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Men’s Health Week – is gender harming men’s health?

Laure-Anais Zultak and Hayley Blackburn

As this week is International Men’s Health Week, we wanted to consider how gender affects men’s health and how we communicate about healthcare.

In order to inform our thinking, we asked a range of experts to share their thoughts on these issues. Their full responses are available and you can read more from:

The topic of gender in health has tended to focus on the health of women and girls (we produced our own blog on this for International Women’s Day in March) but gender can have an impact on the health of all. Indeed, the troubling incidence of male suicide has been well reported and as a result is now increasingly recognised as a very serious issue.

In an age where gender is often seen as being fluid, it can seem a bit old-fashioned to think about men’s and women’s health, but gender affects everyone’s health, however they identify. This can be linked to biology, which plays a part in the different health conditions men and women are affected by. Beyond sex-specific conditions, the way gender is constructed in society can significantly affect men and how they think about their health. We identified three key areas we wanted to explore further:

  • Health behaviours
  • Engaging with services
  • Engaging with treatment

Health behaviours

Research suggests that some unhealthy habits are more prevalent among men than women. For instance, men are more likely to smoke, drive and speed than women. What’s more, recent research has found that the more young men follow ‘traditionally masculine’ roles, the more of these unhealthy behaviours they adopt. This is evidenced by Dr Ian Bank’s experience as an A&E doctor who recognised that most of his patients on weekend nights were men. He told us that men are regularly encouraged by social norms and other pressures to take risks from a young age, which runs counter to messages about healthy behaviours and prevention.

Engaging with services

Once a health issue has developed, men also tend to be less likely to seek care. This may in part be due to the way men are socialised in our societies not to show weakness, which can make seeking help, even from vital health services, a challenge. In addition, while women tend to access health services from a young age, for example to discuss contraception and as they take on caregiving roles, and as a result ‘going to the GP’ becomes part of regular behaviour. Men, on the other hand, do not routinely engage with or access health services, and so do not get in the habit of doing so. These various dynamics mean that too often men can present to health services at a late stage.

Engaging with treatment

When in front of healthcare professional, men can find it difficult to discuss their health problems. Several interviewees noted that it is not uncommon for men to come to their GP with their wife, girlfriend, mother, and for their female relatives to do most of the talking and ask the questions. This echoes findings from our previous blog on gender, in which Elizabeth Eves, an oncology nurse, recounted that most users on a cancer information website were women, many seeking information to help their male relatives. Men tend to be socialised not to look vulnerable and talk about health issues the way women might be. This challenge can be even greater when addressing a female nurse or GP receptionist triaging patients.

What does that tell us about communicating with men on health issues?

Significant barriers exist for men in adopting healthy behaviours, seeking timely care and engaging with healthcare overall, but there are strategies that can be adopted to address some of these challenges.

There have been several initiatives raising awareness of sex-specific conditions and wider health issues among men. These have included mental health awareness campaigns led by and targeted at men, including those led by members of the Royal Family, and campaigns focused on the construction sector. Importantly, the use of humour can be particularly powerful to engage men in health issues, as a way to deflect the seriousness of a situation.

The Movember movement with its moustaches and attempted beards is one such campaign in the UK, so is the French male-cancer screening prevention TV ad centred on the ‘boules’ game and every below the belt double entendre you can think of.

Beyond awareness raising, recent initiatives have also started to move towards sex-specific programmes for health management, such as the weight management programme Football Fans in Training in Scotland.

Making perfect sense of health

At MHP, we make it our mission to make perfect sense of health. While we recognise that many other factors including socioeconomic and ethnic background, sexuality, geography and much more can affect health-related attitudes and behaviours, gender is an important component to take into account when communicating about health.

While this is already the case for conditions that are sex-specific, there will also be a value in keeping patient characteristics in mind when designing programmes tackling health issues that affect all genders. It might be that communications around the flu vaccine or bowel cancer screening, for example, will need to be better targeted to how different people respond to information. If we are truly to have a positive impact on men’s health, we need to think about how we are making it relevant to them, responding to their concerns and expectations and supporting them in engaging with healthcare.

Read more about expert views on men’s health:

 

Peter Baker
Director of Global Action on Men’s Health

What do you mean when you use the phrase ‘men’s health’? What most concerns you about men’s health?

Men’s health certainly isn’t just about prostates, penises and testicles. Men’s health, for me, has to do with everything that impacts on the physical and psychological health and wellbeing of men and boys as well as the steps needed to improve their outcomes. It covers male biology, male behaviours, masculine gender norms, deprivation, employment, education, health policies, the way health services are delivered, and a whole lot more.

How much do you think gender and gender stereotyping affects men’s health?

Gender has a huge influence on the health and wellbeing of men and boys. Masculine gender norms require men to act as if they are physically strong, emotionally inexpressive, independent, in control, invulnerable, willing to take risks and averse to relying on others. These norms are, self-evidently, not well-aligned to the achievement of optimal health and wellbeing. In fact, research shows that those men who identify most with ‘traditional’ masculine gender norms are least likely to seek help for health problems, especially mental health problems, and have the worst health outcomes.

When it comes to self-care specifically, we know that men are more likely than women to smoke, drink alcohol at hazardous levels, not to protect themselves properly from the effects of the sun and have a poor diet. The only area where men do ‘better’ is physical activity, a behaviour that is, of course, consistent with masculine gender norms.

But we must also remember that by no means all men behave in ways that are damaging to their health. Worldwide, for example, most men do not smoke or drink any alcohol. In the UK, smoking rates are falling as is alcohol consumption in younger men, and older men use GP services as frequently as women. When men join a weight loss or smoking cessation programme, they are also more likely to do well.

Gender norms can be utilised to improve the impact of health interventions. Weight loss programmes that are based at football clubs have been very effective, for example, with Football Fans in Training in Scotland being a prime example.

Do you think the language that patients and professionals use is affected by gender and does this affect patient care?

To some extent, yes. Men often use a different way of talking about health issues, preferring the term ‘stress’ to ‘mental health’, for example. Weight loss programmes that refer to ‘diet’ are often avoided by men whereas the ‘Man V Fat’ approach is proving very popular. Men in recovery from serious illness can prefer to discuss information and ‘facts’ rather than ‘feelings’.

This year’s focus for Men’s Health Week is the impact of inequality and deprivation. What are your thoughts about that?

Inequality is a key issue in men’s health. Men who are in the most deprived communities in the UK live about 10 years fewer than men in the most affluent areas. Poverty has a bigger impact on men’s health than on women’s. Gay and bisexual men are more likely that heterosexual men to smoke, drink alcohol at hazardous levels and use illegal drugs. The needs of trans-men have been almost totally overlooked. There are also important ethnic differences – in the USA, black men have a much lower average life expectancy than white men. In men’s health, while we need to improve outcomes for all, we need to focus on those groups of men who are particularly badly affected.

Dr Ian Banks
President of European Men’s Health Forum

What do you mean when you use the phrase ‘men’s health’? What most concerns you about men’s health?

The standard reply on most men’s health websites would be around men’s mental and physical health, but it is about more than this. Much more important in men’s health is men’s use of health services, the speed and rate at which men use services, particularly preventive services and access to early diagnosis.

To say it in a single sentence, men’s health is more than just mental and physical health, it is about the use of health services which can determine the state of men’s health.

General practice traditionally serves the purposes of children and women, because treating women and children was the priority historically after the war. Today, the vast majority of information laid out in general practice surgeries is directed towards women, even down to the magazines on the tables, most are about women. This is partly because a lot of receptionists who bring in or are responsible for buying the magazines tend to be women, but nevertheless it creates that environment.

Even the structure of General Practice seems to be better suited to women. The receptionists tend to be women, because they are low-paid jobs. It is an example of discrimination against women but it has the adverse impact on men of making it hard for them to access services, if they find it difficult to talk to a woman about their problems. Receptionists are not meant to ask patients about their health problems, but often they do it to triage them to nursing staff who are also mostly women. There is already a barrier there in terms about going to see a doctor in the first place, then in being in a room waiting to see a doctor, and then the interaction with the staff.

Some of that is reflected in the ways we bring boys up to be men too. Most young men do not even know how to make an appointment with a GP, as their mothers will have done this for them. It is not surprising that the number of young men who see their GP is pitifully small, compared to women who have a much better grasp of how to go through the labyrinth of issues when trying to make an appointment with a GP. Many women use services for things like contraception, whereas most men will not go to the GP for advice around contraception but simply go to a pharmacy or look online for advice. So, the use of primary care services is skewed.

As an A&E doctor, most of my patients were men, particularly on weekend nights. This reflects how men use services. Part of the reason for this is the way men see their relationship with their work. For a lot of men, if they are working full-time, going to a GP might mean a loss of pay.

There are financial, social and personal reasons why men tend not to use these services as much as women. Addressing these would be very productive in ensuring a better use of services, with better diagnosis of conditions, so you wouldn’t see men who have already had melanoma for six months before turning up in health services – which means that their survival chance is very slim.

How much do you think gender and gender stereotyping affects men’s health?

Before we go into individual areas of the causes of ill health from behaviours such as drinking and smoking, we must recognise the societal pressure on men regarding risk-taking behaviour. Women are told throughout their lives that they should not take risks, but this is the opposite for men. As boys grow up, they are inundated with messages from society and the media that as men, they must be prepared to take risks. The portrayal of men as the people who save others, take risks to help other people, as firefighters, policemen etc, creates a paradox for a young man growing up where on the one hand they are told they must take risks but at the same time they are told they shouldn’t take risks with their health.

This partially explains the risk-taking behaviour that you see in young men, which I have seen in hospital. We must understand why it is that young men do these things in the first place, it cannot be that they are all stupid. I think it is pressure from the messages they are receiving as young people which causes a paradox for them over whether they should, for example, go to the doctor, when that goes against the messages to engage in risk-taking behaviour.

[When it comes to engaging with health services], a lot of men will turn up in General Practice but will hold back what it is they desperately want you to know. We see this with men in pharmacies as well, where men will want to ask a serious question, but they end up walking out with a couple of lollipops. Being able to communicate can be a barrier for men. Very often in General Practice, men turn up with their wives or partners and it is their partner who does most of the talking and who explain everything that is wrong with the man.

A lot of GPs will see men coming in aged 50 who they have not seen for 20 years. GPs will
do every test possible because they know they might not see that man again for another 10 years. There is a very poor ongoing relationship with providers of health services. The internet is now going some way to fill that gap, but it is not the same as having a personal relationship with a healthcare provider.

Do you think the language that patients and professionals use is affected by gender and does this affect patient care?

It starts before that. We need to go to the level where the real problems begin to happen. There are barriers before you reach the health system.

Health information, either on the internet or in booklets, often doesn’t communicate in a way that recognises the person they are talking to is actually a man. That is one of the greatest failings we have had in communication. The level and quality of health information for men, until very recently, has been abysmal.

We need to look at how men deal with health information – they use dark humour all the time over health. For instance, ‘what is the definition of male middle age? It is when your prostate is bigger than your brain!’ It is a classic way of men deflecting the issue sufficiently so that they can actually talk about it. Information should be designed so that men can talk lightly and jokingly to their friends about it, whether about prostate or skin cancer for example, as this allows them to talk about it in a light way. Most women’s information on health is quite stark, even scary, as women are used to addressing very serious issues around health because they tend to address this in the wider family as care providers. Women have a familiarity with bodies, health and health problems in a way that men don’t. That’s why men faint when they see blood whereas I have never seen a woman faint because of blood in anatomy classes.

It is crucial that men are able to deflect the issue sufficiently, so they can talk about it with friends, and this enables them to talk to health providers. This first step of getting into the system is crucial if there is to be early diagnosis or prevention.

A key example is the difference between bowel cancer and aortic aneurism screening programmes. You can’t compare like with like, however in colorectal cancer screenings men have a comparatively low uptake of screening, but for aortic aneurism screening, between 80 to 90 per cent of men turn up. We must ask why that is. The answer is because the aortic aneurism screening is directed specifically at men, they use the language that men use when talking about something that frightens them. They can therefore design the programme completely around men rather than try to meet both genders at the same time. Men and women are different and the way they approach health information is different, so if you tailor the information better you will get a better response.

This year’s focus for Men’s Health Week is the impact of inequality and deprivation. What are your thoughts about that?

As President of the European Men’s Health Forum, I see the impact of inequality on health in a much broader way than we do in the UK. Much of that is gender-based with significant inequality experienced by women, who are not the gold standard for health themselves. However, there are differences in the way disease impacts upon men and women, which is compounded by inequality and deprivation.

When you look at the impact of deprivation on suicide in the UK, there is an obvious link between deprivation and suicide in men but only a slight link between deprivation and suicide in women. The factors which play a role in suicide are different for men and women. Substance abuse levels are much lower in women, yet the level of diagnosis of depression is much higher in women. If substance abuse is so linked to depression, and depression is so linked to suicide, why is depression lower in men when they use substances so much?

Similarly, a diagnosis of depression is over twice as likely in women, but suicide rates are three to four times higher in men. However, if you look at attempted suicide, the number of attempted suicides in women is way, way higher than it is in men. I have very rarely seen an attempted suicide in men but I have seen many attempted suicides in women, most of whom I have been able to save because they have used methods like poison, whereas men tend to choose a definitive route, particularly hanging, gunshots and deliberately crashing their cars.

Everything I have mentioned is linked to social class: depression, substance abuse, attempted suicide and suicide. The higher the deprivation, the more likely you are to be depressed, engage in substance abuse, and commit suicide. However, all of these factors are less affected by social class in women than they are in men. That is the greatest anomaly there is: the different impact of deprivation and social class on men and women.

Heather Blake
Director of Support & Influencing, Prostate Cancer UK

What do you mean when you use the phrase ‘men’s health’? What most concerns you about men’s health?

Prostate cancer is the most common cancer in men – 1 in 8 men will get prostate cancer in their lifetime so it is an important health issue that all men should be aware of. While many men are successfully treated, over 11,500 men die each year from prostate cancer in the UK. Prostate Cancer UK is here to support men who are concerned about prostate cancer as well as men and their families who are going through diagnosis and treatment We also raise awareness of the disease, work to improve care in the NHS, and very importantly fund research to make the scientific breakthroughs that will lead to earlier diagnosis and better treatments. We want to stop prostate cancer being a killer and improve the lives and health of all those men affected.

How much do you think gender and gender stereotyping affects men’s health?

Cancer is a difficult issue for anyone to think about. And because prostate cancer treatments can affect sexual function, which is a very sensitive issue for many men, it can be even more tempting to avoid the subject and not look for information. We hear stories of men living with issues around continence or sexual function which can impact on their health and relationships when they are very much entitled to care that could help them.

We have seen a change though in men’s willingness to talk about their health over the last few years. Through routes such as our work in football we are bringing conversations about health and prostate cancer into normal day-to-day activities and finding that many men are very willing to talk to each other about their experiences.

Do you think the language that patients and professionals use is affected by gender and does this affect patient care?

I would urge everyone, whether patients, professionals or public commentators, to use language which is clear and simple and gives permission to talk about sensitive issues without embarrassment and misunderstandings. It is all too easy to jump to conclusions based on someone’s gender, age or sexual orientation when an honest conversation could have a much better outcome for their health and care.

This year’s focus for Men’s Health Week is the impact of inequality and deprivation. What are your thoughts about that?

This is a major area of focus for us at Prostate Cancer UK. We encourage all men to be aware of their risk of prostate cancer, and particularly want to get the message out to black men whose risk is twice as high as other men – 1 in 4 black men will get prostate cancer in their lifetime.

We are also aware that in the absence of a population-wide screening programme, there will always be inequality as men from more affluent backgrounds may adopt more health-seeking behaviours and have a greater chance of early diagnosis. We are working hard to get to a screening programme for prostate cancer which would increase every man’s chance of an early and accurate diagnosis at a time when the disease can be successfully treated.

For more information about Prostate Cancer UK, our work and how you could get involved please visit prostatecanceruk.org

Dick Moore
Associate Trainer at Charlie Waller Memorial Trust

What do you mean when you use the phrase ‘men’s health’? What most concerns you about men’s health?

Whether talking about men’s or women’s health there are a number of issues common to both including nutrition, sexual health, sexuality, fitness and of course, our ability to avoid or cope with illness or injury. Despite significant overlap there are issues which apply, arguably, more to men than women and vice versa.

How much do you think gender and gender stereotyping affects men’s health?

For millenia, men have been the provider, the fighter, the protector. Strength has been seen as an essential virtue for a man to be successful and anything that might threaten the perception of such strength is to be avoided or defeated. Men, over the years, could not afford to allow their ‘weakness’ to be recognised by others – male or female. Female, because such recognition might reduce their attraction as a potential mate. Male, because such weakness may be exploited resulting in the removal of the man from his position of power and/or authority.

Perception of emotional or mental fragility differs between cultures with mental illness being seen as a character weakness but emotional restraint continues to be valued across the world with those in the West still conforming horribly often to a ‘man up’ culture where to be seen as vulnerable is to be seen as weak.

Although such an approach might be understood in the past, it seems regrettably, to continue to be prevalent today. In offices, classrooms, businesses, families, teams…the feeling remains that any perceived vulnerability is likely to be exploited as unacceptable weakness by one’s competitors and peers.

The fact, of course, is that vulnerability is a part of the human condition. We are all vulnerable and none of us can get through life without the support of others, whether such support be academic, physical or emotional. Indeed, the only thing that is weak about being vulnerable is our inability or unwillingness to ask for help. Our challenge is to spread understanding and acceptance of this fact.

Do you think the language that patients and professionals use is affected by gender and does this affect patient care?

Men are hesitant to talk about health issues. Even, for example, when suffering from a significant physical injury from playing sport, many men are likely to play down the seriousness and the level of pain of such injuries, for fear of being seen as ‘unmanly’.

Do you think that the language around men’s health has been evolving?

In recent years, societal understanding of emotional and mental ill-health has improved significantly. Such issues have been adopted by the media and it has been especially helpful to young men to see and hear high-profile sportsmen, musicians, politicians and media stars beginning to talk about their own mental health. But we have as yet only scratched the surface and there are new challenges to be faced. For example, for years, women have been seen as more emotionally open and less stigmatised by poor mental health. They are more prepared to talk about such things than men. However, the Head of a leading and very academic girls’ school recently expressed her real concern about her high achieving girls. She explained that now that it is accepted that girls can achieve anything that boys can achieve, some of those high achieving girls are developing a belief that, if they are really to compete, they can’t afford to show any vulnerability. This would be a tragedy. Men need high achieving women in their midst to show that vulnerability can and does work hand in hand with success.

Many large businesses understand the threat to their bottom line posed by mental ill-health. British businesses lose more money through presenteeism than through absenteeism. Many such businesses are introducing positive initiatives to care for their employees. Depressingly, many are doing more than many schools and universities which continue to pay lip service to the problem. Real change, as always, needs to start with education.