How ICBs are improving men’s health

Following the launch of the Men’s Health Strategy Kathy Oxtoby takes a look at the state of healthcare for men across the NHS system.

There have been huge improvements in the life expectancy of men over the past 100 years. However, ‘persistently over time men have experienced poorer health outcomes compared to women in terms of higher rates of disease and lower life expectancy’, says the Department of Health and Social Care (DHSC).

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Disparities in men’s health

The inequalities in men’s health are ‘deep, long standing, and largely structural’, says Professor Paul Galdas, Professor of Men’s Health, Department of Health Sciences at the University of York, and Chair, National Men’s Health Academic Network.

‘Men live almost four years fewer than women and spend a significant proportion of their lives in poor health. The gaps widen sharply with deprivation.’

He says men in most disadvantaged areas die more than 10 years earlier and spend almost 20 fewer years in good health than those in the least deprived places. ‘That isn’t a result of biology, it reflects exposure to risk at work and at home, social and economic pressures, and the fact that our health systems often struggle to reach men early enough or consistently enough.’

Conditions such as cardiovascular disease, cancer, type 2 diabetes, and suicide ‘account for much of the burden’, he says. ‘These are preventable, modifiable, and shaped by environments men live and work in. That’s why ICBs, with their population health remit, have such significant leverage.’

Joe Woollcott, head of health policy, education and awareness at Prostate Cancer UK, says there are ‘large disparities when it comes to prostate cancer experiences and outcomes in England, and often these fall down socioeconomic and geographical lines and along the lines of ethnicity as well’.

‘There are inherent inequalities in prostate cancer,’ he says. For example, one in flour Black men will get prostate cancer – double the risk of other men.

There are also factors that complicate the picture in terms of the inequalities affecting prostate cancer. ‘There are socioeconomic factors heaped on top of biological factors, which are affecting men’s experience and outcomes of the disease in the UK,’ he says.

Current guidelines for detecting and diagnosing prostate cancer are that any asymptomatic man can request a PSA blood test from their GP, however, those who do so are not necessarily those most at risk. The men who do request a test ‘are more health literate, generally more affluent, and more comfortable talking with their GPs about what tests they’d like’, he says. ‘There is an inherent inequality based in the current guidelines for detecting and diagnosing prostate cancer. At Prostate Cancer UK we have been campaigning for those guidelines to be updated, so that GPs can proactively talk to their patients about the PSA test.’

First-ever Men’s Health Strategy

November saw the launch of the first-ever Men’s Health Strategy – a plan to tackle physical and mental health challenges faced by men and boys, and reduce inequalities.

According to DHSC, the strategy ‘not only shines a light on the fact that men’s health has been neglected for too long, it sets us up to tackle the injustices and inequalities they face’.

Commitments in the strategy include investing £3 million into community-based men’s health programmes, men’s health training for healthcare professionals through new e-learning modules and resources, and workplace health pilots.

From 2027, subject to clinical approval, ‘men diagnosed with prostate cancer that is being actively monitored or treated will be able to order and complete PSA blood tests at home, or book an in-person blood test locally through the NHS App’.

The strategy will also have a focus on suicide prevention. This includes a partnership on the Premier League’s Together Against Suicide initiative with the Samaritans, which looks to help tackle the stigma around men’s mental health.

Other commitments include ‘enhanced lung disease support for former miners, with increased investment in the Respiratory Pathways Transformation Fund in areas with significant former mining communities’, and ‘funding research to help prevent, diagnose, treat and manage the major male killers and causes of unhealthy life years in men’.

The strategy also commits to a £200,000 trial of new brief interventions ‘to target the rise in cocaine and alcohol-related cardiovascular disease (CVD) deaths, particularly among older men’.

A stakeholder group will oversee implementation of the strategy, with the Government publishing a one year report ‘to ensure accountability’.

Commenting on the strategy, Health Secretary Wes Streeting says: ‘For too long, men’s health has been overlooked. There has been a reluctance to accept that men suffer specific inequalities and hardships.’

He says the strategy ‘marks a turning point – the first time we’re taking comprehensive, co-ordinated action to address the health challenges facing men and boys’.

Dr John Chisholm CBE, Chair of the Men’s Health Forum, says a strategic, gendered approach to healthcare should ‘improve access and outcomes and address inequalities’.  ‘It is particularly welcome that organisations committed to improving the health of men and boys will be involved in a stakeholder group helping to implement the strategy, and that there is a commitment to evaluate progress in a year’s time.

‘It is also encouraging that the strategy addresses societal, structural and systemic issues that hamper the health and wellbeing of men and boys.’

Professor Galdas says the Men’s Health Strategy is important because ‘it moves men’s health into the mainstream’. ‘For the first time we have a national statement that men’s health is a core public health priority tied directly to reducing avoidable mortality and narrowing the gap in healthy life expectancy.’

The strategy aligns with the wider direction reforms in the 10 year plan, namely the shift towards prevention, community based care, and digital access, he says.

‘It also signals very clearly that systems will need to focus on the men with the poorest outcomes. It’s not about new parallel services for men, it’s about ensuring existing pathways work for the men who currently benefit least.’

He says the Men’s Health Strategy gives local systems ‘a framework and a set of practical commitments they can build on’, for example, investment in targeted community based approaches, improvements to digital access through NHS App, neighbourhood health centres, and tools such as Diagnosis Connect that link men to support when a diagnosis is made. ‘Crucially, there’s also a commitment to strengthen the evidence base.’

The Men’s Health Academic Network, which he chairs, will play a ‘central role in helping to make sure ICBs have access to the best available research and data so they can commission more intentionally and evaluate more effectively’, he says.

‘Good work happening across the country’

With men’s health, ‘there’s good work happening across the country, especially where ICBs have integrated men’s health thinking into CVD prevention, smoking cessation, early cancer diagnosis, suicide prevention, and outreach programmes with workplaces, sports organisations, and local VCSE partners’, says Professor Galdas.

Cancer Alliances do ‘a lot of great work in trying to address some of the challenges of various cancers within their areas’, says Mr Woollcott. For example, Prostate Cancer UK worked with Greater Manchester Cancer Alliance on “This Van Can” – a mobile health clinic initiative, which included the counselling and provision of prostate cancer testing targeted at men at highest risk of the disease.

‘Embedding a men’s health lens in commissioning’

The next step for men’s health is ‘to make it consistent’, says Professor Galdas. ‘Men’s health should sit within core prevention and inequalities work, not on the margins.’

He says one of the main areas that matter most is embedding a men’s health lens in commissioning – ‘pathways need to reflect how men engage’. This includes NHS Health Checks, stop smoking services, alcohol and drug interventions, mental health care, and long term condition management. ‘The strategy encourages gender responsive, co-designed models that meet men where they already are.’

It is also important to use trusted settings, he says. ‘Some of the best engagement happens in workplaces, community hubs, and sports settings that men already trust. ICBs should make systematic use of these assets rather than relying solely on traditional clinical routes.’

Monitoring who is being reached also matters. ‘Routine use of sex disaggregated data in quality improvement and commissioning decisions is essential. Some systems are already doing this well. It needs to become standard practice,’ says Professor Galdas.

Men’s Health Forum spokesperson Jim Pollard says that with one in five men dying before the age of 65, the premature killers – heart disease, cancer and suicide – and the social determinants of health that give rise to these conditions need to be addressed. ‘This is not something ICBs or the NHS can do alone. It’s about tackling inequality. The Men’s Health Strategy is a welcome first step to dealing with some of this.’

ICBs need to look to ‘commission services that meet men where they are, not where we might like them to be’. ‘Men are heavily socialised to be breadwinners and providers, rather than to look after their own health. We are conditioned to provide help, not ask for it,’ says Mr Pollard.

‘Think shoulder to shoulder, rather than face to face,’ he says. ‘For example, talking is clearly key to building the sort of social connection that helps reduce suicide, but simply insisting men should “talk to someone” may not be the best way to do it. Perhaps better to provide services which create opportunities for conversations to develop organically – walk-talk groups, shared activities, tea and chat circles. Organisations like Andy’s Man Club, Talk Club and Men Walk-Talk are all leading the way here.’

Anonymity helps men, which may be why they call the Samaritans, so services, in which the first question in person or online is not “who are you?” and “where do you live?” might be helpful, he says.

Men are out in the community, he says. ‘Provide outreach services like health checks and MOTs in pharmacies, workplaces and leisure/sport venues which are easy to access, friendly and know how to sign-post.

‘As part of this, provide training to those working with men in how to do it more effectively. The Forum’s Men’s Health Champions training, for example, develops skills for talking to men – it can be the difference between disengagement or anger and the feeling that someone sees you as a person and cares.’

And be positive about men, he says. ‘Don’t see them as a problem or “hard to reach”. Change that mindset and you will find that men are interested in their health just as much as women.’

Prostate Cancer UK wants to see a reduction in the amount of late diagnoses of the disease, and more men diagnosed in a timely fashion. ‘We want men diagnosed at the right time,’ says Mr Woollcott.

‘That’s about raising awareness of men’s risk and making sure they know how and where they can do something about it.’

The guidelines for GPs and primary care clinicians ‘will have to change so that men at highest risk can receive a timely diagnosis’, he says.

ICBs can do prostate cancer awareness campaigns in their areas through their Cancer Alliances, he says.

Prostate cancer and screening

While prostate cancer is a treatable disease if caught and diagnosed early, as yet there is no national screening programme.

Recently, the charity expressed ‘deep disappointment’ at the recommendation by the UK National Screening Committee (NSC) this November, to reject routine screening for most men at high risk of prostate cancer.

The charity submitted cases for screening Black men, who are at double the risk of their white counterparts, and for men with a family history of cancer.

The committee’s decision only recommends screening men with BRCA gene variations. It marks the first time the committee has recommended screening for prostate cancer for any group, ‘signalling a shift in the evidence base driven by research and diagnostic improvements’, says Prostate Cancer UK.

‘The committee’s decision will come as a blow to the tens of thousands of men, loved ones and families who’ve fought for a screening programme,’ says Laura Kerby, CEO of Prostate Cancer UK.

‘We know that a mass screening programme could save thousands of men’s lives. While screening men with BRCA gene variations will save only a fraction of that, the committee’s decision is the first time they’ve recommended screening of any kind for prostate cancer. It shows that research and evidence can shift the dial and save men’s lives.’

The research programme that could achieve screening for all men is already underway – ‘our £42 million TRANSFORM trial which will bring new evidence back to the screening committee in just two years’, she says.

According to Prostate Cancer UK, the trial will provide ‘concrete evidence’ of the impact of the latest approaches to screening and show the way to an effective screening programme that can save thousands of lives each year. It is ‘the largest and most ambitious trial of its kind in 20 years’, the charity says.

It is backed by the NHS, the National Institute for Health and Care Research (NIHR) and the UK Government, and led by six world-leading researchers, representing four of the UK’s biggest research centres. It will involve hundreds of thousands of men, run over a decade and begin delivering results in as little as two years’ time.

Future vision

Professor Galdas’s future vision is of a health system where men’s health is embedded across prevention, digital access, community partnerships, and workforce training. ‘ICBs should be aiming for measurable improvements in early diagnosis, reduced smoking, lower cardiovascular risk, and better engagement with mental health support among the men at highest risk.

‘Neighbourhood health models and digital pathways will be important. Real progress depends on ICBs commissioning in ways that reflect how men live, work, and seek help.’

His wish list for ICBs includes for them to make men’s health part of the core inequalities mission, and to commission prevention and early diagnosis pathways that explicitly consider men’s engagement patterns. He would also like to see ICBs invest in outreach through workplaces and trusted community assets, use sex disaggregated data routinely to understand reach and impact, and to work with local VCSE partners who already connect with underserved men.

‘Improving men’s health is not about creating something new for men. It is about making sure the system works for the men who currently lose out,’ says Professor Galdas. ‘The new strategy provides the mandate – ICBs now have the opportunity to turn that mandate into meaningful, population level change.’