Transcript Health in the Community

Men’s Health
Alan Dolan
School of Health and Social Studies
[email protected]
Men’s Health
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Men’s health has become a specific area of policy concern
Men's health is also the subject of much media interest.
The main thrust of this interest has been to highlight
important attitudinal and behavioural differences between
men and women
A ‘biopsychosocial’ approach to men’s health takes into
account men’s biology (obviously linked to their sex), as
well as the psychological and social aspects of men’s
gender – i.e. masculinity.
Gender and sex are different
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‘Sex’ refers to the biological differences between
males and females.
‘Gender’ refers to the social and cultural meanings
assigned to being male or female – i.e. the
socialisation processes by which men become
men.
Male gender roles are primarily socially and
culturally determined and, because they have
existed for a very long time, are difficult to
change.
Epidemiology of Men’s Health
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Men are more likely to die earlier than
women at all stages of life, from the
foetus to old age
Average male life expectancy at birth is
currently 75.4 years; for women it is
80.2 years
The Major Causes of Higher Male
Mortality
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Circulatory Diseases
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Cancer
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Accidents
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Suicide
Coronary Heart Disease
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CHD is more common among men than women
CHD accounts for 41 per cent of male deaths
under the age of 75 years
Between age groups 55-64 and 65-74 the agespecific treated prevalence rates double
Age
55-64
65-74
Men
95 per 1,000
184 per 1,000
Women
49 per 1,000
112 per 1,000
The five most common causes of
death from cancer in men (UK 2000)
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Cancer account for 31 per cent of male
deaths under the age of 75 years
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Lung
Prostate
Large bowel
Oesophagus
Stomach
27% (20,680)
12% (9,280)
11% (8,540)
6% (4,300)
5% (4,080)
Prostate Health
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Four times as many deaths from prostate cancer
as from cervical cancer
Prostatic disease is also very common – the main
one is Benign Prostatic Hyperplasia (BPH).
BPH affects 30% of men over 50 and 40% of
those over 60. By the time men reach 80 the
number affected rises to 80%.
Only 13 per cent of men knew where their
prostate was compared to 16 per cent of women.
Testicular Cancer
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Over 1400 men are newly diagnosed with
testicular cancer each year.
Testicular cancer is the most common cancer
in young men aged 15-35
Prompted a series of health promotion
initiatives, such as ‘A Whole New Ball Game’,
and ‘Keep Your Eye on The Ball’,
Accidental deaths: by age and
gender (UK 2000)
0-15
16-24
25-34
35-44
45-54
55-64
65-74
75+
Men
282
943
1,125
985
732
658
755
2,001
Women
157
241
207
264
289
319
524
3,551
All ages
7,481
5,552
Deaths from suicide: by gender and
age (UK 2000)
15-24
25-44
45-64
65+
Men
Women
16.4
23.4
17.5
15.4
3.9
5.1
5.2
5.1
(Rates per 100,000 population)
Men’s health-related Behaviour
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28% of men smoke compared to 26% of
women
27% of men compared to 15% of women
drink alcohol excessively
Men are more likely to use illegal drugs
Men are more likely than women to be
overweight and fail to take enough exercise
Motor-vehicle traffic accidents account for
46% accidental death in men
Access to Health Services
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Women are more likely to then men to consult their
GP (19% compared to 13% of men had consulted GP
in past 14 days)
The difference was most marked in younger men in
the 16-44 age group (20% of women, 10% of men).
10 per cent of men in this age group had not seen
their GP over a three-year period.
(O’Dowd & Jewell 1998)
Access to Health Services
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The same study found that only 16% of men said
that they would consult their doctor immediately
if they had a mildly irritating health problem; 31%
said they would wait until the problem worsened.
Men are 50% more likely than women to die from
skin cancers despite a 50% lower incidence of the
disease among men (Banks 2001)
Access to Health services
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Men are also more willing to make do with
locums and are also more likely to use A+E
services as an alternative to GPs.
Men are less likely to seek help from
practitioners of alternative medicine.
The ‘absent man’ has been noted in a variety
of clinical settings
Well-person checks in GP surgeries are less
well attended by men than women (79%
versus 85%).
Advice and Knowledge
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In a survey of over 20,000 young people nearly 14
per cent of young men said that they had no one to
turn to share health problems, compared to 6 per
cent of young women (Baldings 1993).
More than 80 per cent of men over 35 years had
never discussed health issues as an adolescent with
their fathers. This figure remains high at 64 per cent
for men under 35 (Everyman 2001).
Over 70 per cent of men knew ‘nothing at all’ or only
‘a little’ about prostate cancer (Davidson & Lloyd
2001).
The ‘official’ response
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'…considerable gains may be achieved by specific
targeting of messages to improve men’s general
knowledge about health and, more specifically, to
improve their awareness of the links between their own
behaviour and its health consequences. Unfortunately the
same attitudes and behaviours that put men at greater
risk also tend to make them less accessible to health
promotion messages. Several studies have shown that
men are less ready than women to recognise that they
have a health problem, or to seek professional help’
(Calman 1993: 105)
Biology has a role to play
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Evidence suggests that women have lower neuroendocrine and cardiovascular reactivity to stressors than
men (Manuk & Polefron 1987)
Evidence suggests that men have a life-long sensitivity to
certain prostaglandin metabolities that put them at higher
risk of vascular damage and coronary disease than
women (Ramsey & Polefrone 1987)
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Evidence also suggests that hormonal difference,
particularly the protective effects of oestrogen, make
men vulnerable to some diseases while protecting
women (Kilmartin 1994)
Evidence also suggests that men’s greater
susceptibility to heart disease and stroke appear to
be due in part to men’s tendency to accumulate fat in
the upper abdomen (Waldron 1995).
Masculinity and health-related
behaviour
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‘the development and maintenance of a
heterosexual male identity usually
requires the taking of risks that are
seriously hazardous to health’
(BMJ 2001: 323)
Occupational accidents and
disease
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Manual work is normally more physically
demanding, noisier and more dangerous than
non-manual work
Accidents at work account for about 4% of all
accidental deaths.
The evidence suggests that around 5-6% of
all deaths from cancer are related to
occupations carcinogens (some studies put
the figure far higher at about 20%).
Men and Alcohol
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Alcohol has ‘symbolic’ features, which attract
and satisfy and which are clearly gendered.
For example, being able to take a lot of
alcohol reaffirms the traditional ‘hardness’ of
working class masculinity (Wright 1993).
Men gain ‘status’ via their abilities to ‘play
hard’ as well as ‘work hard’ (Mort 1996)
Drink is also a way that men demonstrate
their virility as men. (Gilligan 1977)
Men’s ‘coping’ strategies
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Men use what are termed ‘masculinesanctioned’ coping behaviour (Eisler and
Blalock 1991).
Men report using certain behaviour, such as
drinking and drug use, as an ‘escape’ or
‘release’ from stressful or difficult situations,
which they often feel are beyond their control
(Gofton 1984, Mullen 1993, Bell and Valentine
1997).
Men’s attitudes toward health
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Men perceive themselves to be less vulnerable or
susceptible to illness than women (Lewis et al 1977).
Men perceive that health is primarily the
responsibility of women (Davidson & Lloyd 2001)
‘Women seem to be more aware of their own bodies
and pay more attention to health messages. Health
messages for men may be more effectively
transmitted through mothers or sisters, wives or
girlfriends’
(Calman 1993: 6)
Men’s attitudes toward health
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Men stress being fit, strong, energetic, physically
active and being in control, while women stress not
being ill and never seeing a doctor (Saltonstall 1993)
Men ‘normalise’ their symptoms (Wilson 1998)
This can mean that men will ‘tough things out’ and
delay seeking help - men put symptoms down to
signs of ageing or stress.
Men’s attitudes toward health
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Men fear wasting doctors time (MHF 2002)
Men are more likely to talk about their bodies
as machines (Blaxter 1990)
Men are less likely to accept emotional pain
as valid (Bendelow 1993)
Structural and institutional barriers exist to
men accessing health services both within
society at large and within the NHS itself
(MHF 2002).
The role of health care services in
improving men’s health
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Extended surgery hours
Increasing men’s awareness of, and access
to, appropriate confidential and anonymous
sources of health information, including
telephone helplines and the Internet.
Outreach activities with men
A designated men’s health worker
Well man clinics
Developing pharmacy services
Within all of this
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Men must not be treated as a homogenous
group.
Addressing the health needs of black and
minority ethnic group men is a priority
Gay men’s health issues must be seen as
much broader than HIV/AIDS or sexual health
in general.
Men’s health needs and concerns alter over
their life span
Male suicide:What can health
services do?
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About a quarter of those who kill themselves have
been in contact with doctors and specialist mental
health services in the years before their deaths.
Improved GP training is key – evidence suggests that
around a quarter of those committing suicide have
contact with a health care professional (usually a GP)
in the week before. Approximately 40% have contact
in the month before death.
Particular strategies may be required to meet the
needs of young people who either cannot, or do not,
choose to access current services.
Working with young men and
health
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More training for medical professionals, in order that
they can engage more successfully with young men
creating safe, confidential and appropriate
environments which will encourage young men to
talk
consulting with young men about their needs
taking masculinity into account when working around
health with young men
introducing more services specifically for young men
- these need to be accessible, informal, flexible and
attractive
It’s not going to be easy
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“While most people see it (suicide
prevention) as important, it is just
horrible to face suicide. If they end up
doing it, you feel such a failure, the
risks are too high.”
(MHF 2001)
Conclusion
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Individual or ‘behavioural’ explanations for
differences in men and women’s health fail to
acknowledge the ways in which biological,
psychological and social aspects of men’s
lives impact on their health.
Better understanding of masculinity and
men’s lives can help the development of more
appropriate professional practice and health
care services for men