Men’s Health Alan Dolan School of Health and Social Studies

Men’s Health 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 ‘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 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 Circulatory Diseases Cancer Accidents Suicide

Coronary Heart Disease 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 and the age- specific treated prevalence rates double AgeMenWomen per 1,00049 per 1, per 1, per 1,000

The five most common causes of death from cancer in men (UK 2000) Cancer account for 31 per cent of male deaths under the age of 75 years Lung27% (20,680) Prostate12% (9,280) Large bowel11% (8,540) Oesophagus6% (4,300) Stomach5% (4,080)

Prostate Health 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 Over 1400 men are newly diagnosed with testicular cancer each year. Testicular cancer is the most common cancer in young men aged 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) MenWomen , ,0013,551 All ages7,4815,552

Deaths from suicide: by gender and age (UK 2000) MenWomen (Rates per 100,000 population)

Men’s health-related Behaviour 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 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 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 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 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 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 '…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 Evidence suggests that women have lower neuro- endocrine 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)

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 ‘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 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 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 Men use what are termed ‘masculine- sanctioned’ 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 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 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 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 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 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? 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 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 “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 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