Policies that take account of men’s health are a critically-important first step towards the design, implementation and delivery of services that lead to better health outcomes. Progress on policy is urgently needed in light of the continuing unnecessarily poor state of men’s health globally: male life expectancy currently lags five years behind female life expectancy and the ‘gap’ is predicted to increase over the next 15 years. There are also emerging issues concerning a number of specific health issues, including prostate cancer which, globally, is now the second most commonly occurring cancer in men.

There has been some progress on engaging policymakers in men’s health in a few European countries (notably Ireland, where there have been two national men’s health policies since 2008) and also in Australia and Brazil, both of which also have men’s health policies.

The World Health Organisation (WHO) centrally has begun to take an interest in the impact of male gender norms on health, as shown in its recent report on primary health care and universal health coverage, but this has yet to result in any practical action. The WHO European region agreed a men’s health strategy in 2018 and the Pan-American Health Organisation (PAHO) published a report on masculinities and health in November 2019.

In most countries, despite the clear evidence that men’s health outcomes are unsatisfactory and represent a heavy burden on health services, limited progress has been made in engaging policymakers in men’s health and in embedding men’s health in health policy and practice. This is true of men’s health in general but also in respect of specific issues of particular relevance to men such as prostate cancer and suicide.

To accelerate progress towards the inclusion of men’s health into policy, new insights are needed into:

• The barriers to policymaker engagement in men’s health at all levels (internationally, nationally and locally).
• The potential impact of ‘male-friendly’ policies on men’s health, drawing on case-studies of existing policies on men’s health (e.g. in Ireland) as well as potential benefits elsewhere.
• Opportunities for advocacy work to advance men’s health policy.
• Strategies and tactics for effectively engaging policymakers.

This project examined these issues using a mix of qualitative and quantitative methods, including:

• A literature review of English language research. This will cover any evidence of policy specifically on prostate cancer or how the disease is included in national cancer plans.
• An online multinational survey of men’s health, prostate and other organisations, men’s health advocates, researchers and other relevant stakeholders. The target sample size for the survey is ≥100.
• A series of semi-structured interviews with key participants in a number of countries including men’s health and prostate organisations and advocates, researchers, health policymakers in and outside of government, and politicians. The target sample size for the interviews is ≥20.
• While the project was global in scope, its focus was on those regions and countries for which most information is available (primarily Europe, North America and Australia).

The project was funded by an educational grant of EUR 25,000.00 from Advanced Accelerator Applications (AAA), a Novartis company that is developing nuclear medicine treatments for cancer. AAA neither sought nor had influence on the project’s design, delivery or findings. The relationship between GAMH and AAA was at all times conducted in line with the ABPI Code of Practice for the Pharmaceutical Industry 2019 and GAMH’s ethical policy which governs its relationships with partner organisations, funders and other stakeholders.

The project was completed and the final report published in November 2020.

Men and self-care

In 2016, GAMH collaborated with Sanofi on the development of a comprehensive global survey. This was conducted among 16,000 demographically representative adults across eight countries (Australia, France, Germany, Italy, Poland, Sweden, the United Kingdom and the United States) and examined attitudes towards men’s health, in particular self-care. The report, Men’s Health: Perceptions from Around the Globe, was launched in November 2016 at a meeting in Brussels (Belgium) attended by policymakers and practitioners at which GAMH’s Director gave an introductory presentation.

More information about this project is available here.

GAMH continued to develop its relationship with Sanofi and funding was approved for a project on men and self-care. The project report, Who Self-Cares Wins: A global perspective on men and self-care, was published on 5 April 2019 to coincide with World Health Day.

The report demonstrates that the commonly-held idea that men are invariably self-destructive when it comes to their health is not true – globally, most men do enough physical activity to benefit their health and do not smoke or drink alcohol – but it also very clearly shows that men’s health is unnecessarily poor. Average global life expectancy for men lags behind women’s by four years (70 v 74 years) and there is not a single country where men live longer than women. Around half of the sex difference in mortality from all causes in Europe is due to smoking and around one fifth is due to alcohol consumption. Globally, about 45% of male deaths are due to health behaviours, according to the Institute for Health Metrics and Evaluation. Improving men’s self-care could therefore lead to major improvements in their health.

Who Self-Cares Wins shows that male gender norms are a key barrier to better self-care for men with men who most closely identify with ‘traditional’ masculinity most likely to exhibit damaging lifestyle behaviours. But health policies and services have not taken men into account. Only three countries have specific national men’s health policies (Australia, Brazil and Ireland). Most global health organisations do not address men’s health either. The report argues that while it is clearly the responsibility of individual men to take care of their own health, strategies to improve men’s health cannot simply be based on exhortations to change lifestyle practices that are rooted in gender norms and other social determinants of health. Who Self-Cares Wins argues that action on a multi-layered and systems-wide basis is needed to improve men’s self-care effectively.

The report’s recommendations include the introduction of health policies, including national men’s health policies, that recognise the needs of men; that full account is taken of male gender norms in policy and service delivery; the establishment of self-care as a strategic priority in public health policy and practice; action to improve men’s health literacy; the development of health services that are more accessible to men; better training in men’s health for health and related professionals; and accelerated research into improving men’s engagement in self-care and better practical guidance for policymakers and practitioners.

The report’s author and GAMH Director, Peter Baker, said: ‘It is indisputable and unacceptable that men’s health is unnecessarily poor in every country in the world. This is in large part due to male gender norms, which lead many men to take risks with their health, and the failure of policymakers and service providers at all levels to take account of men’s specific needs, attitudes and behaviours. That’s why, on World Health Day, we are calling on global and national health leaders to introduce the policies and services that would make a difference.’

Dr David Webber, President of the International Self-Care Foundation, said: ‘In the self-care field as elsewhere, men’s health has been generally overlooked. This report provides a very welcome synthesis of the key issues and clearly shows that there is now enough evidence from research and examples of good practice to make the changes that are needed. Measures to improve men’s self-care should be an essential part of the effort to improve overall health outcomes.’

15 July 2021