What the Men's Health Strategy Leaves Out: Silence, Stigma, and the Gaps That Still Matter

🚨 1. Domestic Abuse: The Hidden Epidemic

ONS data shows that around two million men experience domestic abuse each year, close to the figure for women but male victims are far less likely to report it or seek support. Lifetime prevalence suggests one in five men have been victims, yet public discourse overwhelmingly focuses on women.

The Scale of Male Victimization

Official statistics reveal a substantial but largely hidden problem:

• Annual Prevalence: Approximately 2 million men experience domestic abuse annually in England and Wales
• Lifetime Prevalence: One in five men report experiencing domestic abuse at some point in their lives
• Reporting Rates: Men are significantly less likely than women to report abuse to authorities
• Service Access: Only 2% of domestic abuse service users are men, despite representing 25% of victims
• Recognition Gap: Male victims often don't identify their experiences as domestic abuse

Health Implications

Domestic abuse has profound impacts on male health that the strategy completely ignores:

• Physical Injuries: Direct harm from violent episodes
• Mental Health Crisis: PTSD, depression, anxiety, and elevated suicide risk
• Substance Abuse: Self-medication through alcohol and drugs
• Healthcare Avoidance: Shame and isolation preventing medical help-seeking
• Chronic Conditions: Long-term stress impacts leading to cardiovascular and immune system problems

Strategic Silence

Despite this evidence, the Men's Health Strategy makes no mention of male victimisation. There are no funded programmes, no outreach pilots, and no training modules for healthcare professionals to recognise abuse in male patients. This silence reinforces stigma and leaves male victims unsupported, a missed opportunity for a strategy that claims to tackle silence and stigma.

🎰 2. Gambling Addiction: A Known Risk, Unfunded

The strategy acknowledges that men are more likely to engage in risky behaviours like gambling, but it offers no dedicated funding or intervention programme. With gambling related harm rising especially among young men, this omission is striking. Civic groups have long called for integrated mental health and addiction support, but gambling remains sidelined.

The Male Gambling Crisis

Evidence shows gambling addiction disproportionately affects men:

• Gender Distribution: Men account for approximately 70% of problem gambling cases
• Young Men at Risk: Highest rates among 25-34 year-old males
• Online Proliferation: Digital gambling platforms increasing accessibility and risk
• Financial Devastation: Average problem gambler debt exceeds £17,000
• Mental Health Link: 79% of problem gamblers report depression symptoms
• Suicide Risk: Problem gamblers 6 times more likely to attempt suicide

Health System Impact

Gambling addiction creates cascading health problems the strategy ignores:

• Mental Health Services: Increased demand for depression and anxiety treatment
• Relationship Breakdown: Family stress and social isolation
• Financial Stress: Debt-related anxiety and housing insecurity
• Workplace Impact: Decreased productivity and employment problems
• Self-Medication: Alcohol and drug abuse as coping mechanisms

Missed Integration Opportunity

The strategy mentions risk behaviors but fails to fund gambling-specific interventions. This represents a missed opportunity for:

• Healthcare Professional Training: Recognizing gambling addiction in male patients
• Integrated Treatment: Combining gambling addiction support with mental health services
• Workplace Programs: Including gambling awareness in employee wellness initiatives
• Community Outreach: Targeting high-risk male demographics through sports clubs and venues

🏚️ 3. Homelessness and Housing Insecurity

Men make up the majority of rough sleepers and are disproportionately affected by housing precarity. Yet the strategy does not address how unstable housing impacts access to healthcare, mental wellbeing, or chronic illness. Without secure housing, many men remain cut off from the very services the strategy aims to expand.

Housing and Health Nexus

The relationship between housing and male health is well-documented but ignored by the strategy:

• Rough Sleeping Demographics: Men account for approximately 85% of rough sleepers
• Hidden Homelessness: Many more men in temporary, overcrowded, or unsafe accommodation
• GP Registration: Homeless men significantly less likely to be registered with healthcare services
• Mental Health Impact: Housing instability strongly linked to depression and anxiety
• Chronic Conditions: Poor housing conditions exacerbating respiratory and cardiovascular problems

Healthcare Access Barriers

Housing insecurity creates multiple barriers to accessing the very services the strategy aims to improve:

• Service Registration: Difficulty registering for GP services without fixed address
• Appointment Attendance: Challenges keeping healthcare appointments while rough sleeping
• Medication Storage: Inability to safely store prescribed medications
• Follow-up Care: Difficulty maintaining continuity of treatment
• Mental Health Support: Homelessness stigma preventing access to psychological services

Strategic Blindspot

The strategy's focus on workplace and community interventions largely bypasses homeless men who are among the most vulnerable to poor health outcomes. This creates a significant gap in coverage for men who most need support.

🧑‍🔧 4. Insecure Work and the Gig Economy

Workplace pilots are focused on large employers like EDF Energy, but many men work in casual, insecure, or gig-based roles with no access to occupational health support. The strategy's emphasis on formal workplaces risks excluding the very men most vulnerable to poor health outcomes.

The Changing Nature of Work

The employment landscape has shifted dramatically, but the strategy remains focused on traditional workplace models:

• Job Market Contraction: ONS data shows only 723,000 job vacancies nationwide (November 2024), creating intense competition for employment
• Gig Economy Growth: Over 5 million people in some form of flexible work arrangements
• Male Concentration: Men disproportionately represented in delivery, transport, and manual gig work
• Self-Employment: 4.2 million self-employed workers, often without employee protections
• Multiple Job Holdings: Increasing numbers of men working multiple part-time or temporary positions

🧩 Why These Gaps Matter

The Mens Health Strategy is a welcome step but it is not yet a comprehensive one. By leaving out domestic abuse, gambling, homelessness, and insecure work, the strategy risks reinforcing the very silences it claims to break. These are not just policy oversights they are civic blind spots. And blind spots shape real world outcomes: who gets seen, who gets supported, and who gets left behind.

International Comparisons

Other countries provide examples of more comprehensive approaches to male health that address these omitted issues.

Australia's National Male Health Strategy

Australia's approach offers lessons for addressing gaps:

• Domestic Violence Recognition: Explicit acknowledgment of male victimization alongside prevention focus
• Gambling Integration: Gambling harm included as mental health priority
• Housing-Health Links: Homelessness health services integrated into male health framework
• Work Flexibility: Recognition of changing employment patterns and gig economy health needs

Ireland's Men's Health Framework

Ireland's approach demonstrates comprehensive male health thinking:

• Social Determinants Focus: Explicit attention to housing, employment, and social factors
• Addiction Integration: Gambling and substance abuse treated as interconnected male health issues
• Community Outreach: Services designed to reach men in precarious situations
• Intersectional Approach: Recognition that multiple vulnerabilities compound male health risks

🔹 Conclusion

England’s first Men’s Health Strategy is a long-overdue recognition that men’s health is shaped by silence, stigma, and social context. But a strategy that claims to tackle silence cannot afford to be silent about domestic abuse. It cannot ignore the health impacts of housing insecurity, or treat gambling as a footnote when it’s a growing public health crisis.

These omissions matter. They leave vulnerable men without support when they need it most and risk perpetuating the very invisibility the strategy aims to address.

The investment in suicide prevention, workplace health, and male-specific care is real progress. But progress is not completion. If this strategy is to be more than a headline, it must evolve and be shaped by civic scrutiny and lived experience.

The foundation has been laid. Now it’s time to build the rest.