Dr. Steve Robertson Centre for Men’s Health Leeds Metropolitan University

1. What do we know about men and health and what are the implications for nursing practice and policy? Que savons-nous des hommes et de la santé et quelles sont les implications pour la pratique des soins infirmiers et de la politique? FERASI Lecture, Université Laval, Oct 2010 Dr. Steve Robertson Centre for Men’s Health Leeds Metropolitan University

2. Females are more likely than males to consult a GP – 16% of females and 11% of males did so in the 14 days before interview in 2004/05. Living in Britain, 2006 National Statistics

3. Percentage consulting with an NHS GP in the 14 days before interview by sex and age Living in Britain, 2002 National Statistics

4. Population with a regular medical doctor, by age group and sex (Percent) Statistics Canada http://www40.statcan.ca/l01/cst01/health75b-eng.htm

5. Place of most recent primary care contact by sex. Statistics Canada, National Population Health Survey, 1998-99.

6. Hospital stays in the 12 months before interview by sex and age, 2002 Living in Britain, 2002 National Statistics

7. Average number of consultations per person per year, by sex, age, and economic activity status Living in Britain, 2002 National Statistics

8. Kazanjian et al (2004) Health care utilization by Canadian women. BMC Women’s Health 4(suppl 1): S33

9. Do men have a problem going to the doctors? «Women were no more likely than men to consult a GP in the previous year when experiencing the five most common groups of conditions. In addition, women were no more likely than men to consult at a given level of severity for a given condition type.»Hunt K, Ford G, Harkins L, Wyke S. Are women more ready to consult than men? Gender differences in family practitioner consultation for common chronic conditions. Journal of Health Services Research & Policy, 1999; 4(2): 96-100. «A review of gender-comparative studies does not support the hypothesis that men are less likely than women to seek help when they experience ill-health.»Galdas P, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. Journal of Advanced Nursing, 2005; 49(6): 616-23.

10. Do men have a problem going to the doctors? Gender differences in use of health services in middle-aged and older Australians «The findings suggest men and women identify that they have a need for formal health care at similar levels of self-assessed ill-health.» Parslowet al (2004) Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians. Social Science & Medicine 59: 2121-2129

11. Do men have a problem going to the doctors? Men’s Health Survey – Foundation 49 December 2008 • On-line survey completed by 2,046 men • 70% of men had a health check in the last 2yrs though 24% had not had one in the last 4yrs • 82% of men said they would have a health check if their employer organised it. • 73% of men said they talk about health with friends & family. Social gatherings, family functions and work were the top 3 places where these conversations took place. • The biggest factor that would encourage men to attend a health check was having a doctor they could trust.

12. Research area – North West of England Blackpool

13. Qualitative study- combination of focus groups and interviews Interview Respondents All aged 27-43 years 7 Gay men 6 Disabled men 7 CABS (contingently able-bodied & straight) 7 Community health professionals

14. Blokes don’t care «Yeah, cause it’s important to women, but blokes don’t really bother about it.» [Quinn DM2] «I think it’s, it’s not even an attitude, it’s a non-attitude towards health. They [men] don’t see it as a problem. I don’t think they think that going out and having a binge on Friday night’s a problem.» [Martin CABS3]

15. …. Well maybe a bit. «Generally, smoking, drinking, drugs, if your doing it then obviously you should know what your limit is» [David, GM1] «I do keep fit. Um don’t drink too much, don’t smoke too much, well I probably do at times [laughs]. Watching what I eat to a certain extent, eating fruit and vegetables. Um, so keeping fit, eating healthily and not living life in too much of an excess.» [Martin, CABS3]

16. Moral imperative? SR: «What does health mean to you?» Neil: «It does mean a lot, but I don’t tend to it as much as what I should do.» [Neil, GM5] Dichotomy Don’t care Should care

17. Frank:«If you enjoy a burger, eat it. If there was a salad I didn’t enjoy, and a burger that I would enjoy that was going to do me more harm, I’m sorry but I would eat the burger. I think you have to be a bit sensible, you can’t be totally brash, you have to be sensible and responsible to a point.There is a point and once you get past that point you are being silly again. Some people are too careful, that’s not me.» SR:«So it’s a balance?» Frank:«Yes, you’ve got to get it right.»

19. Responsibility «It’s like your car, if there is nothing wrong with it you can’t fix it. If there’s nothing wrong with you then you are just wasting the doctors time when they could be looking after someone that is ill. Every time you go to the doctor there is a waiting list. They could be sorting someone out who is ill, someone who needs an emergency appointment, and you go in and there is nothing wrong with you. I look at it, the less I go to the doctor, the better of everyone else is that’s ill, I’m not wasting his time.» [Hugh, CABS2]

20. Responsibility SR:«Do you think that the health service has a responsibility to help you stay well?» QUINN:«No, I think it should be like it is. If you injure yourself then you go and get sorted, but it’s not down to them to make sure you’re all right in everyday life. It’s down to you.» [Quinn, DM2] «I think it’s [NHS] got a responsibility to get you well, but it doesn’t have a responsibility to keep you well, that’s down to yourself.» [Frank, DM6]

21. Importance for practice - Legitimation 1) Life stages or changes 2) Family history 3) Concern of family members 4) Non-gendered aspects of identity 5) Health setting

22. 1) Life stages or changes «I was one of the beer drinkers not long ago but now things have changed. We still enjoy ourselves but we take it easy as well until she’s [their baby] of an age where she can look after herself. I want to know I am able to deal with any emergency that may occur.» [Owen, CABS5]

23. 2) Family history «My father died of skin cancer when I was young. So I always get me mum, if I’ve got a scratch on me back I think “is that a mole”, I always get me mum to check that out, she says, “right you ought to go and see a doctor”. So certain things like that I’m very cautious about.» [Martin, CABS3]

24. 3) Concern of family members «Jane [wife] phoned up to make the appointment, she always phones the doctors and tells me when I have to be there . . . I’m not very good at that sort of thing.» [Hugh, CABS2]

25. 4) Non-gendered aspects of identity «I think gay men are more aware of their health than straight men – on the whole I think that gay men are more health conscious» [Gary, GM3] «I think since I’ve been in the chair, I’ve watched what I’ve eaten because I can’t lose it [weight]. I’m worried about getting a belly and not being able to get rid of it.» [Peter, DM1]

26. 5) Health setting «You read in the paper about setting up healthsurgeries in pubs, a load of rubbish, men are just going to stand there and laugh at them with a beer. I can’t see that sort of thing of working at all [. . .] Your pub is your greatest escape, you don’t want to be told that you are ill, you just want a few drinks with your mates and a good laugh.» [Martin, CABS3]

27. 5) Health setting «Workplace I think would be a good idea as a way of targeting people. Provide some incentive for the company to do that for the workers; exercise programmes and health checks. Sort of, you know, an hour off. But I suppose the bosses would have to have an incentive to hold that sort of thing anyway, money is the only thing that talks in business!» [Gary, GM3]

28. 5) Health setting SR:«Where, do you think men would feel safe going with health issues?”» Martin:«I think the telephone would probably be one of the only ways men would do it. They feel a bit more secure over the telephone, they don’t have to talk to someone about it directly, so the telephone, even the Internet I guess. I think it’s because its an anonymous thing.» [Martin, CABS3]

29. Importance for policy (1) Initiatives need to be encouraged that take men’s health promotion outside the NHS SR:«Do you think the NHS should have a role in helping men stay well?» Bob:«Yes, fantastic as another part to the service yes, because it’s a fabulous service [NHS] it really is. As another part of it yes, If there are the resources to do it, without affecting current services then yes. But are they not stretched a little at the moment, I think so!» [Bob, CABS6]

30. Importance for policy (2) There needs to be full evaluation of innovative services both in terms of process (did they manage to engage with men) and outcome (did they improve the health of men) «Outreach services need to be more fully evaluated in terms of whether they create enduring positive health practices that benefit men and those around them.»Robertson, S. Williamson, P. (2005) Men and health promotion in the UK: Ten years further on? Health Education Journal 64(4): 293-301

31. Dr.Steve RobertsonReader in Men’s HealthCentre for Men’s HealthLeeds Metropolitan University Leeds LS2 8AJ UK email: s.s.robertson@leedsmet.ac.uk