Preparing for old age is always going to be too little too late.

The things you have to do to give yourself a decent chance of a good old age are well-known by all of us. You need to eat well, exercise a bit and stay away from drugs (yes, alcohol counts) and other stuff that’s obviously bad for you. You need to fix things when they break in your body, and that includes teeth: an astonishing amount of bacterial infections can be mouth-related.

Whether you’re a man or a woman, you need to stay away from violent men who will hurt you all too readily. There are lots of violent men, everywhere.

Men need to manage their tendency to take fatal risks, to drive cars too fast, to run those red lights. Without intervention, more baby boys are born than girls but by the time they reach twenty those numbers have balance out. Boys die in greater numbers.

Men should work at building meaningful relationships, friendships, community, family. Being connected helps mental health and an extraordinary number of men kill themselves. It is the largest cause of death unto the age of fifty-five.

If health and longevity was a woman’s only aim, she’d probably avoid men entirely – too dangerous, too needy.

If we could choose such things, then being born wealthy obviously helps. Nothing kills quite as consistently as poverty.

The fundamental problem with almost of all of this, is that the things that you could do, have to be done from your early adult life and no one in their twenties believes that they will ever die. Not them.

By the time you’re approaching sixty and can actually start to see the shape of your old age, it’s too late for a lot of things that will make a difference. Stopping smoking helps at any age of course, but by then your chances of cancer or emphysema are high.

Losing weight will helps with arthritis but it will take years of improved roughage to sort out those bowel problems and by the time you’re approaching sixty, keeping regular is something people talk about all too often.

Growing old is not for wimps.

But dying young isn’t such a great alternative.

So eat your greens young man, and pray that some poor unsuspecting woman will adopt you into her life.

WH Auden (1907 – 1973) wrote a poem Epitaph on a Tyrant that found its way onto the side of a carriage on the Northern Line Tube, part of London’s Metro system.

The poems are part of a long-standing effort to bring a bit of culture to the commute and just occasionally they catch the eye and make a person think. Maybe not so much now that everyone has a mobile to grab their attention, Just enough.

Epitaph on a Tyrant

Perfection, of a kind, was what he was after,

His own definition, his own kind

And the poetry he invented was easy to understand;

Certainty, small words, easy solutions to complex problems

He knew human folly like the back of his hand,

Someone to follow, someone else to blame,

And was greatly interested in armies and fleets;

A mob, a troll militia where sticks and stones became bullets and guns

When he laughed, respectable senators burst with laughter,

And some knew no better, but plenty of them did and turned their faces away

And when he cried the little children died in the streets.

Never his children, not on his streets.

Our children, our streets.

From Another Time by W. H. Auden, published by Random House. Copyright © 1940 W. H. Auden, renewed by The Estate of W. H. Auden.

Does it ever stop? We’re retired so the only admin in my life is managing the house. It never ends.

Sometimes though it feels more never-ending than others.

This started with an oven breakdown. Closely followed by a safety scare. And you might think that a visit from the electrician, a new fuse box and a safety check from UK Physical Network, the guys in charge of the electricity supply infrastructure in the UK would be enough.

But from the very start, I knew this would not end with a new fuse box, or even a new system head, apparently the connection between your domestic supply and the broader network. The minute the issue was raised, living in my 1908 house, it was obviously going to be a fundamental problem with my electricity supply. Ho hum.

The guys arrived to dig up my electricity connection, unannounced sometime before eight o’clock in the morning. They stuck a card through the door with a number to ring except it wasn’t their number. There are three separate divisions and for whatever reason the number they gave me was for the souther division. A very nice man on the other end of the call gave me the number for the eastern and the London division.

I live in London so surely I should ring the London number. Alas, no. Third time lucky and the Eastern Division managed to find my reference number. They would call the team and see if they could come back to work on the supply, probably tomorrow. And no, since it was recorded as emergency safety work, they couldn’t give me a time.

An hour later, a team wracked up with a mini digger. Work commenced. One six foot hole at the bottom of the driveway, closing down half of the road and fencing off two house widths of the road and the guys decided the problem wasn’t down there. They headed off for lunch.

Back an hour or two later and another six foot hole, they stopped for supper. After an hour or so, they tested the connection right next to the house, and they decided that the problem wasn’t there either. Another team would likely be required.

Before leaving though, he decided to test the reading at the new service head. The acceptable limit would be 0.8 (ohms?) The reading was 0.13. He took it again, and then again. He switched the meter off and on again, The reading stayed low at 0.13. Right then. All done.

They left. Two six foot holes left behind. It took another day or so for another entirely unannounced team to arrive to almost completely fill both holes, and another day for the guys with concrete to completely fill the holes.

Two days later people arrived to remove the barricades around the holes. Another day later and someone arrived to power wash the driveway.

I have had a seemingly never-ending collection men arrive to dig holes and fill them, all very efficient individually and all extremely polite.

It should feel like success.

Except the car has started to whine when it starts up, and all of the new small city cars seem to be electric. There’s a government deal offering £3500 off a new electric car so we took a look at the well-reviewed Hyundai Inster. I have a test drive on Sunday, an electric charger due to be delivered and an electrician supposed to tell me when he can come to fit it to my lovely new fuse box.

Delivery times for these new cars are 3-6 months.

I feel as if I’m on some kind of domestic upgrade treadmill and all I want to do is get off.

When does it ever end?

Men die younger. Women live longer in poorer health.

Women and girls experience more disability in every region of the world, but men and boys bear a greater share of the global mortality burden. The 2016 Global Burden of Disease data show age-standardised death rates per 100 000 population of 1002 for men and 690 for women. If we understand why, then maybe we can address the causes.

A recent report in the Lancet talks about why men might be dying younger than necessary, whether it’s an innate physical cause or something else. It concludes that “Many of the drivers of men’s ill-health are linked to perceptions and attitudes about manhood and the overall structural organisation of men’s lives and relationships.”

It concludes that our attitudes to what being male means rather than the biological reality, is the problem. And the report goes further to add that the problem is made worse because around the globe, these attitudes are largely ignored, largely invisible. Across the globe, we pay ” insufficient attention to the intersections between masculine norms and men’s health within public health systems”.

An abundance of evidence shows health outcomes and experiences to be different for women and men, and this is true across time, space, and culture. The impact of biological sex accounts for a fraction of these differences; gender explains the rest.

Gender refers to the social phenomena and relationships of males and females in terms of their roles, attributes, and opportunities. In health and otherwise, advantage and privilege are largely the domain of maleness and men. That gender is socially constructed; it lies on top of human biology.

Decades of global research has provided a foundation to continue deepening our understanding of masculinity and masculine norms. Theories of hegemonic masculinity and precarious manhood have established a common set of norms, attitudes, and behaviours related to what it means to be a man in today’s society.^5, 6 

As the recent Lancet Series on gender equality, norms, and health and other publications have recently highlighted, adherence to these specific masculine norms is associated with unhealthy behaviours. Norms are those often unconscious definitions and expectations of being a woman or a man. They guide and exert pressure to conform to certain behaviours.

Norms do not just exist on an individual or interpersonal level but are powerfully embedded in our cultures, institutions, economies, and ways of being. As the recent lancet series articulates across five papers, rigid gender norms undermine the health and wellbeing of all people—girls and women, boys and men, and gender minorities

The Lancet series lays out extensive empirical analyses and literature reviews to document how norms can be either protective or harmful to health: through gender operating as a determinant of health, by influencing health behaviours, and via expression in health systems, policies, and programmes. It shows how rigid gender systems that perpetuate injustices towards girls and women also disadvantage boys and men.

Highlighting and recognising the importance of gender norms provides an opening to understanding how to create needed change. Ultimately, as the Series concludes, the transformation of gender inequality and norms is a political act. Is the world ready to act?

Gender is a slippery thing. On the one hand, it’s everywhere—#MeToo, pay gap reporting, high-profile sexual misconduct cases, and the campaigns to advance women in science, medicine, and global health. WHO consistently states gender equality to be a cross-cutting feature of its work. Gender is ubiquitous in the UN system: UN Women, UNFPA, UNICEF, and the sustainable development agenda.

On the other hand, it’s nowhere. Not in the universal health coverage plans, not among WHO’s ten priority global health threats, and not tied to governance or the accountability of organisational and government leaders. Despite decades of funder and journal policies, sex and gender are not routinely reported in research. Increasingly prevalent gender mainstreaming programmes have proved largely ineffective. 

Gender now runs the risk of being treated like motherhood and apple pie—a common good no one would disparage, but neutered of its radical political nature. Or as “everyone’s problem but no one’s responsibility”, as Geeta Rao Gupta and colleagues argue in their Lancet series paper. An uncomfortable truth is that the shift in global health thinking from women and girls to gender has depoliticised the agenda intended to transform lives and wellbeing. Despite the good intentions of broadening child, adolescent, and maternal health to their larger social context, the gender equality aspiration hasn’t translated into a meaningful action and accountability agenda for women or men.

It hasn’t resulted in men exercising their political prominence and power to drive equity.  And it hasn’t sufficiently overcome the brutal reality for millions of women and gender minorities in the world who suffer sexual and domestic violence, lack access to essential prerequisites for health and safety, or are denied basic human rights and control over their own bodies. Gender analyses that simply reaffirm the value placed on traditional masculinity over femininity, rather than link this to broader relations and patterns of economic and political power, will only ensure the status quo

Promundo Global’s 2019 report, Masculine Norms and Men’s Health: Making the Connections, shows that seven key male health behaviours—poor diet, tobacco use, alcohol use, occupational hazards, unsafe sex, drug use, and limited health-seeking behaviour—account for more than half of all premature male deaths and about 70% of men’s illnesses.

All seven behaviours are partly related to masculine social norms that reinforce the notion that manhood is associated with self-sufficiency, stoicism, risk-taking, and hypersexuality. These norms, individually and collectively, encourage a specific set of health behaviours across the globe that are among the drivers of men’s poor health outcomes and have implications for both men and women.

Research has also called attention to the social determinants of men’s poor health, particularly how restrictive ideas about manhood intersect with poverty, ethnicity, gendered employment patterns, and other factors. Recognising the importance of these issues, the WHO Regional Office for Europe released a strategy in 2018 for addressing men’s health and a similar document from the Pan American Health Organization is expected to be released later in 2019.

Public health experts and researchers need to expand the understanding of men’s physical and psychosocial health to build an evidence base for programming and policy. Presently, much research on masculinity and men’s health draws on a deficit-based approach, whereby men are pathologised or masculinity is framed as inherently problematic or toxic.

It is important to recognise and leverage the fact that many men take care of their individual health and wellbeing and often access health care through their support for the health and wellbeing of their partners or children. Being male needs to be seen as the solution to the problem.

Efforts to address men’s health should build on men’s positive health practices, experiences, and desire for health care, and the importance of taking care of themselves for their own wellbeing and those around them including women, who often bear the social and economic costs of men’s poor health.

Some men seek preventive care, support their partners and children in accessing health care, and use health services adequately. Moreover, many men around the world engage in health promoting behaviours such as regular exercise, healthy diets, and practising safe sex.

Academics and researchers should research healthy masculine norms that could promote healthy behaviour, such as responsibility and self-control, alongside men’s positive involvement as fathers, partners, caregivers, and community members.

Through an asset-based approach, the public health community can help pivot and amplify the conversation to be more constructive and begin to incentivise healthier behaviours among men through embracing positive and health-conscious masculine norms.

Additionally, academics, in partnership with health-care professionals, should evaluate the effectiveness of different health-promotion approaches for male engagement, norm and behaviour change, and health-care service provision throughout the life course, taking account of dynamics of power and poverty.

Rather than blaming men, or presenting masculinity as inherently toxic or damaging, we need to articulate a positive masculine approach, a gendered and intersectional lens that articulates evidence-based concepts of healthy masculinities and men’s wellbeing. The public health community must capitalise on the growing momentum of attention to gender and to men’s health within a framework of universal health coverage.

Men’s health matters for everyone; by adopting a gendered, asset-based approach that embraces social determinants of health, we will be able to improve the health and wellbeing of countless men, women, and families around the world.

I have never thought of myself as a hoarder. It creeps up on a person. Nearly thirty years in the same house and who doesn’t have a stack of who knows what under the bed?

The problem with stuff, lots of stuff, is that sooner or later you have to reckon with it. The carpet fitters are coming in which means all of the furniture will need to be moved about, which in turn means all the stuff lying about and inside the large pieces of furniture will need to move.

The obvious answer is to take this opportunity to throw out a whole load.

Faced with this challenge, my partner is moving at glacial speed through the files that cover every single shelf, wall and floor in our smallest room upstairs. A few years back, faced with the same challenge he managed just two files and carried a betrayed look on his face for at least a month. It got so bad that I offered to clear my files first, only to realise that of the hundreds stashed in the room, only two were mine. Paperwork has never been my weakness.

Meanwhile I’ve made six trips to the tip, most unwisely one on the weekend when everyone and their dog seems determined to empty their dumpy bags full of garden waste.

The surprise is how much bedding we seem to have accumulated. There really is no reason for more than two sets, one to wash and the other to ‘wear’ and yet it would seem that in nearly thirty years, I have never thrown a single sheet out.

Ho hum.

Where stuff cannot be thrown away (basically because it’s not mine and he just cannot deal) then it’s been put in plastic boxes in the garage. Why not the loft? Because the loft is already as full as can be obviously and out of sight, up a loft ladder means that stuff will still be there when we die. At least in the garage, the stuff is visible and one step closer to the tip.

My daughter came home (from her house two streets away) and finally cleared her room. The childhood globe was regretfully put into the tip pile alongside her school artwork. Her memory box was apparently too large for her house (seriously?) so is now located in my garage waiting for space to appear in their loft. If it ever gets there, it too will no doubt languish until the grandkids (God-willing) are left to deal with the house clearance.

Having put the carpet fitting into the diary for the wrong week (one week early) we are now almost ready for them to arrive, next week.

Now about that naked photo in the bedroom….