‘Men have long been forgotten in the provision of primary healthcare services’

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Let me ask you this. When did you last invite a man under 50 into your surgery to discuss areas of health that might affect him in the future?

Having been involved in the promotion of men’s health for over three decades, I find it disappointing that there remain very few specific male health services set up in primary care. It seems men have long been forgotten in the provision of primary healthcare services. This is despite men in general being much more likely to die from strokes, heart disease, cancer, respiratory disease and most other major diseases.

In addition, men are much more likely to develop heart disease at a younger age (Leening et al, 2014), have avoidable accidents from risk taking and are three times more likely than women to take their own life. Suicide remains the largest cause of death for men aged 20-49, with men aged 45-49 having the highest rate (Office for National Statistics, 2022).

While many diseases cannot be prevented, early detection is paramount to improved outcomes.

“No one has probably ever discussed this with them, so how would they know what to look out for if their prostate becomes enlarged?”

The lack of men’s health services may, in part, be due to primary healthcare historically being set up to focus on maternal and child health, but surely, after 75 years of the NHS, we should start to rectify this.

With around 98% of primary care nurses being female (Queen’s Nursing Institute, 2015), it is little wonder that many of the health promotion services on offer tend to promote women’s health issues, such as menstruation, smears, family planning, breast awareness, maternity and menopause. These services give women the opportunity to discuss their health and, conversely, give the health professional the chance to discuss and impart health advice.

However, for many men there is no equivalent opportunity. It is likely that the first time men engage with a health professional is when they become ill. So how are they expected to know when to examine their testicles, what their blood pressure is, what to expect when they are having a heart attack, or what signs and symptoms of colon or prostate cancer are?

Having run men’s health services in many non-clinical places over the years, including pubs, barbers’ shops, Harley Davidson showrooms, fishing fairs, crown green bowling clubs and motorway service stations, I am forever amazed at how interested men are in their health when given the opportunity to discuss it.

Men are often surprised to hear that testicular cancer is a young man’s disease and that it is 95% curable if detected early. Even though, by the time men reach 60, around half will have experienced some discomfort from their prostate gland, rising to 80% by age 80, many will have no idea where their prostate is, nor what it does.

Why should they? No one has probably ever discussed this with them, so how would they know what to look out for if their prostate becomes enlarged? Few men realise that being overweight or obese can lead to type 2 diabetes, musculoskeletal problems, erectile dysfunction and increased risk of heart disease and certain cancers.

My own father had chest pain for five days before having his first heart attack aged 45. He had no idea what signs to look out for, or when to seek medical advice. Although he survived his heart attack, he sadly died aged 62 from undiagnosed prostate cancer that had spread to his bones. The first time he reached out for help was when he could no longer pass urine.

We should all start to reflect on our practice and ask ourselves if we can make changes in the way we engage with our male patients. Perhaps you could invite men in on their 30th birthday to discuss their health and wellbeing with a nurse, and again on their 40th birthday to see what changes may have occurred over the decade. I know many of you will be wondering how on earth you might fit this into your already overloaded surgeries, but maybe preventing an illness in a patient will actually free up time in the future.

If we are to save the NHS from the rising costs of healthcare, it is crucial that we start to focus on preventing illness.

We need to address the gaps in men’s health, increase awareness of male issues, and tailor our services to encourage men to access primary healthcare before they become too sick.

Jane DeVille-Almond is an independent nurse consultant

References

Leening MJG et al (2014) Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ; 349: g5992.

Office for National Statistics (2022) Suicide in England and Wales: 2021 registrations. ons.gov.uk, 6 September (accessed 2 April 2024).

Queen’s Nursing Institute (2015) General Practice Nursing in the 21st Century: A Time of Opportunity. QNI.

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