Wednesday, 25 January 2006
Seanad Eireann Debate
Minister of State at the Department of Health and Children (Mr. S. Power): In recent years, there has been a growing awareness, and indeed concern, about the burden of ill health experienced by men in Ireland. We know that men are dying too young. Currently male life expectancy in Ireland is approximately 75 years, five years younger than that of females. Men have higher death rates for all leading causes of deaths and at all ages and it is projected that this pattern may worsen in the future. Given current trends, it is predicted that by 2015 one third of all men in Ireland will be clinically obese, thereby increasing their risk of cardiovascular disease and diabetes in particular. Should this trend continue, it is likely to impact in a significant way upon the gains made in recent years in the battle against cardiovascular disease which the Government has initiated through the cardiovascular strategy.
For certain groups of men the gravity of the situation is even worse. Compared with men in the highest occupational classes, men from the lower occupational classes have poorer health outcomes and experience significantly higher mortality rates for the five major causes of death in Ireland. Young men are also at particular risk — they are almost four times more likely to die prematurely than their female counterparts and currently have the second highest suicide rate of the 30 OECD member states.
Yet, despite their poor health profile, men in Ireland are reluctant users of health services and are continuing to present too late in the course of an illness. There is however, an increasing recognition that existing services have not always met men’s needs, and that this also is a contributory factor to men’s poor presentation at primary care services in particular. It should also be acknowledged that men’s health has not, until recent years, become the focus of attention at a policy or service level. Indeed while men have been to the forefront of health in every way, as policy makers, doctors, surgeons, oncologists, cardiologists, hospital managers, etc., rarely has the spotlight focused on the value men place upon their own health at a personal or individual level.
In response to this rather grave health profile of men in Ireland, men were identified for the first time in the national health promotion strategy and in the national health strategy, Quality and Fairness, as a specific population group for the strategic planning of health. The National Health Promotion Strategy 2002-2005, targets men as a population group, with the strategic aim to develop a plan for men’s health. The strategy also contains a number of specific objectives which include initiating research in the area of men’s health; working in partnership to inform the development of a plan for men’s health; facilitating the development and implementation of current health promotion initiatives aimed at men; and identifying and developing models of working with men to promote their physical and mental wellbeing.
Action 15 of Quality and Fairness called for the development of “a policy for men’s health and health promotion”. This policy and action plan is now at an advanced stage of development. In setting out to develop such a policy, the health promotion unit of the Department of Health and Children has endeavoured to ensure that it will be based upon sound evidence and that it will also reflect the issues of all stakeholders regarding men’s health. To achieve this goal, a three-year research study was commissioned followed by an extensive nationwide consultation process over a 12-month period.
Health boards have also begun to address men’s health. Some examples of activities include the appointment of men’s health development officers, the publication of a men’s health strategy and a national conference on men’s health. The former North Eastern Health Board has published findings from a qualitative study on men’s health beliefs, attitudes and perceptions entitled Men Talking, and the former Mid-Western Health Board has published a plan for men’s health. The Institute of Public Health has also published an all-Ireland men’s health directory, mapping out activity in the area of men’s health.
In the non-statutory sector, a men’s health advocacy group, the Men’s Health Forum Ireland has been formed and has published a report on the health status of men in Ireland. From 2002 to 2004, the health promotion unit of the Department of Health and Children funded a men’s health research project which was conducted in the former South Eastern Health Board area. The findings of the research entitled, Getting Inside Men’s Health, were launched at a national conference on men’s health which took place in December 2004. This report offered unique insights into the crucial role of gender on men’s health. It demonstrated that the ways in which men perceive their health, take risks with their health and manage their health within the health care system are inherently related to how men define their masculinity.
Among the most pertinent findings from this report were that men tend not to be health conscious or proactive about their own health. Sadly, it is very often on foot of a health crisis that they only then become conscious about paying more attention to their health. Men’s knowledge of fundamental health issues remains poor, for example, over a third of older men surveyed were not aware of common prostate cancer symptoms. There is an overall lack of a preventive health ethos among men in Ireland. While men are slow to access primary care services when they are sick, they are slower still to engage in preventive health checks. Indeed, the report showed clearly that men are very often afraid and anxious about seeking help, with fear and uncertainty about “what might be wrong” possibly posing a bigger threat to men’s health than the reality of ill health itself.
Men are particularly reluctant to seek help for certain conditions. The continued stigma that is perceived to be associated with depression, for example, may prompt many men to “self medicate” with alcohol rather than to seek professional help. Men also play down the gravity of certain risk or health damaging behaviours. With regard to alcohol consumption, for example, half of those consuming over 50 units per week, that is, over twice the recommended maximum limit, considered themselves to be “moderate” drinkers, while nine out of ten weekly binge drinkers similarly considered themselves to be “light” or “moderate” drinkers.
These are just some of findings from the report, which offered many further insights into the issues underlying the very worrying statistics on men’s health. Crucially, the report drew attention to the need for a gender-specific response to men’s health to replace the traditional generic approach. In other words, how men are “as men” influences their understanding and approach to their health, the extent to which they engage in preventive health behaviours or risk behaviours and how timely they are in accessing health services. The 36 specific recommendations in the report offer a clear blueprint for the development of policy and service delivery measures that are more gender-sensitive in the context of men.
In implementing the recommendations of the health promotion strategy and Action 15 of the health strategy, a national interdepartmental and multisectoral steering group was appointed to oversee the development of the policy following the completion of the three-year research project in November 2004. Under the terms of reference of the steering group, it was agreed that the development of a men’s health policy should also be informed by consultation with key stakeholders from statutory and voluntary sectors, health professionals and, indeed, men themselves.
Under the direction of the national steering group, an extensive, three-phase national consultation process was conducted from February to December 2005. Phase 1 comprised six nationwide one-day consultation days, where all relevant stakeholders were invited to identify both the health needs for men in Ireland and appropriate actions to target these needs. Phase 2 comprised eight focus groups with particular populations of men whose voices were not represented in phase 1 of the consultation and for whom it was felt a more targeted consultation was necessary. Phase 3 invited submissions from both specific organisations and target groups and an open call for submissions through the national press.
Some of the most pertinent issues to emerge from this consultation process included the need to depart from the traditional focus on the “deficiencies” of men with respect to their health. Unfortunately, the public and media focus around men’s health tends to be dominated by what has been described as the “men behaving badly” model, whereby men are blamed for failing the health services by not attending, for ignoring health messages and for taking risks. While these problems cannot be overlooked, it is clear from the consultation process that there has been insufficient focus on tackling the underlying causes of these problems or on overcoming the barriers to health within men themselves. There is a need to work with men in a more positive and holistic way and to examine how existing services can be made more responsive and gender-competent for men.
The consultation process has also highlighted the need to embrace a broader, social determinant view of men’s health. While it is incumbent on a national men’s health policy to promote health-affirming changes to men’s attitudes and behaviours, it is fundamentally important to create supportive environments for men, for example, in the workplace, and to strengthen community action to support men’s health. In the case of poorer and less-educated men, for example, we know that health outcomes are very closely linked to education, income and housing. These factors are compounded by issues such as isolation and access to services for many rural men. There is, therefore, the challenge for this policy to embrace the diversity within men and to acknowledge that, within Irish society, there are many different ways to be a man.
Policy also needs to embrace the many paradoxes that impact upon the lives of men and their health, for example, there is now the widespread expectation in modern Ireland that men need to respond to changing roles and demands in society. However, it is known that social, cultural and practical constraints pose significant barriers for men who want to change and in terms of the choices they wish to make. In the case of fathers, for example, the complexities of balancing the notion of new fatherhood with factors such as inflexible work demands, the harsh reality of economic necessity for many men and disapproval or ridicule from other men are often overlooked.
The consultation process also stressed the need for an intersectoral approach at all levels to address men’s health. By adopting a strategic approach to policy implementation, there is much potential to develop alliances and partnerships with many other sectors — transport, education, employment, environment and so forth — and to promote men’s health in synergy with other policies and frameworks within and beyond the health sector.
Finally, the consultation process has made it clear that to adopt a coherent and strategic approach to men’s health in the years ahead, it is vital that there is adequate provision for appropriate structures and resources for men’s health policy at both national and regional levels. This is also important in terms of providing sustainable mechanisms to co-ordinate the work of different agencies to avoid overlap and duplication. It is also imperative that research should continue to underpin the implementation and ongoing evaluation of the policy.
A great amount of preparatory work has been undertaken in advance of the publication of the men’s health policy. While the national steering group has a wide range of expertise, it also now has access to specific Irish research on men’s health and specific information from the national consultation process. The steering group is continuing apace to draft the men’s health policy. Under its terms of reference, the steering group has agreed that both a policy containing higher order recommendations and a specific action plan with costed and time-framed actions will be developed in two separate documents. The men’s health policy is scheduled for publication by the middle of this year, with the action plan to follow by the end of 2006.
In conclusion, while many challenges lie ahead in addressing the grave statistics on men’s health, we will, on publication of a national policy by mid-year, be in a strong position for the first time to tackle these issues in a strategic way. The health promotion unit of the Department of Health and Children has adopted a systematic and coherent approach to the development of the national policy for men’s health that will be both evidence-based and will have consulted all relevant stakeholders.
While there is unequivocal evidence for a specific focus on men’s health, it should be made clear that the potential benefits of a men’s health policy extend far beyond men. As the policy will demonstrate, targeting men’s health can also impact in positive and specific ways on the lives of women and children and on society as a whole. It will also show that efforts to promote a healthier male workforce will inevitably lead to a more productive workforce. A gender-sensitive approach to men’s health, therefore, has the potential to benefit men and, indeed, men’s families and society as a whole.
Mr. Browne: The facts about men’s health are quite startling. On average, Irish men die six years younger than Irish women and they have the second lowest life expectancy in the European Union prior to the last enlargement. Mortality rates among men vis-à-vis women are particularly pronounced in the case of transport accidents, where they are three times higher, and suicide and intentional self-harm, where they are four times higher. Generally, men engage in higher levels of health-damaging and risk behaviour. Irish men, for example, drink 73% more frequently and binge drink 90% more frequently than Irish women. Irish men binge drink six times more often than their counterparts in other European countries.
It is well documented that, compared with women, men have limited contact with physicians, doctors and health care services. Men seem to have difficulty admitting they may have a problem and getting treatment for it. I am very encouraged by the recent policy launched by Fine Gael which is simple in that it calls for regular screening. The policy recommends that all adults over a certain age should be screened every five years for diabetes, heart disease and, in the case of men, prostate cancer and even breast cancer, which can occur in men, although not to the same extent as in women. The key aspect of the policy is prevention rather than cure.
Some time ago somebody pointed out to me that it was an oxymoron that we have a Department of Health and Children. It was suggested it should be called a department of sickness because all the Department does is react to illnesses. Senator Glynn who serves with me on the Joint Committee on Health and Children will no doubt agree that we are always chasing rather than leading in this area. It makes sense that the State should ensure citizens have regular screening in order to prevent common illnesses that if caught in time could be dealt with more quickly and cheaply, but that is not happening. Fine Gael policy suggests that people over 65 years of age should be screened every two years and the Minister should take that on board. Let us forget about focus groups carrying out more research. They are all very well, but we want more concrete solutions.
I visited a widow in her home over the weekend. She explained to me that when her late husband visited the doctor when he was quite ill, he told the doctor that he was fine. His wife had to tell the doctor that he was not fine and explain his problems. Men have difficulty admitting feeling ill and often leave it too late to go to a doctor.
At the recent National Ploughing Championships a medical company carried out a random audit of farmers and other people attending the show. Many of these people were rushed off to hospital afterwards because they had not had their blood pressure checked in years and were on the verge of a heart attack. It is vital that we put a screening programme in place that is aimed at prevention, rather than leaving it too late to provide a solution.
The Minister of State alluded to the fact that socioeconomic and educational background have a significant bearing on people’s health. It is vital we continue to share the wealth of this economy. Over Christmas we heard the Government had taken in over €2.5 billion in extra taxes. Perhaps it would be wise to use that money to promote health education for men. Men could be provided with sample health check packs and encouraged to use the Internet to discreetly obtain information on their medical problems as they often have grave difficulty asking in person. The Department should consider providing a website for men’s health issues where men could get proper medical advice in the privacy of their home or local library without embarrassment.
It would be remiss of us not to refer to sudden adult death syndrome. Unfortunately, in the past number of years we have lost many key sports stars. I think of Cormac McAnallen the former Tyrone footballer who, even though he was superbly fit, collapsed and died. We await the publication of the report on sudden adult death, which seems to be taking a long time. I was assured it would be issued this month, but I have not yet heard about it. Will the Minister of State inquire about the delay in publishing the report? The Tánaiste has been briefed on it and many voluntary groups are waiting for it.
Many voluntary groups plan to avail of and use defibrillators in sports facilities and in the wider community, especially in communities not near a hospital. In the vital few minutes after somebody gets a heart attack, a defibrillator can save the person’s life if used correctly. I urge the Minister of State to inquire about the delay in publishing the report on sudden adult death. Leading cardiologists were involved in it. Voluntary groups awaiting it are unable to progress their case for defibrillators until it is published. As far as I am aware, the report will recommend putting defibrillators in every possible location where they will be accessible to the public. This has happened abroad, but unfortunately not here so far.
I was amused to read recently that single men die younger and married men live longer but that single women live longer than married women. This might lead one to believe that marriage is good for men but bad for women. I am not sure we can build anything on this. I know the Government is working on many of the recommendations in the 2004 report to which the Minister of State referred.
It is vital we have an information campaign. We should move towards a men’s health week like that started in America in 1994 under Bill Clinton, which would raise awareness of illnesses which affect men, such as prostate cancer. It should also provide information to the public and a dedicated website which would discreetly provide information to men who have grave difficulty admitting they have problems. Perhaps a text message service would also be beneficial for the 50% of men who do not attend a physician on a regular basis. Even when they do, some of them will not admit to medical difficulties.
I repeat my call to the Minister to take the Fine Gael policy on board. The Government has taken on board Fine Gael policy on general practitioner-only medical cards and our policy on medical cards for those under five years of age. It is time it looked at this issue practically and provided screening every five years for adults under 65 years of age and every two years thereafter. It must focus on prevention rather than cure.
Ms Terry: I welcome the Minister of State to the House and thank him for his presentation. I thank Senator Glynn for requesting this debate. The debate is worthwhile because this is an area that has been neglected. I am not sure why this is so, but perhaps it is because men have not called strongly for debate and necessary services. Traditionally women’s voices have been stronger in the this regard and we call on a regular basis for improved health services such as breast or cervical cancer screening, etc. We talk about these issues regularly. Senator Glynn is right that we should call for more services for men. We should all be treated equally. If we do not look after everybody in the community, society suffers. I agree the area has been neglected and needs to be addressed urgently.
The Minister of State made a startling statement in his presentation. He said young Irish men are almost four times more likely to die prematurely than their female counterparts and currently have the second highest suicide rate of the 30 OECD member states. It is shocking that we are the second highest, but this comes as no surprise to us. We need to look deeply at this issue and tackle the problem of depression. Why is it that more young men are at higher risk of taking their own lives? This is a serious problem we need to address.
I am also concerned about obesity among young men. Whatever we say about men in this regard, it also applies to women. Obesity is certainly a problem and we need to start tackling it. We need to build a healthier nation and target people at a very young age by getting them involved in sport. We need to encourage them to continue participating in sport throughout their lives so they will remain healthy.
Reference was made to men’s sexual health, which needs to be considered. It is an area of great importance because young people, both male and female, are taking very serious risks. Bearing in mind that many young people are very responsible, we should note that many young men tend to leave responsibility for contraception to women. This is not good enough. We are not just talking about preventing pregnancy but also want to ensure people are healthy and do not contract sexually transmitted infections, including HIV. It is very important that we do much more to educate young people about their sexual health so they will take responsibility for themselves and not expect others to do so for them.
We have been shy when talking about and advertising sexual health. We need to do much more and I hope the Minister of State will make people feel more open in this regard in order that the subject can be discussed in schools. We need to promote sexual health widely and tell young people they must take responsibility for their sexual health and protect themselves. By doing so, they will also protect others.
It is a well-known fact that where there is poverty, both men and women take less care of themselves. There are many reasons for this. One reason is obviously financial in that people will forego going to the doctor when money is scarce. Even if they have a medical card they tend to ignore their health until they develop a serious problem. We need to tackle this and ensure that as many people as possible get a medical card so they will go to a medical practitioner early rather than wait until their medical condition becomes serious.
Let me raise the issue of sudden adult death syndrome, as mentioned by Senator Browne. It is a growing problem and I have been affected by it in that a very close friend, a very fit young person, died suddenly. The syndrome usually affects very fit people. If they were not so fit, their heart problems or other conditions would be noticed earlier. I welcome any research done in this area to ensure we prevent the growing problem of sudden death among young people.
I welcome the programme the Minister of State is to introduce, much of which will involve an awareness campaign. I believe there was an advertisement some time ago asking men whether they had had their MOT this year. This is catchy and represents the kind of initiative we need to take.
Women are used to going for their annual check-up. Men should get into this frame of mind but we must tell them they should do so. They should have one at various stages of their lives. I do not want to pick out any single age group as it is important that people of every age group look after themselves.
Prostate cancer is easily dealt with if detected early. It is important to let men know the symptoms so they will recognise them. Much of the funding should go towards awareness campaigns, be they on television, in newspapers or on posters. This is what needs to be done and I welcome the Minister of State’s initiative.
Mr. Glynn: Cuirim fáilte roimh an Aire Stáit. It could be said that everything comes to he who waits. We have been calling for this debate for quite some time. Having worked in the health area for a number of years, I am very much aware than men’s health has not taken centre stage in the same way as women’s health. There are a number of reasons for this. I am delighted to hear that if other Members are offering to contribute at the conclusion of this debate, it will be continued on another day. That is very important.
For men to reach their full health potential, there is a need for a wide range of agencies and community organisations to address the needs and support initiatives. The Health Service Executive or any other agency or group working alone will not be sufficient to effect the required changes to improve and sustain the gains in men’s health that can be achieved by a multi-agency, multidisciplinary and cross-community approach. It is fair to say the subject is complex and cannot be dealt with in isolation. All facets of the health service and other support structures, be they social or otherwise, must be employed and merged to ensure the implementation of a positive policy on men’s health.
I agree with the remarks of Senator Browne on reactionary services. When speaking in the House recently on diabetes, I said the services, including those associated with men’s health, were pretty much reactionary — they are. There is a reason for this, which I will state later.
Parents should encourage their children to look after their health. Mothers especially have a pivotal role to play in this regard because, traditionally, the Irish male is the kind of individual who, in the main, does not like to admit he is cold if he is not wearing his coat on a cold day. If he puts his coat on it is seen as a sign of weakness. This is a stupid attitude. When I was a young lad and put on my coat on a cold day in the presence of a senior male, he would ask why a young lad would be feeling the cold. He would say I was not cold — this was the attitude. It is a fact that improving or conserving one’s health in any shape or form was regarded as a sign of weakness. Women should encourage the men in their lives to look after their health and should encourage their male offspring to do so from an early age. It is a question of shaping attitudes now rather than reacting to them later.
Reference was made to suicide. Senator Browne will be aware that the suicide rate among young men is seven times higher than that among young women. This statistic, which is absolutely true, is frightening by any standards. It is true because Mary will go home and tell Mammy, Daddy or somebody else her problems while Johnny will not because he will regard doing so as a sign of weakness and not the manly thing to do. How stupid can one get?
Fostering positive attitudes to one’s health should be an objective of parents and they should impart to their children a consciousness of their own health. In the main, once one reaches adulthood one is responsible for one’s own health. Consider the diabetes epidemic, for example. As everybody who has taken an interest in the condition, especially type 2 diabetes, will note, there are some 250,000 diabetics in the country, 90% of whom have type 2 diabetes. Another 25% are as yet undiagnosed, many of them men, although I do not know the ratio.
We have primary responsibility for our own health but it should be pointed out that health has never been on the agenda for men. As a result, Irish men’s lack of knowledge of fundamental health issues continues to be a key area of concern. For example, an ordinary man will have his car serviced but may never have visited a doctor in his life. That person could be suffering from type 2 diabetes but will not have been tested for it, nor will he have had a rectal examination, a prostate-specific antigen test or a blood pressure check. Men will service their cars but will not look after themselves, which is amazing.
There is a need for increased education and awareness of men’s health issues, which should be targeted at both boys and men. Hence, the shaping of the person by parents in the home is of pivotal importance for sons, and also for spouses, brothers and uncles. Improved information, education and awareness is the most important factor for managing health problems more effectively. Male-specific preventive health continues to lag behind, with three out of four men aged 50 or over reporting never having had a digital rectal examination despite the incidence of colorectal as well as testicular and prostate cancer. The National Cancer Forum met with Members before Christmas to give us an in-depth view of men’s health issues, particularly with regard to oncology, which was worthwhile.
Those men who reported having had a digital rectal examination in the past were significantly more likely to be well-educated and to be married or cohabiting. This does not suggest that education and spousal or partner support are key indicators in the preventive health-seeking behaviour of men, but they have a role. The importance of spousal or partner support is borne out by the fact that 98% of what may be termed “reluctant attenders” acknowledged going to the doctor at the behest of a woman. Partners, mothers and wives have a pivotal role to play. It would also appear that male-specific health issues are high on the list of factors that appear to cause men to be reluctant to go to their doctors in the first instance — it is not seen as the manly thing to do.
Men’s health is not just a men’s issue. Health problems affecting men can also have a significant impact on the welfare and qualify of life of women and children. For example, a man’s drink problem has a serious adverse effect on his children and wife or partner. It affects everybody, as anyone who has had contact with Alcoholics Anonymous, Al-Anon, Alateen or other organisations that are supportive to those with drink problems will know.
Men’s health must be viewed as much more than the sum of male-specific illnesses or diseases. A narrow focus can lead to misconceptions that male health problems are limited to the prostate gland, and the subsequent mindset that if the prostate gland is okay, there is nothing else to be concerned about. That is not the case. A more rounded approach that focuses on men’s quality of life, and that supports men to experience optimal social, emotional and physical health, is called for. It is acknowledged that men are more likely to take risks with their health. We need to understand why this is so and why they are more likely to engage in behaviour that damages their health rather than preventing threats to health. We also need to encourage men not to seek help for an illness in its latter stages but when symptoms are first evident. The servicing of one’s car remains a good comparison.
Raising awareness of health issues among Irish men is crucial because a psyche has existed over a number of generations which must change. Sometimes it takes a crisis to act as a wake-up call to an increased health consciousness. Late presentation to health services has been implicated as a key factor in men’s higher mortality rates and lower life expectancy. There is a need to confront what might be described as the traditional male gender script, which confers status on health-damaging and risk behaviours, and which infers weakness and femininity from positive health care practices. In other words, any man who looks after his health is seen as a sissy. The concept that being sick or going to the doctor somehow represents failure or personal weakness in men must be reversed if we are to make progress.
I will detail statistics from one health agency, which speak volumes. On average 1,160 claims were made each year between 1999 and 2004 for myocardial infarction, otherwise known as heart attack, of which some 70% were for men. Recent studies have suggested that one of the reasons why women have a lower rate of heart disease than men is partly due to the protection provided by the natural hormone oestrogen, which is produced until menopause. However, once women have reached that stage, their risk of heart disease rapidly rises to equal that of men. In 2004, 1,185 claims were made, of which 801 were for men, which is 67.6%. Of these 801 claims, 99, or 12.3%, were for men under the age of 50, with the largest number, 234, or 29%, being for men aged between 61 and 70. The volume of heart bypass procedures overall has been reducing due to the use of angioplasty surgery and all that goes with it. The agency’s statistics also deal with cost issues, but we are not concerned with that aspect.
According to national cancer registry statistics published in June 2005, based on studies carried out between 1994 and 2001, an average of 1,371 of the Irish population present with prostate cancer annually. On average, almost 520 men die from this type of cancer each year. Between 1994 and 2001, the number of prostate cancer cases rose by more than 6% per annum on average, which is a real cause of concern. Prostate cancer accounts for 12.8% of all cancer deaths in men. Almost 31% of prostate cancer patients are treated by surgery alone, with nearly 48% of the remainder receiving a combination of treatments including surgery, hormone therapy, chemotherapy or radiotherapy. Over 21% of prostate cancer patients receive no treatment, surgery or therapy for their cancer. The incidence of prostate cancer is higher in the south west than elsewhere, although this may be due to differences in diagnostic practices rather than underlying differences in incidence.
On average, 1,328 people claim each year for prostate gland surgery. Of this figure, some 25%, or 332 cases, present with prostate cancer. Last year the relevant health care agency paid out more than €5.5 million for prostate gland surgery. The average cost of prostate surgery in a private hospital is approximately €5,800. The number of claims for prostate cancer surgery to date in 2005 is up 6.4% on the figure for 1999.
A serious situation exists which must be addressed as a matter of urgency. A multifaceted, multi-agency approach must be taken across the board. The most recent report from the national cancer registry, Cancer in Ireland 1994-2002, estimates the annual incidence of prostate cancer to have increased by between 5% and 6%. The National Cancer Forum is finalising a new national cancer strategy. The forum comprises a multidisciplinary group of oncology experts. As part of its work it has reviewed all issues connected with screening, including examining specific diseases such as prostate and colorectal cancers. The latter condition is particularly pertinent to men’s health. The forum has also developed criteria against which all future screening programmes will be assessed.
It is understood that the forum will decide there is insufficient evidence to recommend the introduction of a population-based prostate screening programme. I do not agree that this issue should be reassessed when the results are available from randomised control trials being conducted internationally. Most people would agree there should be screening. The statistics on the incidence for the dates I have mentioned, and the percentage increase per annum indicate that there are enough undiscovered cases to merit this approach.
This position is inconsistent with the recommendations adopted by the European Union which advocates the introduction of cancer screening programmes that have demonstrated their efficacy, having regard to professional expertise and priority setting for health care resources. The proposals do not provide for specific recommendations in respect of screening for prostate cancer. Appropriate treatment for men diagnosed with prostate cancer is available at all major hospitals throughout the country. Any man who is concerned about prostate cancer should do what he does with his car, namely, go for a service. In other words, he should visit his doctor.
I could continue on this subject. Men’s health is of particular importance because men’s health problems have an adverse effect on their families. This applies equally to men who live alone because all men have mothers, fathers, siblings and other relatives. If a man does not look after his health that has a negative effect on those close to him. I welcome the opportunity to debate this important subject. I hope I will have a further opportunity to engage in such a debate.
Mr. Minihan: I welcome the Minister of State, Deputy Seán Power, and his officials to the House and thank them for contributing to this significant series of statements. I also commend Senator Glynn on his perseverance in seeking this debate. When one hears that a discussion is to take place on a strategy for men’s health one can be forgiven for wondering what this is trying to achieve, what is the purpose of this discussion and what drives the need for a specific policy framework on men’s health.
The health promotion unit, HPU, organised a series of men’s health workshops around the country last year. These consultations involved engagement with all those working with men in the statutory, private and voluntary sectors and, of course, men themselves. The report that followed this consultation process opens with the statement, “A strong public policy gives legitimacy to any men’s health initiatives that might be developed in the future”. It is worth considering this point. Why would initiatives in an important area such as men’s health require specific legitimacy?
The answers are complex. There is disparity in health outcomes between the genders, and among men. On average, Irish men can expect to live to 73 years of age, whereas Irish women can expect to live to 78.6 years. Men die from testicular and prostate cancers although both are treatable if identified early. Heart disease is largely preventable through lifestyle changes. Men perform poorly in respect of certain lifestyle factors. They eat less fruit and vegetables than women, have a higher intake of fat, are more overweight and obese and 75% of all suicides are men, particularly young men. Deaths from road accidents are three times higher in men, especially young men. Men appear in greater numbers in mental hospitals and in prisons. Men are less likely to visit a doctor when they are ill and less likely to report symptoms of disease or illness.
These problems, specific to or more prevalent in men, pose a challenge but also incentivise a strong men’s health policy. They legitimise the steps taken to address these issues. The consultation process confirmed the need for existing and future policy across all sectors to be gender and equality-proofed. All policy moves should be assessed in terms of their impact on the health of men and women.
Gender difference in health promotion needs to be discussed. Where it is discussed, contributors can be accused of reinforcing stereotypes about both women and men. In general the stereotype of the carefree, or careless man, self-assured in his own invulnerability and immortality, and some sort of inverse for women are not helpful.
I was fascinated, however, to read of a new study, published in the journal Physiology and Behaviour, which confirms a common stereotype, namely, that women tend to comfort themselves with sweet-tasting foods while men prefer meat as their so-called comfort food. We need to recognise that there are differences in behaviour between the genders which can lead to different health outcomes, without fear of being accused of reinforcing unhelpful stereotypes.
Recent media reports have highlighted the differing effects the same drug can have on male versus female patients. This does not refer to a complex, prescribed drug but to aspirin. In this month’s Journal of the American Medical Association, it is reported that men taking aspirin tend to have fewer heart attacks, while women have fewer strokes. No one knows why the drug acts differently on men and women, although basic physical differences are suspected. Medical professionals are talking about developing gender-specific testing and gender-specific medicine.
The HPU consultation days also revealed disparities in health outcomes among men as an individual cohort, specifically for men affected by marginalisation. These include socioeconomic inequalities in men’s health, problems of access to health and social services for minority groups of men such as Travellers and ethnic minorities and personal assistance for men with disabilities.
The HPU’s 2004 report states, “the differences in men’s health status and health outcomes arise in particular as a consequence of age, social class, education, employment status [and] the effects of marginalisation”. I would urge that any men’s health strategy would take on board the report’s recommendations, including a careful choice of means to deliver information to minorities, the involvement of people from such minorities in research work, the provision of aggressive community outreach programmes, and the provision of culturally sensitive public service announcements.
Any men’s health strategy that is to effectively tackle the disparities I have outlined must be cognisant of certain basic facts. As the HPU has outlined, a gender approach to health would allow for the development of gender specific policies and initiatives that would enable, in particular, more marginalised and vulnerable men and women to be offered more appropriate and effective health care. It would also encourage and facilitate men to move away from narrow and stereotypical codes of acceptable behaviour, and to develop skills that would make them more adaptive to a changing culture.
I am reassured by the commitments of the Tánaiste in particular, but also by the Government generally to policies that allow for the development of gender specific policies and initiatives as specified by the health promotion unit. These include the following: broader commitments on health, such as improved transparency and effectiveness of administration and funding; restructuring of administration; the National Treatment Purchase Fund; the expansion of public hospital beds; improved staffing; and extended medical card eligibility. All of these matters will play a part in delivering better health care for men as part of the general population.
However, we must ensure that following today’s commendable debate, the challenges leading to disparity regarding men’s health are not only recognised in public policy, but are also adequately addressed in future policy and initiatives. The Progressive Democrats will continue to make this a key objective in policy development and implementation.
Mr. Ryan: I rushed up here because I did not realise that I was contributing so soon, but I am a bad example of how men should look after their health. I should probably have proceeded at a more leisurely pace but I was afraid that we would have no speakers. I had not seen that Senator Feeney was present.
When it comes to health matters, there is no doubt that men are a dreadful bunch of cowards. They try to pretend that health is not an issue or pretend not to know the appropriate vocabulary. They will always try to dismiss, hide or avoid any symptoms in all possible circumstances. I knew a young man from the Gaeltacht, whose vocabulary in English would probably not have extended to a term such as testicular cancer but, unfortunately, he died from it before he was 40. I admire a well known intercounty footballer who was afflicted with testicular cancer in his 20s and has had no problem in advertising this fact to the world.
If one sits in the company of five men and mentions testicular cancer, the reactions will vary from giggles or mild obscenities to changing the subject. I am not pretending to be one bit superior but one should contrast that with how women react to discussing health issues. Women will talk with considerably less inhibition about their health and the manifestations of ill health. They will also pursue recommended methods of self examination. The prospect of self examination to deal with testicular cancer, however, would send any collection of hardened rugby players into a fit of embarrassed giggles.
This is a serious issue and before I even talk about health services, there are many matters to discuss concerning role models. On a related issue, I bring these matters up in my own chemical engineering classes in Cork Institute of Technology when dealing with safety. There is a need to overcome the machismo culture in looking after one’s health sensibly. Women working in industrial settings are much more likely to heed, respond to and take seriously less visible threats such as low level exposure to potentially hazardous chemicals or background radiation. Women will mostly follow the recommended procedures in this regard.
My evidence for women being more safety conscious than men is specifically based on car insurance data. Despite the fact that women drive more safely, one of the classic symptoms of this machismo culture is that most men will swear that women are dreadfully dangerous drivers. It is an overwhelming male belief, although the figures prove otherwise. Insurance companies do not make these things up. They will dangle offers in front of women because they know that women are a lower risk as they take safety more seriously. I do not think this fact is universal, however, as I have discussed this subject with a few young women and I am beginning to notice a fairly masculine style of driving among some of them. Overwhelmingly, however, the evidence proves that men do not take fundamental issues of sensible, safe living, including driving, in the same way as women do.
We should have screening programmes for testicular cancer. Most people seem to believe that a similar screening programme would be a good thing for prostate cancer, although there are serious arguments on both sides. I understand that in half such cases, prostate cancer does not spread, while in the other half it does. Nobody is quite sure why. Men who are treated for prostate cancer go through a traumatic process of radiotherapy and possibly even surgery, although in half the cases such treatment is unnecessary. There may well be unpleasant consequences including impotence and other matters that deeply affect the male psyche and subconscious.
There is an overwhelming case for a testicular cancer screening programme. The uptake figures for the BreastCheck programme do not reach 100%, but if an equivalent screening service were offered for testicular cancer to every man aged between 15 and 35 or 40, I predict the uptake would not be half that for BreastCheck because of the incredible issue of male machismo. We know, for example, that men visit doctors far less than women. Men try to pretend that is because women are all hypochondriacs, but it is an easier excuse than saying that men are afraid to go to a doctor for a check-up if something is wrong. How many men have been warned that they have high blood pressure, yet ignore the issue? Women, on the other hand, will conscientiously and in an organised fashion take whatever medication is prescribed for them.
If one drives around any city and watches people out walking as the evenings grow longer, some 80% of walkers on any given evening are women. Men are in a tiny minority of walkers, even though walking is the simplest form of exercise and the least likely to do any damage if one is unfit. Overwhelmingly, however, one finds that most of those walking and taking other forms of exercise are women. In addition, most of those attending yoga classes and keep fit programmes are women. That is true although until recently field sports were predominantly played by men. I know that the situation has spectacularly and dramatically changed with the spread of women’s football in particular. However, until recently field sports were predominantly a male preoccupation. Outside the competitive machismo of such sports, when it comes to the basic idea of looking after their own health, men have been fairly useless. Let us not even mention alcohol, smoking and other things that are not gender-specific.
Having said that, we must start by talking about such things to young men before they leave school. We must get them to begin to discuss their health. I do not want us to turn them into a generation of hypochondriacs. However, I believe that there is a sensible balance. The first thing is to get young men, before they leave secondary school, to be aware of their health and overcome inhibitions regarding self-examination, and visiting doctors regularly. We must inform them of the undoubted fact that, whatever is wrong with one, attending a doctor will not make it any worse. If it is anything serious, doing so gives one a very good chance of something being done about it.
I have no evidence, but I am convinced that a great number of men who die from various cancers do so as much because they are late, slow or reluctant in finding out what is wrong and getting anything done about it, so that matters progress too far. I have always believed that women, while there are obviously exceptions, are far less inhibited.
The first thing is to introduce young men to the vocabulary and the idea that there is nothing redolent of a tough guy or macho man in ignoring one’s health. It is a strange and contradictory belief that ignoring one’s health somehow shows that one is tougher than those who look after themselves; I hope that it is changing. Once we have done that and, one hopes, created a demand for basic services, we must of course introduce effective forms of screening for those cancers that most afflict men, just as we have begun the process with forms specific to women.
It is not just about cancer, and once we have done that we must examine what I believe is a problem, namely, the fact that we have no culture of exercise or fitness among men once they move beyond the age at which they participate in competitive sports. I do not know whether there is still a serious fitness culture or serious opportunities for men, particularly for those not as well-off as most of us. If one has a limited income, what does one do for exercise once one has moved beyond hurling, football, soccer or rugby? One can walk, but apparently most men do not. One can swim, but our municipal swimming pools are limited in number, expensive and in many cases not much encouragement is given. We must discuss how we can get men into a pattern of healthy living.
There is no point in our shooting off into high-level puritanism and telling people that they must all stop drinking. We should tell them all to stop smoking, however. A man is prepared to fool himself by saying, for example, that he smokes 60 a day as his father did from 16 until his death at 96. That proves nothing other than that the father died at 96. There is a need too for us to confront the culture of binge drinking. It is a predominantly but, unfortunately, no longer exclusively, male issue. There are genuine health questions not appropriate to this debate concerning how we deal with those who end up in hospital because of self-inflicted damage caused by binge drinking. However, that is not a matter for today.
Once we have established a culture whereby men discuss their health, many of the other issues will remedy themselves. If I am ever asked about men’s health, I return to the basic truth that they are cowards. As far as possible, they want to duck the issues. They run away and turn their backs on them to avoid them. They are also extraordinarily prudish regarding such basic things as self-examination. One need only listen to an all-male conversation to realise that most men would not in a million years conduct the sort of routine self-examination that a reasonably health-conscious woman will carry out. We must change that culture.
Thereafter, we can move on to service provision. However, until we get men to begin to take their health seriously, we could provide all the services in the world without effect. If we announced tomorrow that we would have a nationwide testicular cancer screening service, we would have a take-up of perhaps no more than 25%.
Ms Feeney: I am delighted at today’s opportunity to speak on men’s health. I always enjoy listening to Senator Ryan, and I smiled at his opening remarks when he spoke of men being a big bunch of cowards pretending that nothing is wrong. It is not only men who have created that state of affairs. Women like men to be cowards, since they like to mother, mind and nurse them, pretending that women know all there is to know about health. They will always keep men as little boys.
There is also the attitude that “big boys don’t cry”. If a man complains of feeling unwell, women, myself included, are a little impatient. We think that they should get on with it, since they are always moaning and groaning. I believe what Senator Ryan is saying. We need to change the mindset. Teenage girls will start talking about having a smear test from the age of 18 or 20. That is when they would start attending for annual or biannual tests. Boys would never think that they should do anything of that kind. Self-examination and so on would be thrown out. It is not something for boys or men to do.
I made a telephone call this morning and was very interested to hear from a GP friend in a very busy practice in Tallaght that he had conducted a survey of 100 men. It took him four years to carry out. They picked 100 men at random and asked them to take part in the survey. They were brought in for regular health check-ups. They interviewed the small minority that did not take up the call to come in, asking them why. The answer given constantly was that they did not think that the GP would be interested in knowing about their health or that there was any kind of partnership whereby the GP might wish to know about their health. The person conducting the survey found that those men were terribly lonely. Once they got talking to that person, however, they wanted to tell all regarding their health, problems and worries. They were extremely lonely men.
The point has been made time and again about the dangers of alcohol and cigarettes, and we cannot bring that home clearly enough. Alcohol is a drug that destroys young men’s lives. It is affordable and easily accessible, and it does not matter if a young man is drinking, since he is simply seen as macho, which is acceptable. It does not matter if a middle-aged man does it, and he may be even more at risk. On their way home from work they will stop off and meet friends for a few drinks. They probably eat late at night. That is a most unhealthy lifestyle, particularly now that our work environment is changing. We are working fewer hours. We do not work from 8.30 a.m. to 5.30 p.m. Monday to Friday. Flexi-time is available. People have a different lifestyle.
While making notes on the way men’s health is different from that of women, the area of networking came to mind. Women network so easily, as Senator Ryan and others said. A woman will have lunch with a friend and talk about the lovely pair of shoes she saw in Carl Scarpa. She might say, “I’m thinking of buying them but they are a little high and the old back is acting up. I’m suffering some pain. I might go to the doctor because it has been bothering me for a while. It could be my kidneys but it could be my uterus”. It is easy for women to talk about issues like that. What starts off as something trivial will suddenly become very intense and personal. Women trust women when it comes to telling them the most intimate details about their own health.
Sadly, men lack that type of relationship with other men. People will ask someone whether they went for counselling. Women do not need counsellors because we talk to other women. Women listen to women. Men are probably more inclined to need the help of psychologists and counsellors because they do not open up enough with women or men they know. There is nothing wrong with that. I was sad to hear a speaker say earlier that Johnny was stupid because he would not tell his mother that he was feeling unwell. It is nothing to do with stupidity. It is to do with the mindset and the way boys have been reared.
I was interested to hear that men view themselves mechanically when it comes to their health. That is true. Other speakers said that men will take the car for the MOT and make sure their car is okay but their own engine could be falling out, so to speak, and they would not bother going to see a doctor. Senator Ryan talked about the macho element in men, that men are faster drivers and not careful drivers like women. I have been a passenger many times in a man’s car and he will shout at the woman driving the car in front of him. I shout at them as well but he will say, “I bet it is a woman driving that car”. I am always glad to say, when I look at the other driver as we pass by, “You are wrong. It is being driven by a man”. Men are all go. Things do not move quickly enough for them.
With regard to men not going to see their general practitioner as an interested party who will listen to their health problems, and that came from a GP, that attitude must change. Perhaps, through the Health Service Executive, we could encourage GPs to get the message across, whether by way of a notice in their waiting rooms or some other way, that they are interested in talking and listening to men.
Men need less emotional support than women, but that is not to say they do not need emotional support. They do, but men believe they are not getting that from their GP. If they were to go to their GP, however, and talk about their problems they would probably find that would change.
Screening is very important. Last week, we had a meeting with the diabetes society and some of the associated medics who treat diabetics. They were talking about treating 100 patients with blindness brought on by diabetes, which cost the State €250 million. For that €250 million they could have screened many more than 100 people and prevented blindness. That is such a shame. I realise the Minister cannot provide funding to screen for every condition but it should be considered for the type of conditions we could screen for at a low cost and thereby prevent terrible effects like blindness.
I was interested to read lately about a survey carried out in County Mayo, which I tried to find but could not. The results of the survey showed that there is more obesity in pre-school children than in children in primary school. That is a startling fact.
Men are equally as interested in their health as women and if they are given good news they will build on that. Some of my men friends will tell me that they went to the doctor and got the all-clear in terms of heart rate, blood pressure and so on and they are delighted with themselves. With regard to the negative effects, some television advertisements for cars, IT and so on portray younger men as being a bit silly. There is one advertisement — I think it is for a Renault car — in which the man is made out to be a fool. That type of stereotyping of young males is wrong because they are very impressionable. There is much more I wanted to say but I will conclude as we are running out of time.
Mr. Norris: I welcome the Minister of State and his adviser to the House. I was glad to have heard the concluding remarks of what my colleague, Senator Feeney. They were extremely interesting and helpful. I am also glad I had an opportunity to glance through the Minister of State’s speech. I apologise for not being here earlier to hear all the debate but I was detained elsewhere on a matter concerning the CIA rendition flights through Shannon Airport, which is a matter equally serious to that of the question of men’s health.
As men, and I loosely describe myself as such, we are simply following in the wake of women. Women were alerted to the question of gender based illness much earlier than men and they were a lot wiser. They were also rather humorous about it. I remember Germaine Greer talking about the differences between the approach to health of men and women and suggesting that if men got a headache they got their agonised wife to rush them to hospital whereas with women, as she described it wonderfully, the dangly bits would have to fall off, shrivel or disappear before anybody paid them the slightest attention. Thanks to activists such as Germaine Greer and so on, that picture has radically changed and we now have a situation where the entire community is aware of the specific vulnerability of women to cervical cancer, breast cancer and so on.
Men are unlikely to suffer from cervical cancer but a small proportion of men suffer from breast cancer. I only discovered that recently when somebody I know reasonably well was taken to hospital seriously ill with breast cancer. I understand it is a 1% figure but the problem is very real for that 1% of people. This man found a lump on his chest and thought it was a big joke but he went into hospital and found that it was an early manifestation of a malignant tumour. Luckily, he was caught in time and successfully treated but he had to have the breast removed. It is obviously not such an awkward thing for a man as for a woman because the male breast is not as significant a part of physical anatomical attraction as it is for a woman but it is a very serious illness, and it came as a surprise to me to learn that it happened.
Senator Feeney was very gracious towards men. Most people, but not everybody, are drips when it comes to their own health because they are shy or ashamed to take their clothes off in front of the doctor, and God help us if it is a woman doctor. To allow these intimate little bits to be seen and examined, it is almost as if, in the words of the old Catholic theology, they were taking pleasure in it, which I seriously doubt. There is a reluctance or shyness, which is a culturally induced phenomenon, and for that reason I welcome what the Minister of State said about a health awareness programme and getting people into a condition of mind where they are prepared to recognise symptoms, examine themselves and take care. I speak from personal experience because I have a precancerous prostate condition. I receive medical check-ups every year.
Mr. Norris: A patient such as myself receives a PSA test, which is a blood test that can determine whether one has a cancerous tumour. There are circumstances, to which I will return, where such tests are necessary. I had a very severe reaction to an investigation that went wrong, as a result of which I nearly died as I contracted septicaemia. This is unnecessary and I can explain to the House how it can be avoided and why male patients should request plenty of antibiotics before they undergo such examinations.
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