Summary of the impact

The work of White has led to a re-appraisal of men's risk of premature death, both in the UK and abroad. His analysis of morbidity and mortality data has helped stimulate a worldwide debate on the health of men and the risks they face with their health. In the UK, analysis of cancer data has led the leading cancer charities to have a rethink on men's risk of cancer. The EC State of Men's Health in Europe report has helped create a new insight into the equality needs of men and stimulated the production of similar reports globally.

Underpinning research

White's work in the area of men's health began in 1996; in 2001 he conducted a funded `Scoping Study on Men's Health' for the then Public Health Minister, which recognised the scarcity of research on men and the need for more epidemiological data. Following this, a body of work exploring health variations for men (gendered epidemiology) was commenced by White, with Cash. This early work involved mapping sex and gender differences in health across 17 countries¹, this study revealed for the first time the extent of men's risks of premature death across a broad range of health disorders. Further research on the patterns of mortality in men and women aged 15-44 years across 44 countries² led by White built on this work and again highlighted high levels of premature death in men.

In 2009 White was successful in tendering to complete the State of Men's Health in Europe Report³ for the European Commission, covering the 34 countries of the European Union, EFTA countries and accession countries and involved 36 academic partners from across Europe, including Hogston and Raine from Leeds Metropolitan University. Findings here indicated that changes are occurring with the structure of the male population that will result in a smaller working age population supporting a burgeoning older population. In addition, the study gave further evidence of high levels of premature deaths in men across the spectrum of conditions that should affect men and women equally, with 630,000 male deaths as compared to 300,000 female deaths across the EU27 within the age range 15-64 years. The study also gave a much clearer picture of the impact of major social change on men's health, with over 40% of male deaths in the working age (15-64 years) being seen in Lithuania, Estonia and Poland as opposed to less than 18% in Sweden. The study noted that much of men's premature death is avoidable and as much a problem of inequity as biological inevitability.

A follow on study, led by White, analysed trends in life expectancy at birth in 19 EU member states between 1999 and 2008 using the Pollard Decomposition method. The study, which explored the impact of changes in health over the last ten years revealed that most improvements in life expectancy are happening over the age of 65 years with little effect on rates of premature death⁴.

In addition, analysis of cancer data in the UK highlighted a higher incidence and rate of premature deaths from those cancers that should not be seen as sex specific. Further examination of cancer deaths was undertaken by White in collaboration with CRUK and the NCIN resulting in two influential reports on the burden of cancer in men^5,6. This work highlighted that men had a 70% higher risk of dying prematurely from those cancers that are not sex specific and a 60% higher risk of developing these cancers. This work is on-going with further sex-specific analysis of trends over time, routes to diagnosis and stages of cancer at diagnosis currently underway.

References to the research

Related Grants

2010 - 2011 The State of Men's Health in Europe Report. The European Commission DG Sanco (Principal Investigator) (£171,381)

Details of the impact

The State of Men's Health in Europe report was launched at the European Parliament by the European Commissioner, who has referred to the importance of the report in several speeches¹. There have been two further meetings at the European Parliament based on the report stimulating further debate on men's health and its implications for public health policy. The findings of the report were widely covered by the press both in the UK and abroad and included a BMJ podcast². This work has led to two awards for White:

Robert Tiffany International Award 2012, Nursing Standard, Royal College of Nursing Outstanding Contribution Award 2011, Men's Health World Congress, ISMH

White's work was also influential in the development of the EU Role of Men in Gender Equality Report³.

The initial (unpublished) cancer data analysis undertaken by White in 2005 prompted the leading cancer charities and the national cancer director to hold an expert symposium⁴, chaired by Mike Richards, the then National Director of Cancer Services and subsequently cited in the Cancer Reform Strategy⁵. White was a member of the National Cancer Equalities Initiative Advisory Group; a Member of the Cancer Reform Strategy — Awareness working group and a Member of the National Cancer Equalities Initiative working group, where he has contributed to the development of the UK Cancer Strategy. This led to a report being undertaken with CRUK and NCIN based on new examination of data relating to the relationship between sex, age and socio-economic determinants and cancer susceptibility and survivorship⁶. This work was widely reported in the press including a Radio 4 Today interview with White and Mike Richards⁷ and was covered by the ITV news.

An up-date expert roundtable jointly run between the Men's Health Forum and the National Cancer Equality Initiative has recently been held at the King's Fund with White presenting the latest round of data on men and cancer⁸.

Through his research with CRUK/NCIN, his work is now influencing the development of new cancer data at CRUK⁹. The data from the Excess Burden report has been reported in a recent NCIN report (2013) Cancer and Equality Groups: key metrics.

White's work has received wide coverage by the popular press including BBC and ITV News; BBC News 24; BBC World Service; Sky News; a studio interview for BBC Breakfast; Radio 4 PM programme; and the main newspapers, both here and abroad (over 100 citations) along with a profile of his work in the New Scientist¹⁰. He has also had a column in the Men's Health Magazine and profiles of him and his work in national and international magazines. White has presented his research at over 65 conferences since 2008, with over 30 of these international, with key note addresses at the World Congress on Men's Health and papers and an invited lecture tour to Australia in October 2013. White has been invited to key policy meetings and workshops both in the UK and abroad including the National Cancer Equalities Initiative Men and Cancer Gender Visioning Event and a European Commission Health Information Workshop held at the European Health Forum Gastein in 2010.

Key presentations that have influenced European thinking about men's health include a key note presentation at the Gender and Health through Life Conference with support and participation from the Danish EU Presidency 2012; `Men's Health in Latvia' Young Peoples Conference, 2012, Latvia; Gender differences: men's health in the EU. `Health Differences in the Polish Population'. Warsaw, Poland 2011; `The State of Men's Health in Europe'. Robert Koch Institute symposium at the Annual conference of the German Society of Social Medicine and Prevention. Bremen, 2011; and The state of men's health — a global perspective. Congresso Nacional De Epidemiologia, Lisbon — Opening Ceremony (as part of Portugal's Presidency of EU) Portugal 2008.

Part of the impact of White's work has been through his close association with the Men's Health Forum and the European Men's Health Forum, who are the leading men's health organisations in the UK and in Europe. The Men's Health Forum run the national Men's Health Week and hold the secretariat for the All Party Parliamentary Group on Men's Health, and are a strategic partner of the Department of Health.

This media coverage and his work through the Charities in reaching out to policy makers, practitioners and men on the street has been influential in changing attitudes about the health risks men face from premature mortality and the importance of preventative work with men, especially in their early years.

Sources to corroborate the impact

1. DG Sanco, European Commission. Personal contact details listed separately
2. White A, McKee M, Richardson, N, Madsen SAa, de Sousa B, de Visser R, Hogston R, Makara P, Zatoński W (2011) Europe's men need their own health strategy. British Medical Journal 343:d7397 doi: 10.1136/bmj.d7397. Available at:
   http://www.bmj.com/podcast/2011/12/02/aids-30
3. Study on the Role of Men in Gender Equality, prepared for European Commission, edited by Elli Scambor, Katarzyna Wojnicka, Nadja Bergmann, Consortium led by L&R Social Research, with Dissens, abz*austria, INBAS, Written by Belghiti-Mahut S, Bergmann N, Gärtner M, Hearn J, Gullvåg Holter O, Hrženjak M, Puchert R, Scambor C, Scambor E, Schuck H, Seidler V, White A & Wojnicka K, 2013. Available at:
   http://ec.europa.eu/justice/events/role-of-men/index_en.htm
4. Wilkins, D (2007) Tackling the excess incidence of cancer in men: proceedings of the expert symposium health at Leeds Metropolitan University on November 16th 2006. Men's Health Forum, Leeds Metropolitan University, Macmillan, Cancer Backup. Available at:
   http://www.menshealthforum.org.uk/files/images/LeedsMen&CancerProceedings.pdf
5. White AK, Thompson C and Forman D (2009) The Excess Burden of Cancer in Men in the UK. London: NCIN, CRUK, MHF, Leeds Met & White A, Thomson C, Howard T (2013) Excess cancer burden in men. London, CRUK, NCIN, MHF, Leeds Met. Available at:
   http://publications.cancerresearchuk.org/downloads/product/CS_REPORT_EXCESSBURDEN.pdf
6. Launch of Men and Cancer report 15th June BBC Radio 4 the Today Programme with James Naughtie, ABC Radio Australia and 15+ UK regional radio stations. Available on request
7. http://www.menshealthforum.org.uk/22474-men-and-cancer-expert-round-table
8. Statistical Services, Cancer Research UK. Personal contact details listed separately
9. Jessica Griggs One minute with... Alan White. New Scientist 18th June 2011. Available at
   http://connection.ebscohost.com/c/interviews/61969786/one-minute-alan-white