Inequalities in men’s health: why are they not being addressed?

Almost half of England’s population is male, yet inequalities in men’s health seldom get specific attention. The women’s health strategy for England shone a light on the health care needs of girls and women through their life course, highlighting areas specific to their health – such as maternity and the menopause – and inequalities in health outcomes. But the wide, and widening, health inequalities experienced by men also require focus.

Recently, parliament’s Health and Social Care Select Committee has been investigating men’s health, including inequalities, but this needs to be followed by action given the scale of preventable ill health and death among large numbers of men in some communities.

Males have a lower life expectancy than females. Men are twice as likely as women to die prematurely from cardiovascular disease, lung cancer, liver disease and accidents, and 3 in 4 suicides are by men. The pandemic also exacerbated male mortality, as men were more likely than women to die from Covid-19. Although life expectancy is lower on average in poorer areas, deprivation has a greater impact on men: in the most deprived decile of local authorities, male life expectancy is 4.3 years shorter than female life expectancy, compared with 3.3 years in the least deprived decile.

Men living in deprived areas are also more likely to die from preventable conditions. Mortality rates from lung cancer, chronic obstructive pulmonary disease (which is caused mostly by smoking) and heart disease are 2–4 times higher among men living in areas with the most deprivation compared with the least (see Figure 1). Rising death rates from alcohol and drug-related disorders since 2012 are particularly concerning; by 2020 deaths were more than five times higher among men in the most deprived areas compared with the least deprived (see Figure 2). These ‘deaths of despair’ (deaths from alcohol, drugs and suicide) occur predominantly in men.

Like most other causes of death, there is also geographic inequality – which is highest in the North East, reflecting the greater levels of deprivation in Northern regions. A constellation of factors is driving inequalities in men’s health. ‘Left behind’ communities of Northern England, men in particular, face the chronic health disadvantages resulting from persistent and growing socio-economic inequalities. This preventable morbidity and mortality is driven in part by marked inequalities in risk factors such as smoking and obesity/being overweight. Risk factors such as these often cluster, increasing the risk of early onset of disease and multimorbidity and intensifying health inequalities. Access to primary care is also worse in deprived areas, as there is poorer availability and greater shortages in the general practice workforce. Men are also less likely than women to consult a GP, the gender difference being wider in more deprived areas, and have less contact with mental health services.

As well as socio-economic and geographical inequalities, other factors also drive health inequalities between men. For example, Black men are more likely to be diagnosed with severe mental health problems, and older GBTQ (gay, bisexual, trans and queer) men are more likely to experience poor health and wellbeing.

Reducing inequalities in men’s health offers significant potential for health improvements and increased economic productivity resulting from a healthier workforce.

But much of this burden of ill health and death is preventable. Reducing inequalities in men’s health offers significant potential for health improvements and increased economic productivity resulting from a healthier workforce. In particular, economic regeneration of deprived Northern communities is crucial for reducing the profound and entrenched inequalities seen in men’s health. The lack of tangible progress in the levelling-up agenda to narrow the gap in healthy life expectancy is failing to capitalise on the potential health and economic gains to society.

More immediately, however, there are actions that could reduce inequalities in men’s health. A renewed focus on prevention through the restoration of public health budgets that were cut during the austerity years would help to reduce the prevalence of ill health and costs to the health and care system. Fiscal and regulatory measures designed to reduce obesity and smoking are also likely to be more effective than relying solely on individual behaviour change.

At a local level, statutory services can be more proactive in terms of ensuring they reach men who are less likely to access health care. Community groups and charities also play a crucial role in reaching men at high risk of inequalities. For example, Orchid is a charity working with those affected by penile, testicular and prostate cancer. Like other issues discussed in this blog, there are inequalities among men in terms of geography and ethnicity relating to these cancers. Orchid works in ten UK cities to train ‘Community Champions’, particularly from Black and minority ethnic backgrounds, to share information with their networks and their local communities. Charities like this can support men at high-risk of health inequalities, such as those living in poorer areas or who are racialised – as well as those who are less likely to access health care.

In this Men’s Health Week, we renew our urgent call for multi-faceted cross-government action to reduce health inequalities, including in men, and the wider determinants that drive them.