An in-depth look at the current state of mens health in the UK

An in-depth look at the current state of men’s health in the UK

Regardless of what sex you are it’s been shown time and again that diet and lifestyle choices have a significant impact on your health and reduce the risk of disease.  Men and women share similar risk factors for ill health and weight is a concern for everyone, but some conditions are more sex-specific to men.  Targeting men’s health often requires a different approach to women and given the slight disparity in attitudes between the sexes, it’s important that awareness continues to grow to help break taboo’s and create an environment that men feel comfortable enough in to seek help when needed and make behaviour changes that can significantly improve their health.

Apologies as this is quite a hefty blog, but for my own curiosity I just wanted to put everything about men’s health into one place to provide insight and the latest research findings to give a good overview of the health landscape according to men.

This includes:

1. What a typical male diet looks like in the UK?
2. How overweight men are in the UK?
3. What lifestyle choices men are making in the UK?
4. The most common causes of premature death amongst men in the UK
5. Heart disease amongst men in the UK
6. Mental health amongst men in the UK
7. Men’s attitudes towards health and how they access health services

1.What a typical male diet looks like in the UK?  

The National Diet and Nutrition Survey in the UK has shown that both men and women share similar dietary characteristics (1). Both groups eat enough protein and meet the guidelines for total fat but consume too much sugar and saturated fat.  Both sexes also fail to eat enough fibre and very few meet the recommended 5-a-day guidance or eat enough oily fish.  Fewer men than women have micronutrient insufficiencies, but low levels of vitamin D are shared between the sexes, especially during the winter months.

Dietary findings for men (1)

• The average energy intake is 2091 calories.
• The average intake of protein is 87.4g, which is 1.5 times the RNI of 55g per day. Protein requirements differ depending on health status and exercise, but the average is around 0.75g per kg of body weight.  Most of the protein in the diet comes from meat and meat dishes (37%).  Twenty three percent comes from cereals and cereal products, whilst 13% comes from milk and milk products.
• The average intake of total fat is 76.6g per day, which equates to 32.6% of energy intake. This falls within the guidance of no more than 35% of energy intake.  Most of the fat in the diet comes from meat and meat products (24%).  A similar amount (21%) comes from cereals and cereal products including biscuits, cakes and puddings.  Milk and milk products account for 12% of total fat intake.
• The average intake of saturated fat is 27.5g per day, which equates to 11.6% of energy intake.This exceeds the guidance of no more than 10% of energy intake.  The main source of saturated fat in the diet is from meat and meat products (24%). Twenty one percent comes from cereal and cereal products that includes biscuits, cakes and puddings.  The same percentage comes from milk and milk products, the majority of which comes from cheese.  Nine percent comes from fat spreads with 6% attributed to butter.
• Sat fat (21% cereals and cereal products – 5% biscuits,4% cakes, 1% puddings), 21% (milk and milk products – 9% cheese), 3% (eggs and egg dishes), 9% (fat and fat spreads – 6% butter), 24% (meat and meat products), 3% (fish and fish dishes), 6% (veg and potatoes – 3% chips), 1% (savoury snacks), 2% (nuts and seeds), 5% (sugar and confectionary – 4% chocolate)
• The average intake of ‘free’ sugars is 64.3g (12.8 tsp) per day. This is more than twice the guidance of no more than 30g (6 tsp) per day.  The main source of ‘free’ sugars in the diet is from sugar and confectionary (25%), most of which is from table sugar and sweet spreads.  Twenty four percent of ‘free’ sugars comes from cereals and cereal products that includes breakfast cereals, biscuits, cakes and puddings.  Non-alcoholic drinks are also a big contributor with 6% coming from fruit juice and 14% from soft drinks.
• The average intake of fibre is 20.7g per day. This is just a third of the guidance of 30g per day and only 13% of men manage to achieve this.  The main source of fibre in the diet is from cereals and cereal products (38%), which includes pizza, pasta, rice and bread (more men choose white bread over wholemeal). Thirty eight percent of fibre in the diet comes from vegetables and potatoes, with 7% coming from chips. Twelve percent of fibre in the diet comes from meat products, which are breaded or include pastry or potatoes.
• The average intake of fruit and vegetables is 4.2 portions, which is below the recommended 5-a-day. Only 29% of men manage to eat 5-a-day.

The micronutrients (vitamins and minerals)

2.How overweight are men in the UK?

The majority of the male population in the UK are either overweight or obese (2,3,4,5).  Obesity is both a disease and risk factor for many other diseases.  Being overweight or obese increases the risk of having high cholesterol, high blood pressure and type 2 diabetes, which are all risk factors for cardiovascular disease (CVD).  Obesity also increases the risk of joint problems, lower back problems, deep vein thrombosis, colon cancer and erectile dysfunction.  Losing and maintaining a healthy weight can have a significant impact on health and reduce the risk of disease.

The prevalence of overweight and obesity vary throughout the UK but in general, rates are higher amongst men.

England (2)

• Over 60% of men are overweight or obese.
• Men (65.7%) are more likely to be overweight or obese than women (57.1%).

Wales (3)

• Twenty three percent of adults are obese and 36% overweight.
• Sixty five percent of men are obese or overweight compared to 53% women.

Scotland (4)

• Sixty five percent of adults are overweight and 29% of these are obese.
• Sixty seven percent of men were overweight or obese compared to 63% of women.

Northern Ireland (5)

• Sixty percent of adults are overweight or obese (34% overweight and 26% obese).
• Males (65%) were more likely to be overweight or obese compared to females (57%).

3.What lifestyle choices men are making in the UK?

Diet is important but in terms of health it co-exists with the lifestyle choices we make which include physical activity, smoking and drinking.  A sedentary lifestyle can increase the risk of being overweight, which is a risk factor for disease.  Exercise plays a key part in maintaining a healthy weight and also helps to maintain muscle mass, flexibility and bone strength as well as being good for mental health.

Smoking has been proven to cause cancer and respiratory conditions, whilst excessive drinking is known to be a risk factor for certain cancers and liver disease.

Physical activity in men

The government guidelines suggest that we do at least 150 minutes per week of moderate physical activity in bouts of at least 10 minutes, which equates to 30 minutes on at least 5 days.  Alternatively, it’s suggested that 75 minutes of vigorous activity spread over the week will have the same health benefits.  Moderate physical activity is defined as raising your heart beat whilst still being able to carry on a conversation such as brisk walking or cycling.  Vigorous activity is defined as increasing your heart to beat rapidly, making it much more difficult to carry on a conversation such as running, swimming or football (6).

In the UK, men:

71% met the guidelines

10% some activity¹

3% low activity²

16% inactive³

1. Some activity: 60-149 minutes MPA pw or 30-74 minutes VPA pw or an equivalent combination of these.
2. Low activity: 30-59 minutes MPA pw or 15-29 minutes VPA pw or an equivalent combination of these
3. Inactive: Less than 30 minutes MPA pw or less than 15 minutes VPA pw or an equivalent combination of these

Smoking amongst men in the UK

According to findings from the Office of National Statistics (7):

• In the UK, 17% of men smoke compared to 13.3% of women.
• The highest proportion of smokers are aged between 25 and 34 years (19.7%).
• 1 in 4 people in routine and manual occupations smoke compared to just 1 in 10 people in managerial and professional occupations.
• 5% of people in the UK currently use and e-cigarette (vape) – 2.8 million people
• 5% of men report vaping compared to 4.6% of women and the highest proportion of vapers are aged between 35 and 49 years.
• In the UK, 60.8% of people aged 16 years and over who currently smoke said they wanted to quit and 59.5% of those who have ever smoked said they had quit.
• The main reason for vaping is to help stop smoking (48.8%).
• Only 0.4% of people who have never smoked reported that they currently vape.

Drinking in the UK

Guidance around drinking is no more than 14 units per week for both men and women (8).

125ml glass of wine = 1.4 units

25ml shot of spirit (37.5% ABV) = 1 unit

½ pint of lager (4%) = 1 units

According to the ONS (9):

• Men are more likely to drink than women – 9% of men compared to 52.4% of women.
• Men are also less likely to abstain from drinking as 17% of men and 22% of women said they had not drunk in the last year.
• 53% of men said their alcohol consumption was no more than 14 units per week compared with 62% of women.
• 10% of men said their alcohol consumption was more than 14 units per week but less than 21 units per week compared to 7% of women.
• 12% of men said their average alcohol consumption was more than 21 units but less that 35 units per week compared to 6% of women
• 4% of men said their average alcohol consumption was more than 35 units but less that 50 units per week compared with 2% of women.
• 5% of men said their average alcohol consumption was more than 50 units per week compared to 2% of women.

4.The most common causes of premature death amongst men in the UK

• More men than women die each year – 1156.5 compared with 863.8 deaths per 100K people (10)
• In the UK one in five men (19%) dies before the age of 65 years (10)

Leading causes of death in 2015 – taken from findings published in 2017 (11)

Leading causes of death by age group for males in England, 2015 taken from findings published in 2017 (11)

5.Heart disease amongst men in the UK (12)

• Heart and circulatory disease cause more than a quarter (26 per cent) of all deaths in the UK; that’s nearly 160,000 deaths each year – an average of 435 people each day or one death every three minutes.
• There are around 7 million people living with heart and circulatory disease in the UK: 3.5 million men and 3.5 million women.
• Coronary heart disease (CHD) is the most common type of cardiovascular disease.
• Coronary heart disease is the most common cause of heart attack. In the UK there are 188,000 hospital visits each year due to heart attacks: that’s one every three minutes.
• An estimated 915,000 people alive in the UK today (640,000 men and 275,000 women) have survived a heart attack.
• Over half a million people in the UK are living with heart failure.
• There are more than 30,000 out-of-hospital cardiac arrests in the UK each year. The overall survival rate in the UK is less than 1 in 10.

6.Mental health amongst men in the UK (13)

• Over 40% of adults think they have had a diagnosable mental health condition at some point in their life (35.2% of men and 51.2% of women).
• A fifth of men (19.5%) and a third of women (33.7%) have had diagnoses confirmed by professionals.
• In 2014, 19.7% of people in the UK aged 16 and older showed symptoms of anxiety or depression – a 1.5% increase from 2013. This percentage was higher among females (22.5%) than males (16.8%).

As far as men are concerned:

• Just over three out of four suicides (76%) are by men and suicide is the biggest cause of death for men under 35 (14).
• 12.5% of men in the UK are suffering from one of the common mental health disorders (15).
• Men are three times more likely than women to become alcohol dependent (8.7% of men are alcohol dependent compared to 3.3% of women (15).
• Men are more likely to use (and die from) illegal drugs (15).
• Men are less likely to access psychological therapies than women. Only 36% of referrals to IAPT (Increasing Access to Psychological Therapies) are men (16).
• Over three quarters of people who kill themselves are men (17)
• Men report significantly lower life satisfaction than women in the Government’s national well-being survey – with those aged 45 to 59 reporting the lowest levels of life satisfaction (17).
• 73% of adults who ‘go missing’ are men (18).
• 87% of rough sleepers are men (19).
• Men are nearly three times more likely than women to become alcohol dependent (20).
• Men are three times as likely to report frequent drug use than women (4.2% and 1.4% respectively) and more than two thirds of drug-related deaths occur in men.
• Men make up 95% of the prison population 72% of male prisoners suffer from two or more mental disorders.
• Men are nearly 50% more likely than women to be detained and treated compulsorily as psychiatric inpatients (21)
• Men have measurably lower access to the social support of friends, relatives and community (21)
• Men commit 86% of violent crime (21)
• Boys are around three times more likely to receive a permanent or fixed period exclusion than girls (22).
• Boys are performing less well than girls at all levels of education. In 2013 only 55.6% of boys achieved 5 or more grade A*-C gcses including English and mathematics, compared to 65.7% of girls (23)

The Men’s Health Forum suggests that these statistics indicate that male emotional and psychological distress may sometimes emerge in ways that do not fit comfortably within conventional approaches to diagnosis. They also show that men may be more likely to lack some of the known precursors of good mental health, such as a positive engagement with education or the emotional support of friends and family.

A picture begins to emerge of a potentially sizeable group of men who cope less well than they might:

• These men may fail to recognise or act on warning signs and may be unable or unwilling to seek help from support services.
• At the further end of the spectrum they may rely on unwise, unsustainable self-management strategies that are damaging not only to themselves but also to those around them.
• Such a picture would broadly parallel what is already known about men’s poorer physical health.

7.Men’s attitudes towards health and how they access health services

Health literacy is the ability to obtain, read, understand, and use healthcare information in order to make appropriate health decisions and follow instructions for treatment.  There is evidence that men have lower levels of health literacy than women.

• One study found that men were than twice as likely as women to have inadequate health literacy (24).
• An analysis of people with coronary heart disease in south London found that those with low health literacy were more likely to be male, from a non-white ethnic group, live in a more deprived area, have spent fewer years in education, and were less likely to be employed (25).
• A large study of British adults (970 males and 1246 females) found that women were more likely than men to recall seven out of nine cancer warning signs (26).
• According to a National Pharmacy Association study, more men than women admit that their understanding of medicines is poor (23.1% against 15.6% women) (27).
• Men are twice as likely as women to take a new prescription medicine without first reading the patient information leaflet or seeking professional advice (10.9% of men against 5.1% women) (27).
• Men’s purchase of prescription-only drugs without medical advice, usually via the Internet, is of increasing concern because of the risks of toxicity and missed diagnoses (27).
• The percentage of men purchasing prescription-only medications without a prescription via the Internet increases to 67% when considering medications for erectile dysfunction specifically (28).

Men and women display different attitudes towards health and illness.  We have a cultural script about masculinity that tells men they need to be tough, brave, strong and self-reliant. It’s exemplified in phrases like “be a man” and “man up”. Men learn from an early age if they don’t act in this tough, masculine way they lose their status and respect as men.

One study carried out in 2016 found men who buy into the traditional cultural script about masculinity and believe they must be brave and self-reliant in order to be respected, had more barriers to seeking care compared to those who did not endorse these beliefs.  Men validating these beliefs about masculinity and enacting them in their own lives were less likely to seek preventative care and are more likely to delay care when they experienced injury or illness (29).

This all has a huge influence on the attitude’s men have towards their health.

• Health is often socially constructed as a feminine concern and men therefore have to behave as if they are unconcerned about their health if they wish to publicly sustain a ‘real’ male identity (30).
• Many men appear to legitimise health service usage, only when a perceived threshold of ill health has been exceeded. There is also a tendency amongst men to play down symptoms or to view potentially serious symptoms as simply signs of growing old (30).
• Fear surrounding the potential loss of masculinity may result in a façade of control and stoicism, instead of honesty about reporting symptoms and accepting interventions, or openness about feelings and insecurities associated with particular illnesses (30).
• Risk-taking behaviour is associated with masculinity and is, therefore, more common in males than females (30).
• A King’s Fund study that looked at four behaviours – smoking, drinking, diet and exercise – found that men were more likely to participate in a combination of three or four risky behaviours (31).

Men’s health is unique to their gender and as such the approach to tackling the issues men face needs to take account of their risk of disease and their attitudes towards their wellness.

References

1. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
2. Https://www.gov.uk/government/statistics/health-survey-for-england-2016-findings-and-trend-tables
3. Https://gov.wales/statistics-and-research/national-survey/?Tab=current&lang=en
4. Https://www.gov.scot/Topics/Statistics/Browse/Health/scottish-health-survey
5. Https://www.health-ni.gov.uk/publications/health-survey-northern-ireland-first-results
6. Https://www.gov.uk/government/publications/uk-physical-activity-guidelines
7. Https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017
8. https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-units/
9. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/opinionsandlifestylesurveyadultdrinkinghabitsingreatbritain/2017/previous/v1
10. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2015
11. https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed
12. https://www.bhf.org.uk/for-professionals/press-centre/facts-and-figures
13. https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-about-mental-health-2016.pdf
14. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2016registration
15. https://digital.nhs.uk/catalogue/PUB17712/alc-eng-2015-rep.pdf
16. https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/improving-access-to-psychological-therapies-data-set/improving-access-to-psychological-therapies-data-set-reports
17. http://webarchive.nationalarchives.gov.uk/20160107060820/http:/www.ons.gov.uk/ons/dcp171778_351100.pdf
18. https://www.york.ac.uk/inst/spru/pubs/pdf/MissingPersons.pdf
19. https://www.crisis.org.uk/ending-homelessness/rough-sleeping/
20. https://digital.nhs.uk/catalogue/PUB14184/alc-eng-2014-rep.pdf
21. https://digital.nhs.uk/catalogue/PUB12994/drug-misu-eng-2013-rep.pdf
22. http://webarchive.nationalarchives.gov.uk/20160106231734/http://www.ons.gov.uk/ons/rel/crime-stats/crime-statistics/focus-on-violent-crime-and-sexual-offences–2012-13/rpt-chapter-1—overview-of-violent-crime-and-sexual-offences.html#tab-Profile-of-Offenders-Involved-in-Violent-Crimes
23. http://webarchive.nationalarchives.gov.uk/20130320141729/http://www.education.gov.uk/researchandstatistics/statistics/a00195931/
24. https://jech.bmj.com/content/61/12/1086
25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549254/
26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790705/
27. https://www.npa.co.uk
28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069491/
29. https://www.ncbi.nlm.nih.gov/pubmed/25293967
30. https://www.bmj.com/content/343/bmj.d7397
31. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/clustering-of-unhealthy-behaviours-over-time-aug-2012.pdf

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