We Need to Talk About Men's Health
The case for gender-sensitive health policies
Last week, a report was released showing that opioid-related deaths have surged in recent years among teenagers and young adults in Ontario. As in other groups, almost all the reported deaths were caused by toxic, illicit fentanyl. There’s increasing evidence that some policy approaches—including decriminalization, safer supply, and supervised consumption sites—help prevent overdoses, but one of the strongest demographic predictors of overdoses hasn’t prompted a policy response: Most of the people dying are men.
According to the new report by the Ontario Drug Policy Research Network, males account for 68 percent of opioid toxicity deaths in people aged 15 to 24. For people aged 25 to 44, who account for far more deaths overall, men made up 77 percent of deaths.
That more men die of overdoses isn’t new, nor are opioid-related deaths the only type where male deaths are more common. Among other so-called deaths of despair, men account for the large majority: three-quarters of suicides in Canada are by men, and alcohol-related liver disease is almost five times higher in men than women. Men make up the majority of these deaths in other countries, too.
Despite these trends, the gendered nature of health outcomes is rarely mentioned, and even less likely to be acted on, when men are concerned. Take a Canadian Press article about the Ontario study, which mentions multiple demographic factors, including income, housing, and ethnicity, but nowhere says that gender is a major factor in opioid-related deaths.
When it comes to deaths of despair, why are men dying at much higher rates? Some research exists on men’s mental health, but related areas have received little attention. A review of academic articles on the social factors that influence deaths of despair in the United States discusses economic conditions, occupational hazards, education level, and ethnicity, but not gender. Why? It turns out it’s rarely studied: “Some [social determinants of health], such as gender differences were not found because they were little explored in [the] literature.”
Other prominent health gaps between men and women exist. In a report on COVID-19 from August 2022, the Public Health Agency of Canada describes how male mortality was higher, but was higher still and with a wider gap for low-income men and men who are members of visible minorities. Among the highest-income group, 36 per 100,000 men died from COVID-19 versus 28 per 100,000 for women. In the lowest-income group, however, the gap between men and women grew to 79 per 100,000 for men and 48 per 100,000 for women.
There are multiple ways that men have worse health outcomes than women, but my point isn’t that men are worse off than women in general. Girls and women have specific health needs that deserve attention: higher rates of non-fatal self-harm, higher rates of heart attack misdiagnosis because female symptoms are different, extremely long diagnosis times for endometriosis, and lower rates of being prescribed pain medication, to name a few. These are all bad outcomes in need of strategies to address them. It’s a mistake, however, to think that gender disparities can only go in one direction.
Instead, as Richard Reeves, author of Of Boys and Men, puts it, “we can hold two thoughts in our head at once.” We should continue to care about improving health outcomes for women, while also recognizing that men have different needs. Health inequities are bad regardless of who they affect, so we need a system sensitive to these differences.
What does such a system look like? We should start by adding a male-focused lens where the gaps are largest, not at the expense of female outcomes, but in addition to them. Many people believe that healthcare is already biased toward men, and in some cases, they’re right. But not always.
Take counselling, for example. For decades, men have been less likely than women to see a psychologist. A 2014 study found that men accounted for only 27 percent of Canadians who were likely to contact a psychologist if they were thinking of suicide. Another study found that, over 13 years, the Canadian Journal of Counselling and Psychotherapy published fifteen times as many female-focused research studies than male-focused ones. Research has found that boys and men have different expectations and preferences for therapy than girls and women do, which might be playing a role in access and outcomes.
The focus on women in gender-based mental health research might have other effects. Women are diagnosed with depression twice as often as men, and more depression research that looks at gender focuses on women. But given the much higher rate of suicide in men, researchers have questioned if depression is being overlooked in men since it presents differently. In their words, it’s a silent epidemic. The diagnosis of eating disorders is similarly female-focused: most eating disorder assessment tools haven’t been validated on men, and the gold-standard tools give men a lower score—indicating a less serious eating disorder—even when they’re just as ill.
Healthcare professionals are also increasingly likely to be women. In Canada, there are nearly three times as many female psychologists as male ones. Some men might be less likely to see a female psychologist, or less responsive to her approach, especially for some issues. One study on men accessing mental health care concludes that “Peer-led men-only groups may increase participants’ self-esteem and assist in disclosing weaknesses.” It also recommends that doctors receive training on the impact of masculine norms.
To address these inequities, we need more male-focused research and more male providers. Right now, we’re failing to address an important way that gender affects health outcomes. The change won’t happen overnight, but if we’re serious about preventing suicides, overdoses, and other serious problems, we need an approach that’s more sensitive to men.