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Covid-19: Letter to government 19/03/20

The Forum's first letter to CEOs of Public Health and Chief Medical Officers in England, Scotland and Wales.

Duncan Selbie
Public Health England (by email)
March 19, 2020 

Dear Duncan,

Excess COVID-19 deaths amongst men – implications for action

Thank you for everything you and your colleagues are doing to fight COVID-19.

One emerging trend which is causing us concern is the excess mortality from COVID-19 amongst men. We are keen to know what Public Health England is doing to understand this and reflect it in your work.

Following the early results from China, mortality statistics from Italy (via WHO Europe) and Denmark and, based on newspaper reports, the UK suggest that, to date, around 70% of deaths from COVID-19 are male – at a younger average age – despite men being a minority of the older age group most at risk.

Hypotheses for this include:

  • Men are biologically more susceptible to respiratory diseases generally
  • Men’s health behaviours are overall more risky
    • Historically, men have smoked more than women
    • Men, especially working age men, generally seek medical help later
    • Men generally wash hands less
    • Possible gender difference in self-isolation and compliance with advice
  • Traditional views of masculinity can act as an obstacle to behaviour change.
  • Male and female attitudes to ‘man flu’ may be stigmatising male help-seeking for infection.

Our strong belief – which we know is also reflected in your strategy – is that taking proper account of sex and gender (and other health inequalities) leads to better and more effective policy and intervention. To this end, we are keen to get reassurance that you and your colleagues, are:

  • Collecting data, analysing and publicly reporting by inequality group (including sex and age) – on incidence, outcomes and the effectiveness of interventions – both behavioural and medical
  • Including within your research programme the question as to why men are more susceptible to COVID-19 and dying at higher rates – and what actions this requires
  • Understanding how different groups are responding to public health interventions and identify segmented messaging and interventions to reach groups where change is needed

Longer-term we are also concerned that work on the mental health impacts of social isolation and other impacts of the interventions to control COVID-19 also have inequalities within their scope – and are mindful of issues already more salient in men such as risky levels of alcohol consumption and suicide.

We are a small charity but will do what we can to help on any of these issues, recognising that the most effective response is likely to come from your own colleagues addressing these issues directly. Thank you again for everything you are doing.

Martin Tod,
​Chief Executive, Men’s Health Forum

LETTER to Public Health and CMOs, 19/03/20 (PDF, 70kb)