Men and health-seeking practices: what do we know and what does it mean for

policy and practice?

Steve RobertsonCentre for Men’s Health

Leeds Metropolitan University

Females are more likely than males to consult a GP – 16 per cent of females and 11 per cent of males did so in the 14 days before interview in 2004/05.

Living in Britain, 2006 National Statistics

Percentage consulting with an NHS GP in the 14 days before interview by sex and age

0

5

10

15

20

25

30

0- 4 5_15 16-44 45-64 65-74 75 andover

Per

cent

age

(%)

Males

Females

Living in Britain, 2002 National Statistics

Geographical differences

There is a distinct ‘north/south’ divide for life expectancy at birth. For men in the north, life expectancy at birth is around two years shorter than for men in the south.

In Yorkshire and Humber male life expectancy is 75.8yrs compared to a national average of 76.6 and a South West average of 77.8yrs

DoH (2006) Health Profile of England DoH, London

Relative impact of socio-economic factors

Trends in life expectancy by social class 1972 – 2001 ONS Longitudinal Study

Men Women

71.9

74.5 75.176.7

77.679.4

66.467.2 67.7 68.2 68.5

71

65

70

75

80

85

1972-76

1977-81

1982-86

1987-91

1992-96

1997-01

I

V

79.180 80.3 80.8

83.282.2

73.874.9 75.3

76.3 77.1 77.6

65

70

75

80

85

1972-76

1977-81

1982-86

1987-91

1992-96

1997-01

I

V

Average number of consultations per person per year, by sex, age, and economic activity status

0

2

4

6

8

10

Male Female Male Female Male Female

16-44 45-64 65 and over

Working

Unemployed

Economically inactive

Living in Britain, 2002 National Statistics

Inpatient stays in the 12 months before interview by sex and age, 2002

02468

101214161820

0- 4 5-15 16-44 45-64 65-74 75 andover

Per

cent

age

(%)

Males

Females

Living in Britain, 2002 National Statistics

Do men have a problem going to the doctors?

“Women were no more likely than men to consult a GP in the previous year when experiencing the five most common groups of conditions. In addition, women were no more likely than men to consult at a

given level of severity for a given condition type.” Hunt

K, Ford G, Harkins L, Wyke S. Are women more ready to consult than men? Gender differences in family practitioner consultation for common chronic conditions. Journal of Health Services Research & Policy, 1999; 4(2): 96-100.

“A review of gender-comparative studies does not support the hypothesis that men are less likely than women to seek help when they experience ill-health.” Galdas P, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. Journal

of Advanced Nursing, 2005; 49(6): 616-23.

Do men have a problem going to the doctors?

“Women who suffer from diabetes use more healthcare services and have a higher morbidity rate compared to men.” This measured process (visits to physicians) and outcomes (lipoprotein cholesterol, triglycerides, HbA1c) Shalev, V. et al (2004) Gender differences in health care utilisation and medical indicators among patients with diabetes. Public Health 119: 45-49

“Women were less likely than men to report that they had talked to their GP or practice nurse about their diabetes in the previous 12 months” Hippisley-Cox et al (2006) Sex inequalities in access to care for

patients with diabetes in primary care. British Journal of General Practice 56(526): 342-348

“Yeah, cause it’s important to women innit, but blokes don’t really bother about it.” [Quinn DM2]

“I think it’s, it’s not even an attitude, it’s a non-attitude towards health. They [men] don’t see it as a problem. I don’t think they think that going out and having a binge on Friday night’s a problem.” [Martin CABS3]

Blokes don’t care

…. Well maybe a bit.

“Generally, like smoking, drinking, drugs, you know, if your doin’ it then obviously you should know what your limit is” [David, GM1]

“I do keep fit. Um don’t drink too much, don’t smoke too much, well I probably do at times [laughs]. Watching what I eat to a certain extent, eating fruit and vegetables. Um, so keeping fit, eating healthily and not living life in too much of an excess.” [Martin, CABS3]

Moral imperative?

SR: “What does health mean to you?”

Neil: “Er, it does mean a lot, but I don’t tend to it as much as what I should do.” [Neil, GM5]

Dichotomy

Don’t care Should care

Frank: “If you enjoy a burger, eat it. If there was a salad I didn’t enjoy, and a burger that I would enjoy that was gonna do me more harm, I’m sorry but I’d eat the burger.”

SR: “So part of living a full life is….”

Frank: “Enjoy your life, yeah. I think you have to be a bit sensible, you can’t be totally brash, you have to be sensible and responsible to a point. There’s a point and once you get past that point your being silly again. Some people are too careful, that’s not me.”

SR: “So it’s a balance?”

Frank: “Yeah, you’ve got to get it right.”

It’s like your car innit? If there’s nowt wrong with it you can’t fix it. If there’s nothing wrong with you then you’re just wasting their time when they could be looking after someone that is poorly. Every time you go to the doctor’s there’s a waiting list for appointments. So they could be sorting someone out that is poorly, someone who needs an emergency appointment, and you go in and there’s nothing wrong with yer. I look at it, the less I go to the doctors, the better of everyone else is that’s poorly, I’m not taking his time up. [Hugh, CABS2]

Responsibility

Importance for practice - Legitimation

1) Life stages or changes

2) Family history

3) Concern of family members

4) Non-gendered aspects of identity

1) Life stages or changes

“I was one of the beer swilling types not long ago. But now things have changed and we still enjoy ourselves but we take it easy as well until she’s [their baby] of an age where she can look after herself. I want to know I am able to deal with any emergency that may occur.” [Owen, CABS5]

2) Family history

“My father died of skin cancer when I was young. So I always get me mum, if I’ve got a scratch on me back I think “is that a mole”, I always get me mum to check that out, she says, “right you ought to go and see a doctor”. So certain things like that I’m very cautious about.” [Martin, CABS3]

3) Concern of family members

“Jane [wife] phoned up to make the appointment, she always phones the doctors and tells me when I have to be there . . . I’m not very good at that sort of thing.” [Hugh, CABS2]

4) Non-gendered aspects of identity

“I think gay men are more aware of their health than straight men – on the whole I think that gay men are more health conscious” [Gary, GM3]

“I think since I’ve been in the chair, I’ve watched what I’ve eaten because I can’t lose it [weight]. I’m worried about getting a belly and not being able to get rid of it.” [Peter, DM1]

Importance for policy (1)

Initiatives need to be encouraged that take men’s health promotion outside the NHS

SR: Do you think the NHS should have a role in helping men stay well?”

Bob: “ In the maintenance respect? [SR: yeah] I mean, yes, fantastic as another part to the service yes, because it’s a fabulous service it really is. As another part of it yeah, I mean if there are the resources there to do it, without affecting current standards then yeah. But are they not stretched a little bit far at the moment, I would have thought so. [Bob, CABS6]

Importance for policy (2)

There needs to be full evaluation of innovative services both in terms of process (did they manage to engage with men) and outcome (did they improve the health of men)

“Outreach services need to be more thoroughly evaluated in terms of whether they create enduring positive health practices that benefit men and those around them.” Robertson, S. Williamson, P. (2005) Men and health

promotion in the UK: Ten years further on? Health Education Journal 64(4): 293-301

Importance for policy (3)

Care needs to be taken to ensure that the new “Gender duty” and implementation of gender sensitive service delivery recognises that men, and particular groups of men (Social Class V; BME men; disabled men and others), also have specific need in terms of service use and access.

Dr.Steve RobertsonReader in Men’s HealthCentre for Men’s Health

Leeds Metropolitan University Leeds LS2 8AJ

UK

email: s.s.robertson@leedsmet.ac.uk