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Monday 27 March 2023 Dublin: 8°C
Opinion Should we rethink how we approach men's healthcare?
RCSI Professor Dr Seamus Cowman looks at the trajectory of understanding of men’s health in Ireland.

THERE MAY BE a grain of truth in the anecdote that ‘some men take better care of their cars than their bodies’ and the morbidity and mortality statistics provide some support to the contention.

Men in Ireland die, on average nearly four years younger than women and have higher death rates at all ages, and for all leading causes of death.

Evidence of sex differences in the incidence, symptoms and prognosis of a wide range of health problems is documented. It is suggested that in Ireland excess mortality amongst males represents a fundamental inequality in health.

Quite correctly, women’s health has been the source of extensive consultation and careful strategic planning (for example, Breast Check and the Irish Cervical Screening Programme). The Island of Ireland has three national cancer screening programmes (breast, cervical and bowel), of which, only bowel cancer screening is available to males.

In Ireland, prostate cancer is the most common cancer among men in Ireland and the country also has the highest incidence rate for prostate cancer among the EU countries. PSA screening is used widely in the diagnosis of prostate cancer, and it is suggested that with more extensive use, more early stage prostate cancers, may be detected and managed in a timely approach.

There is no national PSA screening programme for men either in Ireland, or indeed internationally, and there are no recommendations emanating from Ireland, the WHO, or health organisations in the USA or Europe for such a programme.

Shift in focus

In Ireland men’s health was not a focus of any major strategic thinking until the launch of the Report from the Men’s Health Forum in Ireland (MHFI) in 2004, which coordinates activity on the island of Ireland. In recent years, MHFI has focused on important policy initiatives, however, the organisation is heavily reliant on the goodwill of volunteers.

Consistent with other European countries a ‘Men’s Health Week’ is held in Ireland in June each year. However, in Ireland, overall national efforts in promoting men’s health are rather fragmented and incoherent and there appears to be a lack of sustained effort and national visibility aimed at increasing awareness of preventable health problems and promotion of health in men of all ages.

Compared with females, males have lower rates of help-seeking behaviours, including lower usage of health care services and consulting with health professionals. Many men fail to get medical attention when sick or in pain and often present at health services in a more advanced stage of disease.

Gender norms are important factors for explaining differences in the use of health care services amongst males and females, and the limited research on men’s health suggests that such behaviours relate to masculine norms, attitudes and behaviour, which expect men to be strong, independent and unconcerned by pain or minor health problems.

Understanding the health of men

In the organisation of health services and the promotion of health it is claimed that there remains a fundamental lack of understanding and clarity on the meaning of ‘men’s health’. The term itself suggests, homogeneity of men’s health issues, whereas, in reality, huge diversity exists between different groups of men.

Internationally there have been efforts to increase health promotion programmes focused on reducing male risk factors such as unhealthy diets, substance use, suicide, smoking, and sedentary lifestyles. It has been found that engaging men with self-health have highlighted the need for gender–sensitised health promotion programmes.

The four main causes of death among males across the Island of Ireland are invasive cancers, circulatory system diseases, respiratory system diseases, and external causes of injury and poisoning. In focusing on mortality, morbidity and health services usage, gender differences become apparent in Ireland.

The incidence rate for all invasive cancers (excluding non-melanoma skin cancer)  is higher for males than for females. The mental health of men in Ireland is of concern, and the link between mental health and physical health is recognised. More males than females die by suicide, and there is a trend of increasing self-harm by men involving drug overdoses, alcohol and other physical harming. Men aged 18 years or over engaged in binge drinking at least once a week and this is the highest rate in the EU. The majority of domestic abuse offenders are male. Males also form the majority of persons in prison and compared with the general population, prison populations have poorer physical, mental and social health.

As far back as 2005, the Vienna Declaration, called upon European countries to recognise men’s health as a distinct issue, and to invest in ‘male sensitive’ approaches to providing health care for boys and young men in school and community settings. In 2018 a WHO strategy for the European region aimed to improve men’s health and well-being through evidence-informed, gender-responsive and equity-driven approaches that transform the gender roles, norms and structures with gender equality and health equity achievements in Europe.

In Ireland there is very little reflection of the WHO strategy, and at this point, there are no quick fixes to improving male health, as this requires changes at personal, societal and policy level. A coordinated approach should include the many small associations/groups representing men. There needs to be political will and targeted funding with monitoring and evaluation. New education programmes in men’s health, for health professionals are essential, with an aim to focus actions on men’s health, including positive health behaviours.

Finally, men must take more responsibility for their own health and the words of Jim Rohn, American Entrepreneur and author must be the mantra:

‘Take care of your body it’s the only place you have to live’.

Dr Seamus Cowman is Professor Emeritus, RCSI University of Medicine and Health Sciences.

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