By Peter Baker, Director, Global Action on Men’s Health
What has men’s health got to do with International Women’s Day? An event which celebrates women might seem an odd time to mention an issue affecting the half of the population that, for the most part, has blocked and continues to block gender parity.
But there are, arguably, several good reasons for highlighting men’s health. The first is that, very clearly, men’s health and women’s health are inextricably linked. This is most obvious in the case of sexual health – if men can be prevented from developing sexually transmitted infections, or are diagnosed and treated sooner, that must be beneficial to women’s health too.
This point was made very clearly at a global high-level meeting on men, adolescent boys and AIDS co-convened in December 2015 by UNAIDS, Sonke Gender Justice and the International Planned Parenthood Federation. The meeting reflected the growing awareness of the need for a global shift in the discussion on HIV and gender so that it becomes more inclusive of men and encourages their greater positive engagement in all aspects of the AIDS response in order to improve their outcomes and to reduce vulnerability among women.
High mortality and mortality rates in men impact on women in another way, especially in lower-income households and countries. The loss or incapacity of the primary breadwinner, usually a man, can have a hugely detrimental affect on partners and children. They may have to take on caring responsibilities, limiting employment and educational opportunities and reducing current and future income. The cost of medicines can also have a huge impact on family resources.
Men make up well over 80% of road traffic fatalities in Bangladesh, a country with one of the highest road death rates in the world. A study found that three-quarters of all poor households affected by the road death of the head of the household reported a decrease in their living standard and 61% had to borrow money as a result of the death.
In many families, men are the main decision-makers about issues affecting health, such as the purchase of food and medicines, opportunities to attend health services, educational and employment opportunities, or contraceptive use. Men who are better informed about health issues are more likely to make choices for themselves and their families that lead to improved health outcomes.
Addressing men’s mental health issues, including alcohol and drug misuse, could also contribute to a reduction in male violence against women, children and other men. A WHO report suggested that, in the USA and in England and Wales, victims of domestic violence believed their partners to have been drinking prior to a physical assault in 55% and 32% of cases respectively. In Australia, 36% of intimate partner homicide offenders were under the influence of alcohol at the time of the incident while in South Africa, 65% of women experiencing spousal abuse within the last 12 months reported that their partner always or sometimes used alcohol before the assault.
Women also have relationships with men they love and care for and they do not want to see them die young or suffer. Globally, male life expectancy, at 68 years, lags five years behind female life expectancy and there is not a single country in which male life expectancy exceeds female. Overall, the gap between the sexes has actually widened since 1970 and will widen further by 2030 – by then, male life expectancy is expected to be seven years shorter than female life expectancy. Men have a >40% probability of dying between the ages of 50 and 74 while women have probability of <30%. Better men’s health and wellbeing would enable women to spend more and better-quality time with their fathers, partners, brothers and the other significant men in their lives.
The highest attainable standard of health is a fundamental right of every human being. Reducing unnecessary suffering by men and enabling them to lead healthy and fulfilling lives is therefore an ethical imperative. It makes good economic sense too: men’s premature mortality and morbidity costs the United States economy some £335 billion annually while the economic burden associated with smoking, excess weight, alcohol and physical inactivity in Canadian men has been estimated at about £18 billion a year.
Investing in men’s health must not mean disinvesting in women’s health of men somehow adopting the mantle of the biggest health ‘victims’. Better health for all requires a new approach that is based on genuine gender mainstreaming and which also takes account of cross-cutting inequalities linked to income, race, sexuality, age and other factors. This has been recognised by the head of the WHO’s Gender, Equity and Human Rights team who has recently written about the need for ‘a more compelling and nuanced understanding of gender’ that includes taking account of men and masculinity in the implementation of the Sustainable Development Goals launched in 2015.
There is a growing evidence base that shows that ‘gender sensitive’ health interventions aimed at men can improve outcomes. There is no longer any need for fatalism about the potential for working with men. Sport has been shown to be an effective medium for engaging men in lifestyle improvement programmes and a study of the core elements that make for successful work with boys and men on mental health promotion, early intervention and stigma reduction found that the settings within which interventions take place need to be ‘male friendly’ and culturally sensitive to the specific requirements of different groups of men and boys.
Research in Ghana has shown that child vaccination programmes designed to involve fathers (not just mothers) in decisions about their children’s use of preventive health services may increase timely immunization coverage levels. Interventions that aim to reshape male gender roles in ways that lead to more equitable relationships between women and men can reduce sexually transmitted infections and prevent intimate partner violence.
Despite the many problems with men’s health, it has been largely overlooked by national governments and global health organisations. Action to improve the health of men and boys is urgently needed and can legitimately sit alongside women’s health initiatives as part of the wider effort to create greater gender equity.