Editorials

Men's health

Differences in men's and women's health experience and behaviour are well recognised.¹ Although policy makers have focused for some years on women's health, men's health has been less well defined. There are now signs that the profile of men's health is growing. Increased interest is expressed in, for example, the 1992 annual report by England's chief medical officer²; a national conference held in London in July; and increasing media coverage is reflected in the growth of men's health magazines.

The growing interest has largely concentrated on aspects of men's health relating to diseases of the prostate and testicle. This sex specific approach encourages comparisons with the women's health movement, with campaigns for national screening programmes for prostatic and testicular cancer analogous to the screening programme for breast cancer. Such an approach has its place. Prostate disease is extremely common, but there is little agreement about effective treatment.³ Half of all men have benign prostatic hyperplasia by the time they are 60 years old, and 90% by the time they are 85. Prostate cancer is the second commonest cancer in men in Britain and the numbers diagnosed are increasing, particularly in older men. Occult cancer exists in about 30% of men over 50 and there is currently no way of distinguishing which tumours will remain dormant and which will metastasise rapidly. The much vaunted test for prostatic cancer, prostate specific antigen, is not sufficiently sensitive or specific to be effective as a diagnostic screening tool.⁴ Similarly, population based screening for testicular cancer has not been recommended, even though it is the commonest cancer in men in Britain aged 20-34 and early treatment has good results. There are, however, good arguments to support campaigns to raise awareness, such as the Cancer Research Campaign's "Keep your eye on the ball," which was launched in September 1995.⁵

Although much needs to happen in such sex specific areas of men's health, concentrating on these areas ignores the important effects of psychosocial pressures on men within modern society. Statistics show that men are likely to die younger from common diseases and to suffer illnesses in which environment and lifestyle play an important part. Men are more likely than women to have unhealthy lifestyles, to drink too much alcohol, to smoke tobacco, and to eat a less healthy diet.⁶ Risk taking and aggression, commonly exacerbated by alcohol, are more prevalent among men, as reflected by the higher accident fatality rates. Men in England and Wales have an average life expectancy that is six years shorter than women's, a 3.5 times higher risk of death from coronary heart disease under 65, a suicide rate double that of women, and a greater risk of contracting HIV and AIDS. The recent report on variations in health⁷ showed not only that there is a gap in mortality between men and women but that it is increasing. This has also been noted in the United States.⁸

It is not just the impact of lifestyles and biology but society's expectations of men that need to be addressed. Such expectations have created an environment in which men are less able than women to recognise physical and emotional distress and to seek help. Available data show that for most illnesses men are less likely than women to consult their general practitioners,⁹ yet their hospital admission rates for diseases such as coronary heart disease and stroke are higher.

The common assertion that women consistently report higher levels of ill health than men is now being questioned. MacIntyre and colleagues have found that the direction and magnitude of sex differences in health vary according to the particular symptom or condition in question and the patient's phase of life.¹⁰ They suggest that sex differences have become oversimplified and should be re-examined periodically to monitor the impact of changes in sex roles on people's experiences of health and illness.

Differences in health status between groups of men are also of concern. The inverse social gradient for mortality is unlikely to be due solely to social class differences in individual lifestyles. Research shows that men of lower social status suffer more financial problems, more stressful life events, less adequate social support, and more feelings of disempowerment within the workplace. In Britain, Asian men have higher rates of heart disease than do their white compatriots,¹¹ and, as noted by Professor Michael Chan at the Medical Group conference on men's health in London last July, Afro-Caribbean men are more likely to suffer from severe mental illness and to be admitted to secure wards. Professor Chan, director of the NHS ethnic health units, suggested that improving the health of men from ethnic minorities will depend on reducing stress generated by unemployment, poor housing, and other forms of racism.

There is little evidence for effective interventions to remedy the inequalities in health faced by men, but the experience of the HIV/AIDS programmes suggests that men need to be targeted, particularly at places where they meet together.¹² Even if equitable health status for all men will be achieved only by redressing social inequalities, more could certainly be done to increase men's access to health care and to promote health, especially in the workplace.

Director of public health and health policy Oxfordshire Health Authority, Headington, Oxford OX3 7LF

Sian Griffiths 

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2. Department of Health. On the state of the public health 1992. The annual report of the Chief Medical Officer of the Department of Health. London: HMSO, 1992.
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7. Department of Health. Variations in health--what can the Department of Health and the NHS do? London: HMSO, 1995.
8. Waldon I. Contribution of changing gender differences in behaviour and social roles to changing differences in mortality. In: Sabo D, Gordon DF, eds. Men's health and illness. London: Sage, 1995:22-45.
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10. MacIntyre S, Hunt K, Sweeting H. Gender differences in health: are things really as simple as they seem? Social Science and Medicine (in press).
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12. Health Education Authority. Men's health. Health For All 2000 News 1994;29:14-5.