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


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


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

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Hill

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ey

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No

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of

York

shir

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Sto

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t

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oo

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am

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rd

No

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Lin

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No

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Wo

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Cam

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Gre

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Staf

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% 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

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ICD

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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

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Hea

lth

Su

rvey

fo

r En

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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

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


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


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

%


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


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

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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

men's health manifesto

Health & Medicine