Ireland have a national men's health policy. Australia will have one. Does your country need one? You might expect the policy officer of MHF England to say that England needs one but he doesn't. David Wilkins explains why he thinks a national men’s health strategy is NOT the best way forward for us all.
In recent years, specialist campaigning organisations in several countries have begun to press governments to tackle men’s poorer health outcomes. There is increasing recognition that it is possible to improve male health and that it is right that health providers should try to do so.
Could it then be a good idea to set our sights on a national men’s health strategy for every interested nation? A national men’s health strategy could pull together all the relevant research; identify the areas of need; provide resources and training; encourage good practice; stimulate public interest; set targets; monitor progress. The appeal is obvious.
I take my hat off to colleagues in Ireland and Australia on the work they have done in bringing their respective governments to the point where they have put national policies in place (this process is complete in Ireland and well underway in Australia). It is a huge achievement in both cases. In principle I have no doubt that a considered and comprehensive national men’s health strategy with wide political support would benefit any nation.
Does that mean though, that aiming for a national men’s health strategy is the best way forward for all of us?
Thinking about this question purely from the English perspective, I’m not so sure.
Lack of resources
Our organisation, the Men’s Health Forum, is large by international standards in this area of work. We have around ten staff ( including administrative support and freelance colleagues). We also have a significant body of professional support. In some countries the whole men’s health “movement” is made up of a just a few people working in their spare time. By comparison with other campaigning health organisations within the UK however the Men’s Health Forum is tiny. We have only a fraction of the resources of – to take a couple of examples – the major cancer or mental health organisations.
The time and effort required to develop outline content for a national men's health policy and to do the necessary lobbying of government would eat up an huge proportion of our capacity. It would also cost us money – no-one would pay us to do it. It could therefore only happen at the expense of all the other things we do.
If, on the other hand, we somehow managed to persuade government to take on the entire development of such a policy itself – maybe via some kind of Commission for Men's Health, there would potentially be more disadvantages than advantages. To be any use, a national men's health policy that would need to have a very wide scope. Numerous physical and psychological conditions would need to be included; gender differences in health behaviours would need to be considered; the link between male gender and economic inequalities would need to be taken into account, as would the link between male gender the social determinants of health. Many of these issues are subject to competing ideologies and interpretations. There is a risk that arguments over the development of a policy could drag on for a very long time.
Political compromise dilutes
The only way to resolve difficulties of the kind outlined above is political compromise. Political compromise invariably results in ideas becoming watered down. Furthermore, it would be obvious that to make any significant impact on men’s poorer health, services would require some restructuring and probably some new resources. You don’t have to be clairvoyant to predict the result. The content of the strategy would be as bland as it was vague.
Finally, there are the questions of political context. Paying particular attention to the health needs of men is at odds with the prevailing political orthodoxy that gender disadvantage affects only women. Many politicians would be disconcerted by this. Their reaction is likely to be unhelpfully cautious at best. Others could simply be hostile. There is also the risk of months or even years of work disappearing overnight as the result of a general election or a change of political direction by the governing party.
So - is this just defeatism or do I have a viable alternative?
Well, the first point to make is that most of the objections I have raised would not matter too much if we had more resources at our disposal. If that were the case, we could confidently throw our weight behind a big campaign for a national men’s health strategy. We could do all the research that that would entail, take on the political arguments and lobby anyone who would listen. And if it all ended in disappointment . . . well, we could afford to take it on the chin and move on.
Gender discrimination is already illegal
Unfortunately we are not in that position. We do however have something on our side which has proved to be – if not perfect – at least a very useable device for encouraging policy-makers and service-planners to take male health seriously. In April 2007, the UK implemented robust legislation prohibiting gender discrimination in the provision of public services. This legislation also places a duty on service-providers to promote “equality of opportunity” between men and women. During the progress of this legislation through parliament, it was made clear that government was expecting the new legislation to result in changes in outcome not just in the intentions of those delivering the service.
Obviously, the primary function of the legislation is to continue the process of achieving fairness for women that has been in progress since the 1970s. In the specific case of health however it has led to a greatly increased recognition of the need to address men’s poorer health outcomes. It has also had the incidental effect of placing the issue of men’s health squarely where it belongs – that is, as part of the debate about how to tackle social inequalities. In short, it has given us a proper basis in law for the arguments we had been making for the previous ten years or so.
Service providers already engaged
Prior to the new gender equality legislation, the Men’s Health Forum was already recognised for its expertise in communicating health messages to men. We also had a reputation for delivering good quality research, training and policy guidance. Our status as the leading organisation in our field had been achieved by detailed work on specific issues – for example in the fields of men’s sexual health, cancer and obesity. This solid platform put us in a strong position to maximise the impact of the gender equality legislation when it arrived. The consequence has been that an increasing number of politicians, policy-makers and health service providers have proved willing to listen to the arguments – especially now that they seem more relevant.
The galvanising effects of the 2007 legislation added to what we had already achieved since our foundation in 1995, means that there has been clearly recognisable progress in our field (and in Scotland too it should be added, where the credit goes to Men’s Health Forum Scotland). There have, for example, been several research projects of national importance looking at men’s health concerns. There has been formal recognition of men’s issues in a number of national health policy documents. Some regional and local agencies have developed public health programmes aimed at men, and some even employ specialist men’s health workers. The UK has the world’s first academic centre for men’s health at Leeds Metropolitan University. The Men’s Health Forum has a series of health guides for men permanently in print, total production numbers of which recently exceeded a million. Our consumer website, malehealth.co.uk, receives over 150,000 hits each month.
The big question
The position in the UK then is pretty good. Of course that does not mean the problem is solved. We are a long way from that position. Given though, that 'men’s health' was barely even a recognisable phrase ten or fifteen years ago, let alone an important social policy issue, we can point to a huge amount of progress.
Would we have got this far if we had chosen at some point to divert our energies towards the pursuit of a national men’s health strategy instead?
For me, the answer to that question is a definite 'no'. I am sure that we would have achieved significantly less within the same timescale.
Could it be argued then, that if you take all the government activity on men’s health that there has been in recent years, England & Wales already has a de facto national men’s health strategy?
Well, no. I would certainly hesitate to make that claim. I don’t think we are that kind of level yet.
So, what is the answer to my headline question about whether or not a national men’s health strategy is a good idea?
In fact, I don’t think anyone knows the answer to that question at the moment. But rather than worry about the answer, we need to realise that it is the question itself that matters. It tells us that it is time for an international debate about how best to advance our ideas politically. That debate will enable us to learn from each other. It will also help us to offer the most effective support to those countries that are not so far down the road as Australia, Ireland, the UK and the other small group of nations where there has been progress so far.
What do you think?