Men’s health: lifestyle, medical engagement and risk

Written by: Rosie Lobley

Health outcomes for men are worse than those of women in a number of key areas, often due to some combination of lifestyle factors: men smoke and drink more than women, and are more highly represented in high-risk professions.1 On average, men experience higher mortality rates and lower life expectancy than women, at least in part because men are less likely than women to seek medical assistance when they become physically or mentally unwell.2 One in five men in the UK will die before they reach 65.3 75% of premature deaths from heart disease and 75% of suicides occur in men; suicide is the single most prevalent cause of death for British men under 50.1

Why don’t men seek healthcare?

‘Masculinity’ as a concept endorses stoicism, self-reliance and high tolerance of pain and sickness.4 Men who view masculinity as a key aspect of their identity may be reluctant to seek treatment when they are physically or mentally unwell, for fear of appearing weak.5

Fear and denial are key factors keeping men from reaching out for healthcare advice or support, as is ignorance of the services available to them. As a whole, men prefer to undergo physical tests than discuss their problems with an HCP.6 Two thirds of men think they are naturally more healthy than others, and a third of men do not recognise the need for yearly health screenings.7 Men who subscribe to traditional beliefs of masculinity are more likely to prefer to see a male healthcare provider (HCP) over a female one; however, they are also less likely to disclose ‘embarrassing’ symptoms to male than female HCPs.8

Women tend to be more familiar with healthcare settings and the need for preventive care than men as they are more likely to attend regular medical appointments for hormonal contraception, cervical smears, pregnancy and child health9 – this in turn feeds into the concept of healthcare as a feminine domain from an early age, as children are taken to HCPs more often by female adults than males.10

Only seven countries around the world (Australia, Brazil, Iran, Ireland, Malaysia, Mongolia and South Africa) have public health strategies in place specifically to address men’s health issues.11

Encouraging healthy behaviours

Peer support is crucial to protecting and maintaining men’s health, particularly in terms of their mental and emotional wellbeing; men often feel more able to disclose perceived weaknesses in single-sex support groups.12

Non-profit campaigns like Movember and Andy’s Man Club, a British mental health charity offering men-only talking groups, are working to encourage men to reach out for help when they need it. Since its inception in 2006, the Movember campaign has provided funding for the development of 70 therapies and 107 prostate cancer diagnostic tests, as well as launching over 1250 men’s health projects in 23 countries.13 Andy’s Man Club, which began in 2016 with nine attendees, now boasts 69 clubs around the country.14

Men’s Sheds – community-based spaces for older men, offering workshop activities and social interaction, with activities tailored to the needs of local users – have demonstrated benefits for both the physical and mental health of users.15 The ‘Shed model’ has been found to be particularly beneficial for men who are reluctant to engage with traditional healthcare systems, by offering a more flexible and informal space where users can feel safe to discuss their issues.16

Well-designed public health interventions targeted specifically towards men can improve outcomes and combat harmful gendered expectations.17 The most effective interventions are often related to sports or physical activity, appealing to perceptions of masculinity.18 A 12-week behavioural intervention programme aimed at ‘hard-to-reach’ men and delivered through 16 English Premier League clubs saw a substantial increase in improved healthy behaviours in respondents who provided follow-up data.19 A similar pilot delivering weight loss intervention through rugby union franchises in New Zealand showed positive results and received encouraging feedback from participants: one key driving factor in the results identified by participants and researchers was the adoption of a social identity as part of a team.20

The UK-based Men’s Health Forum has devised a ‘DIY Man MOT’, using car maintenance analogies to highlight key aspects of men’s health:

Other successful interventions include SHED-IT in Australia, Men on the Move in the US, and a theory-based intervention study in South Africa.21 The majority of successful interventions targeting men’s health were community-based, rather than professionally developed, and adopted a gender-sensitive approach, reaching out to men using culturally sensitive language and humour.

Healthcare, data and research

From a clinical perspective, normalising the disaggregation of health data by sex will give a more accurate picture to improve male healthcare.22 Men and women present with different symptoms for a number of diseases, including but not limited to heart disease, kidney disease, cancer, and stroke.23 Similarly, men and women are exposed to different environmental and occupational hazards, each with differing health implications.24

Gender-neutral or gender-blind reporting of data can lead to gender-specific risks being overlooked.25 Sex-disaggregated data can be used to inform public policy and outreach efforts, especially during outbreaks of infectious disease: COVID-19 is more prevalent and more deadly in men than in women, for example, so prevention and treatment programmes can be targeted accordingly.26

Conclusion

Illness, injury and mortality figures indicate that there remains a need for engagement and outreach by health services to address the reluctance of many male patients to seek care and treatment as they are needed. The success of independent and grassroots programmes aimed at addressing issues around men’s health at the source, often through deploying language and themes which appeal to men’s humour and sense of masculinity, indicates that there is ample scope to broaden this approach. This is particularly relevant when targeting demographics which are the most at risk or most hesitant to engage with the healthcare system.

References
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