England’s first men’s health strategy: will system design still leave some men behind?

The launch of England’s first men’s health strategy is a significant and long overdue step. For the first time, there is an explicit vision and national commitment to address men’s poorer health outcomes and lower engagement with services. But a strategy is only as good as its implementation. In practice, ambitious visions can often disappear into the gap between national policy and local delivery. If the strategy is to make a difference, its impact will depend less on changing men’s behaviour and more on how health systems are designed to respond, particularly for those experiencing intersecting disadvantage. 

Men facing combinations of socioeconomic deprivation, minority ethnicity, disability, insecure or precarious work, and social marginalisation carry a disproportionate burden of preventable ill health. They are more likely to die earlier, live with multiple long-term conditions, and disengage from health services. These patterns are well established in the evidence yet they persist, not because they are poorly understood, but because health systems have struggled to adapt to them. 

Intersectionality helps to explain why risk and disadvantage cluster, and why a focus on gender alone is insufficient. Evidence on changing gender norms shows that men’s health behaviours are shaped by social and structural context, not fixed notions of masculinity, reinforcing the limits of approaches that focus on gender in isolation. However, in health policy, and in men’s health specifically, intersectionality has often remained descriptive; frequently used to name complexity but rarely applied to reshape how services are designed, accessed, and experienced. The challenge for the men’s health strategy will be to ensure this insight translates into meaningful system change. 

Many of the challenges in men’s health are best understood not as problems of individual attitudes or behaviours, but as the result of how health systems are designed. When a service requires a phone call at 8am for a 10am appointment, it is not stoicism that keeps a zero-hours contract worker away, but the risk of losing a day’s pay. Too often, systems are built around assumptions of stable lives, flexible work, and confidence in navigating services. When men do not fit these assumptions, disengagement is frequently treated as an individual failure rather than a predictable system outcome. 

These design features matter most for men facing intersecting disadvantage. For men juggling insecure work, housing pressure, discrimination, caring responsibilities, or disability, health care that depends on flexible time, sustained engagement, and confidence in navigating services is harder to access and easier to fall out of. This has direct implications for implementation of the men’s health strategy. If delivery relies on familiar tropes of male stoicism or focuses primarily on awareness raising and help seeking without addressing how systems actually work, it will fail to shift outcomes for those most affected. The result will be well intentioned activity that reaches those already closest to services, while inequalities remain largely untouched. 

What is needed instead is a much clearer focus on system responsibility. That means asking not only who the strategy is for, but how health systems are expected to change in response. One useful lens to view this through is the 5R framework, five concepts that cut across conditions, settings, and population groups:  

• Reach: are systems designed to proactively reach men least likely to present, rather than assuming men will come forward? For men facing disadvantage, limited contact with services, low trust or previous negative experiences can reduce confidence in care and deter engagement. 

• Responsiveness: when men do engage, do services reflect the realities of their lives? This can include practical issues such as appointment times and modes of contact, but also whether services recognise how distress and need may be expressed differently, shaped by culture, gender norms, and context. 

• Retention: getting men through the door is only part of the challenge. Many interventions lose men early, with limited follow up or learning. Treating disengagement as an individual choice rather than a signal about service fit means systems can fail to adapt. Sustained engagement should be treated as a core outcome, not a by-product. 

• Research: we lack evidence on what works to improve reach, responsiveness and retention for men facing multiple disadvantages, and why. Current data systems rarely support intersectional analysis of service use and outcomes, making it difficult to see who is reached, who isn’t, and when. 

• Relationships: men experiencing intersecting disadvantage are not only service users but fathers, partners, colleagues, and community members whose health is closely linked to the wellbeing of those around them. A relational lens shifts the focus away from men as ‘patients with problems’ and places men’s health firmly within a wider equity agenda. 

All of this points to a familiar risk: that policy ambition is not matched by delivery. The men’s health strategy creates an opportunity to avoid this, but only if intersectionality is treated as a design principle rather than a background narrative. That means being explicit about how services are expected to adapt, not simply which groups are prioritised. 

For implementation, there are clear implications. Delivery plans need to go beyond uptake and activity measures to include reach, retention, and equity of impact. Systems should be encouraged to use routine data to identify where men drop out and to treat this as a prompt for redesign rather than explanation. Workforce development needs to support more gender responsive practice, particularly in services where disengagement is common, such as mental health. Research investment should focus on building a more usable evidence base around service mechanisms, context, and transferability, not just outcomes. 

Some critics argue that a men’s health strategy is special pleading for a group that already holds social power. This misses the point. Improving men's health is about system performance and equity. We do not need to create a parallel men’s health service; instead, we need to fix how existing systems work for men, especially those experiencing the worst outcomes. 

England’s first men’s health strategy will be judged not on its vision and intent, but on whether it leads to healthier, longer lives for the men currently least well served. Intersectionality tells us where the problems lie, implementation will determine whether we are prepared to act on what it reveals.