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Doing it for the boys

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Doing it for the boys

In the UK, the life expectancy of men is lower than that of women, but there is no biological reason for this. Raising awareness of male health issues could start to address this imbalance

Have a think about the customers who come into your pharmacy. Chances are they fall into distinct groups, such as the mums with pushchairs and the older patients with their repeat prescriptions. But how many men aged between 18 and 65 do you see? It’s likely that – other than the odd dad who dashes in for a prescription for his wife or one of his children, and a few smokers seeking advice about giving up – it isn’t very many.

The lack of men accessing health services doesn’t stop at the pharmacy door. Other than the very old and the very young, men are less likely than women to visit their GP, and this has been linked to their higher usage of hospital services. What’s more, men are twice as likely as women to take a new prescription medicine without first reading the information leaflet or seeking professional advice, yet their understanding of medicines is generally poorer.

A recent survey by TENA Men also revealed that one in two men will not talk about their health concerns and one third choose to ignore feeling ill rather than seek medical attention. The problem seems ingrained, so much so that it could be attributed to the Y chromosome that only men possess.

So what has led to this inequality in health literacy between the sexes? It is difficult to pinpoint a definite cause, but possible factors could be the widely held view that health is a feminine subject, which leads to men playing down any concerns they might have or attributing potentially serious symptoms to ‘getting old’, and subconsciously rejecting interventions because of fears that it undermines their masculinity.

Risk-taking behaviour is more common in males than females, and this goes much further than embarking on extreme sports and frequenting the bookies. Men are much more likely than women to make unhealthy lifestyle choices in terms of smoking, drinking alcohol, having a poor diet and not getting enough exercise. Put all of this together, and it is a potent – and unhealthy – combination.

Drawing men in

So what can pharmacy do to address this issue? Sandra Gidley, current member of the Royal Pharmaceutical Society’s English Pharmacy Board and a former MP with shadow ministerial positions within health and equality, is well placed to comment. Sandra says: “The first thing is to work with what you have got. The dads who come in needing something for their children are a good example. While they may appear to be in a hurry, if you provide them with good advice, it will sink in and they are likely to then come back because they realise that the pharmacy is a good source of knowledge.”

Pharmacy staff need to be aware of conditions that men are more likely to seek advice about, and seize the opportunity to offer related lifestyle advice, adds Sandra. “Indigestion is a good example,” she says, “because it presents the chance to talk about how symptoms can be linked to smoking, drinking and dietary choices in a chatty way that won’t make men feel as though they are being lectured.”

Rigidly sticking to the WWHAM protocol is not the best way of gaining additional information, she points out, explaining that it can be more productive to use the questions as the basis for a conversation (see overleaf).

However, as a trustee of the Men’s Health Forum, the organisation that works to promote understanding of health issues that affect men and boys in England and Wales, Sandra warns of the dangers of adopting a ‘one size fits all’ approach. “Just as we know that not all smokers need the same support when trying to give up, remember that not all men are the same,” she explains. “Somebody with an entry level job who doesn’t get any exercise may have the same health issue as a man in a professional role that involves sitting down at a desk all day, but the two cases require very different handling.”

Sandra states that expecting men to make wholesale changes to their lifestyle as a result of coming into a pharmacy is somewhat unrealistic, pointing out: “it is much better that they make one small change that they can sustain”. Examples could include not drinking alcohol every night or walking instead of driving to the pharmacy or GP surgery the next time they visit, she suggests.

For the men who don’t come into the pharmacy, it is worth making the effort to go to them. There have been successful schemes over the years involving pharmacists and their staff going into male-dominated environments such as gyms, working men’s clubs, colleges and pubs. Even making sure your pharmacy leaflet is prominently displayed in these places is a great way of raising awareness of services such as health checks, travel clinics and flu jabs. The same goes for offices, but don’t forget about homeworkers and hot deskers – a spot on a company’s internal website will ensure it is seen by everyone.

Getting serious

Unfortunately, the gender spilt is not restricted to ‘lifestyle’ health conditions such as smoking, diet and drinking. A report published last year revealed that men are over 35 per cent more likely to die from cancer than women, with men aged under 65 years at particular risk. Even more starkly, once sex-specific cancers such as prostate and ovarian were removed from the analysis, men were shown to be 67 per cent more likely to die.

Awareness, not just of cancer symptoms but also of measures that can be taken to reduce cancer risk, is vital. Among the best known campaigns in the UK are National Men’s Health Week, which launched in 2002 and focuses on a different health issue each year, and Movember, which hit the UK in 2007 and aims to raise awareness and funds for prostate and testicular cancer. These initiatives certainly have an impact, encouraging men to talk about health issues and address the risks they face, as well as to seek medical check-ups and help.

Pharmacies have a role to play in promoting these campaigns, and doing what they can to raise awareness of men’s health issues. Putting information about sexually transmitted infections next to the condom fixture is just one small tweak that can make a difference, as can regularly reviewing the leaflets available to ensure the topics covered are not limited to childhood ailments, women’s health and conditions such as diabetes. Sandra points out that while women may make up the customer base of pharmacies, they may well have concerns about the health of a man they live with or are close to, and an information leaflet can be a good way of broaching what can be a tricky subject.

Embracing technology

Sandra hopes that the recent surge in technological advances will improve health literacy among men. “Everybody has a smartphone these days,” she says, “which means men can – quietly and without drawing any attention – look up symptoms they are concerned about. But tablet computers are also incredibly useful in the pharmacy.”

Diagnosing rashes is a great example of making good use of the internet, says Sandra, adding that it also provides an opening to discuss treatment or referral options with hard evidence – literally – in your hand.

However, the internet can also be a dangerous place. Type something innocuous like “back pain” into a search engine, and the results will range from the practical to the downright dangerous. Yet again, there is a role for pharmacy here, this time in highlighting websites that provide reliable information, ideally backed by evidence. A good starting point is the Men's Health Forum and NHS- Men's health.

A burgeoning area is apps for smartphones and tablets. Although popular, Men’s Health Forum external affairs manager Colin Penning highlights the fact that many men’s health apps are sport and fitness focused rather than health focused. He suggests looking at the Health Apps Library on the NHS Choices site at: http://apps.nhs.uk/

A good rule of thumb is to check whether a health website conforms to NHS England’s Information Standard. Organisations that have signed up to this programme are required to undergo a rigorous assessment to check that the information they produce is clear, accurate, balanced, evidence based and up to date.

Tackling tough issues

While embarrassment about sexual health problems on the part of both health professionals and the public is – largely – diminishing, there is still one topic that many men find it difficult to discuss: mental health. And the statistics are alarming. Take suicide rates. More than three quarters of those who kill themselves are men and one in seven men are likely to develop depression within six months of being made redundant. In the current economic climate, this is cause for concern.

While men and women experience mental health problems in approximately equal numbers, men are much less likely to be diagnosed and treated. Again, the reasons for this are complex, but male pride is thought to be at play, alongside the fact that men tend not to have the social network that women often manage to weave around themselves, and therefore don’t feel they have anyone to turn to.

Diagnosing mental health disorders in men can be tricky, as they tend to exhibit different symptoms to their female counterparts. A woman, for example, may recognise her persistent low mood as an issue and visit her GP, who will diagnose depression. Yet in men, the same condition may present with completely different symptoms, such as tiredness, headaches and a sense of isolation. They may be irritable, aggressive or abusive, and engage in risky behaviour such as heavy drinking.

Being aware of these nuances, and having a sensitive and non-judgemental attitude when dealing with patients, and being able to thoughtfully signpost to the appropriate healthcare professional can be all the encouragement a man needs to recognise there is an issue and seek help. It is also important to remember that men who are caring for someone with a health problem – whether mental or physical – may find themselves struggling, and may need to be persuaded to look after their own needs as well as those of their loved ones.

 

Creative questioning

There are certain products and conditions that can be linked to other health topics. Some are obvious, others less so. Here are some examples:

Athlete’s foot – someone describing the symptoms of this condition or who is buying a related product can be led into a conversation about fitness, which in turn provides a great opportunity to talk about recommended activity levels (adults aged 19-64 years should do at least two and a half hours of moderate intensity aerobic exercise such as cycling or fast walking every week, plus muscle strengthening activities such as weight lifting or heavy gardening on two or more days a week)

Vitamin and mineral supplements – anyone browsing these fixtures is likely to be open to advice about products and may be interested in advice on healthy eating and a balanced diet

Bowel health products – most people suffer the odd bout of diarrhoea or constipation every now and then, but it is worth asking if the customer is experiencing any other symptoms, no matter how unrelated they may appear. For example, tiredness and fatigue can be signs of anaemia, which in turn may point towards bleeding inside the digestive tract. Similarly, bloating and pain around the belly button can indicate a bowel obstruction, which can occur in bowel cancer

Hair loss – male pattern baldness is hereditary, but someone who jokes that it is due to their stressful lifestyle provides the perfect route in to talk about ways of reducing stress levels through exercise and meditation

Incontinence supplies – while these may be seen as women’s items, men do suffer with the problem as well, and it is more common with age. It is worth taking the time to explore the exact nature of the problem because dribbling and needing to go to the toilet more during the night can be symptoms of benign prostatic hyperplasia (BPH).

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