Europe's men need their own health strategyA recent European report on men's health shows that it lags behind that of women. Alan White and colleagues analyse the problems and call for more policy, practice, and research aimed specifically at men Ten years ago the BMJ published a special issue on men's health.1 It noted how, although men fare better than women in most conventional measures such as top jobs and earnings, this advantage is not reflected in their health. A report we produced this summer, The State of Men's Health in Europe, 2 3 shows that little has changed. At any given age, men are still more likely than women to die from most of the leading causes, and in the European Union men have more than twice as many deaths a year as women throughout the working ages (15-64 years). This high level of premature mortality in men has psychological, social, and economic consequences for relatives, households, communities, and the workplace. Yet, in both national and European health policy, men and "masculinity" are largely taken for granted. This has limited the development of evidence based programmes that meet their health needs.Differences in mortality and morbidity are not simply the result of biological factors; nor are they intractable. In fact, the health gap between men and women varies considerably. It is much greater in eastern Europe than in western Europe, 4 and within countries it is influenced by class, education, employment, and other social determinants. 5 The clustering of material, cultural, and psychosocial factors seems to be particularly detrimental to the health of many men. 6 These factors contribute to gendered lifestyles and behaviours that have traditionally been seen as predominantly "masculine" 7 and that cause many of the premature deaths in men. Traditional masculine attitudes are associated with unhealthy behaviours such as poor diet, 8 smoking, excessive alcohol consumption, 9 non-use or delayed uptake of health services, 10 and higher likelihood of injury. All of these factors are more common among men living in eastern Europe than those in western Europe and in poorer material and social conditions everywhere.11 Men also seem to have adapted less well than women to the changes that have accompanied the political and social upheavals in eastern Europe in recent decades, such as more transient and unstable working conditions, increasing unemployment, and changing family structures (reduction in marriage and increased divorce).
12Yet, paradoxically, men often view themselves as having better health than women. There is some justification for this view: those men who survive into old age report less disability than women of the same age 2 ; but what is overlooked is that fewer live this long.13 Though the average difference in life expectancy between men and women in the European Union is 6.1 years, it ranges from 11.3 years in Latvia to 3.3 years in Iceland and Lichtenstein.2 Thus, men in general, and younger men in particular, tend to minimise the potential consequences of pra...