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Thursday 29 September 2016
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Improving men’s health using tailored services

Patients & Services

IAN BANKS
BSc BAO BCh MB MSc PhD

President
Men's Health Forum

A part-time GP and A&E officer in Belfast, Ian is a member of the British Medical Association's (BMA) Council for the UK, and has been awarded the BMA accolade, the Association Medal. Ian is the official spokesman on men's health issues for the BMA, president of the European Men's Health Forum and the Men's Health Forum in England and Wales, vice president of the International Society for the Study of Men's Health and deputy editor of the Men's Health and Gender Journal. Ian was appointed Visiting Professor of Men's Health in Europe by Leeds Metropolitan University in 2005 and awarded the Royal Society of Health Gold Medal for public health in 2007. The City of Vienna and the International Society of Men's Health honoured Ian with their award for public health in September 2007

The average man lives a shorter life than the average woman, and for 14 years of that life he can expect to be seriously or chronically ill. For poorer men, life expectancy is even less.(1) In the vast majority of cases, there is no innate genetic reason for this difference, which begs the question: why? And, perhaps more importantly, what can be done to tackle the problem and improve the health outcomes and life expectancy for men?

The current state of men's health
There remains a strong link between social class and health outcomes in relation to men's health. Men who are defined as "unskilled" have a life expectancy of less than 73 years – professional men's life expectancy is more than seven years longer.(2) In certain impoverished areas of the UK, life expectancy is substantially shorter: as young as 54 in some areas of Glasgow's east end – and that's an average.(3)

Circulatory diseases kill more men than any other disease, and the rate is over 50% higher than for women.(4) The number of new cases of prostate cancer has climbed to more than 34,000 a year and the upward trend continues.(5)

As with many other killers, the male suicide rate varies between men of different social classes. Where death rates from suicide have fallen, they have fallen faster for professional men than for unskilled men.(6) On top of this, traditional concepts of masculinity continue to exist, with many men taking the "grin and bear it" approach to their health.

The barriers: men delay seeking advice
Men lack a biological mechanism that regularly and naturally makes them feel aware of, and in touch with, their bodies. What's more, men's reproductive systems don't require them to maintain any regular contact with healthcare services. They do not need to see a doctor to obtain contraception and, of course, they cannot get pregnant.

This all means that even a more open-minded man will not have grown up with much experience of using primary care services. So, in late middle age (when heart disease poses the greatest risk to men), he may delay seeking medical advice.

A friendly place with a friendly face
Even on a basic level, the majority of primary care services are not "male-friendly" environments. From the moment a man walks into his GP surgery (if he is registered at all), he might feel out of place. The receptionist will almost certainly be a woman and there may be many people around who can overhear his conversation with her.

It's common knowledge that a predominance of men find discussing personal health matters (especially if related to sexual health, prostate or mental health concerns) an uncomfortable experience, the thought of which often acts as a deterrent to making an appointment in the first place. Once in the waiting room, he will see posters about smear tests and pregnancy, and magazines geared towards women.

Standard opening hours seriously disadvantage men too, especially blue collar workers, many of whom risk losing a day's pay for clocking off to visit the doctor. And although opening hours are being extended by many practices, too few know it.

There are many ways that practices can make accessing their services a less painful process for male patients. Along with extended opening hours, an increase in "open surgeries" and other "no-appointment-necessary" facilities will appeal to many men, who not only find booking an appointment embarrassing or inconvenient but who may also have irregular and unpredictable working patterns.

Future proofing
The recession is a concern for us all. But with an estimated three million people likely to be without work in the next few months, resulting unemployment represents not only an economic issue but a public health issue too. A recent study from Cambridge University showed that men are more likely than women to become stressed and depressed when they lose their jobs.(7)

The loss of confidence that inevitably results from being made redundant and the sudden lack of a need to get out of bed in the morning can be a toxic combination when it comes to both physical and mental health. Work is what gives most men their identity. While some women might define themselves in relation to their family – "I'm a mother of three" – most men define themselves in relation to their work – "I'm an electrician", "I'm a project manager", and so on.

Anticipating the problems that will stem from this unemployment epidemic (and indeed other such situations which have the ability to impact public health, such as depression, anxiety and alcohol misuse) will enable practice managers to take a proactive approach to managing the changing face of men's health needs.

As with all other areas of men's health, outreach is essential here – and in this instance this means working with employers, infiltrating job centres and planning new facilities around locations and amenities likely to be frequented regularly by local men.

Equally, for men who remain in employment, infiltrating the workplace is key to improving health outcomes. As Dr Howard Stoate MP quite rightly pointed out in his speech on men's health and work in this year's (5 March) adjournment debate in the House of Commons:

"There is no reason why many of the services provided in traditional NHS settings could not be delivered in workplace settings … basic health checks, screening services and routine GP appointments are among the services that could easily be provided in the workplace. Not only do workplace-based schemes produce tangible results in terms of improved health and higher productivity, they also help the NHS meet its obligation under the 2006 Equality Act to ensure that services are delivered more equitably between men and women."(8)

From checking blood pressure to implementing weight management programmes and providing counselling sessions, utilising the workplace as a venue to aid the delivery of primary care services for men is far more than a "great in theory" idea. This approach also fits well with government policy on promoting wider choice and greater flexibility in the delivery of primary care, and Professor Dame Carol Black's agenda to improve the health of the working-age population.

Knowing your audience
The Equality Act's Gender Equality Duty places an obligation upon the NHS to provide a service that is tailored to the different needs of men and women.(9) Primary care trusts are responsible for ensuring compliance and indeed hold the purse strings in their area.

In order to comply with the Gender Equality Duty, we must first understand the barriers that prevent men making use of the services currently available. We must understand an area's demographics, not only in terms of gender but also how this interacts with ethnicity, social class and employment status. We should remember to look at those not using services, as well as those who are. The next step is ensuring that all initiatives introduced are based on feedback received from consultation with local men and are then subject to continued auditing once in place.

The state of men's health in the UK is currently unacceptably poor – and mass unemployment has the potential to make matters a lot worse if improving men's access to healthcare is not made a priority soon. We all have a responsibility to implement change; we know how it can be achieved and know the consequences of burying our heads in the sand. We've talked the talk, now is the time to take action.

References
1. Office for National Statistics. Health Statistics Quarterly. London: ONS; November 2008.
2. Office for National Statistics. Trends in life expectancy by social class 1972-2005. London: ONS; October 2007.
3. NHS Greater Glasgow and Clyde. General facts and figures [homepage on the internet]. Available from: http://www.nhsggc.org.uk/CONTENT/default.asp?page=s1202_1
4. Office for National Statistics. Mortality [homepage on the internet]. Available from: http://www.statistics.gov.uk/cci/nugget.asp?id=1337
5. Cancer Research UK. CancerStats Key Facts on Prostate Cancer [homepage on the internet]. Available from: http://info.cancerresearchuk.org/cancerstats/types/prostate/
6. Office for National Statistics. Suicide rates in United Kingdom [homepage on the internet]. Available from: http://www.statistics.gov.uk/statbase/Product.asp?vlnk=13618
7. Kelland K. Economic gloom hits men harder than women: study. Reuters UK. 10 March 2009. Available from: http://uk.reuters.com/article/lifestyleMolt/idUKTRE5293QB20090310?pageNu...
8. House of Commons debates. Men's Health at Work. Thursday 5 March 2009. Available from: http://www.theyworkforyou.com/debates/?id=2009-03-05a.1091.0
9. Department of Health. Gender Equality [homepage on the internet]. Available from: http://www.dh.gov.uk/en/Managingyourorganisation/Equalityandhumanrights/...