Globally, health outcomes amongst boys and men continue to be substantially worse than amongst girls and women, yet this gender-based disparity in health has received little national, regional or global acknowledgement or attention from health policymakers or healthcare providers. In most parts of the world, health outcomes amongst boys and men continue to be substantially worse than amongst girls and women, yet this gender-based disparity in health has received little national, regional or global acknowledgement or attention from health policy-makers or healthcare providers. 

It is clear that the health status of men is worse than that of women. The Global Burden of Disease study (GBD 2010 study), indicated that throughout the period from 1970 to 2010, women had a longer life expectancy than men (Wang, Dwyer-Lindgren, Lofgren, Rajaratnam, Marcus, Levin-Rector, et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010). Over that 40-year period, female life expectancy at birth increased from 61.2 to 73.3 years, whereas male life expectancy rose from 56.4 to 67.5 years. These figures indicate that the gap in life expectancy at birth widened between the sexes to men’s disadvantage over those 40 years. 

Explaining the gender gap 

According to the WHO European Region’s review of the social determinants of health, Marmot (2013), declares that men’s poorer survival rates “reflect several factors e.g. men are exposed to greater levels of occupational exposure to physical and chemical hazards, behaviours associated with male norms of risk-taking and adventure, health behaviour paradigms related to masculinity and the fact that men are less likely to visit a doctor when they are ill and, when they see a doctor, are less likely to report on the symptoms of disease or illness” (World Health Organization, Regional Office for Europe; 2013). 

Available from: http://www.instituteofhealthequity.org/projects/who-european-review [cited 2014 Feb 21]. (Accessed 25 October 2020). 

Another consideration is that more men die as the result of risk-taking behaviours. In 2010, 3.14 million men − as opposed to 1.72 million women − died from causes linked to excessive alcohol use (Lim; Vos; Flaxman; Danaei; Shibuya; Adair-Rohani, (2012) et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2224-60). For many men, excessive consumption of alcohol is linked to notions of masculinity (Centers for Disease Control and Prevention. Workers Memorial Day – April 28, 2012. MMWR Morb Mortal Wkly Rep. 2012; 61:281). 

Policy silence at global health institutions 

As Hawkes & Buse recently noted, the gender disparities noted earlier are not appropriately addressed in the health policies and programmes of the major global health institutions, including WHO. Policymakers tend to assume that gendered approaches to health improvement are primarily or exclusively about women rather than about both sexes, a position also adopted by most national governments (Hawkes S, Buse K. Gender and global health: evidence, policy, and inconvenient truths. Lancet. 2013; 381:1783-7) 

South African men’s health  

According to a study completed by Mutambirwa, who is a founder member of the South African Men’s Health Society, there are a number of reasons for women’s greater longevity, but suggests that one of the most important ones is that men tend to pay less attention to their health than women and are more inclined to ignore the warning signs of disease. The findings in this study support the findings as discussed by the World Organization (WHO) (martina@mnapr.co.za; graeme@mnapr.co.za; sarah@mnraor.co.za; meggan@mnapr.co.za). 

Men are not formally listed as a key population and/or vulnerable group that requires special attention in the South 

Africa National Strategic Plan for HIV, Tuberculosis and Sexually Transmitted Infections (2017-2022). However, the data below shows that men and boys are vulnerable to ill-health and need special healthcare services and attention from researchers, policymakers and practitioners in South Africa.  

In South Africa 

• TB is the leading cause of natural death amongst men 
• Men account for 56.6% of all TB deaths recorded 
• More men (17%) report having multiple sexual partners than women (5%), which puts them at greater risk of HIV infection 
• HIV testing rate amongst men of 15 to 49 years is 45%. The rate is 59% amongst women in the same age-range 

Other forms of risky behaviour that increase chances that men will experience ill-health are smoking (30% of men report smoking) and risky drinking (28% of men report drinking five or more standard measures of alcohol on a single occasion). 

Implications of risky behaviour and men not making use of available and free health services in relation to TB and HIV means that men suffer from ill-health more and die sooner (South African Health Demographic Survey (SAHDS) (2016), South African National Guidelines for Medical Male Circumcision (2016), WHO Voluntary medical male circumcision for HIV prevention – Fact sheet 2012, WHO Voluntary Medical Male Circumcision for HIV Prevention – Progress Brief 2018).