Do we need a men’s health strategy in the United Kingdom?

‍The following statement represents the views of TRTed on why a men’s health strategy makes sense.

Robust health systems serve as the cornerstone for achieving universal health coverage, ensuring essential diagnostic and treatment procedures are accessible to individuals of all ages, genders and ethnic backgrounds. However, universal health coverage includes not only the availability of these services but other factors such as affordability, accessibility, and the overall quality of healthcare delivery, making it a multifaceted challenge. Left unaddressed, gender inequalities in health and disease awareness, and in the availability of routine health check-ups and treatment can lead to sub-optimal health systems with an excess of preventable deaths and morbidity. Cross-national research in high to low-income countries shows that gender inequalities on both sides are embedded in our health systems universally, and rarely addressed. ^1–3  

In recent decades, researchers have shed light on how health services have approached care consistent with traditional gender norms.⁴ For instance, valuing women based on their reproductive roles and caregiving responsibilities for children while viewing men as strong and less in need of care.⁴ But this may now be changing. The recent decision to establish a women's health strategy in parliament is welcomed across the United Kingdom. This strategy acknowledges the importance of gender-specific health initiatives aimed at improving women's health outcomes. Questions remain, however, on whether any government plans are in place to address the increasing burden of men’s health issues. In the United Kingdom, the life expectancy of males has fallen for the first time in over 40 years, from 79.2 years in 2015–2017 to 79 years in 2018–2020.⁵ 17.5% of all male deaths are during the healthy age bracket of 15 to 65 years old, compared to 11.4% of female deaths.⁶ Further, it is estimated that almost double the number of deaths in men are preventable (36% in men vs. 19% in women).⁷  

Why Do Men Have Worse Health Outcomes?

The disparity in health outcomes and preventable deaths cannot be attributed to a single cause. Many health conditions that disproportionately affect men, such as cardiovascular disease,⁸ obesity,⁹ and diabetes,¹⁰ are not inherently male-specific. Additionally, the high rate of male suicides makes the issue more complex and deep-rooted.¹¹ Furthermore, male-specific conditions often go untreated and misdiagnosed, including sexual health, hormone, and fertility-related diseases.

Experts and activists advocate for a comprehensive, integrated approach that addresses the root causes of these health disparities, which is actively being explored in the United Kingdom. Numerous studies propose explanations for why men are disproportionately affected by chronic diseases and have a higher number of preventable deaths. In fact, an integrated review shared a thematic structure on the overarching themes responsible for disparities in health outcomes.¹²

Masculine Traits are Incompatible with Help-Seeking Behaviours

Consistent trends show that men are less likely to seek help due to feelings of embarrassment and shame of health problems, low symptom awareness, and working in roles that are not conducive to daytime health check-ups. Men's reluctance to engage in help-seeking behaviours often stems from their adherence to traditional notions of masculinity. This fosters traits such as stoicism, invulnerability, and self-reliance, which are all incompatible with help-seeking.¹² Research by the American Psychological Association found that men who strongly embody stereotypical masculine behaviours tend to experience worse mental health outcomes.¹³ Multiple studies have found that just the act of healthcare-seeking is seen as a sign of weakness and vulnerability by some men. ^14.15

To highlight this issue, a recent survey in the United Kingdom of 90 men with hypogonadism (a condition that dramatically impairs quality of life) found more than half (55%) waited 3–24 months before seeking medical advice for symptoms. More concerningly, 35% waited for more than 2 years, with 41% citing ‘‘feeling embarrassed’’ as the reason.¹⁶ While these masculine traits can help individuals overcome challenges, they can also decrease the likelihood of seeking help when it is genuinely needed. Conforming to traditional masculine ideals may lead to unique manifestations of symptoms when problems eventually arise. Self-reliance may lead to self-medication through unhealthy coping mechanisms, such as alcohol and drug use, binge-eating, workaholism, and pursuing multiple romantic partners, all of which can contribute to the observed disparities in chronic diseases among men.¹²

The prevalence of serious health diseases continues to increase across men and women in the western world. Yet the traditional masculine traits may be a driving force behind the inequalities in health outcomes observed between men and women. However, addressing this issue is undoubtedly one of the most challenging problems to solve.

Health Literacy: The Gap in Knowledge

Another concerning issue arises from research indicating disparities in health literacy between men and women. Health literacy, often called health IQ, refers to an individual's knowledge and understanding of disease symptoms and what constitutes a healthy lifestyle. It is thought that men have a worse understanding of disease symptoms, with research suggesting women display a superior knowledge about coronary heart disease than men, the biggest killer of men in the United Kingdom.^17,18 Further, it is thought that men perceive the role of health services differently to women. In fact, research by Lemos et al. (2017) and Schlichthorst et al. (2016) found that male participants tend to only seek health advice for acute health issues, rather than seeing health services as preventative care.^19,20

Make Healthcare Access Easy

A structural challenge for some men is the accessibility and availability of healthcare services outside regular working hours. Booking appointments with healthcare providers in general practices can be challenging due to limited slots and the scarcity of clinics open during non-traditional hours.²¹ Private practices are often less accessible due to substantial out-of-pocket expenses associated with private healthcare, a well-documented deterrent to healthcare engagement.²² Making healthcare services in general practices available beyond standard working hours is one structural change that can help men's access to healthcare services.  

Awareness Campaigns: Challenging the Traditional Masculine Traits

Creating an environment where men feel informed, comfortable being vulnerable and seeking help is critical to ensure that health concerns are picked up and addressed promptly in a safe setting. Awareness campaigns led by organisations such as Movember and Prostate Cancer UK play a vital role in nurturing a sense of community through leveraging the influence of prominent figures to help normalise and destigmatise health issues.^23,24 Furthermore, these campaigns serve as a valuable repository of information and resources easily accessible to the public. The resources provide education on many topics, including diseases, their associated symptoms, available treatment options, and guidance on where to access assistance, to equip individuals with the necessary tools to effectively manage and address their health. The campaigns also actively encourage open dialogue among men to make it commonplace to discuss challenges they may be confronting in their lives. Ultimately, these efforts contribute to reshaping societal perceptions and fostering an environment that is inclusive and accepting, an environment compatible with help-seeking behaviours.  

Male Health Screening Should Be Commonplace

Routine health screening is one important detection method to identify the presence of a disease early in its course. Indeed, in the United Kingdom and across many other European countries, there are nationwide routine health screenings for women for many diseases, including cervical and breast cancer, sexual health, in addition to pregnancy and contraceptive support. These services play a vital role in minimising the impact of diseases in women through early detection leading to improved health outcomes through early treatment.²⁵ While there have been significant advancements in women's health awareness and the development of healthcare strategies in the United Kingdom, we also acknowledge the ongoing need for further efforts and improvements in the women's health space to improve awareness and provide strategies to tackle the high number of preventable deaths in women.

For men, routine health screenings are yet to receive the same level of attention in the United Kingdom. Encouraging men to visit their doctors is one tangible action that can promote disease symptom awareness and allow for the detection of asymptomatic diseases in their early course, as is often seen with prostate and testicular cancer. According to the NHS Summary Report for outpatient appointments by gender, women comprised 57.8% of all visits, compared to 42.1% for men. The age group with the greatest number of attendances was also much younger for women (30–34 years old vs. 70–74 years old).²⁶ Engaging with healthcare leads to better health outcomes.²⁷ With men not only less likely to use health services but also less likely to use them effectively, the need to bridge this gap becomes increasingly evident.^28,29

What is a Men’s Health Strategy, and What Does it Look Like?  

A Men’s Health Strategy would be a government-led coalition aimed at addressing the various existing barriers to improving health outcomes for men. The strategy would also require the election of a Minister in charge of men’s health to lead to structural and policy changes to address the prevailing issues. The goal is to offer a comprehensive, evidence-based, gender-informed approach that involves collaboration with politicians, stakeholders within the NHS, and leading healthcare professionals at both regional and local levels. The All-Parliamentary Party Groups (APPG) recommends the UK strategy should ensure:³⁰  

• Training of all those engaged in health care.  
• The setting up of a National Centre for Men's Health.  
• Greater investment in multidisciplinary research into men's health issues.  
• The setting of clear national and local quantitative and qualitative targets for improving men's health.

Importantly, men's health strategies already exist around the world, with examples as close as Ireland and as distant as Australia, both of which have implemented comprehensive men's health initiatives to great success. As Richardson and Smith (2011) outlined:

• ‘‘The publication of NMHPs in Ireland and Australia represent a significant landmark in the ongoing evolution of the field of men’s health. The policies provide a clear blueprint and an unequivocal evidence base for tackling men’s health in each country… It can be concluded from an Irish and Australian perspective, that having a NMHPAP advances the case for men’s health in three important ways: (i) it provides a vision, identity and branding for men’s health within the wider health policy framework; (ii) it provides a framework for action on men’s health and points towards a more systematic approach to tackling key priorities identified for men’s health in each country; and (iii) it provides an important resource for practitioners, policy makers and advocates who wish to further advance men’s health work.’’

Indeed, In June 2014, the Department of Health and the Health Service Executive commissioned a review of the Ireland male health policy. The review concluded that:

• ''Overall, the policy had made a significant contribution to advancing men’s health in Ireland and paid tribute to the significant progress that had been achieved in: (i) promoting an increased focus on men’s health research in Ireland; (ii) developing health promotion initiatives that support men to adopt positive health behaviours and to increase control over their lives; (iii) building social capital within communities for men; and (iv) the development and delivery of men’s health training for health and other professionals. The review also paid tribute to the significant progress that had been achieved in developing sustainable alliances and partnerships in the area of men’s health involving statutory, community and voluntary, and academic sectors.''³¹

There is a strong opportunity to replicate the success here in the United Kingdom.  Here at TRTed, we support the push for a Men’s Health Strategy as an essential step to improved health outcomes and levelling up in men.  

References

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