Men's Health Around the World

MEN’S HEALTH around the world A review of policy and progress across 11 countries Edited by David Wilkins and Erick Savoye Published by the European Men’s Health Forum (EMHF) Spring 2009 Acknowledgements EMHF wishes to thank all the authors listed in this document for their contributions, time and dedication. I am confident their hard work will contribute to enhancing the public policy profile of men’s health in their country. Our special thanks to the Men’s Health Forum England & Wales (MHF) and to David Wilkins, MHF’s Policy officer, who had the laborious task of coordinating this project and without whom this project would have never seen the light of day. Erick Savoye Director of EMHF © European Men’s Health Forum 2009 All rights reserved. The European Men’s Health Forum welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Men’s Health Forum. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Men’s Health Forum in preference to oth- ers of a similar nature that are not mentioned. All reasonable precautions have been taken by the European Men’s Health Forum to verify the in- formation contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Men’s Health Forum be lia- ble for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Men’s Health Forum. european men’s health forum Copyright European Men’s Health Forum (EMHF) - Spring 2009 ISBN: 978-1-906121-48-8 The European Men’s Health Forum (EMHF) Rue de l’Industrie 11 B-1000 Brussels Belgium Registered in Belgium as international not-for-profi t organisation A.I.S.B.L 15747/2002 offi [email protected] www.emhf.org Contents Introduction 7 Men’s health in Australia 13 Men’s health in Canada 19 Men’s health in Denmark 25 Men’s health in England & Wales 29 Men’s health in Ireland 35 Men’s health in Malaysia 41 Men’s health in New Zealand 47 Men’s health in Norway 53 Men’s health in Scotland 59 Men’s health in Switzerland 65 Men’s health in the USA 69 Men’s health in Europe: an overview 75 Introduction David Wilkins Is the health of men important? This may seem like a rather fundamental question to ask at the beginning of a review of policy and progress in male health across eleven countries. On one level, the answer is bound to be “yes”. Of course the health of every individual man everywhere in the world matters to him and to the people who care about him. The evidence about whether men’s health is important to politicians and health planners however, is rather less convincing. Campaigners for better male health from three continents report in this paper that, despite enormous progress in public health and the sophistication of modern treament approaches, men consistently suffer more serious illness than women and die at an earlier age. Does the very consistency of these patterns suggest though, that poorer health in men is inevi- table. Is it a simple matter of biology? In fact, the biological arguments are much less important than they first appear. There is very significant variation in male/female comparitive mortality rates between one country and another. Female life expectancy in the Russian Federation is more than 13 years greater that male life expectancy; in the Netherlands the difference is only a little over four years. Biology alone cannot explain this. The scientific consensus tends to be that inherent differences between men and women are at most only partly responsible for the discrepancies in morbidity and mortality rates1. Comparing male health with female health is crucial to our debate because it brings into focus those factors that are different for men. But if we put male/female comparisons to one side for a moment, it can be seen that male life expectancy also varies considerably between different groups of men within as well as between countries. Indeed male life expectancy varies within even very small geographical areas. In England for example, it is often pointed out that for each station east from central London on the city’s underground railway system, male life expectancy falls by nearly a year; a man born in the affluent heart of the city, in Westminster, can expect almost to reach the age of 79; a man born a few miles away in Canning Town in East London will not live to see 73. Similar variations in mortality rates can be seen within cities and between re- gions throughout the world. 7 We can easily see therefore that both the sex-comparative data and the data that compares groups of men suggest that non-biological factors are extremely important determinants of male mortality and morbidity. Since non-biological factors are not fixed - that is to say that they are capable of change in response to external intervention - it is consequently safe to conclude that vast and untold numbers of men around the world are dying earlier than they need. Given the political will to address this issue, both sexes could enjoy better health and a longer life even while the differences in outcome between men and women are being tackled. But don’t most of the authors writing in this report also acknowledge that men take less ef- fective care of their personal health? That men tend to use health services less frequently? That men are believed to delay seeking help until later in the development of symptoms? Doesn’t that make it men’s own fault that their health is often so poor, regardless of where in the world they live? It is certainly true that men, by and large, tend to be less knowledgeable about personal health than women and that they are less likely to seek help from medical practitioners. It is also true that men take more “health risks” than women, whether those are direct physical risks such as working in more dangerous professions or driving at higher speeds, or “lifestyle” risks like being more likely to drink alcohol to excess or to eat a less healthy diet. It is remarkable indeed, how entirely consistently these patterns of behaviour are reported by the authors in this paper, despite their describing countries with wide social and cultural differences. Does this mean though, that men deserve poorer health and an earlier death? Surely not. If poorer use of services was an underlying cause of poorer health in a particular minority ethnic community, the political consensus in most countries covered in this report would be that the existing services were failing that community. Most nations with a developed understanding of health inequalities accept that health systems sometimes need to take account of differences between population groups in order to achieve fairer outcomes. There is no logical reason why gender differences in health outcome should not be treated in the same way. If this is so obvious, why do our authors - from countries as culturally varied and geographically distant from each other as Malaysia and Denmark, New Zealand and Canada – report similar difficulties in persuading governments to pay particular attention to the health of men? One reason is the one we have just considered - the idea that the problem lies with men them- selves. This may lead to the regrettable political view that it is up to men to change, not services. This is a fallacious argument that fails to acknowledge men’s poorer health as the inequality that it is. Furthermore, as our authors report, cultural pressures and social expectations make help-seeking very difficult for men all over the world. If men are to change, we must accept that whole societies must change. Some may argue that would be desirable - but the only realistic view to take is that change on that scale is not going to happen in the foreseeable future. 8 Another reason is the sheer familiarity of the differences between the sexes. Politicians and clinicians may have simply become so used to men dying sooner than women that they have ceased to wonder why it happens. This perception may be reinforced by the fact that – as we have seen – there are some potential biological explanations for some of the differences. This may lead people to regard men’s greater burden of premature disease and death as “natural”. Finally, there is the persistence of the view that gender inequalities only affect women. It should be made clear at this point that there are no negative views about women or women’s organisations to be found in this report. Nowhere does anyone take issue with the view that women are seriously disadvantaged in many areas of life in many countries. Several authors indeed, acknowledge a debt to women’s organisations, who have led the way on social change in recent decades. Unfortunately however, the widespread association of the very word “gender” solely with the concerns of women is extremely unhelpful. The chapter on “Gender Equity” in Closing the gap in a generation2, the World Health Organisation’s important recent report on the need for worldwide action to address health inequalties, does not contain a single sentence about male health.

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