Closing the gender gap needs national and local change

We must develop services that men feel comfortable using, says MHF president Dr Ian Banks.

As a GP, journalist, spokesman for the British Medical Association, and, most significantly, president of the Men's Health Forum, I have for many years been campaigning for greater recognition of the specific health issues of men and the need to develop sex sensitive health services. Until recently there has been too little interest, knowledge, or understanding of the term 'men's health.'

Well into the early 2000s policy makers continued to overlook the need to develop an inclusive approach to men's health. And although appreciation of sex sensitive approaches to healthcare provision has now grown, men's health in the UK remains astonishingly poor. But I'm hopeful that recent developments will bring positive change—namely, the government's gender equality duty, introduced in April 2007, which applies to all public bodies. However, closing the gender gap can be achieved only if policy and advice on best practice can be successfully implemented at a local level.

The gender equality duty demands that public authorities put gender equality into the mainstream of all functions and policies, by carrying out 'equality impact assessments' (tools for public bodies to identify the effects of a policy or function). The duty requires the NHS to tackle men's low level of access to GP services, men's underuse of particular services (such as smoking and weight management programmes), the lack of health information aimed at men, and men's lower life expectancy.

National legislation not filtering down

Nationally we are moving in the right direction, and progress has been made to put men's health needs on the map. However, transforming national policies into local services remains a problem. National legislation is not filtering down to the local level in a consistent or strategic way, and research endorsed by the Equalities and Human Rights Commission concluded that compliance is disappointingly poor. Services are often inconsistent, temporary, and underfunded.

What is more, little monitoring or reviewing of health outcomes exists. The largest men's health project in England (Bradford Health for Men) is an example. The scheme, introduced in 2002 and partly funded by local primary care trusts, is coming to the end of its five year programme—with no indication of how the knowledge gained will be implemented in future provision of men's health services.

Knowledge is a key factor in translating national policy into local services. Currently, local staff are ill equipped with the tools and knowhow needed to implement change effectively. Staff need to feel empowered and supported to embrace men's health initiatives; it is not a question of chastising primary care trusts for failing to comply with the duty but of educating them on how best to do it.

To develop effective services we must first understand the barriers that prevent men using services. We must understand an area's demographic profile in terms of sex but also how sex interacts with ethnicity, social class, and employment status—and must have a clear view of who is not using services as well as who is.

Although long term health education programmes in schools will influence the behaviour of men in future generations, immediate changes to current services will improve health outcomes today. Making health services more male friendly through extended opening times of general practices and introducing outreach services that target men in safe, familiar environments are just a couple of the ways this can be achieved.

Providing men with what they ask for

One project that has shown how to engage with men and promote simple ways to achieve healthier lifestyles is the 'Go' campaign at Halton and St Helens Primary Care Trust. In response to poor health statistics among men in Halton's deprived neighbourhoods, the trust developed a way to engage with men aged over 40 years through the delivery of free health checks. A dedicated service was built around the needs of local men, involving flexible times for health checks, non-clinical settings, and accessible venues. Motivating the target audience to attend the health checks was a key challenge, given that men in the most deprived areas are often disengaged from services and, in some cases, socially isolated. Provision of what they asked for - 'a service just for us' - provided an excellent motivational tool.

The initial results of the programme, which is being evaluated by the University of Liverpool, have surpassed all expectations, with the first sessions being oversubscribed. The programme has continued to meet its challenging targets. More than half (57%) of the men attending have since gone on to access other services, including diet and exercise interventions, smoking cessation programmes, and health trainer services. This success reflects ongoing engagement that will result in genuine improvements in health. This kind of approach, which takes practical steps to target those in need, will help to convert positive policy aims into improved health outcomes.

How men deal with their health is not going to change overnight, yet ignoring their underuse of existing services is condemning them to unnecessary suffering. It is our responsibility to implement change and develop services that men feel comfortable using. Only then will we see improved outcomes and a closing of the gender gap.

A version of this article first appeared in the British Medical Journal (cite as: BMJ 2009;338:b2129As)