A radically new approach is needed to tackle the serious health problems facing men around the world, says Global Action on Men’s Health in a new report.

Who Self-Cares Wins: A global perspective on men and self-care busts the myth that men are invariably self-destructive when it comes to their health – globally, most men do enough physical activity to benefit their health and do not smoke or drink alcohol – but very clearly shows that men’s health is nevertheless unnecessarily poor. 

Average global life expectancy for men lags behind women’s by four years (70 v 74 years) and there is not a single country where men live longer than women.

Genetics account for 1-2 years of the ‘sex gap’ and the remaining deficit is in large part due to men’s health behaviours such as smoking, a poor diet and excessive alcohol consumption. Around half of the sex difference in mortality from all causes in Europe is due to smoking and around one fifth is due to alcohol consumption. Globally, about 45% of male deaths are due to health behaviours, according to the Institute for Health Metrics and Evaluation. Improving men’s self-care could therefore lead to major improvements in their health.

The evidence from multiple studies shows that:

• Men generally have lower health literacy levels than women.
• Male mental health problems are under-diagnosed, because men are less likely to contact health services for help and often present their mental distress differently from women.
• About a quarter of men globally are too sedentary with inactivity levels highest in the high-income countries.
• Men generally have less healthy diets than women with lower consumption of fruits, vegetables, nuts/seeds and whole grains.
• Adult men are more than five times more likely to smoke than adult women and well over a third of men drank alcohol compared to a quarter of women
• Men generally under-use primary healthcare services, including GPs, pharmacies, dentists, optometrists and health checks or screening.

Male gender norms are a key barrier to better self-care for men. Men are expected to be self-sufficient, to act tough, to be physically attractive, to be heterosexual, to have sexual prowess, and to use aggression to resolve conflicts. These norms inevitably make it harder for men to practice better self-care.

Research shows that men who most closely identify with ‘traditional’ masculinity are more likely to exhibit damaging lifestyle behaviours. H

ealth policies and services have not taken men into account. Only three countries have specific national men’s health policies (Australia, Brazil and Ireland). Most global health organisations do not address men’s health either.

But Who Self-Cares Wins believes that recent developments – including the UN’s Sustainable Development Goals (which call for action on a range of diseases caused by risk-taking behaviours), the adoption of a regional men’s health strategy by WHO Europe, and an expanding evidence base about how to engage men effectively in health – provide a new opportunity to improve men’s self-care. The report argues that while it is clearly the responsibility of individual men to take care of their own health, strategies to improve men’s health cannot simply be based on exhortations to change lifestyle practices that are rooted in gender norms and other social determinants of health.

Who Self-Cares Wins argues that action on a multi-layered and systems-wide basis is needed to improve men’s self-care effectively. Global Action on Men’s Health is therefore calling for:

• Health policies, including national men’s health policies, that recognise the needs of men.
• Full account to be taken of male gender norms in policy and service delivery.
• Establishing self-care as a strategic priority in public health policy and practice.
• Action to improve men’s health literacy.
• Health services that are more accessible to men.
• Better training in men’s health for health and related professionals.
• Accelerated research into improving men’s engagement in self-care and better practical guidance for policymakers and practitioners.

The report’s author and the Director of Global Action on Men’s Health, Peter Baker, said: ‘It is indisputable and unacceptable that men’s health is unnecessarily poor in every country in the world. This is in large part due to male gender norms, which lead many men to take risks with their health, and the failure of policymakers and service providers at all levels to take account of men’s specific needs, attitudes and behaviours. That’s why, on World Health Day, we are calling on global and national health leaders to introduce the policies and services that would make a difference.’

Dr David Webber, President of the International Self-Care Foundation, said: ‘In the self-care field as elsewhere, men’s health has been generally overlooked. This report provides a very welcome synthesis of the key issues and clearly shows that there is now enough evidence from research and examples of good practice to make the changes that are needed. Measures to improve men’s self-care should be an essential part of the effort to improve overall health outcomes.’