HC 1048-III Health CommitteeWritten evidence from the Men's Health Forum (PH 64)

1. Summary

(a)In this paper we have focused on the Marmot Review and health inequalities.

(b)In principal we support the government’s approach to the Review and the related policy of passing public health budgets to local authorities.

(c)We are concerned, however, at how this will work in practice. This is because many local authorities have had to cut existing services and because too great a gulf in responsibilities between local authorities and the NHS could be counter-productive.

2. About the Men’s Health Forum

(a)The Men’s Health Forum (MHF) is the only independent national organisation campaigning for better health for men and boys. We are a registered charity and a Strategic Partner of the Department of Health.

(b)Our vision is a future in which all boys and men in England and Wales have an equal opportunity to attain the highest possible level of health and well-being.

(c)We work to achieve this through:

(i)Policy development, research and lobbying.

(ii)Supporting other organisations and services to engage more effectively with boys and men on health issues.

(iii)Leading the annual National Men’s Health Week.

(iv)Publishing the award-winning range of mini manual health booklets for men.

(v)Running the unique “consumer” website for men: www.malehealth.co.uk.

(vi)Working with MPs and government.

(vii)Developing innovative and imaginative best practice projects.

(viii)Training service providers and others.

(ix)Collaborating with the widest possible range of interested organisations and individuals.

(d)Our work focuses particularly on those groups of men with the worst health and we are striving to ensure that we take account of the diversity of men and their needs.

(e)Although our concentration is on male health, we are committed to the principle of achieving better health for both sexes. We recognise particularly that the health of men and women is often interconnected. We do not advocate improving male health at the expense of female health nor do we argue in favour of diverting health resources from women to men.

3. How the Government is Responding to the Marmot Review on Health Inequalities

(a)We welcomed the government’s White Paper’s acknowledgement of Professor Sir Michael Marmot’s extensive series of recommendations in this area. It is crucially important that Professor Marmot’s work is not lost – and indeed that that all the earlier work on tackling health inequalities that has been at the forefront of public health activity in recent years should continue to inform future activity. We will not improve the health of individuals as effectively as we can without also acting in this wider context.

(b)We welcome the decision to build public health provision around a life-course framework as Professor Marmot’s review recommended. We think this approach will be helpful in our own field. Several previously published MHF papers have acknowledged the importance of “transition points” in men’s lives and this approach accords with the life-course approach.

(c)While we welcomed Professor Marmot’s Review, we also consider that it largely omitted the inequality issues that cross-cut those related to income, including gender inequalities. The Men’s Health Forum believes that the differences in health outcomes between men and women are significant and must be tackled. These differences relate to life expectancy (women outlive men by four years on average) and premature mortality (42% of men die before the age of 75 compared to 26% of women). In the case of one major killer, cancer, men clearly bear an excess burden – they are 40% more likely to die from any cancer and 70% more likely to die from one of the cancers that can affect both sexes – because of their riskier lifestyles, lower symptom awareness and almost certain later presentation to health services. It is essential that any initiatives to tackle health inequalities take account of gender alongside other key dimensions of inequality, such as race and disability.

(d)Our recommendation is that heath data in policy and planning documents should always be expressed in gender-disaggregated terms. The government’s public health policy in general, and the aim to focus on outcomes and any attempt to deliver Professor Marmot’s recommendations in particular, will benefit from this approach.

(e)Presenting data routinely in this form would be extremely easy to do, since there are virtually no circumstances where the relevant information is not immediately available. Doing so would offer the considerable advantage of placing gender equality issues in front of policy-makers, planners and health professionals throughout the decision-making process and into service delivery.

(f)In principle, we support the relocation of public health departments within local authorities, and of the associated decision to “ring fence” budgets allocated to public health. This should enable a greater degree of local sensitivity and democratic accountability. This should be balanced, however, against the need to ensure it is focused on delivering public health priorities identified by Professor Marmot and is not used to subsidise related services that local authorities have previously provided such as leisure centres and public parks.

(g)It should also help with the engagement of local third sector organisations in the planning and delivery of health improvement initiatives. However, the current picture emerging from around the country is that local authorities are cutting back on this type of work. We are concerned that the local authorities in most need of tackling health inequalities, in particular men’s poor health, will be those least able to.

(h)The potential difficulty with many aspects of the new arrangement, which has been widely voiced, is the possibility of disengagement of public health from wider NHS service delivery.

(i)This risk is compounded by the decision in the Health and Social Care Bill to give much greater decision-making powers to GPs. GPs, it is fair to say, do not have a strong track record of prioritising public health issues (albeit for very recognisable and understandable reasons). They also have generally shown little interest in tackling health inequalities, including men’s health.

(j)If joint-planning and joint-working between GP consortia and public health departments proves hard to achieve consistently across the country, then the capacity to make the necessary progress on public health and health inequalities with be very significantly undermined.

June 2011

Prepared 28th November 2011