The state of men’s health in EuropeBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7054 (Published 29 November 2011) Cite this as: BMJ 2011;343:d7054
The European Commission’s recently published report, The State of Men’s Health in Europe, shows marked differences in health outcomes between men,1 which are strongly related to their biology, culture, and socioeconomic realities.
The report is a huge undertaking: an attempt to describe the salient health issues of the 290 million men and boys of the 27 member states of the European Union, the four states of the European Free Trade Association, and three EU candidate countries.
Included in its findings are that: working age men have significantly higher mortality rates than working age women (210% higher mortality rate in the 15-64 age range; 630 000 men per year versus 300 000 women); public health activity that benefits men’s health is patchy across the EU; and working men underuse health services compared with women and unemployed men. A key conclusion of the report is that “Gender equality initiatives will have a positive impact on the way men’s needs are taken into account within government health strategies and at the more local practitioner level.”1
Health ministers should be reminded by their treasury counterparts that because of lower birth rates, rising life expectancy, and the higher death rate in men in the 15-64 age group, by 2060 there will be nearly 24 million fewer working age men (aged 15-64 years) than now across the 27 member states of the EU. There will also be about 32 million more (mainly non-working) men over 65. Health ministers should then be asked what is being done in practical terms to limit this health and economic disaster, which will influence not just men but the whole of society.
The report includes a depressing review of current policy and practice: only Ireland has a national men’s health policy, and in many countries a “one size fits all (sexes)” approach pinpoints the importance of the authors’ call for policy makers to design and implement sex specific policies. It seems that in much of the EU men’s health has not yet sufficiently entered the political, or medical, consciousness to yield meaningful changes in service delivery.
The good news, however, is that a raft of public health measures that do not specifically target men have nonetheless had a greater effect on male morbidity and mortality because of men’s more flawed lifestyles. The usual suspects are to be found here, such as smoking bans, road safety legislation, and health and safety in the workplace. However, European nations continue to vary widely in,for example, restrictions on smoking in enclosed public spaces.
Although the workplace represents a key hazard for many men, it is also a key site for placing health services that men are more likely to use, a point that the report mentions only in passing. Instead it focuses on the (albeit worthy) work of major sports clubs in England in engaging with the community and carrying out match day health checks for men. Yet the evidence for a win-win situation for employers (reduced absenteeism, improved productivity, and workforce retention) and employees (happier and much healthier) in workplaces with good quality worksite health programmes is strong, with returns on investment of between 2.8 and 6.0 times; this is important knowledge for governments, employers, and unions.2
The report mentions the failure of educational providers to focus on men’s health and men’s underuse of available facilities but fails to mention the Royal College of General Practitioners’ men’s health curriculum or similar resources in other countries. The mere existence of a curriculum does not guarantee its use, however. Educational providers have an obligation to use such resources to help dispel the myth that men are disinterested in their health and should encourage health providers to look outside the box of traditional care to better engage with a target group that demands and deserves healthcare on its terms and on its turf.
Chastising men for underuse of existing services, which are often open only during working hours, and for not being interested in their health is simplistic, unfair (working men’s taxes help fund the system), and ignores the results of studies that show men are interested in their health.3 One local initiative to improve men’s access is a once or twice a week evening clinic, which attracts workers who are unable to attend during office hours (author’s observation). Research is needed to determine the effect of such clinics on outcomes.
The report notes that consideration of the social determinants of health—especially educational level, employment, income, and social inclusion—would have the most effect on changing men’s health behaviour. Challenges include finding ways to keep young men who are likely to be marginalised in an education system that often fails them, boosting men’s health literacy, and engaging men of all ages who feel marginalised—with improvements in health being just one of the benefits. Research using the “plan-do-study-act” template of the UK NHS Institute for Innovation and Improvement can be inexpensive and provide relatively rapid results about the effectiveness of a new programme.4
A major challenge is to engage with the many men who do not access health services. One key area is the growing phenomenon of men’s sheds, with more than 20 in Ireland and more than 700 in Australia, where they originated.5 6 They provide a community based outlet for men who want to learn practical skills with key principles of local governance, ownership, sharing, and mentoring with other men in a non-judgmental setting.7 Sheds have benefits across a wide range of social and health areas, including social inclusion, health literacy, and healthier lifestyles.
Men’s health in Europe has far to go: the challenges are immense but the potential benefits, both socially and economically, are compelling. This report represents a springboard to an exciting future.
Much adequately resourced research is needed, especially in the area of engaging with those men at greatest risk (men in lower socioeconomic groups). There is great potential in educating healthcare providers about alternatives to traditional in-hours primary care.
Cite this as: BMJ 2011;343:d7054
Competing interests: The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.