Men's health: are we living on a volcano?

Is the truth about men's health as deeply buried as the lost city of Pompeii once was? MHF president Dr Ian Banks uncovers the evidence.

When Mt Vesuvius erupted in 79AD, its most recent deadly expression of tectonic premature exasperation, it covered with ash at least two major cities both of which lay uncovered for centuries until the true nature of the disaster was uncovered.

At the time it was put it down to the 'gods'. Fatalism was the order of the day. People still live next to 'volcanoes'. Men in Europe, for example. This is a volcano already erupting and for many men and their families, it is getting worse not better

• 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.

The shorter male life expectancy at birth (74.6 years vs. 80.8 years for women) is slowly rising, albeit not in all countries. 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 (eg. Carlton) are only expected to live until the age of 54. 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.

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.

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 probelms. As a result, men are more likely to lead unhealthy lifestyles and to remain undiagnosed.

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. 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.

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.

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.

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.

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. 

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.In New Zealand, the government has launched a $3m programme to run over the next year promoting greater awareness of men's health. The Irish government has launched a national 'Policy for men's health and health promotion'.

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 Bradford Health of Men in the UK.

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, 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.

• A longer version of this article complete with references, tables and additional information was first published in the 4.7MB version March 2009 (Volume 6, Issue 1, Pages 10-13) under the title 'Elam: lost city rediscovered'.