Editorial

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 popula-

tion – and 72% of male prisoners suffer

from wo or more mental disorders com-

pared with 5% of men in the general

population.

46% of male psychiatric inpatients (com-

pared with 29% of female patients) are

detained and treated compulsorily.

Boys are five times more likely to be

diagnosed with Attention Deficit Hyper-

activity Disorder than girls.

84% of children excluded from school are

boys.

Ian Banks, MDPresident of The EuropeanMen’s Health Forum,11 rue de l’Industrie,B-1000 Brussels, Belgium

E-mail:office@emhf.org

Online 12 February 2009

10 Vol. 6, No. 1, pp. 1

Elam: lost city rediscovered

Ian Banks

When Mt Vesuvius erupted in 79AD, its most

recent deadly expression of tectonic prema-

ture 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 Her-

culaneum and the clue to its previous exis-

tence 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.

0–13, March 2009

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).

So is it all men’s fault?

Men’s use of health services and health infor-

mation is generally poor across Europe. At the

same time, the delivery of healthcare and infor-

mation 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 avoid-

able inequalities between countries.

Poor health and premature death in men

also affect their families and are an unneces-

sary burden on health services and the wider

economy.

These problems require responses that take

account of the specific needs of men.

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 East-

ern 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 expectan-

cies, national life expectancy figures can hide

� 2009 WPMH GmbH. Published by Elsevier Ireland Ltd.

Editorial

Box 2

Council of EuropeRecommendation [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 includ-

ing actions related to health care, health

promotion and disease prevention in an

equitable manner;

3. consider issues related to the improve-

ment of access and quality of health

services as these relate to the specific

and differing needs and situations of

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 expec-

tancy 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 magni-

tude of such variations in life expectancy sug-

gests that these are not solely attributable to

biological causes.

Men’s health outcomes are closely related

to the social construction of their masculi-

nities: 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, masculi-

nity 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.

men and women;

4. develop and disseminate gender sensi-

tive knowledge that allows evidence-

based interventions through systematic

collection of appropriate sex-disaggre-

gated data, promotion of relevant

research studies and gender analysis;

5. promote gender awareness and compe-

tency in the health sector and ensure

balanced participation of women and

men in the decision-making process;

6. establish monitoring and evaluation fra-

meworks on progress on gender main-

streaming in health policies

Men, women and health

We, as European citizens, must strive to under-

stand 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 pro-

blems for individuals and society.

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 con-

tinue 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 improve-

ment. 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

Vol. 6, No. 1, pp. 10–13, March 2009 11

Editorial

Box 3

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 assign-

ing 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 var-

ious social groups and between women

and men.

12 Vol. 6, No. 1, pp

their biology and their socialisation in an

equitable manner (Box 3) [10].

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 infor-

mation 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

. 10–13, March 2009

failing to engage effectively with men, espe-

cially men in disadvantaged groups who are

left exposed to the risks and costly complica-

tions associated with poorly managed illness

as a result.

A step change would be achieved by bring-

ing primary health services outside of their

clinical settings, and by promoting their avail-

ability 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 work-

place 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 com-

plications. 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 com-

munity 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 lit-

eracy from an early age so that they can

become more independent in the manage-

ment 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 aspira-

tions, 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.

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,

Editorial

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.

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 health-

care. 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 Eur-

opean countries and internationally have

demonstrated the effectiveness of such

approaches. A particularly well documented

study is the 5-year government-funded (s 3

million) Bradford Health of Men in the UK [12].

[

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 work-

place. The role of governments, non-govern-

mental 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.

References[1] Eurostat. Life expectancy and mortality. pp.

95–98 in Eurostat Yearbook 2003: the sta-

tistical guide to Europe. Data 1991–2001.

Available at: http://epp.eurostat.ec.europa.

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_dad=portal&_schema=PORTAL&p_product

_code=KS-CD-02-001.

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[14] O’Connor D. $3 million funding for new

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