A global men's health epidemiology within an intersectional framework

Males have lower life expectancies and greater disability-adjusted life-years (DALYs) than females, and particularly poor outcomes are seen among males in marginalised contexts. In this paper, we provide an epidemiological overview and highlight the intersectional nature of men's health. We analyse mortality and DALYs data from the 1990-2023 Global Burden of Diseases, Injuries, and Risk Factors Studies to illustrate our intersectional framework and draw attention to how health varies in men and to show key themes. Conditions that contribute most to the poor health of males include non-communicable diseases (eg, cardiovascular diseases and cancers), substance use, suicide, injuries (eg, road traffic incidents and interpersonal violence), and respiratory infections (eg, tuberculosis and COVID-19). Although cardiovascular disease and cancer make the largest contributions to men's higher mortality rates, determinants of health such as violence and war, migration, economic stagnation, and labour market changes due to automation and new technologies will disproportionally affect their health in the future. Injuries, violence, and other external morbidity causes often occur at a young age and in unequal distributions across the sexes, making a large contribution to DALYs. Although biology plays a role, the pattern of many diseases contributing to health differences reflects the intersection of health behaviours, shaped by patriarchy, ideas of masculinity, and structural drivers (including commercial determinants of health); many of these are preventable. Although improvements in some health behaviours are seen, exceptions occur in marginalising social conditions (eg, incarcerated men, men experiencing homelessness, men with mental illnesses, men with substance use disorders, men with low income, men who have sex with men, and those who are gender non-conforming). Multiple data sources detail men's shorter life expectancies and the drivers compared with women, but going beyond sex disaggregation remains challenging and is an urgent priority for research and health monitoring.