Men's Health: A Global Problem Hiding in Plain Sight

Thursday, March 24, 2016

Men’s health is surely one of the most significant public health problems to have been largely overlooked by policymakers and practitioners. This is despite the clear evidence of poor outcomes for men.

  • In the United States in 2013, male life expectancy at birth was 76 years compared to 81 years for females.
  • There was a similar 5-year gender gap in Western Europe (the respective figures were 79 and 84) and globally (69 and 74).
  • The gap is actually getting wider at the global level and is expected to reach 7 years by 2030.

There are groups of men who experience outcomes that are of particular concern:

  • White males in the United States have a life expectancy of 77, but the figure for Black males is just 72.
  • In Australia, males from the indigenous Aboriginal and Torres Strait Islander population have a life expectancy of 69 years, some 11 years lower than that of the nonindigenous male population.
  • Males in the most socioeconomically deprived areas of England have a life expectancy (74 years) 9 years shorter than males in the least deprived areas. They also spend a smaller proportion of their shorter lives in good health (71% compared to 85%).

Men Portrait

Why is men’s health poor?

The reasons for poor male health are not primarily biological. They are the result of risky health behaviors (e.g., tobacco, alcohol, an inadequate diet), exposure to hazards at work, low symptom awareness, and suboptimal use of health services, especially primary care. Men who conform most closely to male gender role norms are much more likely to take risks with their health and delay seeking help. Men also tend to have limited social networks, especially when they are older, and are reluctant to discuss their health and well-being with others. This increases the risk of mental illness and makes it less likely that they will be advised or encouraged to seek help for any kind of health problem.

Men’s health is overlooked

Even though the World Health Organization (WHO) and others have for many years advocated “gender mainstreaming” in health policy and practice, men have remained largely invisible. Most governments, as well as global agencies like WHO, the World Bank, and the Bill & Melinda Gates Foundation, are focused primarily on the health of women. The Office on Women’s Health in the U.S. Department of Health and Human Services was established in 1991, but there is no equivalent Office on Men’s Health. Women’s health is hugely important, of course, especially given the multiple disadvantages they face, but this does not necessitate a lack of attention to men’s health. The health of men and women need not be seen as a zero sum game.

Better men’s health is good for women

In fact, improving men’s health would be good for women too. Healthier men would be productive for longer, contributing more to family incomes, and would have less need of caring support, most often provided by their female partners or daughters. Men with better mental health and lower levels of alcohol misuse are less likely to perpetrate gender-based violence. Longer male life expectancy would also leave fewer wives, partners, sisters, and mothers grieving for the men they have lost prematurely.

…And saves money

Better men’s health would save a considerable amount of money. Men’s premature mortality and morbidity costs the U.S. economy an estimated US$479 billion annually, while the economic burden associated with smoking, excess weight, alcohol, and physical inactivity in Canadian men has been estimated at about US$27 billion a year.

The ethical case for action

More important is the ethical case for action. The WHO Constitution states, “The highest attainable standard of health [is] a fundamental right of every human being.” Now that the evidence base for tackling men’s health is increasingly robust—gender-sensitive interventions have been shown to reduce men’s risk taking, improve their use of health services, increase their participation in screening programs, and enhance their mental health and well-being—the development of coherent and sustained strategies on men’s health must be seen as a moral imperative.

Signs of change

There are some signs that the message is beginning to get through:

  • Since 2009, three governments (Australia, Brazil, and Ireland) have published national health policies on men’s health.
  • The Men’s Health Forum in England and Wales is one of a small number of NGOs to have been designated a strategic partner of the Department of Health.
  • In the United States, in January 2016, the White House, in partnership with the Department of Health and Human Services, the Men’s Health Network, and Disruptive Women in Health Care, hosted a men’s health symposium with speeches from Cabinet Secretary Broderick Johnson and Surgeon General Dr. Vivek Murthy.

A WHO report on the social determinants of health in Europe argued that national governments should develop strategies that “respond to the different ways health and prevention and treatment services are experienced by men and women…and ensure that policies and interventions are responsive to gender.” The head of WHOs Gender, Equity, and Human Rights Unit has suggested that gender, including the male one, should be taken into account in the implementation of the United Nations’ recently agreed-upon 17 Sustainable Development Goals.

Next steps

So what should happen next? The following five actions would make an enormous difference:

  • Global health organizations and national governments addressing the health and well-being needs of men and boys in all relevant policies and through the introduction of overarching national men’s health policies.
  • Men and boys being encouraged and supported to take better care of their own health as well as the health of their partners and children.
  • Health practitioners taking greater account of the specific needs of men and boys in service delivery, health promotion, and clinical practice. Improving men’s access to primary care is a particular priority, especially for mental health problems.
  • Other agencies and organizations, such as schools and workplaces, becoming more aware of their significant potential role in improving the health of men and boys.
  • Sustained multidisciplinary research into the health of men and boys.

In short, men’s health must become a public health priority. Better health for all cannot be achieved if the many problems currently facing men are left hiding in plain sight.

The Widening Gap

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