NATIONAL MEN'S HEALTH WEEK 2009:

Statistics

This section includes a statistical commentary on men's use of services. General men's health statistics are here on the MHF site.

Visits to GP

Overall

Men are much less likely than women to use primary health care services.

• Men in Great Britain visit their GP four times a year
• Women visit six times.

GP visits and age

The difference in usage is most marked for the 16-44 age group — women of this age are twice as likely to use services as men.

According to National Statistics analysis, the higher consultation rates by females is evident in all age groups except pre-school children, and is distributed across a wide range of illnesses in addition to the obvious needs of women to consult for contraceptive and pregnancy care.

GP visits and unemployment

Men who are economically inactive are more likely to consult their GP than those who are working, with 19% of men in this group having consulted their GP in the last two weeks compared with 8% of those in employment.

GP visits and ethicity

There are also important differences in access by black and minority ethnic men.

Black Caribbean men had a higher consultation rate, and Bangladeshi men were twice as likely to have contact with a GP, than men in the general population. This increased with age, with the highest consultation rate (seven per year) found in Bangladeshi men over 75 years.

Why don't men go to their GP?

Men's lower usage of primary care services is reflected in a range of qualitative work that strongly suggests that men are frequently reluctant to seek help until they are in pain or convinced that they have a serious problem. One large study of men aged 25-35 found that men generally preferred to keep their health worries to themselves, and delayed going to the doctor for as long as possible.

The most frequent reasons given included that they:

• did not want to waste the doctor's time,
• were deterred by GP appointments systems,
• had work or family responsibilities that meant they had no time to deal with minor illnesses.

Many men also considered it 'wussy' to talk about health problems and felt embarrassed to see a doctor about 'below the belt' problems.

For younger men especially, lack of familiarity with the health system may also be a factor. (Young women tend to use health services routinely.)

Full-time working and long working hours have also been an important barrier for many men.

Effect of Opening Hours

It is practically difficult for a man to attend a health service which is open only or mostly during the 'normal' working day if he is at work at the same time. Many men will, of course, have started work, or be commuting to it, during the critical morning 'window' when appointments can be made with a GP. There is also evidence that men may be deterred by a perception that primary care services are aimed mainly at women and children and feel like 'feminised' spaces.

Recent Danish research has examined the potential impact of men's lower contact rate with GPs and suggests that, because men present later than women with severe symptoms, it may be linked to higher hospitalisation and mortality rates.

This finding is consistent with UK and Europe-wide data on malignant melanoma which shows (as stated above) that while women are more likely to develop this type of cancer, men are more likely to die from it. The most plausible explanation is that men tend to present when the cancer is more advanced and therefore harder to treat. However, the reasons for men's apparently poor use of health services — and the consequences of this for health outcomes — are not yet well-understood and this area requires further investigation and research.

The UK Government has recently pushed GPs into extending their opening hours and this may make it easier for men to access services. There is also an intention to create different points of access to primary care, including sports centres/stadia, pharmacies and walk-in centres, and to explore the potential for delivering more health services via workplaces; again, these developments, if implemented effectively, have the potential to improve male access.

It would also be useful to consider the potential role of other 'non-health' agencies that men may be in contact with, for example in the fields of criminal justice, housing, social care and post-school education, as well as those offering general advice. These services could, at the very least, provide their male users with information on health and refer them into the health system where appropriate.

Dental Check-ups

There is a similar pattern for dental check-ups: women are much more likely than men to seek regular dental check-ups, and younger men are one of the groups least likely to seek regular check-ups.

Emotional Expression

Many men appear to have more negative attitudes towards emotional expression, and this helps to explain their under-use of mental health services. This is partly a result of their perceptions of their own role — but it also reflects many men's experience that being emotionally expressive and/or displaying vulnerability may often not be well received by others.

Gender differences in help-seeking behaviour in relation to mental health problems start early, with male teenagers reporting less understanding of mental health, more stigma associated with mental illness and less willingness to use mental health services.

A survey of people aged 14-16 found that only 52% of boys talked to their friends about their feelings more than once a month, compared to 82% of girls.

Family Planning Clinics

A relatively small proportion of men visit family planning clinics: in 2006-2007, about 1.1 million women attended compared to 117,000 men.

Health Improvement programmes and community-based services

Men are much less likely to take part in mainstream health improvement programmes. Despite the high levels of weight problems in men, in the recent 'Counterweight' GP-based project in the UK only one-quarter of participants were male, while the pilot of one programme delivered in partnership with a commercial slimming organisation had a participation rate by men of 12%.

Similarly, the vast majority of those signing up to a community pharmacy initiative to deliver weight- management services were women, with just 15% of users being men. There are also clear and similar sex differences in participation in NHS smoking cessation programmes as well as the Expert Patient Programme and cancer support groups.

There is good evidence too that men make much less use than women of community-based services generally. Older men, for example, typically do not feel that organisations run specifically for their age group are appropriate for their needs, except perhaps as a last resort. They tend to avoid organisations where the membership (and staffing) are dominated by women, and consider that attendance at a day centre suggests that they have 'given up'.

Pharmacies

There is also evidence that men, especially young men, generally do not use community pharmacies as a source of advice and information about health.

Referral Policies

Another significant barrier is ineffective referral policies; where older men are referred, whether by social services, GPs or PCT staff, they are more likely to attend.