What gravestones can tell us about global men’s health

Tuesday, February 9th, 2016 |

I’ve been working as an advocate in the men’s health field for over 20 years but there are still moments when the significance of what I’m trying to do strikes me in a new and different way. About six months ago, when I was walking through the cemetery near my home in Brighton, on England’s south coast, I started to notice the inscriptions on the headstones of couples who had been interred side-by-side.

In virtually every case, in graves dating from 1900 onward, the husband died first and at a much younger age than his wife. Of course, it’s hardly news that men die younger than women but what was different about seeing the headstones was that it made real and human what is normally discussed as a population-wide statistic. The graves were telling a story about ordinary people’s lives, not just about the men who usually died unnecessarily young but also about the women who were left alone, often for decades, to deal with the emotional as well as the practical consequences of bereavement.

It’s all-too easy in my role as an advocate, especially when talking to large NGOs, governments, and international bodies like the WHO, to use the abstract language of human rights and health policy or to refer to large-scale data. But this overlooks the individual men – the fathers, brothers, sons, husbands, and partners – I aim to represent. The experiences of individual men should sit alongside the hard evidence at the forefront of the case for tackling men’s poor health and their unacceptably high risk of an early death.

One of the first men I talked to about men’s health, back in the 1990s, was a man in his 30s who had all the classic symptoms of testicular cancer but did nothing until he mentioned them to his wife. She insisted he see a doctor but, by that time, the cancer had spread to his abdomen and pelvis and he was fortunate to survive. Another man told me that, in his early 60s, he was working very long hours, eating badly and not taking any exercise. He began to experience extreme tiredness which he put down to stress and ignored for as long as he could. He then developed rectal bleeding which he dismissed as being caused by haemorrhoids. Again, it was his wife who finally persuaded him to seek help; a large rectal tumour was discovered which subsequently spread to his lungs.

More recently, I heard the story of a man in his 20s, who from a very young age, had learnt, especially from his father, that boys and men should not show their feelings. Following a diagnosis of schizoaffective disorder, he was on the verge of taking his own life by jumping off a bridge when he was persuaded by a stranger that he could actually get better. He stepped back from the brink and the encounter proved to be a turning point in his recovery.

These stories could be from men in virtually any country in the world. They very neatly illustrate men’s often risky lifestyles, their unwillingness to share their health worries or their feelings, and their reluctance to approach health services. These behaviours help to explain why there is no country where male life expectancy exceeds female life expectancy and why, globally, age-specific mortality rates are falling much more slowly in men than women.

The better news is that we now know that this is not inevitable. Men’s health can be improved. Again, rather than refer to academic evaluations of good practice, I’ll mention a group of men who live in a deprived city suburb and have joined a healthy eating and fitness programme. This is aimed specifically at men and run by a local community centre in partnership with a professional soccer club.

The men told me that the program, which runs over 10 weeks, has improved their knowledge of health issues and helped them make more informed choices. Several have lost weight, reduced their ‘bad’ cholesterol levels and blood pressure, and improved their fitness. The men also described how their self-esteem and self-confidence have been boosted. They all feel that the male-targeted soccer dimension to the program has helped motivate them to participate.

This project, and others like it, show that men can and will respond to well-designed interventions that aim to improve their health. They can begin to overcome the constraints imposed by male role norms around health and self-care. But men’s health improvement projects are currently few in number; many more are urgently needed in communities, workplaces, and sports and leisure venues. We should also take action to improve men’s use of mainstream health services, especially primary care which, to many men, appears to be a service mainly for women and children.

More governments should follow the lead taken by those of Australia, Brazil, and Ireland, the only ones to have introduced national men’s health policies to date. International health organisations, not least the WHO, should also act to ensure that their work on gender really is about gender, i.e. men as well as women. Until now, gender mainstreaming has, in effect, largely been about women’s health. This has recently been recognised by UNAIDS which, together with Sonke Gender Justice and the International Planned Parenthood Foundation, organised a high-level symposium which looked at the need for a global shift in the discussion on HIV and gender so that it becomes more inclusive of men and encourages their greater positive engagement in all aspects of the AIDS response in order to improve their outcomes and to reduce vulnerability among women.

We have become so accustomed to men’s health problems and their early deaths that they are almost seen as the norm. There are only nine countries that now have a life expectancy for men of 80 years or more, headed by Iceland where a boy born in 2012 can anticipate living for just over 81 years. The fact that global life expectancy for boys currently stands at just 68 years shows just how much effort is still required to tackle male health inequities. Until that happens, cemeteries around the world will continue to reflect the death toll among men who have left behind their families and friends far too soon.

This article was first published by Global Health Hub on 8 February 2016.

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