journal of men's health
Volume 6, Issue 3 , Pages 143-146, September 2009

Men's health: past, present and future

  • Siegfried Meryn, MD

      Affiliations

    • President of the International Society of Men's Health, Medical University of Vienna, Austria
    • Corresponding Author InformationCorresponding author.
    • ,
  • Ridwan Shabsigh, MD

      Affiliations

    • Director, Division of Urology, Maimonides Medical Center, Professor of Clinical Urology, Columbia University, New York, USA

Received 24 August 2009

Article Outline

 

Siegfried Meryn

Editor-in-Chief of jmh and President of ISMH

Ridwan Shabsigh

Section Editor of jmh and President WCMH

It is with great pleasure and anticipation that we introduce and celebrate the World Congress on Men's Health 2009 in this issue of the journal of men's health (jmh). The articles published in this issue of the jmh fulfil our editorial commitment to publish original and important research and commentary that can inform clinical decisions and patient care. The 10-year celebration of the 1st Vienna Men's Health Report [1], the first Men's Health Report in the world, and the 6th World Congress on Men's Health pose at least three critical questions that need to be answered:

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What has been achieved? 


What is men's health?


What is the future of men's health?

Fewer than 100 years ago, when the life and probably health expectancies of both men and women were about equal, gender specific health was not an issue. In the 20th century women's health for the first time was well established as a field in the mid-1970s and early 1980s [2]. The realisation that the health of men is an area that requires specific attention has only recently been recognised. Ten years ago, there was very little mention of male health issues other than perhaps of prostate or testicular cancer. Historically, there has been little interest in what is now understood by the term “men's health” [3]. Until the 1990s it was an issue almost completely overlooked by government, health policy makers and practitioners, the media, and, not least by men themselves. By the late-1990s however some change started to occur. In England the government was committed to tackling health inequalities and acknowledged that health was influenced by a range of social determinants as well as behaviour. Men's health specifically was rarely mentioned in policy but, less formally, some ministers and officials at the department of health again acknowledged that it was a problem [3]. At the more popular level, interest in men's health issues was generated by the publication of an increasing number of glossy “middle-shelf” men's magazines notably Men's Health launched in 1995. The impact of these magazines has nevertheless been double-edged. As well as helping to “normalize health” as an issue for men, they have simultaneously contributed to male anxieties about body image and “performance,” including performance at work and sexually [3].

Since the Beijing Platform for Action at the 1995 UN-International Conference for Women, mainstreaming gender equality was predominantly seen as a commitment to ensure that women's as well as men's concerns and experiences became incorporated into all aspects of organisations, from employment issues through to organisational governance, delivery, and outcomes.

In 1999 Viagra became available. This generated enormous media coverage of an exclusively men's health condition – erectile dysfunction- and, in turn, discussion of related issues, such as men's relationships with women, depression, heart disease and diabetes and men's general reluctance to seek help from physicians and other health care practitioners. But men's health – or even the need for a comprehensive approach to gender and health - continued to be largely overlooked. However, there were a few exceptions to this generally gender–“insensitive” approach. The most significant of these was the Institute of Medicine (IOM) report on gender and sex [4]. This document not only defined gender and described its significance but it also highlighted the importance to recognise when there is a need for gender specific research or single-sex services. Until the IOM Report, research has neglected to examine how sex differences influenced men's health or to identify the health risks associated with being male, although comparative studies have included male subjects. The report produced by the Institute of Medicine's Committee on “Understanding the Biology of Sex and Gender Differences” underscores the need to study the effect of sex differences at all levels of biomedical research. The report emphasises that research that includes sex as a variable will have limited value unless the differences between the sexes are scientifically examined and clarified [4].

In recent times it has finally been recognised that this drive for equality must also recognise the health issues that seem to have a more detrimental effect on men and that all health policy must be viewed through a lens that recognises both men and women [5].

The European Men's Health Forum and the International Society for Men's Health (ISMH) have introduced 2004 the Vienna Declaration at the 4th Biennial World Congress on Men's Health & Gender (WCMH) held in Vienna. Dr Ian Banks, President of the European Men's Health Forum (EMHF), presented the EMHF's “Vienna Declaration on the Health of Men and Boys in Europe”. This milestone in men's health, with the potential to make a real difference has now been supported by the Department of Health in Britain by Caroline Flint, UK Minister of State for Public Health [6], [7].

Finally even medical training began belatedly to address men's health. In 2006, the Royal College of General Practitioners launched a new interactive short course, Men's Health in General Practice to help GP's, practice nurses and other primary care professionals expand their knowledge and understanding of men's health needs and improve their consultation techniques. The Irish department for health and children officially addressed 2009 poor men's health on a national scale and introduced the Irish Men's Health Policy – the first of its kind in Europe. The development process of this health policy report included:

A gender-mainstreaming -, a social-determinants -, a community-development -, a health promotion, preventative -, an intersectoral and interdepartmental - and a holistic and positive approach!

There is benefit, as it is recognised that the tendency to create gender-blind policy has had the effect of serving neither men nor women effectively!

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What is Men's Health? 

But before discussing how to improve men's health one has to define “What is Men's Health?” International definitions have provided some insight into the defining boundaries of the men's health fields. The Australian Men's Health Network defines men's health as conditions or diseases that are unique to men that are more prevalent in men, that are more serious among men, for which risk factors are different for men or for which different interventions are required for men [8].

The Men's Health Forum England defines men's health thusly: “A male health issue is one arising from physiological, psychological, social or environmental factors which have a specific impact on boys or men and/or where particular interventions are required for boys or men in order to achieve improvements in health and well-being at either the individual or the population level [9].

Are there other definitions and what are the main problems with men's health?

Definitely the lower life-expectancy and higher mortality rate, the higher incidence of cardiovascular disease, cancer, the weight and obesity epidemic, mental health problems as well as sexual and reproductive health, risk-taking behaviours, the underuse of health services and the lack of specific health information.

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Men's health under-researched! 

As already mentioned in an editorial of jmh this year [10] Men's health topics generate minimal research and are marginalised in scholarly agendas, at least relative to the amount of energy put into women's health research as shown by MO Baerlocher and Verma [11]. Data provided by the Canadian Institute of Health Research (CIHR)- Institute of Gender and Health (IGH) showed that funding since the creation of CHIR in June 2000 to March 2005 for women's health made up 52% of total funding compared to research on men's health which made up only 21%. In the United States the National Institutes of Health (NIH) claim to have spent in 2005 3,551 Billion US Dollars on what they categorised as “women's health research.” How much money was spent on “men's health research”? It wasn’t one of the categories. The NIH also has an “Office of Research on Women's Health” (ORWH), but there is no “Office of Research on Men's Health” [11].

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What is the future of men's health? 

A range of actions are needed to improve men's health. It is important, however, that these are taken within the context of achieving greater health equity between the sexes. This should help to ensure that there are also parallel improvements in women's health and that both sexes are not pitted against each other in a competition for resources. Health policy and practice furthermore needs to take greater account of the differences between men in relation to social class, ethnicity, age, sexual orientation and disability in order to tackle men's health problems effectively [12]. Men who are on the margins of society arguably have the worst health experiences of any group in the world. Poor men, those who are currently or previously incarcerated, those of minority status, for instance, predictably suffer poor health outcomes and limited access to health care. Going forward, it will be important for the field of men's health to recognise poverty as one of the world's most powerful social determinants of health and its particular impacts upon men. Poverty predicts not only lack of access to health care and unfavourable health outcomes, but also devastating social experiences such as incarceration, under-education, and unemployment that produce and aggravate what AMW Young has termed the “health jeopardy” that men face. There is certainly an urgent call to address these numerous health issues. MH Tan in his jmh editorial [2], describes how the situation in Asia is further compounded by the triple tragedies which are engulfing the Asian region, resulting in “growing old before becoming rich”, “falling ill before getting old” and “escalating health care cost compounding the very tight development budget”.

Men's health is no doubt a major concern in this century! Many of the key male health problems are associated with life-style factors such as smoking, alcohol, overweight, inactivity and unsafe sex. These life-style factors are also influenced and compounded by issues of social deprivation and poverty. Earlier public health intervention aimed at the middle years of adulthood would help reduce the financial and social burden of premature male death and male ill-health.

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BRIDGE THE GAP 

It is therefore that the ISMH starting with the WCMH 2009 proposes an initiative to join forces to “BRIDGE THE GAP” in order to initiate a joint effort uniting international and European scientific societies as well as medical organisations in the field of men's health, urology, cardiovascular health, diabetes, obesity, and primary care with additional contributions from individual national experts and from the pharmaceutical industry. The main objectives are to raise greater awareness of the neglected field of men's health and especially its multi- and interdisciplinary nature and to propose policy recommendations towards a more holistic approach to male health care and support. We sincerely hope that many more researchers and contributors from all fields of medicine will take up the challenges and conduct good collaborative interdisciplinary studies to answer key men's health issues which are vital to elevating men’ health status in the whole world.

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References 

  1. 1st Vienna Men's Health Report.
  2. Tan HM, et al. jmh Vol. 5, No 4, pp. 265-266, December 2008.
  3. Baker P. Coalition on Men and Boys 2008 http://www.comab.org.uk/.
  4. Which very comprehensively highlighted the importance of gender in practice, research and health policy, 2001.
  5. A White, Men 2008, Elsevier.
  6. ISMH News The Journal of Men's Health & Gender Vol. 3, No. 3, pp. 220-222, September 2006.
  7. Banks I. The Vienna Declaration: just one more thing? The Journal of Men's Health & Gender, Volume 4, Issue 3, pp. 220-221.
  8. Witzeman, Pardou T. National Academy Press 2003.
  9. Men's Health Forum (2004). Getting it sorted. Retrieved September 19, 2006, from www.menshealthforum.org.uk.
  10. Meryn S, journal of men's health, Vol 6, No. 1, pp. 2-3, March 2009.
  11. Baerlocher MO, Verma S. Men's Health research: under researched and under appreciated? Med Sci Monit 2008; 14(3): SC5-6: Available at: http://www.medscimonit.com/fulltxt.php?ICID=836565.
  12. Young AMW. Disparities in health among men: toward a global perspective. jmh, vol. 4, no.3, 222-5. September 2007.

PII: S1875-6867(09)00269-3

doi:10.1016/j.jomh.2009.08.191

journal of men's health
Volume 6, Issue 3 , Pages 143-146, September 2009

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