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Men’s Health Week: delivering accessible services

Poor use of services by men has a direct impact on their health and wellbeing. This will often manifest itself in late presentation and, especially in the case of mental health, aggravate the condition by heavy drinking or other risky behaviour. National Men's Health Week 2009 seeks to address this issue and to challenge men to make better use of services

Ian Banks
President
Men's Health Forum

Men take too many risks with their health, perhaps drinking alcohol excessively, smoking, eating a poor diet, using illegal drugs, having unsafe sex or driving dangerously.

Often underpinning men's poor health is a reluctance to seek help from services such as the GP or pharmacist, or to take part in health improvement programmes like weight-loss clinics. But this is not purely a matter of stubbornness and stereotypes; this is often because services are not designed and delivered in ways that take account of men's  particular needs.

The grim facts
The state of male health in the UK is astonishingly poor, with the average man likely to be seriously or chronically ill for 14 years of his life.1 A total of 41% of men are still drinking over the recommended limit at least once a week and 22% of men are smokers.2 Circulatory diseases kill more men than any other disease and the rate is over 50% higher than for women. The number of new cases of prostate cancer has climbed to over 34,000 a year and the upward trend continues. The state of men's health in the UK is unacceptable and will only get worse (particularly now with mass unemployment) if closing the gender gap and improving men's access to primary healthcare is not prioritised.

The nature of the challenge
A number of psychological and social factors combine to make the challenges of tackling men's health significant. Traditional concepts of masculinity continue to exist, with many men taking the "grin and bear it" approach to their health. Men of working age visit GPs less often than women, even when taking account of women's visits for reproductive health reasons, and it is the widespread experience of practitioners that men present later in the course of an illness than women.

Generally speaking, primary care services are not male friendly – the environment, the timing and the lack of specific attention to male health needs. Opening hours are now improving but too few know it.

Men are not a homogenous group. Social class, ethnicity, sexuality, disability, age and other demographic factors impact on men's use of services. Gay men, for example, are often reluctant to use traditional primary care services because they may experience homophobia. Men from black and ethnic minorities are less likely to seek help for mental health problems from services that have failed to understand their needs. Migrant workers may not understand how to access the health system effectively and older men are often reluctant to use community services where women are in the majority and consider that attending a day centre suggests they have "given up".

Men and health services
So, as a primary care nurse or health visitor, what role can you play in reversing this trend? In what ways can you make the services you provide more tailored to men's needs and how can you both improve accessibility and improve participation? The solution is two-fold: first, we need to focus our efforts on pushing new methods of primary care provision that we know are popular with men. Second, we need to re-evaluate traditional healthcare settings and look to make them more "male friendly" in their approach – be this through outreach initiatives, extended opening times or waiting room environments. This is where nurses in primary care can make
a difference.

A friendly place with a friendly face
Even on a basic level, the majority of primary care services are not "male-friendly" environments. From the moment a man walks into his GP surgery – if he is registered at all – he might start feeling out of place. The receptionist will almost certainly be a woman and there may be many people around who can overhear his conversation with her. Once in the waiting room, he sees posters about smear tests and copies of Woman's Own and Bella strewn across the table.

Being able to sign in for an appointment in a private booth, or even at a reception where the queuing system dictates a good deal of space between one patient and the next (as if you were in the bank), could make a world of difference to a nervous patient. Access to male-friendly information and magazines could also provide a welcome distraction in an overflowing waiting room.

Open for business
One of the main barriers to more men accessing primary care services is opening hours. Standard opening hours seriously disadvantage men, especially blue collar workers, many of whom risk losing a day's pay for clocking off to visit the doctor.
A few weeks ago, I was visiting a colleague at a Liverpool group practice, when it struck me that there was not one single man in the waiting room. In comparison, when I popped into the walk-in centre next door, the opposite was the case – there was not a single woman in sight (apart from behind the receptionist's desk, of course). This supports my theory that extended opening hours, more anonymous and "no appointment necessary" services can make a significant difference when it comes to catering for the needs of men.
However, male take-up of walk-in centres and other such services still leaves a lot to be desired. Men lack a biological mechanism that regularly and naturally makes them feel aware of, and in touch with, their bodies. What's more, men's reproductive systems don't require them to maintain any regular contact with healthcare services. They do not need to see a doctor to obtain contraception and, of course, they cannot get pregnant. This all means that even the more open-minded man will not have grown up with much experience of using primary care services. So, in late middle age (when heart disease poses the greatest risk to men), he may delay seeking medical advice.

This is why the focus needs to be on not only improving access to traditional, mainstream primary care services, but also embracing initiatives that will actually make a difference. A one-size-fits-all approach for both men and women will add little.

Primary care professionals have a significant role to play in preventing public health problems, such as drug and alcohol misuse, poor diet and smoking, from becoming serious medical issues. It might be lifestyle-based initiatives that, alongside traditional screening clinics, can help to encourage men into the system in the first instance.

MOT checks for men or health improvement campaigns on lifestyle issues can be delivered in local heath centres, in the workplace, at the pub or in the home. The key theme here is to encourage men to make better use of the widest possible range of services.

A colleague of mine, Jim Leishman, a charge nurse and men's health co-ordinator with NHS Forth Valley, has been involved in health assessment and health promotion clinics for men in Scotland since 2001. The clinics are based on 40-minute appointments with a community nurse trained in men's health issues. This system has been successful because the longer appointments offer time for real engagement, and lifestyle issues such as weight, stress and emotional health can be addressed alongside tests for the usual health indicators. Primary care nurses must use the communication skills for which they are known to engage with men and allow scope to explore other health issues.

An awareness campaign
This year's National Men's Health Week offers an opportunity for nurses to find out more about male health initiatives and take part in a local event. The Week runs from 15–21 June 2009 and will focus on men's access to primary healthcare. It aims to raise awareness of the need to improve outreach and provide men with the type of services that meet their needs and will also raise men's awareness of the different services and options available. Events will be taking place up and down the country at local, regional and national levels. I would urge nurses and health visitors to take an interest and support local events, organised by individual primary care or other health organisations, workplaces and community groups – and get involved.

Getting men into the system before it is too late will not only reduce the financial burden on the NHS in the future but will also help to improve health outcomes for men now. We all have a responsibility to implement
this change.

For further information visit: www.menshealthforum.org.uk or www.malehealth.co.uk

References
1. Office for National Statistics (ONS). Health Statistics Quarterly. London: ONS; 2008.
2. Office for National Statistics (ONS). Over a third of adults exceed regular daily drinking limit. London: ONS; 2009.