‘Let’s see what shit men have been up to today’ – Grayson Perry’s suggested alternative name for the TV News. The artist and author of The Descent of Man was speaking at a landmark conference, Engendering Men’s Health, that looked at masculinity, gender and health. The event took place in University College London on 14 October 2019.

In a presentation that combined hilarious stand-up comedy with serious cultural analysis, Perry explained to a packed hall why he believes masculinity to be a skeuomorph. A skeuomorph is an object that retains non-functional and now ornamental design cues or attributes from structures that were inherent and essential to the original.

In other words, although traditional masculinity may have served a purpose at a time when men’s work was hard and physical, it no longer has any practical use. However, said Perry, “you can close down a pit overnight but you can’t close down masculinity overnight”. Gender norms change slowly.

Perry was dismissive of the so-called ‘men’s rights’ agenda – essentially an attempt to return to the rigid gender order of the 1950s – and set out what he called ‘real men’s rights’. These include the right to be weak, the right to be vulnerable, the right to be uncertain, the right not to know and the right to be flexible. Perry also stressed the need to move beyond seeing certain attributes as ‘masculine’ or ‘feminine’; instead, he said, we need to understand which are more positive or negative for society. We need to bring up our boys with the more positive attributes if masculinity is to change.

Before Perry’s presentation, the conference heard from a wide range of rather more academic but nonetheless still stimulating speakers who explored the evidence on men, masculinity and health, intersectionality and men’s health, and reframing narratives of men’s health, women’s health, masculinities and gender.

What’s the evidence on masculinities and men’s health?

The scene was set by Veronica Magar, Director of Gender, equity and human rights at the World Health Organisation. She shared some data from WHO’s World Health Statistics Overview 2019, a very significant report because its analysis is sex-disaggregated wherever possible. Global life expectancy has improved significantly for both sexes but at a faster rate for women. Men are more exposed to health risk factors – such as tobacco or alcohol – and are less likely to seek medical help. Veronica suggested that WHO’s work on men’s health would be accelerated if member states started to raise it as an issue. This would help to build on the work already underway in Europe, where the WHO Regional Office has published a men’s health strategy, and also in the Americas where the Regional Office plans to publish a report on masculinity and health shortly.

Gary Barker, Promundo’s CEO, introduced the concept of the ‘Man Box’, the set of beliefs, communicated by parents, families, the media, peers and others, that place pressure on men to act as men are ‘supposed’ to. These pressures encourage men to be self-sufficient, to act tough, to be physically attractive in a certain way, to be heterosexual, to demonstrate sexual prowess and to use aggression to resolve conflicts. Promundo believes that 40-50% of men are inside the Box and that, the more deeply a man is inside, the more harm he will do to others and to himself. Promundo calculates that the cost of the Man Box to the UK health system is a staggering £3.1 billion a year.

I spoke on behalf of Global Action on Men’s Health and highlighted some findings from our recent report on men and self-care. Given that men in some UK neighbourhoods now have a life expectancy of around 90 years, it is no longer possible to claim that men’s premature mortality is genetically determined. With about 45% of global male deaths due to health practices, male gender norms clearly play a key role. But not all men’s health behaviours are negatively affected by gender norms (men’s interest in physical activity is helpful, for example) and there are other significant determinants of poor male health, not least the historic neglect of the issue by policymakers and service providers. Only three countries in the world currently have national men’s health policies.

Leeds City Council has taken a gender-sensitive approach to health following the publication of two major reports, one on men’s health and one on women’s health. Tim Taylor, Head of Public Health at the Council, explained that male-targeted suicide prevention work has been a particular focus, especially for low-income isolated men living in high-rise accommodation. The work in Leeds is a great example of how research can lead to positive changes in policy and practice on gender and health issues.

What is an intersectional approach and why is it needed?

While men’s health in general needs more attention, it is clear that there are specific groups facing particular problems. An intersectional approach to men’s health allows us to see how multiple identities, such as gender, age and race, can overlap, and compound disadvantage and inequality.

The health needs of homeless men were discussed by Rob Aldridge from the UCL Institute of Health Informatics. His research suggests that nearly one in three homeless deaths are due to causes amenable to timely and effective health care. This high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.

Genny Turay, Head of Support at Ditch the Label, an anti-bullying international NGO, presented an analysis of 19 million tweets which revealed how masculinity is defined in online opinion. Key features of the masculinity construct include violence, stoicism, muscularity and heterosexuality. Eating meat, drinking coffee and beer, and a preference for rock and metal music genres were also seen as defining preferences of masculinity, while the masculinity ‘anti-christ’ was associated with being gay, skinny, emotional and gentle. There is extensive bullying of young people who do not fit the ‘masculinity’ stereotype and because of homophobia and transphobia. Ditch the Label tackles this through non-judgemental online support and the provision of educational materials for teachers.

Movember’s Ahead of The Game programme was described by Tracy Herd, Programme Manager, Young Men and Sport at Movember UK. It aims to support good mental health and resilience in boys by engaging parents, coaches and boys themselves. The programme is based on the concept of going to where young men are (in this case, organised sport) and providing emotional literacy workshops and online support.

Marion Wadibia, CEO at NAZ, a charity that provides sexual health promotion and HIV support services to Black, Asian and Minority Ethnic (BAME) communities in London, explained that black men have the highest rates of late diagnosis for sexual health problems. The ‘power’ associated with masculinity, Marion highlighted, is not evenly distributed, but one that depends on race and positionality in society. She stressed that those affected by multiple levels of disadvantage must be part of the debate and involved through co-production and co-delivery of services.

Reframing narratives on masculinities, gender and health - what next?

Social norms that dictate how men should behave remain a large driver of poor health outcomes, but remain under-addressed in the global health agenda and under-discussed in society and policy.

The challenge of discussing masculinities in ways that are male-positive and also recognise women’s needs were discussed by several speakers. Olivia Burns, Associate Director of Communications at Prostate Cancer UK described how the charity has rebranded to put men at the centre of everything they do. It now goes to where men are, including at the football, to raise awareness of prostate cancer and reach out to all those affected through communicating positive messages about men and their value as fathers, brothers, sons and friends, including through the charity’s ‘Men, we are with you’ advert.

Oxfam’s campaign to encourage men to do more domestic and care work was highlighted by Thalia Kidder, Women’s Economic Empowerment Lead. Women in poor rural areas can spend 11 hours a day on this work and it can affect their health outcomes. Oxfam aims to promote domestic and care activities as a social good shared by men and women, not a gendered activity.

Ideas of what men and women should do and be in a society, which in turn impacts their health, are heavily influenced by advertising, explained Jessica Tye, Operations Manager – Investigations at the Advertising Standards Authority. The regulator is now taking action to tackle harmful gender stereotyping of both men and women through their new guidance. One example of an unacceptable advert would be one that showed a man being unable to change a nappy.

When it comes to masculinities most men only know their own story, said Aaron Gillies, best-selling mental health writer and CALM ambassador. Posting his personal story of depression and anxiety on social media was ‘transformative’ for Gillies. He received a large number of responses from strangers who wanted to help, including many middle-aged white men who do not talk to anyone about their own problems. Gillies concluded by noting that while there is now more awareness of mental health issues and people are increasingly urged to talk and seek help, the support services are often not available to enable this.

The Government Equalities Office’s view is that gender equality benefits everyone and that men and boys are an important part of the conversation when trying to achieve lasting change, explained Orla Mackle, Team Leader – Gender Norms Policy at the GEO. It is important to move away from the blame culture and notions of ‘toxic’ masculinity and to recognise that men can also experience inequalities and are not privileged in a simplistic way. GEO will shortly be publishing a report on men and gender norms.

The conference ended with a drinks reception where guests could view commissioned artwork from the Slade School of Fine Art. The works explored themes of colonialism and masculinity, the deconstruction and destabilizing of masculinity, and gender-fluidity and psychological well-being. The artists, Louis Bennet, Magnus Ayers and Blythe Cheung, had the opportunity to discuss their work with artist Grayson Perry.

I judge the conference to have been hugely significant. This was not just because of the range and quality of the speakers and the examples they provided of excellent work on men, masculinity and health. It goes deeper than that. For years, those of us who work on men’s health have often felt as if we were mostly talking to each other and making little headway in wider public health policy and practice. Looking at men’s health in the context of gender and health provides, I believe, a new way forward. It has the potential to take us beyond the notion that there is a binary divide between men’s and women’ health and that action to improve outcomes for one gender is detrimental to the other gender. This need not be a zero sum game. There is now a significant opportunity for men’s health and women’s health advocates to work together at the local, national and global levels.

I am very grateful to all the speakers and also to the UCL Centre for Gender and Global Health, Global Health 50/50 and Promundo for providing the means to host the conference and for sharing the billing with Global Action on Men’s Health. It is a partnership that I very much hope will continue to develop and achieve positive change for the health and wellbeing of people of all genders.