A STEP INTO NO MAN’S LAND: Improving men’s use of primary care services

Tuesday, February 4th, 2014 |

Men are not a success story for the UK’s health services. Their unnecessarily poor health and early death is in fact good news only for the funeral business.

Is this because the Y chromosome and a problematic prostate condemn men to physical frailty or because they are simply foolish, feckless and increasingly fat? Much better explanations are that men have been brought up to believe they have to be strong, silent and stoical and that health services have not done enough to change men’s risk-taking behaviours or help them to access services.

Primary care services are currently a no man’s land – they are used ineffectively by men, especially those in the most disadvantaged groups. This often results in late diagnosis, especially for mental health problems. It means that treatment, when it eventually starts, may not be as effective, that men are more likely to end up in hospital and that they frequently die too young. This is a tragedy for men and their families and it also represents a major extra and preventable cost for the NHS and the wider economy.

A few statistics to illustrate the problem. In England, in 2008–9, females aged 15–80 years had significantly more consultations with GPs than males; the biggest gap was in the 20-44-year age group. Men visit a pharmacy on average four times a year compared to 18 times a year for women, according to the National Pharmacy Association. The Adult Dental Health Survey for England, Wales and Northern Ireland 2009 found that women were more likely to have made an appointment with an NHS dentist in the past three years (62% versus 54%).

The European Men’s Health Forum (EMHF), for whom I work as a consultant, is tackling this problem across Europe. At a recent major health conference, European Health Forum (EHF) Gastein, EMHF’s workshop on the issue concluded:

  • Primary care services are currently used ineffectively by men, leading to late diagnosis of serious conditions and the use of counterfeit drugs purchased online
  • Engaging with health care is perceived by many men to be incompatible with masculine norms and men, particularly those in full-time work, face many practical barriers such as restricted opening hours
  • These practical issues must be addressed, including through the use of digital technologies for making appointments
  • Pharmacies have a potentially significant role as a first point of contact with the health system
  • Training for health professionals on men’s health issues is important
  • There is a need for better outreach services
  • Men’s health literacy, including symptom awareness, should be improved
  • New ways of encouraging men to seek help from health services could be developed (e.g. identifying situations where men currently feel comfortable asking for help and exploring how these could be made relevant to health settings)
  • Key transition points in men’s lives, such as becoming a father, present opportunities for engagement with services

EMHF is now working with its Europe-wide and national partners to change health policy and practice so that the needs of men are met more effectively. Without this kind of focus and commitment, too many men will continue to die too young from a major health inequality that is still all often overlooked.

EMHF’s report on its workshop at EHF Gastein can be read here.

An article on men’s use of primary care by Peter Baker and Ian Banks in the journal Trends in Urology and Men’s Health can be read here.

[This blog is a slightly edited version of one that first appeared on CALM’s Malestrom blog.]

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