It is surely time for a men's health strategy in the UK. Or, rather, a strategy for each of the UK's nations. Seven other countries—including our nearest neighbour, Ireland—already have men's health strategies or policies. The UK Government has also signed up to World Health Organization (WHO) Europe's regional men's health strategy (WHO Regional Office for Europe, 2018). A Women's Health Plan for Scotland was published in August (Scottish Government, 2021) and a women's health strategy for England is being developed (Department of Health and Social Care, 2021). A complementary approach is now required for men.
The case for action is clear. Around one man in five still dies before the ‘traditional’ retirement age of 65, with cancer, suicide and cardiovascular disease being the biggest killers of working-age men in the UK (Men's Health Forum, 2021). Men make up 70% of patients in critical care with COVID-19 and account for 57% of all deaths (Public Health England (PHE), 2020). The pandemic has actually reduced male life expectancy, by 1.3 years in England (PHE, 2021).
One of the main reasons for men's poor COVID-19 outcomes is that they are more likely to have one of the underlying health problems, such as hypertension, diabetes or lung disease, which increases vulnerability to the virus (Tharakan et al, 2021).
Some sub-populations of men, such as those on low incomes or who are rough sleepers or disabled, are much more likely to have higher levels of all-cause morbidity and mortality. In Blackpool's Bloomfield ward, one of the most deprived in England, male life expectancy is just 67 years (Blackpool Health and Wellbeing Board, 2021). Black Caribbean men were almost three times more likely as white men to die from COVID-19 during the first wave of the pandemic in England (PHE, 2020).
Men take more risks with their health than women. They are much more likely to drink alcohol at hazardous levels, to use illegal drugs, to consume too little fruit and vegetables, and to add too much salt to their food, as well as to eat more red and processed meat. They are less likely than women to follow COVID-19 prevention guidelines and to wear a mask, wash their hands or get vaccinated.
Men are 32% less likely than women to visit a GP. Despite being 75% of suicides, men make up just 33% of those referred to Improving Access to Psychological Therapies (IAPT) ‘talking therapies’ (Office for National Statistics, 2021; Baker, 2021a). Men comprise 76% of premature deaths from heart disease, but only a minority of those attending NHS Health Checks. Bowel cancer is more common in men than women, but men are less likely to take part in the national screening programme.
‘One of the main reasons for men's poor COVID-19 outcomes is that they are more likely to have one of the underlying health problems, such as hypertension, diabetes or lung disease, which increases vulnerability to the virus’
The causes of men's health problems are complex. We know their premature mortality is not primarily caused by biology, although that plays some part in men's susceptibility to heart disease at a relatively early age and their weaker immune response to COVID-19. Of greater significance is the impact of male gender norms. These constitute the ‘playbook’ that boys and men are expected and exhorted to follow (Ragonese et al, 2019). Risk-taking is encouraged, while admitting vulnerability and asking for help is stigmatised. Ragonese et al (2019) suggested that self-sufficiency and emotional control, acting tough and risk-taking, feeling superior to other men, having many (female) sexual partners, exercising power and control over women and other men, a belief that a muscular body is attractive, and having a fixed belief in ‘traditional’ male and female roles, are among the masculine norms that can affect many men's health outcomes. They also, of course, impact on the lives of those around them.
The historic neglect of men's health by policymakers and service providers is another key factor. The health system has not taken account of the problems facing men in the way services are configured and delivered, particularly the accessibility of primary care to men of working age. Public health campaigns, including those on COVID-19, have not adopted the techniques used by commercial marketeers for years to persuade men to buy colognes, drinks and cars. And there has been no sustained effort, essential for long-term change, to inform and educate boys and young men about health and how to use services.
Systematic action is now needed to ‘level up’ men's health, to use a phrase currently popular with the Government. A national men's health strategy should be the first step. Other countries with such strategies have found that, while they are not a panacea, they have proved a catalyst for action and contributed to improved health outcomes. Perhaps tellingly, since Ireland introduced its strategy in 2008, men there have experienced a significantly bigger increase in life expectancy than men in the UK (Baker, 2021b).
The All Party Parliamentary Group on Men and Boys is currently looking into the merits of a strategy and is expected to recommend one to the Government when it reports later in January. In the meantime, the Men's Health Forum, along with other organisations that work with men, launched a campaign for a strategy on 19 November, International Men's Day.
Nurses have been significantly involved in men's health. The Men's Health Forum was established by the Royal College of Nursing in 1994 and nurses have played a leading role in many innovative local men's health programmes, including the Bradford and Airedale Health of Men initiative, the Preston Men's Health Project and many others (Baker, 2018). The role of nurses in men's health must form part of the strategy and, hopefully, nurses and their organisations will add their support to the campaign.
The pandemic has spotlighted the urgent need for action on men's health. If not now, when?