Second Opinion: Men’s health is determined by jobs, society and other outside factors

Men have always been less healthy than women. They are four times more likely than women to kill themselves and 20 times more likely to die from work-related accidents. Biological differences between males and females do not explain the gap in health status. Being a man is bad for health.

Society expects men to work in risky jobs such as construction, agriculture and fishing. They work longer hours than women and spend less time with their children. Men’s health is consumed by their job if they have one, by unemployment if they don’t, and by society’s beliefs about the way men should be.

Ireland was one of the first countries in Europe to recognise gender as a major determinant of health and to develop a policy: the National Men’s Health Policy: Working with Men in Ireland to Achieve Optimum Health and Wellbeing 2008-2013 (NMHP).

Some excellent initiatives are happening at grassroots level, and many individuals and groups of men have better health as a result of their involvement in policy projects and programmes. Unfortunately, not enough of the policy has been implemented to make a difference to men’s health as a whole, and men’s overall health status has disimproved.

Weight problems

Recent studies show that overweight and obesity in Irish men is more prevalent than five years ago. Findings from the

Global Burden of Disease Study 2013

, which was published by the World Health Organisation last month, show Irish men are now among the fattest in the EU, with 66 per cent of males over 20 years overweight or obese. Only the UK, Malta and Cyprus have higher prevalence figures. “Not only is obesity increasing [globally] but no national success stories have been reported in the past 33 years.”

The proportion of overweight and obese men in Europe will increase between now and 2030 and will reach 90 per cent in Ireland, the highest level calculated.

Dr Noel Richardson, director of the National Centre for Men's Health at the Institute of Technology, Carlow, reviewed the NMHP actions that have been implemented to date. His paper, Building Momentum, Gaining Traction: Ireland's National Men's Health Policy, 5 years on, was recently published in the international journal New Male Studies.

Parts of the policy have been implemented, particularly those related to research, man-friendly health information, training, and workplace and community initiatives. Several reports are now available to inform practice, including Facing the Challenge: The impact of the Recession and Unemployment on Men's Health in Ireland (2011) by the Institute of Public Health and Young Men and Suicide Project: A Report from the Men's Health Forum in Ireland (2013).

A men’s health training package, Engage, aims to make frontline service providers more sensitive to men’s needs.

The HSE will deliver the training to 150 participants this year. Workplaces have produced health information booklets specifically for men, including An Post and farmers’ organisations.

The Men’s Sheds movement has been spectacularly successful and there are now almost 200 of these sheds throughout the country. They provide meeting places where men get involved in mutually agreed activities such as carpentry projects and health promotion.

Funding challenge

The launch of the NMHP coincided with the economic crash so implementation has been a major challenge with no new funding or staff.

Richardson’s review shows that “despite an exponential growth in men’s health work in recent years, there is still a huge void between the breadth of policy actions called for in the NMHP and the resources available”. More worryingly, because it is cost-neutral, “one of the most difficult challenges has been to get ‘buy-in’ across Government departments on policy implementation”. The structures needed to ensure joined-up working “did not materialise”.

The NMHP is not the only policy to be partly implemented.

Health is determined by factors outside the health system, such as educational attainment and the environment, so most health policies need joined-up Government at implementation stage. This seldom, if ever, happens. Obesity is more prevalent now than when The Policy Challenges: The Report of the National Taskforce on Obesity was published almost 10 years ago, because Government departments have not collaborated in the way envisaged in the report.

The implementation of Healthy Ireland, the new framework for action to improve health and wellbeing, depends almost exclusively on, as the document says, “a whole-of-Government” approach.

Unless this happens, there is little hope for anyone’s health, men’s included. The HSE intends to evaluate the NMHP this year and the findings may ensure joined-up working in future.

Jacky Jones is a former HSE regional manager of health promotion. drjackyjones@gmail.com