Let's hear it for the boy
A lack of health services specifically aimed at men has seen an increase in the health inequality gap, but pharmacy teams have a role in giving them a hand
Many GP practices run well woman clinics, which offer support for a multitude of problems including gynaecological issues and the menopause, alongside family planning and antenatal care, but very few offer clinics aimed specifically at men. According to the Men’s Health Forum (MHF), health services are still not effectively engaging with men, and men are less likely than women to visit their GP, attend an NHS health check, opt for bowel cancer screening, visit a pharmacy or take a chlamydia test.
Dr Jeff Foster, a GP with a special interest in men’s health, highlights that the NHS still has no specific provision for men, yet in every aspect of health, men do worse than women. “Men’s health training within the NHS is often minimal or absent and there is a need to make men’s health a subspecialty,” he says. “Men’s health is a good buzzword but nothing is really being done. There is deliberate targeting for women’s screening, such as breast cancer and cervical cancer, but not for men. It takes a change in attitude and a large financial investment.”
In February 2020, the MHF raised concerns that men’s sexual health could be about to “fall victim to the law of unintended consequences”. New plans for the National Chlamydia Screening Project in England will see screening targeted only at women, with services in community settings such as GP practices and pharmacies. Men will not be offered a test unless their partner has chlamydia or they are showing symptoms. However, there are often no symptoms, which means men can still pass the infection on to their partner or partners.
“We believe this change risks significantly reducing the amount of engagement by the health system with young men about their sexual health,” says Martin Tod, CEO of the MHF. “Not enough analysis has been done to understand the wider sexual health implications of this policy change – and to assess the role of the chlamydia screening programme within an overall sexual health strategy – particularly if the engagement by GPs and other health professionals with young men on sexual health issues is reduced by a significant degree and not replaced in some other way.”
Currently, there are no national men’s health strategies across the UK
Currently, there are no national men’s health strategies across the UK and there is a long way to go to bring men’s health into the forefront of health policy. An editorial in The Lancet in November 2019 stressed the importance of “raising the profile of men on the political agenda to achieve gender equality and to accelerate progress on all [health-related sustainable development goal] targets”.
“The MHF has been calling for a national men’s health policy for a number of years,” says men’s health expert and former CEO of the MHF Peter Baker. “But a policy hasn’t been consistently advocated and needs an ally at senior level. A UK policy could ideally have achievable objectives around key health issues, such as smoking, obesity and mental health, taking proper account of the gender differences between men and women. There are interesting initiatives around the country but these are not consistent or part of an overall strategy.”
In October 2019, MPs from the Women and Equalities Committee called on the Government to give serious consideration to implementing a national men’s health strategy, with a particular focus on mental health and harmful gender stereotypes in schools and colleges. This was based on the fact that four in five suicides are by men, suicide is the biggest cause of death for men under 35 and there has been a sharp increase in the rate among men aged 35 to 64.
Following this in January 2020, the Health Inequalities Cross-Party Group in Scotland discussed men’s health inequalities. Martin Tod said at the meeting: “In the UK, nearly one man in five dies under the age of 65 and this is nearly one man in four in Scotland. According to data from the National Records of Scotland more men than women die within each age bracket recorded from the age of five to 89. Statistics also show that the gap in life expectancy between men and women has been narrowing; however, overall growth in life expectancy has been stalling for both sexes.”
Widening the scope
Many existing men’s health strategies focus on sexual health, prostate and testicular cancers and suicide. However, men are affected by a range of other health issues and inequalities. For example, men are slightly more likely than women to suffer from type 2 diabetes and are three times more likely to have a diabetes-related amputation. There is also clear evidence that specific services, such as weight management and mental health, need to be gender-specific to encourage more men to get involved. According to the MHF, over three-quarters of men are overweight or obese yet only 10 to 20 per cent of those on NHS weight loss programmes are men.
A national strategy needs to recognise that men cannot be viewed as a homogeneous group. Professor Will Nutland, a public health doctor at the London School of Hygiene and Tropical Medicine and co-founder of prepster.info, a grass-roots initiative focusing on the HIV drug PrEP, says there can be an embedded presumption in sexual health that people are talking about heterosexual men. “Men having sex with men have a higher risk of living with HIV than heterosexual men,” he says. “Some groups of men are less likely to access sexual health clinics and some may not even know what is available. Many of these men are from some African countries or are new to the UK. They are more vulnerable because they don’t understand how to navigate the health service or don’t speak English.”
Importance of investigation
The MHF calls for men’s health champions in local and national organisations – and in every GP practice – to improve provisions for men on the NHS. Ultimately, the aim is for men’s and women’s health to be treated on more equal footing. “If a man in in his 40s or 50s and feels tired all the time or has erectile dysfunction, this is often blamed on stress and his age, yet there could be serious underlying medical issues,” says Dr Foster. “If women are in their 40s or 50s and tired all the time with no sex drive and other symptoms, they may be tested for the menopause and other health conditions.”
Dr Foster works for the NHS but also runs a private men’s health clinic. “We offer a private multidisciplinary clinic, highlighting that men shouldn’t ignore their symptoms and assume these are normal for their age,” he says. “We provide an environment in which men don’t feel that their symptoms are embarrassing or abnormal. We look at the possibility of an underlying disease, not just poor lifestyle habits. We offer MOTs to pre-empt cardiovascular disease and diabetes and also check for testosterone deficiency. If a man has erectile dysfunction, we won’t just offer Viagra but will explore why this could be happening, especially because of its links with cardiovascular disease.”
Men are slightly more likely than women to suffer from type 2 diabetes
Online vs in-store
With few male-specific NHS services, Dr Daniel Atkinson, clinical lead at Treated.com, says it is understandable that some men may decide to use online sources or online pharmacies to get the help they need, but this can be a difficult field to navigate. “A simple Google search of symptoms could lead to an incorrect diagnosis, or incorrect information, if it comes from a source that has not been verified,” he says. “This is the same for ordering medication online – using an outlet that is trusted and certified is so important to ensure you’re receiving legitimate and adequate medication.”
In 2019, men’s health writer Jim Pollard of the Men’s Health Forum wrote about making community pharmacies more appealing to men. “Research found that about three quarters of women had visited a pharmacy to obtain medicine or ask for advice in the previous month compared to two-thirds of men,” he says. “If pharmacies have the space, offer diagnostic tests to attract men into the store – blood pressure, blood sugar, cholesterol etc. There is evidence that men like this approach and they certainly prefer walk-ins to appointment systems. Make it easy and make it normal.”
Professor Nutland says that community pharmacies are ideally placed to help remove the taboos on HIV and sexual health testing. “Use posters and information leaflets to show that the pharmacy team is open to different aspects of sexual health, or have rainbow badges or HIV ribbons,” he says. “Some people with HIV are being diagnosed too late because someone wasn’t brave enough to offer them an HIV test. Offer online and in-store HIV testing within the pharmacy to make this easier, especially in areas where there is known to be a higher incidence.”
Ireland was the first country in the world to adopt a National Men’s Health Policy, which ran from 2008 to 2013. The policy focused on three core areas – settings (e.g. workplace), populations (e.g. young men) and topics (e.g. smoking cessation) – and called for more strategies on reducing stigma and normalising taboo subjects such as depression and erectile dysfunction. This policy was then replaced in 2016 with a new action plan Healthy Ireland: Men Hi-M 2017-2021.
In 2015, Peter Baker, men’s health expert and former CEO of the MHF, carried out a formal review of the original Irish policy, looking at its impact alongside that of similar policies in Brazil and Australia. “The policy in Ireland was very successful, especially at a community level,” he says. “It had a big impact on training the health workforce, giving healthcare professionals insight into masculinity and men’s health issues, and also focused on research into engaging with men in different settings.
Australia’s National Men’s Health Strategy 2020-2030 was launched in April 2019. It built on the country’s National Male Health Policy 2010, outlining Australia’s national approach to improving health outcomes for all men and boys, particularly those at greatest risk of poor health. The five priority health issues within the strategy are: mental health, chronic conditions, sexual and reproductive health and conditions where men are over-represented, injuries and risk taking, and healthy ageing.
According to an editorial in The Lancet in November 2019, a recent strategy in Brazil has involved extending clinic opening hours so that men are encouraged to accompany their partners to antenatal appointments, which include a medical consultation specifically for the men. “The Australian policy takes a similar approach to the one in Ireland,” says Peter. “It looks at social determinates of health, such as education and employment, rather than taking a biomedical approach. This led to the development of the Men’s Shed project – the men’s health longitudinal study and work with aboriginal men. In Brazil, the policy is more focused on sending men to primary care services, mainly GPs and sexual health clinics.”