Men’s health policies: Long overdue

This article, “Men’s health policies: long overdue,” was published by the World Health Organization and is available on the National Institutes of Health PubMed Central website. It is distributed under the Creative Commons Attribution IGO License (CC BY 3.0 IGO). 

In adopting Transforming our world: the 2030 Agenda for Sustainable Development, countries pledged to reach the furthest behind first. However, to achieve this goal, major gender disparities in health-care access and outcomes must be addressed. Globally, men have shorter life expectancy and higher mortality than women. In 2023, global life expectancy at birth was 71 years for men and 76 for women, a gap that has been consistent since 1950.¹ The global mortality rate in 2023 was 176 deaths/1000 for men and 113 deaths/1000 for women.²

These gender disparities in health are more pronounced in groups of men who are marginalized by race, disability, age or sexual orientation, particularly in post-colonial societies. For example, in southern Africa, the epicenter of the human immunodeficiency virus and tuberculosis epidemics, the migrant labor system disempowered and negatively affected the health of millions of African men and their families. Young men were placed in urban environments with extremely poor living and working conditions. These workers then returned to rural areas, spreading new diseases within rural populations.³

Yet responses to gender inequities affecting men’s health have been uneven and frequently polarized. Historically, men’s health has largely been ignored by international health agencies, funders and national programmes,^4–6 a situation that has been described as a systematic neglect.⁷ But targeting men’s health is politically sensitive: these discussions have been, and sometimes still are, perceived as reinforcing male privilege, rather than realizing men’s right to health. Men are still not identified as a vulnerable group in most national health policies. Men and women are treated as competing populations, with men somehow less deserving of attention. Yet, given the evidence on health access and outcomes, men are clearly the furthest behind.^5,8

Over the past 15 years, a small number of committed individuals and organizations have focused attention on and advocated for men’s health.^9,10 As a result, a few countries have formulated men’s health policies, in some cases up to 20 years after formulating policies for women, older people and people with disabilities. The Irish Department of Health and Children led the way with a comprehensive report on men and their health. Building on this report, Australia, Brazil, Islamic Republic of Iran, Malaysia, Mongolia, South Africa, the World Health Organization (WHO) European Region and the Quebec province in Canada have since produced policies addressing men’s health.

These policies confirm that men have higher mortality and lower engagement with health services than women, and address individual and systemic risk factors driving these disparities. Policies propose entry points to engage men in care including fatherhood in Brazil, voluntary medical male circumcision in South Africa and an approach in Quebec that promotes positive aspects of masculinity. In Australia and Ireland, the policies prioritize the health needs of groups of marginalized men. In Leeds, United Kingdom of Great Britain and Northern Ireland, gender is now considered when commissioning all new services, which has changed the way in which interventions such as cancer and suicide risk prevention are provided. Gender is integrated into broader development planning in Mongolia, while policy-makers in the Islamic Republic of Iran have identified context-specific risk factors for men’s health. In a concise overview of key issues, the WHO Regional Office for Europe highlights men’s high burden of injury, road traffic accidents, suicide and mental health, and shows how financial insecurity and migration increase men’s vulnerability and social exclusion.

However, most policies have insufficient focus on monitoring and lack specific, achievable targets and timelines. Existing country policies would be strengthened by clear monitoring and evaluation frameworks and implementation plans. To date, only the Irish policy has undergone a formal evaluation,¹¹ which showed a considerable impact on community-level interventions, research and training for health and related professionals. However, the evaluation found that the recommendations and scope were too extensive, undermining the policy’s impact, and success in addressing broader structural risk factors was limited.

For men, one of the major structural risk factors is violence, fueled by alcohol and firearms. Globally, the gender disparity in mortality is most evident in deaths from interpersonal violence, especially among young, marginalized men. For example, in 2017, South Africa had seven times the global homicide rate, with no decrease since 2009.¹² Homicide victims were predominantly male (87%; 16 835/19 477) and young (aged 15–44 years). Alcohol use was strongly associated with violent deaths, and one third of all homicides were firearm-related. Stricter legislation can reduce major risk factors, but strong global alliances are needed to challenge the powerful alcohol and firearm lobbies and reduce the levels of interpersonal violence.

To improve men’s health, the global health community needs to be more ambitious in proposing systemic changes. Future policies require an increased focus on the social determinants of health: the conditions under which people live, work and age, and the inequities that give rise to these conditions. Even in a high-income country like the United Kingdom of Great Britain and Northern Ireland, for example, there is a 27-year difference in life expectancy for different groups of men depending on socioeconomic status, far larger than the gap between men and women.⁹

In addition to national policies, global health institutions and funding agencies have an enormous influence on health responses, and many continue to explicitly equate gender with women, such as the United Nations (UN) Inter-Agency Network on Women and Gender Equality, the Joint United Nations Program on HIV/AIDS (UNAIDS) Agenda for accelerated country action for women, girls, gender equality and HIV: operational plan and the sustainable development goal (SDG) 5 on achieving gender equality and empowering all women and girls. A review of 37 regional and global health policy documents on sexual and reproductive health found that only five of them included targets for men.¹³ When men were included in global health policy documents, it was frequently in an instrumental way, to protect the health of women, rather than to address the health needs of men. Language in global goals should be reviewed for consistency across four critical, interlinked goals – poverty, health, gender equality and reducing inequality – to ensure that the SDGs are evidence-based and truly equity-focused.

In recent years, some positive developments have occurred: some governments have adopted men’s health policies; men’s health organizations have emerged in many countries and globally; a growing body of research has been published in dedicated men’s health journals; UNAIDS and WHO have shown an increasing interest in this topic; and evidence of good practices is emerging. Robustly evaluated projects now exist, demonstrating that a gender-targeted approach works, described in the Global Action on Men’s Health Delivering men’s health report.¹⁴ Equally important is the inclusion of men in other health policies such those related to cancer, sexual health, obesity and mental health. For example, the national suicide strategy of the United Kingdom focuses on men, while the European Commission recommends introducing prostate cancer screening programs across the European Union (EU) countries. In another positive development, over 40 countries have introduced human papillomavirus vaccination for girls and boys, a measure the European Commission recommends for EU Member States.

These developments are encouraging but more action is needed. As governments work towards universal health coverage, men’s health must be recognized as a fundamental issue, not a peripheral consideration. Addressing gender inequities in health, including those affecting men, is essential to ensuring that no one is left behind.

Morna Cornell

Morna Cornell is Senior Research Officer at the Southern African IeDEA (International Epidemiology Databases to Evaluate AIDS) data centre based in the Centre for Infectious Disease Epidemiology (CIDER), School of Public Health & Family Medicine.