Download - Men's Health Manifesto
November 5th, 2014
• Charity that works to improve men’s health services and the health of men and boys in England and Wales
• Founded in 1995 by the RCN
• Works in partnership with universities, companies, other charities, local authorities, PHE, NHS England and DH
• Provides secretariat to APPG on Men’s Health
39.1%
Male deaths – under 75
25.0%
Female deaths – under 75
Source: ONS 2014, England & Wales
19.6%
Male deaths – under 65
12.0%
Female deaths – under 65
Source: ONS 2014, England & Wales
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
Life Expectancy at Birth – 1980-2012
Male Female
Male
Female
Source: ONS 2014, England & Wales
3,130
2,335
981
1,746
2,004
804
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Circulatorydiseases
Cancer Respiratorydiseases
Male
2002 2012
1,945
1,635
675
1,118
1,471
581
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Circulatorydiseases
Cancer Respiratorydiseases
Female
2002 2012
Source: ONS Age-standardised mortality rates (ASMRs) per million population
273 884 3,458 10,284
30,990
81,066
111,553
203 509 1,690 6,561
21,550
61,533
165,737
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
1-4 years 5-19 years 20-34 years 35-49 years 50-65 years 65-79 years 80+ years
Number of male and female deaths by age
Men Women
Source: 2012 Mortality Statistics. ONS 2013, England & Wales
• Male-targeted organisations• Prostate Cancer UK
• CALM
• GMFA
• Survivors UK
• Working With Men
• Centre for Men’s Health, Leeds Beckett University
• General organisations• Diabetes UK
• Centre for Mental Health
• Action on Smoking and Health
• Alcohol Concern
• PSHE Association
• Face up to the reality
• Invest in research
• Focus on prevention – no let-up on the big killers
• Don’t wait for men to engage – especially on mental health
• Remove the barriers to using health care, mental health and preventative care – especially for men of working age
• Reach out proactively
• Make the most of it when men do come to you
• Design targeted programmes around the needs and attitudes of the highest risk men & boys
• Tailored health awareness and literacy, especially amongst boys
• Organisational focus across the whole health system
Male71%
Female29%
CVD deaths under 65
Male44%
Female56%
NHS Health Checks
ONS, E&W, 2014 MHF FoI, sum of 51 LAs where data available, 2014
16%
1%
48%
35%
% collecting gendered uptake data on NHS Health Checks
Didn't answer
Estimated
Gendered data notcollected
Data available bygender
Source: Men’s Health Forum FOI Requests, 2014
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Lam
bet
h &
So
uth
war
k (M
HF)
Hill
ingd
on
No
rfo
lk
Suff
olk
East
Su
ssex
Ric
hm
on
d U
po
n T
ham
es
Ho
un
slo
w
Dar
lingt
on
No
rth
Eas
t Li
nco
lnsh
ire
Cen
tral
Bed
ford
shir
e
Lew
ish
am
Bar
kin
g an
d D
agen
ham
Bla
ckp
oo
l
Bir
min
gham
Kir
klee
s
Wo
rces
ters
hir
e
Sto
ckp
ort
Wig
an
Bre
nt
Surr
ey
Isle
of
Wig
ht
Win
dso
r &
Mai
den
hea
d
Lan
cash
ire
Sun
der
lan
d
Wes
t B
erk
shir
e
Cu
mb
ria
Bu
ckin
gham
shir
e
Ply
mo
uth
Sutt
on
No
rth
So
mer
set
East
Rid
ing
of
York
shir
e
Der
by
Solih
ull
Sto
ckto
n
CTR
L F
Tam
esi
de
Bar
ne
t
Har
tlep
oo
l
Co
un
ty D
urh
am
Bra
dfo
rd
No
rth
Lin
coln
shir
e
No
rth
Tyn
esid
e
Wo
lve
rham
pto
n
Lin
coln
shir
e
No
rth
Yo
rksh
ire
Cam
bri
dge
shir
e
Gre
enw
ich
Staf
ford
shir
e
Ne
wca
stle
-Up
on
-Tyn
e
% gendered data in JSNA
Source: Men’s Health Forum – analysis of 143 JSNAs, 2014
Face up to the realityMore measurement and reporting against inequalities to tackle ‘hidden failure’
• Ensure all data at all levels are fully and relevantly disaggregated – including health checks, screening, access to psychological therapies (IAPT) – by gender –cross-referenced also vs. deprivation and other protected characteristics – age, ethnicity, sexuality etc. – and male-relevant measures such as work status
• Fill gaps where data are not collected or where men under-report, such as sexual violation and mental health
• Inspection bodies (e.g. CQC) to assess outreach & access as well as service delivery by gender – and report by gender
• [Locally] Go beyond the difference in life expectancy in local JSNAs – use all available data
• [Locally] Council ‘scrutiny’ of local men’s health
• [Locally] Track progress and delivery of local public health programmes amongst men and boys
Men27%
Women73%
Last 5 years of MRC funded projects
MRC-funded projects making explicit reference to ‘men, women, boys or girls (2009-13)
0
5
10
15
20
25
30
35
40
1999 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MRC funded projects by gender
Men Women
2.89
1.65 1.58 2.01
1.70 1.92
1.53 1.62 1.42 1.54
2.89
1.27
2.21
-
0.50
1.00
1.50
2.00
2.50
3.00
3.50
Male to female cancer mortality ratio (all ages)
Source: CRUK, Mortality rate ratios are European age-standardised, of male to female cancer mortality (excluding NMSC), UK, 2010.
Invest in researchNational Institute for Health Research and other national research funders to invest in research into knowledge ‘gaps’ on causes, good practice and health economics of
• Men’s mental health & wellbeing – especially for those with a dual diagnosis of substance abuse and mental health problems
• Cancer – with focus on the excess burden of cancer in men – and including interaction with wellbeing and mental health
• Other conditions with excess male incidence – such as motor neurone disease, tuberculosis and mesothelioma
• Interventions and services that work for weight management and behaviour change – including diet and eating disorders
• Engagement with primary care, mental health, preventative services and screening – including trials of men’s drop-in clinics
• Self-management of long-term conditions
• Erectile dysfunction – especially clarifying care pathways
22
19
0
10
20
30
40
50
60
1974 1978 1982 1986 1990 1994 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Men Women
General Lifestyle Survey and Opinions and Lifestyle Survey, England, Office for National Statistics licensed under the Open Government Licence v.2.0.
52
38
73
66
24
7
2
0
10
20
30
40
50
60
70
Packeted Hand-rolled Both - mainly packeted Both - mainly hand-rolled
Men Women
Opinions and Lifestyle Survey, England, Office for National Statistics licensed under the Open Government Licence v.2.0. 2012
0
10,000
20,000
30,000
40,000
50,000
60,000
Under 16 16 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75+
Alcohol-related NHS hospital admissions (wholly attributable to alcohol)
Male Female
Ho
spit
al E
pis
od
e St
atis
tics
, Hea
lth
an
d S
oci
al C
are
Info
rmat
ion
Cen
tre,
En
glan
d -
Dat
a fo
r to
tal n
um
ber
o
f ad
mis
sio
ns
for
each
ICD
-10
co
de.
20
12
/13
24.4
66.6
25.1
57.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Men - Obese Men - Overweight including obese
Women - Obese Women - Overweight including obese
Sou
rce:
Hea
lth
Su
rvey
fo
r En
glan
d 1
99
3-2
01
2
5
78
213 224
252
285
367 372
311
250
169
126
81 65 59
43
15 6
1 17 34
57 60 51
75
100 90
67
53
37 27 26 29 16 7 3
-
50
100
150
200
250
300
350
400
1014 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95+
Male Female
Source: 2012 Mortality Statistics. ONS 2013
Focus on prevention: no let-up on the big killersContinue to focus on male-tailored interventions to tackle the primary causes of the biggest killers: CVD, cancer and mental health• Smoking – via plain packaging and full implementation of an updated DH tobacco
action plan – with specific action on roll-ups• Drink – incl. via minimum unit pricing, restrictions on promotion and more
informative packaging – tackling affordability, availability and attractiveness of alcohol products to men
• Obesity – incl. via male-tailored weight-loss programmes, increased food literacy and more focus on out-of-home and workplace eating
• Mental health – recognising that men are four times as likely to take their lives as women
• Drugs – men are nearly three times more likely to die from overdoses as women• Sedentary lifestyle, lack of exercise and inactivity - lifestyle – men may be more
active than women but too few get the recommended minimum levels of exercise
• HPV – extend vaccination to boys• Social determinants such as unemployment, deprivation, educational
underachievement and poor housingSupport a pro-health environment, food and drink culture – making it easier to have a healthy life
Wang Y et al. BMJ Open 2013;3:e003320©2013 by British Medical Journal Publishing Group – UK GP data
2,587
11,573
530
1,546664
7,449
757
5,183
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Self-employedfull-time
Employee full-time
Self-employedpart-time
Employed part-time
‘00
0
Men Women
Source: ONS, Labour Force Survey, UK, Feb-Apr 2014
MEN
1.0%
3.6%
10.0%
57.1%
28.3%
Less than 6 Hours
6 up to 15 hours
16 up to 30 hours
31 up to 45 hours
Over 45 hours
0% 20% 40% 60%
WOMEN
2.2%
10.3%
31.0%
45.7%
10.7%
0% 20% 40% 60%
Less than 6 Hours
6 up to 15 hours
16 up to 30 hours
31 up to 45 hours
Over 45 hours
Source: ONS Feb-Apr 2014
Male80%
Female20%
Suicide
Male36%
Female63%
DK1%
IAPT referrals
Don’t wait for men to engage – especially on mental health
Remove the barriers to using health care, mental health and preventative care – especially for men of working age
• Fix opening times and access for full-time workers
• Improve online access, booking and other interaction
• Stop using drug or alcohol problems as an barrier to mental health treatment – invest in integrated care for dual diagnosis
• Deliver on the recently announced access & waiting time standards for mental health
• Tackle stigma and discrimination, especially in the workplace and especially for men with stigmatised problems such as mental health, eating disorders, breast cancer and sexual violation
• Greater use of self-help groups and peer-led services
Don’t wait for men to engage – especially on mental healthReach out proactively
• Take services to where men are: workplaces, online, pubs, sports grounds, betting shops, prisons etc.
• Where it’s not already happening, extend occupational health to include screening and preventative health measures
• Create a ‘Mental Health Diversion Duty’ in the criminal justice system and emergency care – intervening more effectively to reduce the number of people arrested under Section 136. Deliver national coverage by 2017
• Increase health check outreach and uptake amongst men
• Start bowel cancer screening earlier, especially for higher risk men, including MSM
Make the most of it when men do engage with health services:
• Include cancer symptom awareness, mental health, sleep apnoea and erectile dysfunction in health checks
• Special focus on high-risk infrequent attenders
• Co-design new services with men
73.8
76.077.1
78.379.2
79.980.8 81.4 81.8
82.979.0
80.681.4
82.383.1 83.4
84.1 84.485.0
85.9
66.0
68.0
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
86.0
88.0
1 2 3 4 5 6 7 8 9 10
Life Expectancy
Male Female
Source: ONS, Inequality in Healthy Life Expectancy at Birth by National Deciles of Area Deprivation: England, 2010-12
79.1
74.0
82.9 83.0
79.5
86.6
66.0
68.0
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
86.0
88.0
England Blackpool / Manchester East Dorset / Purbeck
Life Expectancy at birth – 2010-12
Men Women
Source: ONS
70.8% 73.3%
85.7%
72.6%63.1%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Full-time work Part-time work Unemployed Retired Student
% higher risk (2-4 risk factors)
Source: 2013 Street Survey, Lambeth & Southwark, Men’s Health Forum
24.4%
41.4%
20.0%
60.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Whiteemployed
Whiteunemployed
Black employed Blackunemployed
% current smoker
Source: 2013 Street Survey, Lambeth & Southwark, Men’s Health Forum
30.126.7
15.4
22.6
26.1
0
5
10
15
20
25
30
35
Full-time Part-time Unemployed Retired Student
Five or more portions fruit/veg per day
Source: 2013 Street Survey, Lambeth & Southwark, Men’s Health Forum
51.9% 52.5%
69.4%
39.8%
47.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Full time Part time Unemployed Retired Student
%
Source: 2013 Street Survey, Lambeth & Southwark, Men’s Health Forum
3.1
5.1
6.1
6.1
9.2
9.2
10.2
11.2
13.3
15.3
26.5
27.6
32.7
13.6
0 5 10 15 20 25 30 35
Sexual health
Obesity
Oral health
Addictions
Respiratory
Muscular skeletal
Other
Relationships
Diabetes
Heart conditions
Cancer
Depression
Stress
All
Unemployed
Source: 2013 Street Survey, Lambeth & Southwark, Men’s Health Forum
1 in 7 men may develop depression within 6 months of being
made redundant
Mind report, 2009
Unemployed All
Extra risk of death for unemployed men actively seeking work20%
cited in the HDA Evidence Review, 2005
800
155
0
100
200
300
400
500
600
700
800
900
Men Women
Extra deaths by suicide during 2008-2010 recession years
Preventing suicide in England: One year on, Department of Health, Feb. 2014
Rate of Heart Attack over time, by Employment Status
Du
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7.
Design targeted programmes around the needs and attitudes of the highest risk men & boys
Male targeting – esp. higher risk groups and stages of the life course – with particular focus on areas and transitions where groups have higher risk• Unemployed men• Men experiencing relationship breakdown• Men in the criminal justice system• BAME men – e.g. prostate cancer, mental health & diabetes• GBT+ men – e.g. sexual health, incl. chem-sex, and smoking• Male carers• Homeless men• Isolated older men• Young dads• Excluded boys
64%
55%
25%
5%
49%
37%
14%
22%
59%
54%
75%
72%
82%
34%
64%
51%
5%
48%
33%
71%
0% 20% 40% 60% 80% 100%
Arthritis
Bowel cancer
Breast cancer
Cervical cancer
Dementia
Lung cancer
None of the above
Osteoporosis
Prostate cancer
Skin cancer
Which of the following conditions, if any, do you think you know the symptoms of?
Male Female
Lower claimed symptom awareness
Populus survey on behalf of Saga – August 2013 – 11,729 men and women 50+
13%
23%
0%
5%
10%
15%
20%
25%
Total Usage of NHS Choices
Male Female
Base: All adults 16+ in England, NHS Choices Omnibus, January 2014
52%
59%
0%
10%
20%
30%
40%
50%
60%
70%
Know how to contact an out-of-hours GP service
Male Female
Base: GP Practice Survey. All adults 16+ in England, 2013-14
Tailored health awareness and literacy, especially amongst boys
Support Personal, Social, Health & Economic (PSHE) education to include:
• Diet, activity, sexual and mental health, first aid and self-care for men and boys
• Understanding and using the health system
• Development of empathy and emotional intelligence and healthy sexual behaviour
• Tackling mental health stigma
Male-tailored information and education – for men and boys
Support men’s desire for information about their conditions
Invest in building symptom awareness – esp. for cancer, obstructive sleep apnoea and depression – and social marketing to support lifestyle change
Organisational focus across the whole health systemSupport change on the ground – training, leadership, incentives, process and policy
• National Men’s Health Policy (as in Australia and Ireland) – incl. a national strategy for improving the mental health of men and boys
• Assign responsibility for men’s health & set up men’s health champions in local & national organisations – and in every GP practice
• Include men’s & boy’s health in all health professional, psychology and PSHE teacher training
• Include mental health in legal, policing and other front-line service training• Support professional development re men’s health incl. communication,
targeting and service design – with particular focus on ‘difficult issues’ (e.g. mental health / erectile dysfunction / weight etc.)
• Align health system incentives – incl. fair QOF allocation by gender• More personal commissioning and budgeting to enable men to drive
change and have services that meet their personal needs• Government support to persuade the World Health Organisation (WHO) to
include men’s health as a priority• [Locally] Have a joined up local men’s and boys’ health policy and plan –
reflected in the HWB strategy
1. Have a national Men‘s Health Policy• Including a national strategy for men’s mental health
2. Drive access – don’t wait for men to engage• Ensure primary care, mental health and screening work for full-time
workers
• Not just for one-off conditions: 40% of men with LTCs work full-time
3. Support research• Mental health, men & cancer – especially more targeted screening
and early diagnosis
4. Join up care for people with drug, alcohol and mental health problems
5. Build gender into performance and outcome reporting• Align incentives to drive change
1. Ensure programmes to tackle obesity, reduce smoking and reduce harmful drinking are targeted to deliver for men and tailored to reflect what works with menEnsure the 41% higher incidence of TB amongst men is tackled in their planned tuberculosis strategy
2. More explicit public mental health strategy, including measures needed to improve men’s wellbeing and reduce suicide
3. Target at least 50% male uptake in NHS Health ChecksDrive good practice to meet men’s needs and lifestyle – with outreach to the highest risk groups
4. Drive symptom awareness and knowledge of the health system – especially how to seek help – starting with boys in school
5. Complete the work to make all published data and performance indicators ‘local, gendered and useful’
1. Analyse all available data on men’s health and other equalities in your Joint Strategic Needs Assessment
2. Review men’s health at the Health & Wellbeing Board and reflect gender in your Health & Wellbeing Strategy. Track delivery
3. Integrate drug and alcohol services with mental health. Offer joined-up care for people with a dual diagnosis
4. Get to at least 50% male participation in NHS Health Checks – by designing to meet men’s needs and lifestyle – and outreach to the highest risk groups
5. Tailor health improvement programmes – especially for weight-loss – to reflect what works with men. One size doesn’t fit all
1. Collect and regularly review gendered performance data for every area of the practice's work
2. Make sure services, including screening and routine appointments, are as accessible as possible for men (and women) in full-time and shift work
3. Assign a practice and CCG lead for men's health
4. Be especially sensitive to stigmatised problems like mental health and eating disorders
5. Train your organisation to understand men's health issues and deal more effectively with men
1. Look after yourself – give your mental and physical health more priority• Look after your relationships and wellbeing
• Stop smoking
• Drink sensibly
• Be active
• Watch your weight
2. Get advice and help as soon as you think there might be a problem. • It’s your right – you won’t be wasting the health professional’s time
3. Turn up to your NHS Health Check and find out about screening that might be useful to you (although it’s your decision)
4. Support your mates and colleagues with their mental and physical health – always take it seriously