Main findings from this study
This is the first study to explore the social determinants of health from a male perspective across an entire city. Our study suggests that there is a clustering of known social determinants that are detrimental to health around deprived areas of Leeds and that there are marked gender differences evident. Although the current analysis did not allow for individual’s experiences to the mapped, it is notable that there was a common group of MSOAs which saw the highest proportion of men struggling with the social determinants of health. Those areas of Leeds that showed poor educational attainment also had a high proportion of long-term unemployed men, a higher proportion of men claiming benefits, more problematic housing and divorced men.
Implications of the findings
With the move of Public Health into local government, the link between targeting the social determinants of health as a means of improving the health of the local population has been acknowledged, but fiscal constraints mean more focused provision may prove more cost effective.
Planning services for effective public health requires targeting of resources to achieve maximal effect. What has become apparent through the study is the impact of the social determinants on men have been generally under-reported in the literature and this has perhaps left a cohort of vulnerable men hidden from Commissioners’ eyes. The clustering of factors that influence men and their health suggests they need to be recognised and tackled as a whole; focusing on single items negates the complexity of the broader picture.
Breaking the data down by MSOA gives a more detailed view of where services should be targeted and also gives visibility to the social problems that men are facing and a possible explanation for some of the health challenges they face. This is most starkly seen with regard to the high level of suicide in men within Leeds, with over 5 times more men dying as a result of taking their own life as compared to women, with living in the high rise flats, creating the most notable risky setting [
13,
59,
60].
The analysis of educational attainment across the City showed that there is a need to consider not just how to get young boys better engaged with schooling, but that support may be needed for men throughout their lifespan. With some areas of Leeds having nearly a third of their male population with no educational qualifications this adds greatly to their risk of unhealthy lifestyles and risk of premature death [
55,
61‐
63]. By targeting boys early in their school life they can be helped to overcome some of their deficits and this has long term benefits with regard to their cognitive skills and achievement, behaviour, mental health, other school related outcomes, and adult outcomes [
64].
In support for the need for sex-specific data on the social determinants [
32,
36] a key observation made in the Leeds study [
13] was that although there were comprehensive locality maps of deprivation produced by the Leeds public health observatory, they rarely offered sex-specific data, leaving the possibility that those most at risk (either male or female) to be missed within any subsequent planning decisions. By making explicit the data on men and women it can also help inform health policies relating to the potential impact of the social world they live in.
The Leeds Report was initiated by the Health and Wellbeing Board and the Director for Public Health, and is now being considered by the Scrutiny Board of the Council, with view to stimulating a City-wide response to the report’s findings. This will be the first time that a whole city has instigated a review of services for men and offers up a model for how other cities can tackle men’s health.
There has already been some response, with, for instance, a new service being introduced into the high rise flats in Leeds. The introduction of the bedroom tax and the system of housing allocation has impacted on where young single unemployed men are being housed, with more now being located in the high rise blocks of flats than previously. The Commissioners have noted that this is creating a new problem, where these mostly white young men are suffering from low self-esteem, depression and social isolation. By offering support on their doorsteps has started to create a safer environment for them and an opportunity to identify physical and emotional problems earlier than previously.
Further research is needed with those living in the high risk areas to determine if they are affected by multiples of the factors identified in this paper, in the same way that are now being identified through the clustering of lifestyle factors such as smoking, drinking and sedentary behaviour [
65]. This might enable a much more nuanced level of care planning for those individuals who are the most vulnerable.
Limitations of this study
The data that has been presented gives an overview of some of the key aspects of the social determinants that could be seen to affect the health of men, however the study was based on available data and was part of a bigger study, and therefore should not be seen as comprehensive.
This is not a longitudinal study and therefore the current data cannot be directly matched. There is a growing realisation of the clustering effect of factors that impact on health and wellbeing [
66], however the health data available through the public health observatory does not allow for grouping of social factors at the individual level.
There may well be other levels of difference based on the intersectional factors, such as age, ethnicity, sexuality, and disability; this would need to be incorporated into future studies.