Foreword
This Public Health Annual Report was initially inspired by a complex mix of feelings. As Chair of the Cumberland Community Safety Partnership, one of my roles is to receive reports from Domestic Abuse Related Death Review (DARDR) panels, which consider the circumstances surrounding every death – whether by murder, neglect or suicide – in which domestic abuse is thought to be a factor. These are always tragic, frequently harrowing accounts of the experience of a (usually, but not exclusively) female victim of domestic abuse and a (usually, but not exclusively) male perpetrator – or sequence of perpetrators. In Cumberland we have an unusually high number of such reviews underway compared to other parts of the country, and there are only so many of them that you can read before patterns of appalling male behaviour and attitudes towards women become obvious. And of course, situations that lead to a death are very much the tip of the iceberg when it comes to domestic abuse; while reliable data are difficult to come by, the sheer number of women in Cumberland suffering abuse by men is distressing. Alongside this there appears to be at least a sub-culture, exemplified by the online influencers known as the “manosphere”, that is promoting misogyny, contempt of, and exploitation of, women – so-called “toxic masculinity”. So on the one hand, this report was inspired by the furious question – just what is wrong with men?!
On the other hand, it is also clear that men are suffering too. As shown in this report, men have much higher rates than women for deaths related to suicide, drug and alcohol use; many are significantly struggling with mental health challenges; they appear to be falling behind women in education; and for many, employment opportunities are not what they were, leading to a wider economic and social malaise. These outcomes are concentrated in men experiencing higher levels of deprivation, cumulative adversity and limited access to support structures. All of which prompts the same, though this time sympathetic, question – just what is wrong with men?
So that is the underlying question behind this report. Inevitably, the answers are complex. Disadvantage begins early, with boys experiencing lower levels of school readiness and higher levels of exclusion and contact with the justice system. These early experiences impact on work, place and identity, interacting further with cultural factors and economically disadvantaged communities affected by deindustrialisation.
Men’s health inequalities are further shaped by social norms around masculinity, including expectations of strength, self-reliance and emotional control. While these norms can help provide a sense of identity and bring with them some very positive implications, they can also discourage help-seeking and contribute to risk-taking, silence and late presentation to services; taken to an extreme they can indeed be toxic.
The report also finds that existing systems do not consistently meet men’s needs. Men are less likely to engage with preventative services and often present at crisis point. Service design, access barriers and cultural expectations all play a role in reinforcing these patterns.
The evidence highlights the need for a more targeted, gender-transformative and preventative approach to men’s health in Cumberland. By addressing the social conditions that shape risk, intervening earlier in the life course, designing services that better work for men, and helping to create healthier concepts of masculinity that are fit for the 21st Century, it is possible to reduce health inequalities and improve outcomes for men, women and children alike.
Colin Cox
Director of Public Health, Customer and Community Wellbeing