Many men’s health outcomes are unnecessarily poor, globally, nationally and locally. Average global life expectancy for men lags behind women’s by four years, for example, and there is not a single country where men live longer than women.

Around half of the sex difference in mortality from all causes in Europe is due to smoking and one fifth is due to alcohol consumption. Globally, about 45% of male deaths are due to health behaviours. Improving men’s self-care would therefore lead to major improvements in their health.

To mark World Health Day 2019, Global Action on Men’s Health (GAMH) is publishing a new report, Who Self-Cares Wins: A global perspective on men and self-care. The Day is focused on universal health coverage, one important part of which is enabling people to self-care to improve their health and well-being. The UK Self Care Forum defines self-care as ‘The actions that individuals take for themselves, on behalf of and with others in order to develop, protect, maintain and improve their health, wellbeing or wellness.’

Who Self-Cares Wins challenges the idea that men are invariably self-destructive when it comes to their health – globally, most men do enough physical activity to benefit their health and do not smoke or drink alcohol – but the evidence from multiple studies shows that:

• Men generally have lower health literacy levels than women.
• Male mental health problems are under-diagnosed.
• About a quarter of men globally are too sedentary.
• Men generally have less healthy diets than women.
• Men are much more likely to smoke and drink alcohol than women.
• Men generally under-use primary healthcare services, including GPs, pharmacies, dentists, optometrists and health checks or screening.

Male gender norms are a key barrier to better self-care for men. Men are expected to be self-sufficient, to act tough, to be physically attractive, to be heterosexual, to have

sexual prowess, and to use aggression to resolve conflicts. These norms inevitably make it harder for men to practice better self-care. Men who most closely identify with ‘traditional’ masculinity are more likely to exhibit damaging lifestyle behaviours.

Health policies and services have not taken men into account. A recent study suggests that Malawi’s national recommendations for routine health care address women’s needs only, that men’s relative absence from health services contributes to high rates of male morbidity and mortality, and that men need to be successfully engaged within the health care system. Only three countries (Australia, Brazil and Ireland) have specific national men’s health policies, although Iran is apparently about to introduce one too. Most global health organisations do not address men’s health.

But Who Self-Cares Wins suggests that recent developments – including the SDGs (which call for action on a range of diseases caused by risk-taking behaviours), the adoption of a men’s health strategy by WHO Europe, the forthcoming PAHO report on masculinities and health, and an expanding evidence base about how to engage men effectively in health – provide a significant opportunity to improve men’s self-care.

GAMH also believes that the 2017 UNAIDS report, Blind Spot, should serve as a blueprint for analyses of a range of global men’s health issues. It shows that men are less likely than women to know their HIV status, less likely to access and adhere to HIV treatment and more likely to die of AIDS-related illnesses. It highlights the impact of gender norms on men’s attitudes and behaviours to prevention and treatment and recommends a range of gender-sensitive policy and practice responses, including making health and HIV services more easily accessible to men and boys.

Who Self-Cares Wins calls for:

• Tougher tobacco, alcohol and sugar control measures (men are the biggest consumers of these products).
• Health policies, including national men’s health policies, that recognise the needs of men.
• Full account to be taken of male gender norms in policy and service delivery.
• Establishing self-care as a strategic priority in public health policy and practice.
• Action to improve men’s health literacy.
• Health services that are more accessible to men.
• Better training in men’s health for health and related professionals.
• Accelerated research into improving men’s engagement in self-care and better practical guidance for policymakers and practitioners.
• Recognition of the heterogeneity of men and a more intense focus on communities of men with the worst health outcomes.
• Actions that build on the positive aspects of many men’s experience, knowledge, skills and attitudes to health and wellbeing and involve men as active agents in self-care initiatives.

The report argues that while it is clearly the responsibility of individual men to take care of their own health, strategies to improve men’s health cannot simply be based on exhortations to change lifestyle practices that are rooted in gender norms and other social determinants of health. Action on a multi-layered and systems-wide basis is needed to improve significantly men’s self-care and their health outcomes.