Global Men's Health News editorial

Sperm counts have fallen by 52% globally since 1971, with male infertility now contributing to around 50% of infertility in couples. By 2050, 155 of 204 countries are projected to have fertility rates too low to maintain their population, resulting in both social and economic upheaval. While the underlying cause of declining male fertility remains to be fully understood, exposure to endocrine disrupting chemicals (such as microplastics, pesticides and flame retardants) in industrialised regions is

known to significantly negatively impact male reproductive functioning, and infertility is also associated with a range of physical health conditions in men, including cardiovascular disease.

Despite this global challenge, male infertility is neglected in policy and service provision on a global scale, as outlined in Out of Focus, GAMH’s recent report on gaps in provision for men in sexual and reproductive health (SRH) policy. Poor collection of data on men’s fertility globally means that regional and global public health institutions are not sufficiently informed about the issue, leading to reduced focus and interest in tackling low male fertility rates. Only 16% of analysed policies for this report refer to male fertility, with policy more likely to focus implicitly or explicitly on women’s fertility. Focus on fertility in SRH policy tends to be covered under discussions on family planning, where the priority is on managing fertility rates. There is no current body of global policy or frameworks with dedicated attention to addressing male or couple infertility.

Male infertility is associated with psychological challenges for men and their partners, and there is currently inadequate and poor-quality infertility treatment, services, support and information tailored to men or couples. Where fertility services do exist, they typically only serve women. In the USA, there are just 197 male infertility specialists to serve a national population of 162 million men and boys, and male infertility examinations in this context are not conducted in 25% of couple infertility cases, despite global consensus on the importance of examining both partners. Concurrently, erectile dysfunction (ED) rates are on the rise globally, especially among young men. Many of the underlying factors for ED mirror those of infertility, and these dovetailing factors contribute to an alarmingly rapid and multi-faceted decline in the quality of male SRH.

In the absence of appropriate services, many men turn to the private sector to diagnose or treat their infertility. The high costs associated with private sector health care create a two-tier system, where men with the financial resources can access fertility care and those without cannot. This gap is more pronounced in Global South contexts like The Gambia, where provision of adequate fertility care for men is fulfilled almost exclusively by the private sector. Meanwhile, the recent global emergence of ‘sperm tech’ providers – companies offering a variety of male fertility services, ranging from mail order sperm tests and sperm storage to semen analysis visualisation and tailored ‘fertility plans’ – in response to insufficient mainstream treatment options for men poses numerous health and ethics challenges, beyond affordability. The accuracy of home test results is considered to be less reliable than that of those conducted in laboratories and evidence of the effectiveness of many ‘sperm quality improvement’ approaches promoted by private providers is contested. Compounding this, these private services often do not adequately consider potential factors in reduced fertility beside sperm quality. While bolstered regulation and oversight of these providers is a crucial first step, demand for their services will not diminish until provision of comprehensive, accessible and affordable fertility services are secured for men and couples everywhere.

Tim Shand and Conor Evoy, ShandClarke Consulting

What do you think? Please let us know at office@gamh.org.

Enabling men to make more effective use of primary care services and to self-care better is a central feature of much men’s health work. One potential and innovative stepping stone to this goal is now being implemented, albeit currently on a small scale, in the United Kingdom by the Men’s Health Forum (Great Britain). It is based on a peer-to-peer approach with volunteer Health Champions trained to discuss health and wellbeing concerns with men in workplaces and local community settings and signpost them to services when appropriate. The model seems well suited to reduce the barriers to men’s engagement with health care and empower men to take more control over their health.

I have been delivering Men’s Health Champion training programmes in the UK with my Men’s Health Forum colleague Jim Pollard since 2019. Over 400 people have so far been trained, initially through face-to-face courses but, since the pandemic, almost entirely online. Participants are usually from workplaces, often large ones such as the military, transport companies and the health service or local schools and colleges, national or local charities and housing organisations. The interactive course, delivered in two two-hour sessions, covers common men’s health problems and their causes, the impact of lifestyle on men’s health, the role of Men’s Health Champions, how men can change their health behaviour, how to talk to men about their health and wellbeing, and how to signpost men to support and information. Attendees report significant increases in knowledge and confidence and an independent evaluation of the first tranche of training courses found they had a positive impact.

The Men’s Health Forum hopes to expand the online training programme to offer it more regularly to more people. To enable the initiative to reach its full potential, funding will be sought for marketing, the provision of low- or no-cost courses for disadvantaged groups, a train-the-trainers programme and also an independent evaluation of its impact over time. There are also plans for a greater level of ongoing support for course participants in their role as Champions. There is no reason why Men’s Health Champions should not also be trained up in countries besides the UK. The global impact could be significant.

My point here is not so much to commend the Forum’s work, although I do heartily, but to raise the issue of peer-to-peer working – ie men supporting other men – as something  to consider. It can provide a stepping stone to traditional services which is particularly important when those services are, for different reasons in different places, difficult to access at the best of times.

I recently wrote a paper on Men’s Health Champions. More information on the training courses delivered by the Men’s Health Forum is available here.

Peter Baker
Director

What do you think? Please let us know at office@gamh.org.

• Download the Australian report
• Download the UK report

Men’s Health Week is here: a time to be positive about men’s health

It’s International Men’s Health Week once again. In fact, this is the 30^th Men’s Health Week since its launch in the USA in 1994.

This is, I think, a good time to be positive about men’s health rather than focus, as we often do, on all the problems. There can be no doubt that, over the past 30 years, men’s health organisations, advocates and researchers have succeeded in pushing men’s health onto policy and research agendas and influenced the way many services are delivered. Eight countries now have national men’s health policies and we have good evidence of the impact such policies can have. There are currently active discussions about the introduction of a policy in the UK. The WHO European region published a men’s health strategy in 2018 and PAHO (the WHO region for the Americas) wants to see their adoption in more countries. The Movember Institute of Men’s Health was launched in December 2023 and will both accelerate research and translate it into practical real-world outcomes. It will complement the great work already being done at the Center for Men’s Health at Georgetown University, the University of British Columbia, the National Centre for Men’s Health in Ireland and elsewhere. We now have solid evidence of ‘what works’ in men’s health that we can use to convince politicians and policymakers that investing time and money in men’s health will make a difference.

The men’s health sector is building effective alliances with other organisations, often ones with more resources and influence. GAMH is working closely with the European Cancer Organisation, for example, and I co-chair its men and cancer workstream. There’s growing activity at the grassroots level, with Men’s Sheds just being one example. There are now Sheds in Australia (where the movement started), UK, Ireland, USA, Denmark, Canada, Sweden and New Zealand. The International Men’s Sheds Association estimates that some 1,800 Sheds are supporting 100,000 men worldwide. There’s been major progress on the clinical front too. Only last week research was announced showing that a spit test, which could be conducted at home, is more accurate at identifying prostate cancer for men at high genetic risk of the disease than the current standard blood test. This could lead to much earlier detection of aggressive cancers and much better outcomes for many men. Prostate cancer screening programmes are likely to be introduced across Europe in the next few years.

I could go on at length but I will mention just one more important positive development. As a movement, we are now talking less about men as a homogenous group and are focusing much more on specific groups of men with the worst health. This could apply to men in low-income countries and, in higher-income countries, to men who are ethnically and racially marginalised, on low incomes, gay/bisexual/transgender or homeless. This ‘intersectional’ approach is essential if we are to make an impact where it is most needed and to create more equitable outcomes.

This brief overview of what’s going well will, I hope, encourage all of us to continue our much-needed work. We clearly still have a long way to go and men’s health may not yet be mainstream but it is definitely no longer at the margins.

I wish our members, and the men they work with, a very happy Men’s Health Week.

Peter Baker
Director

Pioneering paper backs call for men’s health policies

This may be a first: a major paper in a prestigious medical journal has called for specific health strategies and national plans to tackle the ‘significant health challenges faced by males’. The authors stress that progress on health strategies for men has so far been slow with only a few countries publishing designated policies.

The paper, published this month in Lancet Public Health, looks at differences across the lifespan between females and males for the top 20 causes of disease burden globally and is based on an analysis of the Global Burden of Disease Study 2021 (see graphic above). It found that females are more likely to be affected by non-fatal conditions such as musculoskeletal conditions, mental health problems and headache disorders while males are disproportionally affected by conditions that lead to premature death, such as COVID-19, road injuries, cardiovascular disease and respiratory and liver diseases. It concludes that males face a higher disease burden overall.

The study recommends that policy initiatives ‘need to recognise the different health-seeking patterns of males and should, among other strategies, engage in cross-sectoral actions, including working with the social and education sectors to promote positive and healthy gender norms and roles at all levels of education, to address behavioural risks that are globally more common among males, such as smoking and alcohol use.’

GAMH and many of its members will continue to make the case for national men’s health policies as well as for more regional policies, following the example of the WHO European region which published a men’s health strategy in 2018. This Lancet paper adds hugely to the evidence-base that is needed to persuade governments to act and is a sign that our policy messages, for a long time somewhat niche, are now cutting through to wider audiences. The men’s health sector must take full advantage of this new research and the opportunity it presents.

Peter Baker
Director

Prostate cancer cases worldwide expected to double by 2040

One of the most significant and thorough reports in global men’s health to date was published by The Lancet on 4 April. It presents the findings of The Lancet Commission on prostate cancer: planning for the surge in cases. While we know, of course, that men’s health is about much more than prostates or even urology in general, it cannot be denied that prostate cancer is set to become a massive health issue. As the Commission report notes,  prostate cancer is already a significant cause of morbidity and mortality worldwide – it is the most common cancer in men in 112 countries – and the number of new cases is expected to double (from 1.4m to 2.9m a year) between 2020 and 2040. And there is no certain way of preventing this increase through public health interventions.

What the Commission proposes, therefore, is a range of strategies to deal with the problem. These include tackling late diagnoses, especially in low- and middle-income countries (with trials of screening in these countries), using artificial intelligence to aid the interpretation of scans and biopsy samples, developing outreach programmes that use smartphones as tools for prostate cancer education, researching the drivers of ethnic differences in disease prevalence (rates of prostate cancer are twice as high in men of African heritage compared to men of European origin), ensuring a more equitable distribution of treatments for advanced disease, and addressing the shortage of specialist surgeons and radiotherapy equipment. The Commission supports prostate cancer screening in high-income countries focused on men aged 45-69 in Black populations and 50-69 for others. Interestingly, because the rise in prostate cancer is likely to be mirrored by rises in other conditions such as diabetes and heart disease, the Commission suggests that early diagnosis programmes should focus not just on prostate cancer but on men’s health more broadly.

It is of course possible to quibble with some of the Commission’s findings. It is disappointing, for example, that there was so little emphasis on potential prevention measures, such as investigating the possible protective impact of HPV vaccination.  The age ranges proposed for screening programmes will also be too restrictive for some advocates in the prostate cancer field. But, overall, the Commission should be congratulated for a producing a comprehensive report of genuinely global relevance, for helping to raise the profile of prostate cancer and men’s health generally, and for providing the evidence that GAMH and other organisation can use in their advocacy work.

GAMH is currently working on a report on prostate cancer that is scheduled for publication in the fourth quarter of 2024. We will consult with our members on a draft as soon as it is ready. But, in the meantime, please tell us what you think of the Lancet Commission report, its strengths and weaknesses, and any issues you think we should be paying particular attention to. You can contact us at office@gamh.org.

Peter Baker
Director

Effective advocacy will improve men’s health

Last week, I attended the UK government’s new men’s health ‘task and finish’ group. Its role is to develop practical ways to improve men’s uptake of primary care services. The group is meeting at the same time as Parliament’s ‘Select’ Committee on Health and Social Care conducts an enquiry into men’s health and the Department of Health considers applications for the new role of men’s health Ambassador. Recently, the Prime Minister, Rishi Sunak, visited a Men’s Shed and the main opposition (Labour) party’s health spokesperson, Wes Streeting, announced his intention to introduce a men’s health strategy in the UK.

None of this happened by accident. It follows decades of sustained advocacy work by men’s health and other men’s organisations in the UK. This, in turn, builds on a growing body of scholarship and the practical experience of a range of community projects. But it is the advocacy element that is crucial. It brings the research and good practice to the eyes and ears of decision-makers, including government ministers, and makes it easier for them to see the advantages of taking action.

One of the main barriers to progress in men’s health worldwide has been the lack of advocacy work by the men’s health sector. Partly this reflects limited resources and capacity. It also reflects what it is possible to get funding for – generally service delivery, not campaigning – and an understandable belief that policy change in our field is just too difficult and takes too long to achieve.

But there are now signs of real change, and not just in the UK. Movember is investing heavily in policy development and advocacy across its six key national markets. Men’s health organisations in Denmark, the USA, Australia and elsewhere are actively engaged in advocacy. GAMH’s primary role is making the case for the policy changes that will improve men’s health at the international level. We are working with the European Cancer Organisation to push for HPV vaccination for boys to be introduced across the region.

If we are serious about achieving our goals, we need to intensify our advocacy effort and make a case that decision-makers can no longer ignore.

Peter Baker
Director

King Charles shows how men’s stories make a difference

Even the most vehement republican must acknowledge that the publicity surrounding the UK King’s recent health problems have highlighted men’s prostate and cancer issues to an unprecedented extent.

We are told King Charles, 75, underwent routine surgery for an enlarged prostate and, while in hospital, it was discovered that he also had cancer of a currently undisclosed type. The King has withdrawn from public duties while he receives treatment.

On the day after the announcement of his enlarged prostate, there were 16,410 visits to the relevant National Health Service website page compared with 1,414 visits the previous day. Prostate Cancer UK saw an almost doubling in the number of users of its online risk checker. For a while in the UK media, it was difficult to avoid urologists talking about the prostate and all the things that can go wrong with it.

Whether this will result in significantly more men being diagnosed earlier with prostate disease or cancer remains to be seen. But it is highly likely that the public discussion of the issues, combined with the King’s willingness to be open about his health, will at the very least have led to a greater awareness of the prostate and men’s health more generally. This can only be a good thing.

It shows the impact those in the public eye can have when they raise the profile of a health issue and, perhaps even more importantly, the power of people’s personal stories. These can be the stories of all of us, not just of the rich and famous. Men’s health organisations are very good at making a robust evidence-based case for change. But science, research, data, statistics, graphs and charts can only get us so far. It is the emotion and authenticity that comes with someone’s lived experience of a health problem as well as the empathy it can generate that can really cut through and make the difference.

Of course, it can be hard, for reasons we all understand only too well, to find men who are willing to share their stories publicly. But it is certainly not impossible and I’m convinced that the men’s health sector as a whole needs to get better at combining ‘hard’ evidence with lived experience if we are to make the progress we all want.

Peter Baker
Director