Memorandum by The Men's Health Forum (WP
33)
1. INTRODUCTION
1.1 This short paper outlines the response
of The Men's Health Forum (the Forum) to the recent publication
of the Public Health White Paper. The Forum is the leading charity
working with health and other professionals to improve the health
of boys and men in England and Wales. Amongst other things, the
Forum is involved in:
— Research and policy development;
— Providing information services;
— Stimulating professional and public
debate;
— Working with MPs and Government (in
particular, the Forum provides the secretariat for the All-Party
Parliamentary Group for Men's Health);
— Developing innovative and imaginative
projects;
— Collaborating with the widest possible
range of interested organisations and individuals;
— Organising the annual National Men's
Health Week.
1.2 The Forum exists because, to put it
simply, male health is much poorer than it need be. Average male
life expectancy, although rising, is just 76 years and, in some
disadvantaged social groups and communities, it is as low as 71
years.
1.3 Poor male health is largely caused by
the health-related behaviours of men and boys rather than biology.
Many men have unhealthy diets, drink alcohol excessively and delay
seeking help with health problems. But while men are currently
far from "fully engaged" in their own health it is equally
true that health services are far from "fully engaged"
with men. There is still a limited understanding of how to develop
the kind of services that will impact on male health effectively.
1.4 The Forum broadly welcomes much of the
White Paper. In one respect it is fundamentally flawed, however.
Despite some encouraging references to several specific aspects
of male health and to the need, in general, to target health improvement
at specific population groups, there is no evidence of a strategic
response to gender health inequalities. This omission is despite
the Department of Health's apparent commitment, stated in several
previous policies, to tackle inequalities related to gender as
well as those linked to social class, ethnicity, age and geography.
The Forum hopes that gender equality issues will be addressed
in the forthcoming delivery plan for the white paper.
2. WILL THE
PROPOSALS ENABLE
THE GOVERNMENT
TO ACHIEVE
ITS PUBLIC
HEALTH GOALS?
2.1 The Forum believes that Choosing Health
is the most comprehensive plan for improving public health ever
produced for England. Whilst it is certainly far reaching in scope,
and has been informed by an extended and large-scale consultation,
a prime opportunity for a more "joined-up" approach
to working with men has been missed.
2.2 If the Government wishes to achieve
the key public health goal of reducing inequalities, far more
attention must be paid to the issue of gender. For too long, "gender"
has featured in Department of Health policies and plans merely
as a word added to a long list of other inequalities (primarily
social class and ethnicity). Rarely have specific actions to tackle
gender and health inequalities been included. This clearly has
implications for both male and female health but, as far as men
are concerned, it means that there has been no strategic response
to, for example, the marked inequalities in cancer and heart disease.
2.3 Men are much more likely to develop
cancer than women and to die from it. Age-standardised data for
England shows that the incidence for all cancers for men is just
over 400 per 100,000 population. The figure for women is just
under 340 per 100,000. That is a difference of almost 20%. The
comparable figures for mortality show an even bigger difference
between men and women—over 40%.
2.4 Of the 10 most common cancers that can
affect both men and women, nine are more common in men—in
many cases very markedly so. In total, men are almost twice as
likely as women to suffer from these nine cancers. In death rates,
the picture is even starker. Men are twice as likely to die from
all of these 10 cancers. If the incidence of these most common
"shared" cancers in men could be reduced to the level
experienced by women, there would be a very significant impact
on cancer rates in the population as a whole.
2.5 There is also a marked gender inequality
for the other major killer, coronary heart disease (CHD). For
the 35-44 age group, the age-specific death rates for CHD per
100,000 UK population are five times greater for men than women;
for the 45-54, 55-64 and 65-74 age groups, the respective ratios
are five, three and two.
2.6 There can be little doubt that cancer
and heart disease—and many other major diseases—are
"gendered"—in other words, they have a disproportionate
impact on one gender. Any attempt to tackle these diseases without
taking account of this inequality is likely to be less than optimally
effective. Ignoring gender in these circumstances would be as
ill-advised as ignoring ethnicity when tackling a condition which
affects a particular ethnic group disproportionately.
2.7 The Forum also believes that, in order
to achieve the Government's broad public health goals, it is important
to take gender into account even where there are no marked gender
inequalities. It is clear that men and boys have gender-specific
health attitudes and behaviours and respond to different health
improvement interventions. For example, in the key area of obesity,
men are much less well-informed than women about what constitutes
a healthy diet, are more likely to drink alcohol at levels that
contribute to weight problems and are generally less likely to
perceive themselves as having a weight problem. They are also
less likely to seek help for weight problems and, if they do,
they are less likely than women to respond to diet-focused interventions.
Unless men's specific attitudes and behaviours are taken into
account in tackling obesity, as well as a wide range of other
public health issues, it is much less likely to be effective.
To put it simply, what works for women will often not work for
men, and vice versa.
2.8 It is vital that the significance of
gender—and, from our point of view, the particular needs
of men and boys—is highlighted in the forthcoming delivery
plan. Unless the Department of Health is specific about this,
the needs of men will remain largely unaddressed by primary care
organisations. Given that the recent Department of Health document
National Standards, Local Action requires primary care trusts
to address gender equity in service planning and delivery, it
would seem entirely appropriate—and be entirely consistent—for
the delivery plan to include this issue too.
2.9 More positively, the emphasis in the
White Paper on delivering health interventions in the workplace
and using IT is likely to prove helpful for improving men's access
to health information and services. This is good news for men
who are proportionately less likely to access traditional health
services. There is now robust evidence that men are particularly
likely to respond to health promotion in workplace settings. There
is also a great deal of anecdotal evidence that suggests that
men in particular will be more responsive to approaches utilising
the Internet, text messaging and Health Direct. For example, the
volume of visits to the Forum's "consumer" website,
www.malehealth.co.uk, is steadily rising and there are now over
780,000 "user sessions" and 42 million "hits"
a year. Over 3,000 individuals have registered on the site to
receive a monthly newsletter providing information about new developments
and content.
3. WHETHER THE
PROPOSALS ARE
APPROPRIATE, WILL
BE EFFECTIVE
AND WHETHER
THEY REPRESENT
VALUE FOR
MONEY
3.1 The Forum broadly welcomes the range
of proposals in the White Paper and believes that, as a whole,
they offer a useful approach to improving public health. There
are specific areas where we would have wished to have seen more
robust action—notably, a complete ban on smoking in public
places. (The current exemption to the ban will leave customers
and staff in pubs in the most deprived, working-class neighbourhoods—which
are less likely to serve food—most at risk of passive smoking.)
Our principal concern, however, is that the measures will not
be as effective (and cost-effective) as they could be if gender
is not taken into account.
4. WHETHER THE
NECESSARY PUBLIC
HEALTH INFRASTRUCTURE
AND MECHANISMS
EXIST TO
ENSURE THAT
PROPOSALS WILL
BE IMPLEMENTED
AND GOALS
ACHIEVED
4.1 The infrastructure and mechanisms necessary
to achieve implementation in a way that takes effective account
of gender are not yet in place. In this submission, the Forum
wishes to highlight three key areas: the lack of an evidence-base
of good practice; the weak research base; and inadequate training.
4.2 Although there are now an increasing
number of examples of practice in relation to working with men
and boys, there is no systematic means of evaluating and disseminating
these. The Health Development Agency had, until 2004, plans to
develop an evidence-base of good practice in men's health but
these were abandoned at an early stage, largely as a cost-cutting
measure. It is essential that this plan is resurrected as soon
as possible and the Department of Health should now take a lead
on this.
4.3 The research base in gender and health
is weak. In the area of cancer, for example, while the gender
inequalities can be measured, the reasons for them are not yet
fully understood. For example, the balance of genetic and behavioural
factors requires further detailed investigation. The Department
of Health should initiate a research programme in respect of cancer
and other major killers to fill the current gaps in knowledge.
A better understanding of the causes of gender inequalities will
enable more effective health improvement interventions to tackle
them.
4.4 Training for health professionals on
gender issues is largely non-existent. It is difficult if not
impossible for health professionals at any level and working in
any field to work effectively with men without an adequate understanding
of the social construct known as "masculinity". Health
professionals need to know what makes men and boys "tick"—how
they think about health, how they behave and how to get them "hooked"
into taking more interest in, and care of, their health. Although
there are now some signs of change (eg the Royal College of General
Practitioners intends to develop training on men's health for
qualifying GPs), the pace of change is too slow and too patchy.
The Department of Health must ensure that the public health workforce
receives adequate training in this important issue.
4.5 Choosing Health is also very enthusiastic
about the role of schools. The Forum believes it is important
to remember that even in a school setting, however, that the specific
needs of boys can be overlooked. Teachers and other staff working
in schools require additional training on how to work effectively
with boys on health and health-related issues. There is a particular
need to train staff to address the needs of boys in sex education;
many of the staff delivering the subject lack the confidence to
work with boys and also fail to engage them in the subject.
The Men's Health Forum would welcome the opportunity
to contribute further to the national debate around Choosing Health.
January 2005
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