What is the current state of men's health in the UK? That was the them of MHF Director Peter Baker's keynote address to the MHF's Stakeholders' Forum in October 2005. We bring you the speech in full...
If you look at the statistics, it's clear that men's health remains unacceptably and unnecessarily poor. While it's true that life expectancy is slowly increasing, and now stands at 76 years at birth for men, this masks a wide range of deeper problems.
There are, for instance, serious inequalities between men in terms of life expectancy. At the most extreme, men in part of Glasgow, Shettleston, have a life expectancy of just 63 years, about the same as a man in China. Remember, 63 is an average figure — that means that half the men in Shettleston are dying well before they even reach retirement age. It's an extraordinary statistic.
In England, life expectancy varies hugely, depending on where you live and your social class. Alan White has looked at the variation between nearby wards in Leeds. This shows that in the more affluent area of Wetherby, average male life expectancy is about 79 whereas in the poorer City and Holbeck ward it is barely 66. What this chart also shows, very dramatically, is the far greater proportionate impact of economic and social disadvantage on men's health compared to women's. There is a 16% difference in life expectancy between men in the two wards, compared to 8% between women.
But life expectancy is just one measure of health. It's also important to look at the incidence of particular diseases. Prostate cancer affects 30,000 more men each year and the rates are rising fast, as are the rates of benign prostate disease. Testicular cancer rates have doubled over the last 25 years, a trend that appears linked to a broad range of urological problems in men that are also increasing, including undescended testicles, fertility problems and hypospadias, a congenital condition where the urethra does not open in the usual place at the tip of the penis.
But, as we all know, men's health is emphatically not just about the male-specific conditions. In National Men's Health Week 2004, we highlighted the issue of men and cancer and showed that men are about twice as likely as women to develop one of the 10 most common cancers that men and women 'share' and about twice as likely to die from it. In fact, this very basic statistic was not very widely known, even among cancer specialists, and demonstrates the importance and significance of a gender analysis of health data.
In National Men's Health Week 2005, we looked at obesity data, highlighting the fact that men are more likely to be overweight or obese than women and that, if present trends continue, three quarters of men will be overweight or obese by 2010.
Next year, as you will hear later, we will be focusing on men and mental health. At the sharp end of this issue is, of course, suicide, still the biggest cause of death in young men, although the statistics are now improving slightly. Research recently published in the Lancet has highlighted the particular problem of suicide in prison, where the suicide rate is five times higher than among men in the general population. Over 1,300 men in prison aged 15 and over killed themselves between 1978 and 2003.
Alan White has recently calculated that, if you look at years of life lost through premature death, suicide accounts for more years of life lost among men than prostate cancer. The figures are about 100,000 life years lost for suicide compared to about 30,000 for prostate cancer. This is an extraordinary statistic. Yet, clearly, suicide receives much less attention and much less funding.
More broadly, one in seven men aged 25-44 is worried enough to be described as 'anxiety-ridden', according to a recent study by consumer researchers Mintel. Indeed, there is now talk of an 'early life crisis' among young men who are juggling the demands of work and family life and worrying about their health and income. Another study, this time by Newcastle University researchers, found that more 50 year old men than women were clinically depressed.
To complete this rapid overview of the statistics, I want to mention the health of black and ethnic minority men. Unfortunately, the data is somewhat sparse but we do know that heart disease is more common among Indian, Bangladeshi and Irish men and that stroke is more common among Black Caribbean, Bangladeshi and Indian men. Prostate cancer is more common among African-Caribbean men while Irish men are more likely to be obese and Bangladeshi men are nearly twice as likely to smoke as men in the general population. This data shows quite clearly how important it is to target specific groups of BME men if their health is to be improved.
With all these problems, one might expect men to be overwhelming health services with their demands for help and support. We all know this is far from the case, however, and that men remain under-represented users of primary care services. You all know, I'm sure, about men's use of GP services so I'd like to give you another lesser known example which we highlighted in our policy statement on men and weight during this year's NMHW.
Despite the much higher prevalence of overweight and obesity in men, men are massively under-represented in weight management programmes in primary care. For example, only 26% of participants in the national primary care "Counterweight" intervention are men, and only 12% participation by men was achieved in a pilot partnership programme involving "Slimming World". Men are also much less likely to have their weight routinely recorded by their GP.
It's important to be reminded, I think, of the scale of the problems we face but at the same time not to sink into despair. There are also many positive signs, some of which I want to highlight in the rest of this presentation.
First, there can be no doubt that there is a growing awareness of men's health issues at a national level. The public health white paper, published about nine months ago, highlighted several specific aspects of men's health, although of course it lacked the strategic approach we were hoping for. Even more significantly, the DH report Choosing health through pharmacy, published in April, contained a section dedicated to men's health, largely based on material we had submitted at the consultation stage. I consider this a real breakthrough and we can now hold this document up as a model for all DH policy.
The DH also funded, for the second year running, a Haynes manual, this time on men and weight, published in NMHW. The Department sponsored our conference, Hazardous Waist, enabling us to attract over 300 delegates and 50 speakers while still charging a fee of under £100.
At the risk of sounding like a PR man for the DH, I also have to give it credit for continuing to develop male-specific health information in the form of Prime and Fit magazines. These have their obvious flaws but they are at least an attempt to engage with a male audience in a more sophisticated way. And, at least the magazine aimed at young men isn't saying that to be healthy you need to spend hours in the gym working on your six-pack.
Secondly, there is without doubt a growing evidence-base for effective men's health work, partly based on work by the Forum but especially by the work many of you and your colleagues are doing locally. The large-scale projects underway in Preston, Knowsley, Sefton, Bradford and elsewhere, as well as a wider range of smaller projects across the country (I can't possibly mention them all), are beginning to make an impact. And, of course, there are the hundreds of one-off events run locally during NMHW. This activity is demonstrating to PCTs that investing in men's health can make a difference and makes good sense. The developing evidence base also enables policymakers and practitioners to develop initiatives with much greater confidence of success. It is still important to acknowledge, of course, the serious problems that still exist in many areas in raising both start-up and sustained funding for many men's health initiatives.
Thirdly, there is now growing interest in developing men's health work outside of the NHS. We have been working with the Royal Mail and BT to deliver health improvement programmes with a male focus. The BT Work Fit programme, which you will hear more about later, is especially significant, not least because it is open to all 90,000 BT staff in the UK, 75% of whom are men. Other companies are also interested in targeting men — BP, for example, is introducing a weight reduction programme for its male seafarers because of the rising level of obesity and the consequent health and safety problems.
There is a corresponding interest in men's health amongst a growing number of NGOs. The best evidence for this is the range of support for NMHW. Take a look at the back of the HGV Man manual for the list of partner organisations, many of whom also signed our consensus statement on men and weight called Â¾ Is Too Many. By the way, if your organisation hasn't yet signed up to this, please do so now. Have a word with David Wilkins — he can tell you what to do.
There is a fourth area that is also indicative of the attention now being paid to men's health. This is perhaps the one that has, over the next few years, the potential to make most change and bring about a real mainstreaming of men's health. I'm talking about the forthcoming duty on public sector bodies, including health, to promote equality between men and women. This is being introduced as part of the Equality Bill that is currently going through parliament.
The gender duty will impose on health organisations, alongside other public sector bodies, a general duty to promote equality of opportunity between men and women. Crucially, in my view, this will include making policies and services more sensitive and responsive to the different needs of men and women. This has the potential to lead to exactly the kind of gender-sensitive provision we have been advocating.
What's especially significant is that both the EOC and the Women and Equality Unit at the DTI, that are leading on the introduction of the duty, are constantly raising men's health as the leading example of how the duty will benefit men. Men's access to primary care services has received particular emphasis. We are working with both the EOC and the DTI to make sure that men's health is fully taken into account in the drafting of the legislation and the code of practice that will introduced alongside it. Taken together with the responsibilities National Standards, Local Action already places on PCTs to take gender equity into account in service planning and delivery, it seems clear that men's health will be forced onto the health agenda at a much higher level than has previously been the case.
Finally, I want to mention the impact men's health advocates are now beginning to have at the European level. I was at the European Men's Health Forum's first conference in Vienna a couple of weeks ago and it was astonishing to see the range of activity now taking place across the continent, from Denmark to Hungary. What was especially encouraging was the agreement of the first European Declaration on the health of men and boys which was signed by all the organisations represented at the conference and which can now also be signed by anyone else who believes that men's health is a Europe-wide problem that requires a Europe-wide solution. If you'd like to sign-up too, and I hope you will, details of how to do so will shortly be on our website.
The EMHF conference took place alongside the World Congress on Men's Health. This event highlights the level of interest in men's health that now exists throughout the world and this slide shows how many men's health organisations we can now work with during International Men's Health Week and in many other ways. We really are now part of a global movement.
So, to sum up, how would I diagnose the state of men's health today? Clearly, the statistics continue to indicate serious and deep-seated problems, not least the wide variations in life expectancy between different social classes and geographical areas. But, much more positively, we are seeing a much higher level of engagement with men's health at the national and local levels. An increasing number of organisations, in the statutory, private and voluntary sectors, are showing a clear interest in taking action. And, now legislation is coming that has the potential to mainstream men's health in a completely new way.
Just 10 years ago, such a prognosis would have been laughable. Those of us who were men's health advocates at the time felt we were doomed to spend our lives shouting from the sidelines. How much has changed. Now we can look forward with some genuine optimism to a time when we will start to see real changes in the planning and delivery of health services and when there will no longer be an inherent contradiction in the term 'men's health'.
Page created on October 19th, 2005
Page updated on December 1st, 2009