journal of men's health
Volume 6, Issue 2 , Pages 95-97, June 2009

Men's under use of health services – finding alternative approaches

Centre for Men's Health, Faculty of Health, Leeds Metropolitan University, Leeds, West Yorkshire, UK

Article Outline

 

In England and Wales in 1999, 20.5% of men compared to 11.4% of women died while still of working age (15–64 years) (calculated from the Office for National Statistics (ONS) 1999 [1]). In 2007, 21% of working age men compared to 12% of working age women died (calculated from ONS 2008 [2]). This suggests that despite advances in medical science and an increasing longevity we are, perhaps, still not having the impact on young and middle aged men as we would like.

In the UK this is being addressed as a key priority area in health care, with the publication last year of the influential ‘Working for a Healthier Tomorrow’ report on the health of the working age population [3]. That report suggests that there is a requirement to re-invest in this important demographic segment due to the high levels of economic and social capital caught up with these young men.

The recently launched European Global Health Report [4] rightly recognises that we have many health challenges in this age group. It also notes that many of these require multi-directional action as we cannot rely on just advances in medical science to solve the problems. Unless we can encourage individuals to change their lifestyle and be more proactive in managing their health care, the burden of ill-health will outgrow our society's ability to cope. A significant factor in addressing this threat is the need to get our populations to increase their capacity to self care, including the owning of responsibility to seek early and effective health care such that prevention of long term problems is possible.

Although we have an abundance of received wisdom about men's usage of health services there is still a lot of uncertainty over the reality. For a start there are a lot of men out there and they are not a homogenous group. It is inevitable that the distribution curve of usage will have extremes [5], [6], [7]. What we do know is that, in crude terms, the overall counts of attendance at family practice services show that working age men do have less contact with family practitioners than working age women.

The population-wide survey of attendance and hospital admissions undertaken by Juel & Christensen's study in Denmark concludes that this male pattern of lower contact rates to the general practitioner leads to higher hospitalisation and mortality rates. This is compatible with a scenario in which men delay attending for longer than women, such that they are more likely to be hospitalised for or die from these conditions [8]. An analysis of UK data by White & Banks [9] also suggests that men who present are more likely to have a condition that can be categorised as ‘serious’.

There are some conclusions that can be drawn from established data on the way men live their lives. In the UK more men work full time (13.97m men to 7.86m women), fewer men work part-time (1.86m men to 5.67m women)[10], with fewer of those men working full time having any form of flexible working pattern (18.3% men to 27.4% women) [11]. In addition, 28% of men (9% of women) work more than 45hours per week and 39% of self employed men (16% of women) work over 45hours [11], so that attending for health checks during the working day are at best problematic, at worst impossible. But there is another impact of such working practices as the majority of community health promotion activities (such as weight loss groups) are also run during the day and are, therefore, difficult for men to access. Further factors that limit access include the socialisation process that men are subjected to, sponsoring a feeling that they should be able to manage problems by themselves [12], [13].

Problems seem to be compounded by socio-economic factors. A community-based project in Preston, England found that men from disadvantaged backgrounds had commonly experienced failures of informal (family, community) and formal (institutional, medical, statutory) support, leading men to (mis)manage their health in their own ways [14]. The Miami Overtown study in the USA found that two-thirds of their male sample did not have a primary care health practitioner. Whilst 60% of men in that study had reported seeing a health practitioner within the last year only one-third reported having any form of regular monitoring, which could be indicative of a population that is only using a service at crisis points in their lives [15]. This finding is supported by a recent analysis of American health service usage, which reported that 21.8% of men, compared to 11.6% of women, reported having no regular and definable access to healthcare [16].

It seems that there are two main issues we need to address regarding men and help seeking – that of perceived challenges in access to healthcare and that of an unwillingness to undergo what many men construe as an ordeal. These can be broken down further. Firstly, men are not invited to engage in preventative health care activities (e.g. formal screening programs, contraception and antenatal care). Secondly, services are predominantly provided during conventional working hours, problematic for men, who as has been discussed are more likely to be constrained by inflexible working and potentially vulnerable employment. Thirdly, beyond these structural constraints, how men and women manage their health and well-being is also influenced by their own health beliefs and how these impact on their health behaviour [17].

In part we can promote change by having a more informed society and by working with boys and men with regards to their health and wellbeing. However, providing men with information and improving men's awareness of health issues does not necessarily mean that behaviour change will follow, especially when economic, social and structural barriers appear to deter change. We also have to look to the reality of how many men live their lives, such that the onus of responsibility must be shared between health professions and men themselves. In order to fulfil our end of the bargain we must be accountable for providing services that are both accessible at times a working man (and woman) can access them and that are designed to be as inclusive as possible.

An important report has just been published in the UK on Gender and Access to Health Services [18]. Its recommendations include the suggestion that more effort needs to be made to get to where the population works. This plea that services should become more flexible and should try to reach out to men is made by almost all the reports that have looked at men's health. As part of the European Men's Health Forum (EMHF) Vienna Declaration there is a call for investment in ‘male sensitive’ approaches to providing healthcare [19]. This is also a key component of the new Irish men's health policy and a major plank of the Equality Bills that have been passed in both Norway and the UK, with Gender Equality enshrining within the law the need for services to be meeting the needs of both men and women.

Good occupational health services that focus on the emotional and physical well-being of the workforce, as well as their safety, is imperative and the work of the European Network for Workplace Health Promotion, the European Agency for Safety and Health at Work (EU-OSHA) and organisations such as the Royal Mail in the UK are to be applauded for their approach [20]. But other opportunities also exist to target men more effectively and if there is a wish to go out to where men are, then the world of sport is an important setting to consider.

Two important initiatives are underway in England, the first is ‘Premier League Health,’ which is using the pull of Football's Premier League clubs, such as Chelsea and Manchester City, to attract young men into sessions that are aimed at getting them fit and to coach them on how to remain healthy and improve their wellbeing. The second is being run through our Centre for Men's Health at Leeds Metropolitan University in collaboration with The Leeds Rhinos, our local Rugby League club, where we are currently running a season long campaign called ‘Tackling Men's Health’. This has been sponsored by the Department of Health Regional Office for the Yorkshire & Humber district as part of the national ‘Change 4 Life’ campaign. At the ground on match days we are offering free health checks and are planning to run a weight loss group and a smoking cessation group before the matches start.

This may not be seen as health care as we currently know it, but if we truly want to see change in the population's health then perhaps we also need to see some more radical thinking in the way we deliver health services.

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References 

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PII: S1875-6867(09)00035-9

doi:10.1016/j.jomh.2009.03.001

journal of men's health
Volume 6, Issue 2 , Pages 95-97, June 2009

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