journal of men's health
Volume 6, Issue 1 , Pages 10-13, March 2009

Elam: lost city rediscovered

President of The European Men's Health Forum, 11 rue de l’Industrie, B-1000 Brussels, Belgium

Article Outline

 

When Mt Vesuvius erupted in 79AD, its most recent deadly expression of tectonic premature exasperation, it covered with ash at least two major cities: Herculaneum and Pompeii. They were not to be re-discovered for centuries. Herculaneum, a fair sized port east of Naples, was found only by an engineer drilling a well shaft and instead of water he found mosaic fragments. Not exactly what he expected. Further exploration revealed an entire city buried, apparently forgotten. Even by modern standards Pompeii was huge compared to Herculaneum and the clue to its previous existence lay in an uncovered section of the town. From both these observations the true nature of the disaster was uncovered. But for many, not least those who would rather ignore the ever present threat from a volcano-worth of potential damage, it was better to put it down to the ‘gods’. Fatalism was the order of the day. People still live next to ‘volcanoes’. For men in Europe there is often no informed choice when it comes to any sort of health information or care. This is a volcano already erupting and for many men and their families, it is getting worse not better (Box 1).

Box 1.

75% of suicides are male.

73% of adults who ‘go missing’ are men.

90% of rough sleepers are men.

1 man in 8 is dependent on alcohol.

Men are more than twice as likely to use Class A drugs.

78% of drug-related deaths occur in men.

Men make up 94% of the prison population – and 72% of male prisoners suffer from wo or more mental disorders compared with 5% of men in the general population.

46% of male psychiatric inpatients (compared with 29% of female patients) are detained and treated compulsorily.

Boys are five times more likely to be diagnosed with Attention Deficit Hyperactivity Disorder than girls.

84% of children excluded from school are boys.

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So is it all men's fault? 

Men's use of health services and health information is generally poor across Europe. At the same time, the delivery of healthcare and information is often not appropriate for men. There is a lack of investment and research in men's health.

Men's life expectancy is unnecessarily low across Europe. Death rates from preventable causes at all ages are unacceptably high. Furthermore, there are significant and avoidable inequalities between countries.

Poor health and premature death in men also affect their families and are an unnecessary burden on health services and the wider economy.

These problems require responses that take account of the specific needs of men.

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Men and their health 

The shorter male life expectancy at birth (74.6 years vs. 80.8 years for women) [1], [2] is slowly rising, albeit not in all countries. The report on Inequalities in Health across Europe [3] noted, in particular, that life expectancy in men in countries undergoing social and economic change drops dramatically, as seen in the Eastern European countries since the collapse of the communist regime. In Estonia and Latvia the death rate in men was over four and a half times that in women in the age groups 15–24 and 25–34 years [4].

Even in countries with higher life expectancies, national life expectancy figures can hide profound variations between groups of men at the local level. In the UK, men in the most deprived areas of Glasgow (e.g. Carlton) are only expected to live until the age of 54 [5]. This is 8 years less than the average life expectancy for men in India (62 years) and 28 years less than that in the more affluent areas of the same city (82 years in Lenzie) [5].

There are biological factors associated with specific men's health problems such as higher infant mortality, disorders of the reproductive system, lower oestrogen protection against cardiovascular disease. However, the magnitude of such variations in life expectancy suggests that these are not solely attributable to biological causes.

Men's health outcomes are closely related to the social construction of their masculinities: boys and men are still socialised to be tough and strong and to appear in control [6].

Many men neglect their health and, for some men, especially younger ones, masculinity is often characterised by risk taking, an ignorance of their bodies and a reluctance to seek medical intervention for suspected health problems [7], [8]. As a result, men are more likely to lead unhealthy lifestyles and to remain undiagnosed.

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Men, women and health 

We, as European citizens, must strive to understand the implications of gender on our health, wellbeing and illness such that the impact of being a man or women in our current societies can be taken into consideration by policy makers and practitioners (Box 2). Failure to take account of the differences between men and women through the perpetuation of a one-size-fits-all approach will do little to diminish our inequalities and, at worst, will create new problems for individuals and society.

Box 2.

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Council of Europe Recommendation [9] 

Recommendation CM/Rec(2008)1 of the Committee of Ministers to Member States on the inclusion of gender differences in health policy (adopted on 30 January 2008) states that:

The governments of member states should:

1.in the context of protection of human rights, make gender one of the priority areas of action in health through policies and strategies which address the specific health needs of men and women and that incorporate gender mainstreaming;

2.promote gender equality in each sector and function of the health system including actions related to health care, health promotion and disease prevention in an equitable manner;

3.consider issues related to the improvement of access and quality of health services as these relate to the specific and differing needs and situations of men and women;

4.develop and disseminate gender sensitive knowledge that allows evidence-based interventions through systematic collection of appropriate sex-disaggregated data, promotion of relevant research studies and gender analysis;

5.promote gender awareness and competency in the health sector and ensure balanced participation of women and men in the decision-making process;

6.establish monitoring and evaluation frameworks on progress on gender mainstreaming in health policies

It is also essential that the broader public comes to recognise the strains and benefits of being a particular gender. There are significant relational issues between men and women as none of the gender attributes exist in isolation. Without the realisation that how a man or woman lives their life can affect their partners, children and society in general we will continue to see great harm through ignorance of the other's position.

Comparison between men and women must be used primarily as a basis for identifying outcomes that may be susceptible to improvement. It is very clear that there are major issues affecting women's health – and men's health – that need to be tackled. To be effective, health promoting interventions need to address the differences in health outcomes between women and men, boys and girls in terms of their biology and their socialisation in an equitable manner (Box 3) [10].

Box 3.

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World Health Organisation 

The following is an extract from a Report by the WHO Secretariat on integrating gender analysis and actions into the work of the WHO [11].

•In order to ensure that women and men of all ages have equal access to opportunities for achieving their full health potential and health equity, the health sector needs to recognize that they differ in terms of both sex and gender. Because of social (gender) and biological (sex) differences, women and men face different health risks, experience different responses from health systems, and their health-seeking behaviour, and health outcomes differ.

•In many societies, women have less access to health information, care, services and resources to protect their health. Gender norms also affect men's health by assigning them roles that promote risk-taking behaviour and cause them to neglect their health. Furthermore, gender interacts with race and other social stratifications, resulting in unequal benefits among various social groups and between women and men.

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Investing in ‘male sensitive’ approaches to providing healthcare 

Men are less likely to make effective use of health services yet this does not mean that men don’t care about their health. There is an increasing body of evidence suggesting that men can be encouraged to take their health seriously, provided they are approached in a male sensitive way [12].

In most European countries health information remains provided to the public and the patient on a ‘one-size-fits-all’ basis, despite evidence of significantly lower levels of health literacy in men. Health services are failing to engage effectively with men, especially men in disadvantaged groups who are left exposed to the risks and costly complications associated with poorly managed illness as a result.

A step change would be achieved by bringing primary health services outside of their clinical settings, and by promoting their availability in a way that encourages male uptake (Box 3). Successful outreach pilots have demonstrated the increased effectiveness of this approach in sports stadia and the workplace for instance. Better health literacy and support can generate healthier lifestyles, and with earlier presentation will, in most cases, significantly reduce the financial and non-financial costs associated with medical complications. European institutions and national governments can play a key role in facilitating practice development and sharing in these areas.

Work should be initiated on health for boys and young men at schools and in community settings as the development of a healthy lifestyle and mental well-being before adulthood is likely to further reduce and delay the risks of poor health. It is imperative that young boys and girls be given the opportunity to develop their health literacy from an early age so that they can become more independent in the management of their own health and learn to use health services effectively.

Attention must be paid to the development of interventions that are sensitive to the aspirations, attitudes, and behaviours of young boys and adolescents. The focus on young men must continue into adulthood, with interventions targeting other community settings, such as leisure facilities, sports grounds and working environments.

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Men's Health policy in Australia, New Zealand and Ireland 

This is not to say things are not being addressed. Since the formation of the European Men's Health Forum there have been changes:

The Australian federal government has recently announced that it will develop the country's first ever national men's health policy [13]. The announcement focused on men's lower (by 4.8 years) life expectancy, the much higher suicide rate in men, the high level of disease related to injuries, HIV/AIDs mortality, and the especially poor health of indigenous men (average life expectancy, 59 years).

In New Zealand, the government has launched a $3m programme to run over the next year promoting greater awareness of men's health [14]. The funding will go into initiatives aimed at encouraging men to be more aware of their health and to access healthcare. Workplace clinics and improved health information are part of the package.

The Irish government was expected to launch a national ‘Policy for men's health and health promotion’ in autumn 2008. This stems from a commitment made in the National Health Strategy, published in 2001[15].

Evidence-based practice in a number of European countries and internationally have demonstrated the effectiveness of such approaches. A particularly well documented study is the 5-year government-funded (€ 3 million) Bradford Health of Men in the UK [12].

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Conclusion 

There is no excuse for the failure to recognise the burial of facts. Mens health is a commonly neglected area with huge personal, familial, and economic consequences. The evidence base for change is increasing, not least in the workplace. The role of governments, non-governmental organizations (NGOs) (Box 4), industry, and the media will be essential to make sure we do not have to drill down once again to find fragments of the Y chromosome, colourful as they are. Mosaic males are always better alive than dead.

Box 4.

The Vienna Declaration for the health of men and boys in Europe.

Available online in English and other European languages http://www.emhf.org/index.cfm/item_id/305.

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References 

  1. Eurostat. Life expectancy and mortality. pp. 95–98 in Eurostat Yearbook 2003: the statistical guide to Europe. Data 1991–2001. Available at: http://epp.eurostat.ec.europa.eu/portal/page?_pageid=1073,46587259&_dad=portal&_schema=PORTAL&p_product_code=KS-CD-02-001.
  2. Eurostat. Eurostat statistical yearbook 2008. Available at: http://epp.eurostat.ec.europa.eu/portal/page?_pageid=1073,46587259&_dad=portal&_schema=PORTAL&p_product_code=KS-CD-07-001.
  3. Mackenbach JP (2005). Health inequalities: Europe in profile. An independent expert report commissioned by and published under the auspices of the United Kingdom Presidency of the European Union, October 2005 (http://www.fco.gov.uk/Files/kfile/HI_EU_Profile,0.pdf).
  4. White A, Holmes M. Patterns of mortality across 44 countries among men and women aged 15-44 years. Jmhg. 2006;3(2):139–151
  5. CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World health Organization; 2008. Available at: http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf.
  6. Doyal L. Sex, gender and health: the need for a new approach. BMJ. 2001;323:1061–1063
  7. Hearn J. Men and Gender Equality Policy. pp. 24–31 in Varanka J, Närhinen A, Siukola R (eds) (2006) Men and Gender Equality: Towards Progressive Policies. Conference Report. Reports of the Ministry of Social Affairs and health 2006: 75. Helsinki: Ministry of Social Affairs and Health. Available at: http://www.stm.fi/Resource.phx/publishing/store/2007/01/hu1168255554694/passthru.pdf.
  8. Juel K, Christensen K. Are men seeking medical advice too late? Contacts to general practitioners and hospital admissions in Denmark 2005. J Public Health. 2008;30(1):111–113
  9. Council of Europe. Recommendation CM/Rec(2008)1. Available at: http://www.migualdad.es/mujer/politicas/docs/14_CMRec_2008_1E.pdf.
  10. Ostlin P, Eckermann E, Mishra US, Nkowane M, Wallstam E. Gender and health promotion: a multisectoral policy approach. Health Promot Int. 2006;21(Suppl 1):25–35
  11. World Health Organization. Integrating gender analysis and actions into the work of WHO: draft strategy. Geneva: WHO. Available at: http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_19-en.pdf.
  12. Bradford Health of Men. Healthy living initiative. Bradford: HoM. Available at: http://www.healthofmen.com/about.html.
  13. Department of Health and Ageing. National Men's Health: national men's health policy. Canberra: Commonwealth of Australia. Available at: www.health.gov.au/menshealthpolicy (accessed 6 July 2008).
  14. O’Connor D. $3 million funding for new men's health programme. Wellington: Government of new Zealand. Available at: http://www.beehive.govt.nz/release/3+million+funding+new+men%e2%80%99s+health+programme (accessed 22 january 2009).
  15. Department of Health and Children. Quality and Fairness: A Health System for You. Health Strategy. Dublin: The Stationery Office; 2001. Available at: http://www.dohc.ie/publications/pdf/strategy.pdf?direct=1.

PII: S1875-6867(09)00007-4

doi:10.1016/j.jomh.2009.01.003

journal of men's health
Volume 6, Issue 1 , Pages 10-13, March 2009

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