Talking about men’s health

Over the past year, The King’s Fund has been running a project exploring how different groups of men think about their health and how they experience health services. The work was commissioned by the Department of Health and Social Care through the National Institute for Health and Care Research as part of wider work on the Men’s Health Strategy for England, which sets out a vision and a national commitment to address men’s poorer health outcomes and lower engagement with services.

We spoke to around 100 men from a range of backgrounds at different stages of their lives and across different parts of the country, aiming to recruit men adversely affected by health inequalities. We know that different factors like socio-economic deprivation and minority ethnicity are associated with risk and disadvantage, but we wanted to understand how the intersection of these factors affects men’s lives when it comes to their health. You can read our report here.

When I told friends and colleagues about the project, several asked whether it was right to focus on men in this way. There were two thoughts behind this challenge. Firstly, isn’t masculinity the gender of privilege and advantage? Why do men need even more help? Secondly, apart from sex-specific health topics such as prostate cancer or the menopause, is it helpful or necessary to have gendered discussions about health?

The facts show that, when it comes to population health, men have consistently worse outcomes across many dimensions. Men live on average four years fewer than women, and are twice as likely to die prematurely from several common preventable conditions, such as cardiovascular disease. Perhaps most starkly, three in four people who die by suicide are men. These inequalities are exacerbated by other risk factors, with deprivation having a greater impact on life expectancy for men than for women. Men in the most deprived areas die around 10 years earlier than those in the least deprived areas.

Although many of the challenges men experience in relation to health and health services are not unique to them, the ways they respond are often shaped by the context of their lives. Our work underlined the importance of understanding how gender influences health, and how people think and talk about it.

So, what did we learn? Based on the focus groups and interviews, here are six key considerations for policymakers, commissioners and service providers for supporting men’s health.

1. Design services around men’s lives

Services can much more effectively support men if they are designed with the needs of specific communities in mind, including the specific barriers and enablers to engaging them. This includes crucial practical factors, such as where and when services are offered, with men in insecure or inflexible employment being much less able to take time off work to seek treatment. It also includes more psychological factors, such as how different groups of men think about specific health issues. It really matters how services are framed and who delivers them, so that they feel credible and relevant to men’s lives.

2. Talk differently about mental health

One of the most striking findings was the wide variation in how men feel about mental health. While many younger men are comfortable with the concept of everyone experiencing a spectrum of mental wellbeing, many older men are alienated by this way of thinking. These men tend to externalise any mental health issues they experienced and talk about them in terms of the specific challenges in their lives that were causing them difficulty, such as work, money or relationships. Support for mental health therefore needs to be tailored so that men are engaged in ways that resonate with their perspectives and values.

3. Make every contact count

Many of the men we spoke to had negative views of the NHS, especially of general practice. These attitudes were often rooted in prior experiences of seeking care that led to them feeling unsupported or not meaningfully listened to. Many men have little engagement with health services before middle age, and when early contact is dissatisfactory, this can have a lasting impact on their willingness to seek help in the future. Many men told us they delayed or avoided seeking help due to the anticipated difficulty of getting the care they needed. This underlines the importance of using early contact to develop a trusting relationship with the health system.

4. Recognise the central role of employment in creating good health

Employment was the dominant health factor in the lives of many of the men we engaged with. Workplace roles, relationships, job security and performance requirements were viewed as having a significant impact on their long-term wellbeing. More should be done to understand how roles can be health-enhancing, as well as which features impact negatively on health, and use this to improve the health-related quality of employment. Given how sceptical many of our participants were about workplace-based mental health support, often seeing it as largely tokenistic, it is important to establish what good workplace mental health culture, policies and support look like.

5. Build on positive aspects of masculinity

Masculinity is complex, varying greatly across age, culture, class and other contexts. We found that masculine norms can influence how comfortable men feel about acknowledging concerns or seeking help, whether this is from fear of appearing weak, being a burden, or from a responsibility to care for others. The men we spoke were able to reflect on the impact this had both for themselves and for other men. Rather than thinking of masculinity as a barrier or risk factor, health systems might more successfully engage men by seeking to support the positive aspects of masculinity.

6. Address disadvantage across different groups of men

We spoke to a wide range of men and observed many different pressures relating to factors such as income, deprivation, ethnicity, geography, disability, long-term health conditions and sexual orientation. Deprivation-related factors on health were particularly apparent. They directly affected the time and money available for practicing healthy behaviours such as eating well, exercising, seeking help or attending appointments. It is vital that population health strategies do not dismiss health-related behaviours affected by disadvantage as a matter of personal choice. Instead, they need to understand how disadvantage impacts on different groups of men across communities, and develop plans that address this and support men affected by health inequalities to live healthier lives.

Our conversations not only demonstrated the importance of listening to different groups of men, but underlined that commissioners need to think about how they can best tailor services to engage and support men. I was repeatedly struck by how much more effective services could be if they worked in partnership with the men we spoke to, responding to their perceptions, needs and experiences. In some cases, this was about relatively small, practical improvements to how care is offered. In others, it pointed to the need for wider societal change, for example in the role of the workplace. But these insights were united by the potential benefits of rethinking and reshaping the relationship between services and the people they serve, to better focus on what will genuinely make a difference to their lives.