The scale of the global challenge in men's health

The good news

Health outcomes

Male life expectancy at birth has improved significantly over the past 40 years with the global average increasing from 56 years in 1970[1] to 70 years in 2016.[2] In 2016, life expectancy for men was 80 years or more in 15 countries.

Healthy life expectancy at birth – the number of years that someone can expect to live in good health – also increased for men, from 58 years to 62 years between 2005[3] and 2016.[4]

Men’s health practices

Many men’s health practices are beneficial to their health. A clear majority – three quarters – of men globally are not smokers, for example, and the global prevalence of smoking in men fell by an average of 2% a year in the period 2005-2015.[5].

Around 60% of men globally do not currently drink any alcohol[6] and the proportion of male non-drinkers aged 16-24 in England specifically increased from 16% to 25% between 2005 and 2015, a trend also reported for some other countries.[7] Around three-quarters of men globally do enough physical activity to benefit their health.[8]

Many men monitor their health status and make conscious decisions about when and how to seek help.[9] The notion that men generally do not use, or largely avoid, primary care health services is also a myth.[10] They attend primary and secondary care services in large numbers. Men also attend health checks and use screening services. In the UK, for example, eight out of 10 men aged 65 take up the offer of screening for abdominal aortic aneurysms.[11] There is evidence that differences in consultation rates in primary care between male and female patients in receipt of medication for cardiovascular disease and depression are relatively small.[12]

Men generally want to take charge of their health and four men in every five feel as confident as women when it comes to managing their own health, according to an international survey of men’s health in which 16,000 adults across eight countries participated,[13] In a separate survey, 90% of men in Ireland indicated that they like to be very involved in decisions about their own health and the medicines they take.

Health policies

Many national and international health organisations are now showing a greater interest in addressing men’s health issues. WHO Europe’s new men’s health strategy for its 53 member states is of particular significance.[14] Ireland updated its national men’s health policy in 2017[15] and Australia is developing a new policy for 2020-2030.[16] UNAIDS has recommended a range of gender-sensitive policy and practice responses to tackle the burden of HIV and AIDS on men.[17]

The problems

Health outcomes

In 2016, average global male life expectancy lagged behind women’s by four years.[18] There was not a single country where men lived longer than women. About 70 countries had a life expectancy ‘sex gap’ of five years or more and two countries, Lithuania and Russia, had a gap of over 10 years. In Russia, a baby boy born in 2016 is expected to live for 66 years and a baby girl for 77 years.

The sex gap is widening. In the 40 years between 1970 and 2010, adult mortality fell by 34% in women and 19% in men globally. The gap between adult male and female mortality widened by 27% in that period.[19] It is projected that, by 2030, the difference in life expectancy between men and women will increase to seven years.[20] A separate, more recent study predicts a sex gap of six years by 2040.[21]

Life expectancy varies greatly between men in different countries. In 2016, life expectancy for men was 81 years in Switzerland, the highest in the world, but 60 years or under in over 20 countries (the lowest was 51 years in Lesotho).

There are significant differences in male life expectancy within countries. Average male life expectancy in the UK was 80 years in 2016, 10 years above the global average, but men living in one deprived neighbourhood in the town of Blackpool had a life expectancy of 68 years.[22] In a much more affluent neighbourhood in the town of Bracknell, life expectancy was 90 years.

Race is also very relevant. In the USA, for example, African American males have a life expectancy (71 years) that is approximately eight years shorter than that of Hispanic males (79 years) and about five years shorter than that of White males (76 years).[23] African American males living in poverty are at the greatest risk for overall mortality.[24] In Australia, the indigenous Aboriginal and Torres Strait Islander male populations have an estimated life expectancy of 69 years, 11 years lower than that of non-Indigenous men.[25] Roma men in the Czech Republic and Hungary live about 10 years fewer than non-Roma men.[26]

Men’s health practices

Men generally have lower health literacy levels than women. A study of British adults found that men were twice as likely as women to have limited health literacy.[27]

Men are more likely to kill themselves than women. Globally, the suicide rate for men in 2016 was 14 per 100,000 compared to 8 per 100,000 for women.[28] The highest rate for men was in Europe at 25 per 100,000 compared to 7 per 100,000 for women.

Men are more likely than women to drink alcohol at risky levels or use illegal drugs and this, at least in part, may be an attempt to cope with mental health problems.[29] (Alcohol and drug use in men is covered in more detail below.) Men are also more likely to be at-risk or problem gamblers[30] or to report an addiction to pornography.[31] There is evidence that men are more likely to be affected by so-called ‘workaholism’.[32]

Men generally have less healthy diets than women. Fruits, vegetables, nuts/seeds and whole grains were, on average, less heavily consumed by men than women globally in 2010.[33] Men are generally less likely to have practices that avoid risks to their health. Adult men are still more than five times more likely to smoke than adult women.[34] Over 15 countries have an age-standardised male prevalence rate of 50% or more for tobacco smoking with the highest rate (78%) in Timor Leste. Gay and bisexual men are more likely to smoke than heterosexual men.[35]

Globally in 2016, around 39% of adult men drank alcohol compared to a quarter of women (25%).[36] On average, men consumed just under two ‘standard drinks’ a day, well over twice the amount consumed by women. (One standard drink is equivalent to 10g of pure alcohol.)

Many men take significant risks with their sexual health and, consequently, put their sexual partners at risk too. Men generally have more sexual partners than women, are more likely to acquire a STI, and are more reluctant to practice safer sex, especially condom use. Less than 60% of adult men in 13 low- and middle-income countries said they used a condom at last sex with a non-regular partner.[37]

Men generally under-use health services, particularly primary care services. Studies from around the world – including Australia,[38] Malaysia,[39] Malawi,[40] Suriname,[41] UK,[42] North America[43] and the European Union[44] – show that men are less likely to seek help from primary healthcare services than women. Men are particularly reluctant to seek help for mental health problems.[45]

Men in the UK are less likely to participate in free health checks designed to detect undiagnosed cardiovascular disease and diabetes or the risk factors for these conditions.[46] Men are also less likely to have an eye health check.[47] Despite being at greater risk of bowel cancer, men are less likely to take part in screening programmes. One international review of 15 programmes in 12 countries found that women had higher participation rates in 14 programmes.[48] The sex difference was greatest in Finland, with a 75% participation rate among women compared to 60% among men.

Health policies

There has been a marked lack of interest in men’s health by the world’s most influential global health institutions. An analysis of the policies and programmes of 11 such organisations, including WHO, found that they did not address the health needs of men.[49] A complementary study of 18 Global Public Private Partnerships for Health (e.g. GAVI, Global Road Safety Partnership and TB Alliance) came to similar conclusions.[50] An assessment of the World Bank’s gender policies and its financing for gender programmes in the context of global health found that it had given little emphasis to the needs of males.[51]

A study by the Global Health 50/50 initiative, based at the University College London Centre for Gender and Global Health, looked at the gender-related policies of 140 major organisations working in and/or influencing the field of global health.[52] Its analysis showed that:

  • Only 40% of organisations mention gender in their programme and strategy documents
  • Most organisations (66%) do not define gender in their institutional policies
  • 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)
  • Only 55% of organisations state a commitment to gender equality in their strategies or policies
  • 34% state a commitment to gender equality to benefit all people (women and men)
  • 21% state a commitment to gender equality to benefit women and girls exclusively
  • 65% of organisations do not disaggregate their programme data by sex

The report argued that ‘many global health organisations still operate with a narrow view of gender and its relationship to health …. It is important to again emphasise that the concept of gender is not interchangeable with women …. A focus on the health of women forms part of and is complementary to, but not synonymous with, the promotion of gender equality in health.’

The omission of men from the agendas of international health organisations is mirrored at the national level. Only three countries – Australia, Brazil and Ireland – are known to have published national men’s health policies. While all three policies have had a positive impact, they have also been criticised for a range of problems pertaining to governance, implementation and monitoring as well as a lack of resources.[53] Governments in some other countries – including Canada, Denmark and the UK – have funded men’s health organisations and projects but not adopted a systematic approach.

The policy vacuum around men’s health has meant that relatively few services are actually targeted at men or delivered in a way that meets men’s needs. Men often find conventional primary care services difficult to access.[54] Booking systems can be hard to use and appointments may not be available at convenient times, often because of work commitments.[55] The increasing number of men working in the insecure ‘precariat’ sector of the economy may well find it even harder to take time off work for medical appointments.

REFERENCES

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[2] WHO. Life expectancy and Healthy life expectancy. Data by WHO region. 2018. http://apps.who.int/gho/data/view.main.SDG2016LEXREGv?lang=en (accessed 26 November 2018).

[3] GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1603-1658. doi: 10.1016/S0140-6736(16)31460-X.

[4] WHO. Life expectancy and Healthy life expectancy. Data by WHO region. 2018. http://apps.who.int/gho/data/view.main.SDG2016LEXREGv?lang=en (accessed 26 November 2018).

[5] GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017;389(10082):1885-1906. doi: 10.1016/S0140-6736(17)30819-X.

[6] GBD 2016 Alcohol Collaborators.  Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018;392(10152):1015-1035. doi: 10.1016/S0140-6736(18)31310-2.

[7] Fat LN, Shelton N, Cable N.  Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005–2015. BMC Public Health 2018;18(1):1090. doi: 10.1186/s12889-018-5995-3.

[8] Guthold R, Stevens GA, Riley LM, et al. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Global Health 2018 6(10):1077-1086. doi: 10.1016/S2214-109X(18)30357-7.

[9] Vincent AD, Drioli-Phillips PG, Le J, et al. Health behaviours of Australian men and the likelihood of attending a dedicated men’s health service. BMC Public Health 2018; 18(1):1078. doi: 10.1186/s12889-018-5992-6.

[10] MacLean A, Hunt K, Smith S et al. Does gender matter? An analysis of men’s and women’s accounts of responding to symptoms of lung cancer. Social Science and Medicine 2017;191:134-142. doi: 10.1016/j.socscimed.2017.09.015.

[11] Public Health England. NHS Abdominal Aortic Aneurysm Screening Programme: Annual data tables 2016-17. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/671364/AAA_screening_annual_data_tables_1_April_2016_to_31_March_2017.xlsx (accessed 26 November 2018).

[12] Wang Y, Hunt K, Nazareth I, et al. Do men consult less than women? An analysis of routinely collected UK general practice data. BMJ Open 2013;3:e003320. doi: 10.1136/bmjopen-2013-003320

[13] Sanofi Consumer Health Care (2016). Men’s Health: Perceptions from Around the Globe: A survey of 16,000 adults. http://gamh.org/wp-content/uploads/2016/11/Men4Selfcare_Report.pdf (accessed 26 November 2018).

[14] WHO Europe (2018). Strategy on the health and well-being of men in the WHO European Region. http://www.euro.who.int/__data/assets/pdf_file/0003/378165/68wd12e_MensHealthStrategy_180480.pdf (accessed 26 November 2018).

[15] Health Service Executive (2016). National Men’s Health Action Plan: Healthy Ireland – Men (HI-M) 2017-2021. Working with men in Ireland to achieve optimum health and wellbeing. Department of Health; Dublin, Ireland.

[16] Commonwealth Department of Health (2018). National Men’s Health Strategy 2020-2030:Draft for Public Consultation. https://consultations.health.gov.au/population-health-and-sport-division-1/online-consultation-for-the-national-mens-health-s/supporting_documents/Draft%20National%20Mens%20Health%20Strategy.pdf (accessed 27 November 2018).

[17] UNAIDS (2017). Blind Spot: Reaching out to men and boys. Addressing a blind spot in the response to HIV. http://www.unaids.org/sites/default/files/media_asset/blind_spot_en.pdf (accessed 27 November 2018).

[18] WHO. Life expectancy and Healthy life expectancy. Data by WHO region. 2018. http://apps.who.int/gho/data/view.main.SDG2016LEXREGv?lang=en (accessed 26 November 2018).

[19] Rajaratnam JK, Marcus JR, Levin-Rector A, et al. Worldwide mortality in men and women aged 15–59 years from 1970 to 2010: a systematic analysis. Lancet 2010;375(9727):1704-1720. doi: 10.1016/S0140-6736(10)60517-X.

[20] GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117-71. doi:10.1016/S0140-6736(14)61682-2.

[21] Foreman, KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet 2018;392(10159):2052-2090. doi: 10.1016/S0140-6736(18)31694-5.

[22] Office for National Statistics (2018). Health state life expectancy by 2011 Census wards, England and Wales: 2009 to 2013. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/articles/healthstatelifeexpectancyby2011censuswardsenglandandwales/2009to2013/pdf (accessed 27 November 2018).

[23] American Psychological Association Working Group on Health Disparities in Boys and Men (2018). Health disparities in racial/ethnic and sexual minority boys and men. http://www.apa.org/pi/ health-disparities/resources/race-sexuality-men.aspx (accessed 27 November 2018).

[24] Zonderman AB, Mode NA, Ejiogu N, et al. Race and Poverty Status as a Risk for Overall Mortality in Community-Dwelling Middle-Aged Adults. JAMA Internal Medicine 2016;176(9):1394-1395. doi:10.1001/jamainternmed.2016.3649.

[25] Australian Institute of Health and Welfare (2018). Deaths in Australia. https://www.aihw.gov.au/reports/life-expectancy-death/deaths/contents/life-expectancy (accessed 27 November 2018).

[26] European Commission (2014). Roma Health Report: Health status of the Roma population. Data collection in the Member States of the European Union. https://eige.europa.eu/resources/2014_roma_health_report_en.pdf (accessed 27 November 2018).

[27] Wagner CV, Knight K, Steptoe A, et al. Functional health literacy and health-promoting behaviour in a national sample of British adults. Journal of Epidemiology and Community Health 2007;61:1086-1090. doi: 10.1136/jech.2006.053967.

[28] WHO. World Health Statistics data visualizations dashboard. http://apps.who.int/gho/data/view.sdg.3-4-data-reg?lang=en (accessed 29 November 2018).

[29] Rochlen AB, Paterniti DA, Epstein RM, et al. Barriers in diagnosing and treating men with depression: a focus group report. American Journal of Men’s Health 2009;4(2):167-75.  doi: 10.1177/1557988309335823.

[30] Merkouris SS, Thomas AC, Shandley KA, et al. An Update on Gender Differences in the Characteristics Associated with Problem Gambling: a Systematic Review. Current Addiction Reports 2016;3(3):254-267. doi: 10.1007/s40429-016-0106-y.

[31] Rissel C, Richters J, de Visser RO, et al. A Profile of Pornography Users in Australia: Findings From the Second Australian Study of Health and Relationships. The Journal of Sex Research 2017;54(2):227-240. doi: 10.1080/00224499.2016.1191597.

[32] Snir, R, Harpaz, I. The workaholism phenomenon: A cross-national perspective. The Career Development International 2006;11(5): 374-393. doi: 10.1108/13620430610683034.

[33] Micha R, Khatibzadeh S, Shi P, et al. Global, regional and national consumption of major food groups in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys worldwide. BMJ Open 2015;5:e008705. doi: 10.1136/bmjopen-2015-008705.

[34] WHO. World Health Statistics data visualizations dashboard. http://apps.who.int/gho/data/view.sdg.3-a-data-reg?lang=en (accessed 29 November 2018).

[35] Fallin A, Goodin A, Lee YO, et al. Smoking characteristics among lesbian, gay, and bisexual adults. Preventive Medicine 2014;74:123-30. doi: 10.1016/j.ypmed.2014.11.026.

[36] GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018;392(10152):1015-1035. Doi: 10.1016/S0140-6736(18)31310-2.

[37] UNAIDS (2017). Blind Spot: Reaching out to men and boys. Addressing a blind spot in the response to HIV. http://www.unaids.org/sites/default/files/media_asset/blind_spot_en.pdf (accessed 27 November 2018).

[38] Australian Institute of Health and Welfare. The health of Australia’s males.  https://www.aihw.gov.au/reports/men-women/male-health/contents/access-health-care (accessed 3 December 2018).

[39] Tong SF, Low WY, Ng CJ. Profile of men’s health in Malaysia: Problems and challenges. Asian Journal of Andrology 2011;13(4):526-533. doi: 10.1038/aja.2010.125.

[40] Yeatman S, Chamberlin S, Dovel K. Women’s (health) work: A population-based, cross-sectional study of gender differences in time spent seeking health care in Malawi. PLoS ONE 2018;13(12): e0209586. doi: 10.1371/journal.pone.0209586.

[41] Smits C, Toelsie JR, Eersel M, et al. Equity in health care: An urban and rural, and gender perspective; the Suriname Health Study. AIMS Public Health. 2018;5(1):1-12. doi: 10.3934/publichealth.2018.1.1.

[42] Baker P. Men’s health: an overlooked inequality. British Journal of Nursing 2016;25(19):1045-1057. doi: 10.12968/bjon.2016.25.19.1054.

[43] Rosu MB, Oliffe JL,Kelly MT. Nurse Practitioners and Men’s Primary Health Care. American Journal of Men’s Health 2017;11(5):1501-1511. doi: 10.1177/1557988315617721.

[44] White A (2011). The state of men’s health in Europe. Extended report. https://ec.europa.eu/health/sites/health/files/state/docs/men_health_extended_en.pdf (accessed 3 December 2018).

[45] Lindinger-Sternart S. Help-Seeking Behaviors of Men for Mental Health and the Impact of Diverse Cultural Backgrounds. International Journal of Social Science Studies 2015;3(1). doi: 10.11114/ijsss.v3i1.519.

[46] Coghill N, Garside L, Montgomery AA, et al. NHS health checks: a cross- sectional observational study on equity of uptake and outcomes. BMC Health Services Research 2018;18(1):238. doi: 10.1186/s12913-018-3027-8.

[47] Dickey H, Ikenwilo D, Norwood P, et al. Utilisation of eye-care services: The effect of Scotland’s free eye examination policy. Health Policy 2012;108(2-3):286-293. doi: 10.1016/j.healthpol.2012.09.006.

[48] Klabunde C , Blom J , Bulliard J-L, et al. Participation rates for organized colorectal cancer screening programmes: an international comparison. Journal of Medical Screening 2015;22(3):119-126. doi: 10.1177/0969141315584694.

[49] Hawkes SBuse K. Gender and global health: evidence, policy, and inconvenient truths.  Lancet 2013;381(9879):1783-7. doi: 10.1016/S0140-6736(13)60253-6.

[50] Hawkes S, Buse K, Kapilashrami A. Gender blind? An analysis of global public-private partnerships for health. Globalization and Health 2017;13:26. doi.org/10.1186/s12992-017-0249-1.

[51] Winters J, Fernandes G, McGivern L, Sridhar D. Mainstreaming as rhetoric or reality? Gender and global health at the World Bank. Wellcome Open Research 2018;3:18. doi: 10.12688/wellcomeopenres.13904.1.

[52] Global Health 50/50 (2018). The Global Health 50/50 Report: How gender-responsive are the world’s most influential global health organisations? London, UK.

[53] Baker P (2015). Review of the National Men’s Health Policy and Action Plan 2008-13: Final Report for the Health Service Executive. www.mhfi.org/policyreview2015.pdf (accessed 19 December 2018).

[54] Coles R, Watkins F, Swami V et al, What men really want: A qualitative investigation of men’s health needs from the Halton and St Helens Primary Care Trust men’s health promotion project. British Journal of Health Psychology 2010;15:921-939. doi: 10.1348/135910710X494583

[55] Lopes RCC, Luiz FS, Barbosa ACS, et al. Sociodemographic profile of men users of primary care and health. Revista de Enfermagem da UFPI 2018;7(3):29-34. doi: 10.26694/2238-7234.7329-34.

‘Men have long been forgotten in the provision of primary healthcare services’ - article in @NursingTimes by nurse consultant Jane DeVille-Almond.

We welcome Kenton Boston to his new role at @menshealthfdn and look forward to working with him to promote men's health in Canada and beyond.

On 22 April, we’ll host the first free masterclass of the #PROTECTEUROPE project, with Margaret Stanley of @IPVSociety and Beatriz Serrano Carro of @ICO_oncologia

Do you want to learn more about the epidemiology of HPV?

Register at: https://www.europeancancer.org/events/287:protect-europe-masterclass-epidemiology-hpv.html

#EIW2024

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