The COVID-19 pandemic has refocused attention on many health inequalities, not least those related to gender. Globally, men and women are thought to be infected with COVID-19 in roughly equal numbers. But, overall, men are 40% more likely than women to die from COVID-19 and almost three times more likely to require admission to an intensive treatment unit.
Men of colour and men in lower-income groups have suffered particularly high mortality rates. Men’s mental health and wellbeing has suffered in many countries and, at the same time, non-governmental organisations that focus on engaging and supporting men have experienced funding pressures that may lead to reduced services.
Of course, highlighting the impact of COVID-19 on men does not mean that the many gendered dimensions of the pandemic which affect women disproportionately can be ignored. Women are at the forefront of efforts to tackle the pandemic, representing the vast majority of health and social services staff globally. They also consistently carry the primary responsibility for caregiving and other unpaid work at home. Gender-based violence has increased during the pandemic and women may be more susceptible than men to long COVID. The reporting of such outcomes is often poor in many countries.
There is a clear and urgent need for gendered policy responses to ensure that the specific needs of men, women and people of diverse genders are not overlooked. Relatively early in the pandemic, in May 2020, WHO published an advocacy brief on gender and COVID-19. This encouraged member states to conduct a gender analysis of data and to invest in gender-responsive research on the potentially differential adverse health, social and economic impacts of COVID-19 on women and men. The brief stated that ‘the findings of such analys[es] should be used to fine-tune response and recovery policies.’
We are unaware of any government that has actually followed WHO’s advice and developed policy and practice in respect of COVID-19 that takes full account of the position of all genders. The Sex, Gender and COVID-19 Health Policy Portal’s recent analysis of 76 countries found that less than one-third (31%) of policies identified the beneficiaries by sex or gender, that most of the policies that did identify a beneficiary focused on women and that only 3% mentioned interventions targeting men.
The WHO itself has not yet established a gender and COVID-19 working group, despite a public commitment from the Director-General in September 2020. The Biden administration’s National Strategy for the COVID-19 Response and Pandemic Preparedness rightly highlights the impact of the pandemic on women’s health, but its one-dimensional approach to gender is revealed by the complete omission of men.
This lack of action is despite calls for a properly gendered policy response from many advocates in the men’s and women’s health fields, including Women in Global Health, GENDRO and Global Action on Men’s Health (GAMH). A paper published by the Centers for Disease Control and Prevention (CDC) emphasised the importance of addressing men’s vulnerability to COVID-19 in the policy response to the pandemic, particularly for men who are marginalized or disadvantaged because of their race, ethnicity, sexual orientation, or status as incarcerated or homeless. However, despite its provenance, even this analysis has not succeeded in stimulating any concrete activity in the USA or elsewhere.
The absence of a gendered policy response to COVID-19 is set in the context of the longstanding failure to address gender adequately in broader health policy. This is especially pertinent for men’s health. An analysis of 35 national health policies in the WHO European Region member states, for example, found that the term ‘men’s health’ appeared once. Globally, just four states – Australia, Brazil, Iran and Ireland – have developed national men’s health policies along with one city, Quebec.
Men’s higher mortality from COVID-19 can in part be explained by biology (males have a weaker immune response to the virus than women) but their outcomes could still be improved by both short- and long-term gendered policy responses. Action to improve COVID-19 prevention and help-seeking which are influenced by gender norms is needed. A few potential areas are compliance with mask-wearing, handwashing and social distancing, addressing workplace health and safety risks, facilitating testing and self-isolation, and maximising vaccination uptake.
The underlying conditions (eg. hypertension, chronic lung disease, diabetes) that disproportionately affect men and which contribute significantly to their poor COVID-19 outcomes – as well as having a broader impact on their life expectancy – must also be tackled.
Many have said that our societies must ‘build back better’ as part of the recovery plan from the pandemic. This cannot succeed through a ‘gender-blind’ approach that overlooks men’s health. The opportunity to achieve the long-overdue leap forward in gender-transformative policy and practice that will make a real difference to the lives of men – as well as women – around the world must now be seized.
About the authors
Peter Baker, Director, Global Action on Men’s Health (UK)
Clara Alemann, Director of Programs, Promundo (USA)
Stephen Burrell, Assistant Professor (Research), Department of Sociology, Durham University (UK)
Derek M. Griffith, Director, Center for Research on Men’s Health, Vanderbilt University (USA)
Shirin Heidari, Founder and President, GENDRO (Switzerland)
Jasmine Kelland, Lecturer in Human Resource Studies/Leadership, Plymouth University (UK)
Arush Lal, Vice-Chair, Women in Global Health (USA) and LSE Department of Health Policy (UK)
Sushmita Mukherjee, Director – Gender, Project Concern International (India)
All the authors are members of Gender and COVID-19 Working Group (Men and COVID-19 Sub-Group).
AL is Board Vice Chair, Women in Global Health (unpaid advisory). PB receives fees from Global Action on Men’s Health, a charitable organisation, for his work as Director. He also receive fees for consultancy work from other not-for-profits including the European Cancer Organisation, Men’s Health Forum (GB) and Hampshire County Council.SB receives funding from the Leverhulme Trust as an Early Career Fellow, based in the Department of Sociology at Durham University and is a trustee for White Ribbon UK, and co-chair of the Steering Group for Changing Relations CIC. No other conflicts of interest were declared.