs were highly successful. This intervention has also been rolled out in other European countries and adapted for use by hockey clubs in Canada.

Grassroot Soccer uses football to educate and mobilize at-risk young people (male and female) in several sub-Saharan African countries to overcome health challenges and live healthy lives. Its SKILLZ curriculum uses football-based activities to encourage healthy habits and equitable gender norms among teenage boys and it assists with referrals to various health services, including sexual and reproductive health services.

There are now signs that men’s health is beginning to be taken more seriously. Four countries have developed national men’s health policies – Australia, Brazil, Iran and Ireland. WHO-Europe, which covers 53 countries, is preparing a men’s health strategy that is expected to be approved in September. UNAIDS has identified that a male-targeted approach is needed if the burden of HIV and AIDS on men is to be tackled effectively. Around 20 countries have recently extended their HPV vaccination programmes to cover adolescent boys as well as girls because it will help to reduce the incidence of the cancers caused in both sexes by HPV as well as genital warts.

But there is still a long way to go. One recent analysis, The Global Health 50/50 Report, looked at the gender-related policies of 140 major organisations working in and/or influencing the field of global health. Its analysis showed that only 40% of organisations mention gender in their programme and strategy documents and that just 31% define gender in a manner that ‘is consistent with global norms’ (i.e. a focus on men as well as women and also on the structures and systems that determine gender roles and relationships).

A game-changer for men’s health could be the UN’s Sustainable Development Goals. These include a commitments to reduce premature mortality from non-communicable diseases and road traffic accidents as well as to tackle substance misuse. These problems are experienced disproportionately by men and cannot be properly addressed by a response that fails to engage them. This opportunity to tackle an issue, the health and wellbeing of men and boys, that has for too long been hiding in plain sight must not be missed.

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