The men’s health strategic vision for England, published in November 2025, highlights key foci for physical health of men, including:

• high levels of frailty in ‘young old’ populations who are sleeping homeless and 30 year earlier death compared with the general population. It is mainly men who are homeless and rough sleeping
• rates of cancer, circulatory and respiratory conditions drive much of the difference in life expectancy between the most and least deprived men nationally. Risk factors for these conditions, such as smoking and obesity, are higher in the most deprived areas of the country
• men develop cardiovascular disease around six years earlier than women
• there is a higher prevalence of type two diabetes in men
• cancer incidence and mortality is higher in men than women above the age of 60 years
• cancer incidence rates are 19% higher for men in the most deprived quintile compared with the least deprived quintile
• men carry the greatest burden of respiratory disease, particularly those who smoke, are former industrial workers and live in the most deprived communities
• two thirds of live disease is in men, linked with alcohol consumption, obesity and viral hepatitis

The strategy includes a plan, formed around meeting men where they are. 

Major commitments include:

• the investment of £3 million over three years from April 2026 into community-based men’s health programmes, targeting areas at highest risk
• men's health training for healthcare professionals via new e-learning modules
• workplace health pilots in male-dominated industries through the Keep Britain Working Vanguard Programme
• enhanced lung disease support for former miners via the Respiratory Pathways Transformation Fund
• home PSA testing for prostate cancer patients from 2027 via the NHS App (subject to clinical approval)
• £200,000 trial of interventions to tackle rising cocaine and alcohol-related cardiovascular deaths

An additional major investment from national government has been the Premier League’s Together Against Suicide initiative with the Samaritans, embedding match day messages and support at stadiums. While positive, this strategy fails to recognise the lack of premier league teams in the areas with the highest suicide rates, including Cumberland, Westmorland and Furness, Blackpool, and Darlington. While the strategy is welcomed, it must be ensured that interventions do not neglect those most at risk.

In the 2022 health survey for England, men were slightly more likely to self-report good health compared with women (76% vs 74%), and less likely to report acute sickness. Women more commonly reported musculoskeletal conditions, mental, behavioural and neurodevelopmental conditions and conditions of the digestive system, while men more commonly reported heart and circulatory conditions.

Hypertension and cardiovascular health

Deaths due to circulatory causes is one of the leading causes of health inequalities both within and outwith men in Cumberland (Figure 7 and Figure 8). Men are more likely to have hypertension ‘all’ and untreated hypertension than women. Modifiable risks factors for cardiovascular disease accumulate over a lifetime (obesity from childhood, poor diet, lack of exercise, alcohol consumption, obesity), while early intervention for cardiovascular health has the potential to be highly effective, if utilised. Psychological trauma and chronic stress are increasingly being recognised as increasing risk of cardiovascular disease (Song et al., 2019).

NHS Health checks are important appointments offered free to adults age 40 to 74 years, five yearly, to assess for signs of chronic conditions including cardiovascular disease. Uptake of checks in Cumberland was 27.4% in 2024 to 2025, below the national average of 37.5%. There is a stark gap in publicly available data for NHS health check uptake by gender. The last national figures on 2017 to 2018 data showed women were more likely to attend than men (44% vs 38%). Locally acquired data for 2024 to 2025 reflects this pattern, with 3,951 females attending for health checks, compared with 3,222 males.

Fingertips data indicates that men in Cumberland have higher levels of certain risk factors: smoking (three percentage points higher) and overweight and obesity (10 percentage points higher), although women have higher levels of physical inactivity (three percentage points higher).

Preventative pathways such as routine health checks rely on proactive help-seeking, yet men are less likely to engage with these services, increasing the likelihood that cardiovascular disease is first identified at either a more advanced stage, or at the point of fatal consequence. As with other health conditions, this pattern reflects not a lack of concern for health, but the interaction between masculine norms, work pressures and service design.

Prostate cancer

Other than skin cancer, prostate cancer is the most common cancer in men both nationally and in Cumberland, with risk increasing with age (Figure 12). However, lung cancer is the leading cause of cancer death nationally.

For the 12 months ending October 2025, lower proportions of people were diagnosed with prostate cancer during the early stages, one to two, in Cumberland compared with England (53.8 vs 57.5%). The difference between local and national early stage diagnosis has been reducing since 2022 (Figure 13).

There is currently no national screening programme for prostate cancer. While this remains a contested decision, the conclusion of the UK National Screening Committee remains that the current available screening tests are not fully reliable at picking up cancers that actually need treatment, and some of the investigations and treatments are invasive and harmful, not balancing the need for a screening programme to do more good than harm. However, a targeted approach to screening based on risk is currently being considered.

Instead, diagnosis with prostate cancer relies on individuals presenting to medical services with symptoms such as frequent nighttime urination, weak stream of urine or difficultly passing urine. 

The pattern of high proportions of later stages of diagnosis of prostate cancer in Cumberland may represent later presentation and delayed engagement with diagnostic pathways, consistent with wider evidence on men’s health-seeking behaviour locally, including lower uptake of preventative care and a higher tendency to seek help only at crisis point.

For many men in Cumberland, psychological distress is closely linked to experiences of redundancy, insecure employment, declining physical capacity or perceived failure to meet provider roles (Ashworth, E. et al, 2026). Contact with the justice system factor is also associated with poor mental health, with half of the boys and men in contact with the justice system reporting anxiety or depression, compared with 15% of the general population. Cultural norms that value stoicism and “getting on with it” can discourage early disclosure, leading men to internalise distress and delay seeking support. As a result, mental health difficulties frequently come to attention only once they have escalated, often alongside physical illness, financial strain or crisis events, with consequences that extend beyond individual men to families, workplaces and communities.

Available data on mental health and wellbeing is generally scarce and not available split by sex. Where data is available, the ratio of higher suicide rates in men compared with women does not tend to correlate with diagnosis of mental health conditions. NHS England population survey data conducted every seven years since 1993 show that women have a higher prevalence of diagnosed common mental health conditions than men across all age groups at all time points, including anxiety disorders, depression and phobias.

A local survey in the Cumberland, conducted by The Big Question study (explored further in the next section) found that a higher proportion of men reported thoughts of self-harm compared with women (52% vs 47%), however women were slightly more likely to have previously ever self-harmed (28% vs 25%), and slightly more likely to seek help (57% vs 51%) (Ashworth, E. et al, 2026). Participants reported varying quality of help received; while some were supported by healthcare organisations, there was report of private therapy, third-sector organisations (e.g. Andy’s Man Club and Samaritans) and organisations outside of Cumberland.

Key challenges in seeking help were varied and somewhat echoed those in surveyed professionals supporting children and young people. Some Big Question respondents reported self-reliance and management, stigma, previous negative experiences, difficulty in asking for help, accessibility, lack of long term support for men and feeling they had to reach crisis point before being eligible for support.

These findings echo wider knowledge that men are less likely to report symptoms or engage with services at an early stage, and are more likely to present later, with more severe or complex manifestations of distress. This helps explain why men in Cumberland experience disproportionate rates of mental health-related economic inactivity, substance use and suicide, despite lower diagnosed prevalence of common mental health conditions.

Debt and gambling harms

Gambling is widely known to be a harmful commodity, impacting on psychological and physical health. While overall gambling levels are highest in people with better psychological health and life satisfaction, at-risk and problem gambling prevalence is higher in those with poor health, low life satisfaction and wellbeing (source: NHS England). Being male and having poor mental health are strong predictors of at-risk gambling.

In understanding patterns of gambling, one challenge is the reliability of data. Much of what is available, and quoted below, comes from GambleAware; this is an organisation funded primarily by voluntary donations from the UK gambling industry and has previously faced scrutiny over conflicts of interest regarding ties to the industry and lack of independence concerns, including in a case raised by the Good Law Project which was later closed by the Charity Commission. The data that follow should therefore be seen in this context.

In 2020 data collated by GambleAware, around 7% of the population of Great Britain were negatively affected by someone else’s gambling. In 2020, Of the 7%, affected others were more likely to be a women, 25% were a spouse or partner, 21% were a mother or father, while 9% were a son or daughter. Impacts were felt most severely by partners, parents or children of problem gamblers.

In further data collected by GambleAware, through the Annual GB Treatment and Support Survey 2024, Cumberland appears to have gambling problems below the national average. It is important to note the limitations of the Problem Gambling Severity Index (PGSI), the screening tool used to assess problem gambling. The tool assesses for presence of harms at that moment only, not severity of harms, wider impacts or ongoing to harms to people who have previously had gambling. However, this still generated an estimated fiscal cost of £5,542,704 of harms associated with gambling, predominantly though welfare costs and hospital inpatient stays.

Direct harms to gamblers were financial harms, relationship harms, mental and physical harms (those with a gambling disorder have an increased risk of all cause mortality), employment and education harms, criminal harms and cultural harm (source: OHID, PHE). These are echoed in harms felt by those impacted by harm, with 75% reporting feelings of anger, anxiety, depression, sadness, or distress and 60% reporting negative financial impacts (source: GambleAware).

Men and women demonstrate differing patterns of gambling behaviour and associated harms. Research consistently finds that men are more likely to engage in higher-risk, competitive and rapid-cycle forms of gambling such as sports betting, poker, online betting and casino gambling, whereas women are more likely to participate in chance-based formats such as gambling machines (Baggio et al., 2018). Males gamble proportionately more than females, except regarding scratch cards. Harmful gambling among men has been more strongly associated with sports betting and substance use, whereas among women it appears less associated with substance-use networks (Baggio et al., 2018).

The structure of gambling activities also differs in ways that may influence harm. High-intensity formats such as online sports betting and casino games are characterised by rapid cycles of staking and reward, and greater opportunities for escalation and solitary play, whereas other formats are more socially embedded. Recent research indicates that for both men and women, gambling motivated by coping is strongly associated with severity of harm, with maladaptive emotion regulation emerging the key predictor (Theodorou et al., 2025).

The National Men’s health strategy highlights gambling as key concern in men’s health. Men were highlighted as more likely to experience gambling rating harms, to gamble online and engage in online gambling, increasing exposure to gambling-like content. A new national gambling tax law was announced in the 2025 budget and provides protected funding for gambling harms prevention (30% of levy funding), treatment (50% of levy funding), and research (20% of levy funding). The Government has committed to developing a coordinated approach to gambling prevention, including a new voluntary sector grant, delivering a research programme and increasing treatment and support services. It is imperative that Cumberland advocates for shared receipt of these resources and that statutory organisations support voluntary sectors in doing so.

Suicide rates

Across the UK, suicide and injury or poisoning of undetermined intent is the leading cause of death for both males and females aged 20 to 34 years. Men were more than three times as likely to die by suicide compared with women in this age group. Since 2001, the leading cause of death in men aged 35 to 49 years has changed from ischaemic heart disease to suicide in 2011-2015 and accidental poisoning more recently (source: ONS).

In 2022 to 2024, there were 137 suicides in men and women in Cumberland, the third highest out of 153 upper tier local authorities in England and a rate of 19.4 per 100,000 population (source: ONS). Suicides rates in Cumberland are increasing, and at a higher rate compared with England.

In 2022 to 2024, men in Cumberland had the 7th highest rate of suicide deaths nationally. Of the 137 suicide deaths in Cumberland, 98 were in men. This is a rate of 28.2 per 100,000, significantly above the national rate of 16.8. In the same period, women in Cumberland had the highest rate of suicide related deaths, with a rate of 11.2 per 100,000 compared to 5.5 per 100,000 nationally. This is further explored in Chapter 4: Work, place and identity in adult men’s lives.

Suicide: the big question

Suicide rates in Cumberland show a persistently high burden, particularly among men. This fact prompted The Big Question, a mixed-methods study commissioned by Cumberland Council and undertaken by Liverpool John Moores University, to explore why suicide risk remains high and how it is experienced locally (Ashworth, E. et al, 2026).

Men and women were similarly likely to report suicidal thoughts (57% of men compared with 55% of women), and men were slightly more likely to report having received support. Of the 40 men who reported a previous suicide attempt, 27 (67.5%) reported receiving support after (although only 30 gave responses). Of 99 reporting suicide attempts, 52 received support (52.5%), with 94 out of 99 responding to this question. These findings suggest that high male suicide mortality in Cumberland is not by total disengagement from services, but by more complex factors. However, it may also be that those responding to the survey are a selection of people more likely to engage with health services than the general population.

Respondents were asked to comment on mental health challenges and contributing factors to the high suicide rates in Cumberland. Responses included mental health conditions, chronic pain and other long-term illness, neurodivergence (often diagnosed late), intergenerational trauma and adverse childhood experiences. Drugs and alcohol were described as coping mechanisms, and the long-term impact of suicide bereavement was prominent, with over half of respondents reporting being affected by the death of someone who died by suicide. Of the 781 respondents, 52% reported havening been bereaved or affected by the death of someone who died by suicide. This was lower in men than women (44.6% vs 55.2%). Common relationships were friend, family and work colleague, with many participants citing knowing more than one person who died by suicide.

Acute triggers reported to precede crisis included relationship breakdown, abusive relationships, interpersonal conflict and bullying. Environmental and socioeconomic stressors were also prominent, including isolation, rurality and transport barriers, financial strain, seasonal factors (poor winter weather), limited recreational opportunities and a labour market shaped by a small number of dominant employers. Some respondents highlighted access to firearms within agricultural settings as a specific risk factor, while social media was described as increasing isolation and undermining communication.

Attitudes and assumptions are known to shape help-seeking. Suicide was perceived as taboo for many, with suicidal thoughts often minimised or normalised. A “Cumbrian tendency” towards stoicism and emotional restraint among men was frequently cited, alongside shame and concerns about confidentiality in close-knit communities. Attitudes to mental health were reported to be shifting across generations to become less conservative and more liberal. Frustration with the availability and continuity of support was common.

Taken together, these findings reinforce and evidence that suicide in Cumberland reflects the interaction of identity-based pressures, place, constrained opportunity and delayed help-seeking. Men may articulate distress and access support at points, but remain vulnerable where help is fragmented, short-term or poorly aligned with lived realities. Addressing suicide risk therefore requires approaches that recognise identity and place as determinants of health, alongside timely, sustained and culturally aware support.

Suicide risk therefore requires approaches that recognise identity and place as determinants of health, alongside timely, sustained and culturally aware support.

Substance use is a significant public health concern in Cumberland, contributing to mortality, hospital admissions, crime and unmet support needs. In 2022 to 2024 there were 164 drug-related deaths in Cumberland, an age-standardised morality rate of 21.9 per 100,000 which is around double the national average. Cumberland had the third highest rate of local authorities nationally, with only Blackpool and Middlesborough having higher. Drug related deaths are around double in men compared to women, at 27.6 (7th highest) and 6.9 (14th highest) per 100,000 respectively, and are rising in recent years in both men and women (Figure 16) (Sources: ONS, 2024 and Cumberland statistical summary, 2025).

Local assessment data for Cumbria indicate that there were approximately 2,400 individuals using opiates and crack, with opiate prevalence higher than regional and national averages, and around 5,594 adults estimated to be dependent on alcohol at similar rates to England overall.

In 2024 to 2025 there were 1,940 people in treatment for drug and alcohol use (source: NDTMS), 1290 (66.5%) of whom were male, 1145 (59.0%) in the 30 to 49 year age group. People with opiate dependence formed the largest treatment group (875 out of 1940, 45.1%) with the next largest treatment group being people with alcohol misuse (685 out of1940, 35.3%).

Co-occurring mental health needs are common among those entering treatment, while unmet need for treatment among dependent people persists at similar or higher levels than national benchmarks. These patterns occur alongside rising levels of drug-related crime and a growing proportion of treatment clients who are parents, underlining both the personal and social impact of substance use in the area.

Regarding children and young people, in 2023 the youth substance team received around 100 referrals for young people across both Cumberland and Westmorland and Furness. Most of these referrals were young men, with over half of referrals for drug use and around a third for alcohol use. In 2023 to 2024, there was a rate of 44.7 per 100,000 alcohol specific admissions for under-18s in Cumberland, around double the national rate and the highest rate in the Northwest of England (source: Fingertips).

National data 2023 to 2024 collated by the Office for Health Improvement & Disparities found that 21% of people started treatment in substance services had no home of their own, higher in people starting treatment for opiate problems. Almost three quarters of adults had a mental health need. Table 2 shows the national breakdown by sex of adults in contact with drug and alcohol treatment services. The age group with the highest number of people in contact is 40 to 44 years, at 53,747 individuals.

Table 2: Adults in contact with drug and alcohol treatment services between 1 April 2023 and 31 March 2024, England, by sex

Cumberland is experiencing a crisis in drug related deaths in men and women, at 27.5 and 14.2 deaths per 100,000 population respectively. The rates of deaths have tripled for men and nearly tripled for women over the last ten years.

Safer Drug Consumption Facilities (SDCFs) are a relatively novel intervention: settings where people can consume drugs procured elsewhere while in the presence of health care professionals to reduce and respond to overdoses and offer access to healthcare and social services. Globally, many countries including Scotland have introduced SDCFs. Evaluation of existing SDCFs found they were cost-effective, reduced drug related deaths and injecting harms, associate with increased uptake of addiction care, reduced publicly discarded syringes around the facilities and can provide links to housing and mental health services. Despite the evidence in favour of SDCFs, the Misuse of Drugs Act prohibits the legal operation of SDCFs, and the UK parliament has announced their intention to keep this legislation in place, even if Scottish pilot evaluations demonstrate benefit, precluding the opening of SDCFs in England. In the face of high and up-trending drug related deaths and harms, it is important that due consideration is given to novel, potentially revolutionary drug treatment service models such as SDCFs, and that local authorities most impacted by drug related deaths advocate for these approaches.

Interpretation

While cardiovascular and respiratory disease remain important contributors to mortality among men in Cumberland, it is deaths from external causes, particularly suicide, drug poisoning and injury, that most sharply contribute to differences in men’s outcomes from both women locally and men nationally. These deaths tend to occur earlier in the life course, disproportionately affecting men of working age, and therefore contribute heavily to the gap in life expectancy. Perspectives from local practitioners and professions regarding the root causes of these patterns are explored in Box 1.

Box 1: Local professional and practitioner perspectives regarding the underlying factors in Cumberland leading to high rate of deaths due to ‘external causes’ (suicide, poisoning and injury).

Practitioners working with men and boys consistently described these deaths not as isolated events, but as the culmination of cumulative distress: unresolved trauma, economic insecurity, relationship breakdown and delayed engagement with support. This aligns with professional survey findings, where emotional suppression, trauma and low aspiration were among the most commonly observed challenges, and where the majority of practitioners reported that boys and young men often or almost always hold back from seeking help. These patterns raise the need to explore when these inequalities begin, if they can be prevented earlier and how this prevention might take shape.

Deaths of despair

The combined mortality arising from suicide, drug poisoning and alcohol-related causes is often described as “deaths of despair” (DoD). The term was originally used by economists Anne Case and Angus Deaton to describe rising mortality in the United States, particularly among White men without higher education, linked to long-term economic and social dislocation (Case & Deaton, 2022).

Subsequent research in England, including analysis by the University of Manchester, has shown a similar pattern, with deaths of despair disproportionately concentrated in the North of England and in coastal areas. This research characterises deaths of despair as an “avoidable human cost of inequitable resource deprivation” (Camacho et al., 2024). Key factors associations with DoD were living in the North, unemployment, White British ethnicity, living alone, economic inactivity, employment in elementary occupations, and living in urban areas (Camacho et al., 2024).

Many communities in Cumberland experience a clustering of these risk factors. Rising mortality due to suicide, drug-related deaths and alcohol-related harm locally reflects a pattern consistent with deaths of despair, highlighting the cumulative impact of economic insecurity, social isolation and limited access to early support. This framing reinforces the need to address upstream determinants and underlying causes of cycles of deprivation.