The issue of men's health merits specific attention as evidence grows regarding epidemiological differences that are observed between men and women. This is particularly related to men's premature mortality, which is associated with non-communicable diseases, and the morbidity related to men's health-seeking behaviours, their mental health and wellbeing, and violence.
In many key areas, men's health outcomes are worse than women's. The chief causes of men's poor health are associated with their risk-taking behaviours (eg alcohol, diet, smoking) and their under-use of health services. With regards to cancer, men are less aware than their female counterparts regarding the symptoms of potentially significant problems. In the UK, for 2016–2018, life expectancy at age 65 years was 18.6 years for men and 21.0 years for women (Office for National Statistics, 2019).
In the UK, unlike some other countries, there has been no strategic response to men's health problems. There is no national or local policy, and joint strategic needs assessments have not addressed gender as well as they could and should have done.
The Equality Act 2010 and the Health and Social Care Act 2012 have placed a duty on health services to address gender health inequalities, and this is also featured in the NHS Constitution (Department of Health and Social Care, 2015).
When there are ‘gender-sensitive’ health interventions that have been aimed specifically at men, these have been shown to improve men's outcomes. Taking seriously the unique needs of men in policy development, implementation and evaluation, including further expansion of nurse-led initiatives (in schools, hospitals, GP surgeries, clinics and so on), has the potential to make a difference to men's health.
Health inequalities
When making efforts to reduce health inequalities this means that everybody has to be provided with the same opportunities so that they are able to lead a healthy life, regardless of where they live or who they are. In England, people living in the least deprived areas are living around 20 years longer in good health than those people who are living in the most deprived areas. The existence of health inequalities is the antithesis to the principles that underpin social justice, as they are avoidable. Health inequalities do not occur randomly or by chance. They are determined socially by circumstances that are generally beyond a person's control. These disadvantages have an impact on people and limit their chance to live longer, healthier lives.
Public Health England (PHE), as is the case with other public bodies, has a duty, under the Equality Act 2010, to ensure that it gives consideration to the needs of all individuals when shaping policy and delivering services. When there are health inequalities, the right of everyone to experience the highest achievable standard of physical and mental health is not being enjoyed equally across the population. The Equality Act (2010) introduced nine ‘protected characteristics’:
- Age
- Disability
- Gender reassignment
- Marriage and civil partnership
- Pregnancy and maternity
- Race
- Religion or belief
- Sex
- Sexual orientation.
PHE are required to provide health intelligence for those groups which share protected characteristics, and this includes data regarding gender inequality. Tackling inequalities requires that more attention is given to those who are at greatest risk of poor health if the aim is to make a positive impact.
Gender
Gender, according to the Pan American Health Organization (2019), is a historically and culturally constructed set of characteristics, such as symbols and norms and roles that are sustained through the actions of societies, where the difference between women and men is based on biological characteristics and on alignment with a system of sex and gender. This goes towards explaining how those differences are translated into inequality between men and women. The sexual division of labour, for example, is based on these sex/gender differences.
Men and women undergo and live through different processes of socialisation, with both having unequal access to resources and experiencing different risks. The upshot of this is that it results in a wide range of health and social care problems, including differences in self-care and in the ways in which people seek help.
Men's health epidemiology
In the field of health and social care there has to be a relational gender perspective that provides a comparison of the health and wellbeing of men and women, informing how their individual situations can and do influence each other. It is important to remember that significant inequality is also experienced by women, and when making comparisons this could give the impression that women's health is the gold standard and the health of men is evaluated against this. Women also have many unmet health needs; it is women who bear the risks that are associated with, for example, pregnancy and childbirth.
‘Improved health services are needed for both men and women. It should never be about which sex is treated more unfairly.‘
Within the European region, men's life expectancy varies between countries by up to 17 years, and within-country the differences between men from various socioeconomic backgrounds remain stark.
Undertaking unsophisticated comparisons has the potential to lead to competition, and competition is often carried out in arenas that are already facing scarce resources. Improved health services are needed for both men and women. It should never be about which sex is treated more unfairly.
September 2019 marked the first anniversary of the World Health Organization (WHO) European men's health strategy (WHO, 2018a). Gender inequality in life expectancy still remains locally, nationally and internationally, despite decades of public health interventions to address this disparity. Within the European region, men's life expectancy varies between countries by up to 17 years, and within-country the differences between men from various socioeconomic backgrounds remain stark. Globally, life expectancy for men is 70.5 years compared with 75.6 years for women: the average world male life expectancy for men is 5.1 years less than for a female (Global Burden of Disease, 2017). There are disproportionally more male preventable diseases and more premature deaths in men between the ages of 30 and 69 years.
Despite numerous efforts to address the inferiority of men's health compared to women's using a variety of approaches, such as the engagement and establishment of third sector organisations, for example, charities that would include the Movember initiative, and in some countries, such as Ireland, Australia and Brazil, legislation, there still remains a considerable difference in gender-specific mortality rates.
The main contributors to male mortality are non-communicable diseases, for example, cardiovascular disease, cancer, diabetes, respiratory disease and injuries. In Europe, in 2015, these disorders in men accounted for more that 4 million male deaths (WHO, 2018b). When providing health services for women, these are gender-specific, such as breast screening, cervical screening and gynaecological services. Men's health care services, however, are often neither gender-specific nor streamlined.
Public health
Making changes such as stopping smoking, improving diet, increasing physical activity, losing weight and reducing alcohol consumption have the potential to help people significantly reduce their risk of poor health. One approach to changing behaviour is to make every contact count (Health Education England, 2020). The Making Every Contact Count initiative makes use of the millions of day-to-day interactions that health and social care organisations and health and social care staff have with other people as they encourage behaviour change. The overall aim is to have a positive effect on the health and wellbeing of individuals, communities and populations, locally, nationally and internationally.
In England, local Councils are well placed to influence lifestyle and they should be doing this as they exercise their duties to promote health, challenge inequalities, and ensure that there are robust plans in place to protect the population and to offer public health advice to NHS commissioners. Councils are in a position to scrutinise and add value to the way health services are planned and delivered by posing questions about men's health and actions that are being taken to improve it. The Centre for Public Scrutiny (an independent charity) promotes transparent, inclusive and accountable public services. In Table 1 the Centre for Public Scrutiny poses ten questions that need to be asked regarding men's health with a proposed nursing response.
Table 1. Ten questions that need to be asked regarding men's health along with the nursing response
| The questions | The nursing response |
|---|---|
| 1. What is the difference between male and female life expectancy in the different parts of our area? What is driving it? | Understanding the data in your area and comprehending what the influencing factors are |
| 2. Do we collect and report all health data by gender? Are there any data we do not report by gender? | Assessing own practice and determining if data are gender disaggregated, identify gaps |
| 3. Do we have any local research to determine health differences between men and women or boys and girls? | Audit, research and evaluation of service to inform gaps in service provision |
| 4. How many men and women use our weight loss services? Do we run the same programmes for men as women? | Assessment and evaluation of current service provision: are they available, do they engage men and women? |
| 5. What is the split in NHS Health Check uptake between men and women in our area? | Promoting NHS Health Checks, particularly to men most at risk, and increasing awareness of other screening programmes (chlamydia, bowel cancer and abdominal aortic aneurysm) available to men |
| 6. How do we join up services for men and women with a combined substance and mental health problem? Does a substance problem stop people being able to access mental health services? | Are your services accessible to those people with combined substance and mental health problems? |
| 7. What public health outreach programmes do we have to reach men? | Do services go to where men are, their workplaces, sports clubs, faith organisations, places of entertainment providing health education or check-ups? |
| 8. Are there any groups of men with particularly poor health? What services are available for them? | Are you aware of the needs of men who have particularly poor health and are services responsive to their needs? |
| 9. What is being done to promote better health awareness and health literacy among men and boys? | Ensuring that health clinics are ‘male-friendly’ and available at times men find most convenient, and men's health posters and leaflets are on display. Organising local health promotion activities linked to national events, such as Men's Health Week each June and Movember in November |
| 10. Who is responsible for men's health in your organisation? Do you have a strategy to tackle poor men's health? Do Commissioning Groups have a person responsible for tackling men's health? | Who is responsible in your organisation for men's health? Are you active in developing and influencing strategy? |
The public health role of the nurse has much to offer with regards to addressing the inequalities that men experience in health and social care. The ten questions posed in Table 1 are as applicable to nurses as they are to local councils.
Conclusion
Inequalities in men's health and the high rate of mortality from non-communicable diseases pose a large public health challenge locally, nationally and globally. This is disturbing considering that non-communicable diseases can be prevented through lifestyle changes along with early detection and treatment.
Gender blindness in any field is unacceptable. Gender matters in healthcare and we cannot delay any longer the need to address gender-related inequality. When gender inequality is addressed the benefits can have a positive impact on the health and well-being of all genders and all ages, as well as protecting human rights.
Practice nurses have a central role to play in the overall public health agenda and specifically with regards to addressing health inequalities.
KEY POINTS
- In many key areas, men's health outcomes are worse than women's. The chief causes of men's poor health are associated with their risk-taking behaviours (eg alcohol, diet, smoking) and their under-use of health services
- ‘Gender-sensitive’ health interventions aimed specifically at men have been shown to improve men's outcomes
- It is important to remember that significant inequality is also experienced by women, and when making comparisons this could give the impression that women's health is the gold standard and the health of men is evaluated against this
- When gender inequality is addressed the benefits can have a positive impact on the health and well-being of all genders and all ages, as well as protecting human rights