Men, Health a European Perspective

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Men, Health a European Perspective

• Professor Alan White
• Centre for Mens Health
• Leeds Metropolitan University
• Chair, The Mens Health Forum

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Gender Mainstreaming and Health

• 'The Community is legally required to ensure that
  equality between women and men is an objective in
  all policy areas.
• All objectives and actions should contribute to
  promoting a better understanding and recognition
  of mens and womens respective needs and
  approaches to health.
• Markos Kyprianou, the EUs Commissioner for
  Health and Consumer Protection, 2006

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The Equality Act 2006

• The Gender Equality Duty is a general duty that
  applies to all public bodies and to private
  bodies providing a public service. In practice,
  it will
• require public authorities as employers or
  service providers to actively consider whether
  they are treating women and men fairly and
  meeting their different needs.
• DTI, 2005 p14

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Womens Health

• Rose to prominence in the 70s 80s
• Driven by the feminist movement
• Highlighted key areas of discrimination and
  inequality
• Created a strong lobby within Governments and the
  WHO

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Interest in men women's health

• Women
• Political issue
• Based on tackling oppression / power and the
  paternalistic nature of medicine
• Sat alongside general social changes
• Located within Feminist theory

• Men
• Little interest from men
• Little political concern over the state of mens
  health specifically
• No media interest
• Masculinity theory focused elsewhere

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Female Reproductive Tract
Male Reproductive Tract
http//health.allrefer.com/health/prostate-cancer-
male-reproductive-anatomy.html
http//health.allrefer.com/pictures-images/normal-
female-anatomy.html
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• Neither men nor women are minorities, needing
  special treatment. All patients in the NHS are
  either male or female and if services are to be
  effective, efficient and evidence based, the
  recognition of this reality needs to be at the
  heart of the planning and delivery of care.
  Failure to pay attention to differences between
  men and women will clearly reinforce existing
  gender differences
• Doyal, Payne Cameron (2003)

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http//www.inmagine.com/the-anatomy-of-health-phot
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• Sex
• Genetic/physiological or biological
  characteristics of a person which indicates
  whether one is female or male.
• Gender
• Refers to women's and men's roles and
  responsibilities that are socially determined.
  Gender is related to how we are perceived and
  expected to think and act as women and men
  because of the way society is organised, not
  because of our biological differences.
• WHO 1998

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Defining a mens health issue

• A male health issue is one arising from
  physiological, psychological, social or
  environmental factors which have a specific
  impact on boys or men and/or where particular
  interventions are required for boys or men in
  order to achieve improvements in health and
  well-being at either the individual or the
  population level.
• Mens Health Forum 2004

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Comparison of the ratio of total deaths of men
and women across the major disease classification
groups, 17 Western European Countries, age
brackets 1 24 years, 25 74 and 75
White Cash 2001
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Life expectancy for men and women, EU25, 2004
Calculated from Eurostat 2006
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Office for National Statistics 2004
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Relative impact of socio-economic factors on life
expectancy in England
Men
Women
Trends in life expectancy by social class 1972
2001 ONS Longitudinal Study
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Life expectancy for men and women in Wetherby and
City Holbeck, 2004
Years
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Deaths by age group
Health Statistics Quarterly , 19, 2003
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Median ratio between men and women for all 44
countries for rates of death from all causes by
age
White Holmes 2006
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Patterns of mortality in the young

• Study of young men women 15-44 years across 44
  countries
• Data from the WHO Mortality Database
• 6 causes of death examined
• Accidents and adverse effects
• Suicide and self- inflicted injury
• Malignant neoplasms
• Diseases of the circulatory system
• Homicide and injury purposely inflicted by other
  persons and
• Chronic liver disease and cirrhosis
• White Holmes (2006)

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Percentage of deaths occurring within the age
band 15 44 years for men and women for the
States of the European Union (year of data in
brackets)
White Holmes 2006
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Death rates for Accidents Adverse Effects, for
men and women, with median for EU countries
White Holmes (2006)
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Death rates for Suicide, for men and women, with
median for EU countries
White Holmes (2006)
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Death rates for Malignant Neoplasms, for men and
women, with median for EU countries
White Holmes (2006)
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Issues in relation to men and cancer

• Men have a higher incidence and higher rates of
  premature mortality in nearly all cancers that
  should affect men and women equally
• Where women have higher incidence men still tend
  to die sooner

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Deaths due to selected cancers, for men and women
under age 75 years, 2003
Calculated from Mortality statistics cause.
Review of the Registrar General on deaths by
cause, sex and age, in England and Wales, 2003
Series DH2 no.30
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Calculated from Mortality statistics cause.
Review of the Registrar General on deaths by
cause, sex and age, in England and Wales, 2003
Series DH2 no.30
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Calculated from Mortality statistics cause.
Review of the Registrar General on deaths by
cause, sex and age, in England and Wales, 2003
Series DH2 no.30
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Registrations of newly diagnosed cases of
malignant neoplasm of colon rectum cancer,
England, by age and sex, 2001.
Calculated from Cancer statistics Registrations.
Series MB1 no. 32. Registrations of cancer
diagnosed in 2001, England, Office for National
Statistics
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Deaths as a result of malignant neoplasm of colon
rectosigmoid junction, rectum and anus, by age
and sex, 2001 for England Wales
Mortality statistics cause Review of the
Registrar General on Deaths by cause, sex and
age in England Wales 2001
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Death rates for Cardiovascular disease, for men
and women, with median for EU countries
White Holmes (2006)
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Death rates for Chronic Liver Disease
Cirrhosis, for men and women, with median for EU
countries.
White Holmes (2006)
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Death rates for Homicide, for men and women, with
median for EU countries
White Holmes (2006)
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Examples of gendered health problems

• Coronary Heart Disease
• Mental and emotional health problems
• Overweight and obesity
• Cancer
• Sexually transmitted disease
• Domestic violence
• Autoimmune illnesses ie diabetes, multiple
  sclerosis
• Osteoporosis

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Sex differences

• Differences associated with the sex chromosomes
• Differences in immune response
• Differences in symptoms, type, and onset of
  cardiovascular disease
• Differences in response to toxins
• Differences in brain organisation
• Differences in pain
• Wizemann Pardue (2001)

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Social determinants

• The social gradient
• Stress
• Early life
• Social exclusion
• Work
• Unemployment
• Social support
• Addiction
• Food
• Transport
• (Wilkinson Marmot 2003)

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Risk factors for the majority of non-communicable
diseases

• Tobacco
• Alcohol
• High blood pressure
• High cholesterol
• Overweight
• Low fruit and vegetable intake and
• Physical inactivity
• WHO 2002

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Masculinity

• In exhibiting or enacting hegemonic ideals with
  health behaviours, men reinforce strongly held
  cultural beliefs that men are more powerful and
  less vulnerable than women that mens bodies are
  structurally more efficient than and superior to
  womens bodies that asking for help and caring
  for ones health are feminine and that the most
  powerful men among men are those for whom health
  and safety are irrelevant
• Courtenay, 2000

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Scoping Study on Mens Health

• Mens access to health service
• Mens seeming lack of awareness of their health
  needs
• Mens seeming inability to express emotions
• Mens lack of social networks
• White 2001

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Centre for Mens Health

• Gendered health epidemiology
• State of mens health across Europe
• Patterns of Mortality in men women 15-44 years
  across 44 countries
• Experience of service use ( provision)
• Bradford Health of Men
• Use of NHS Direct online
• Framework 7 bid on Mens usage of Health Services
  across Europe
• Experience of illness ( diagnosis)
• Prostate cancer
• Diabetes
• Coronary Heart Disease
• Education dissemination
• Dip/ BSc/MSc Mens Health
• Me, masculinity health Northern Research
  Interest group
• Academic wing of the MHF
• Books, journals and conferences
• Membership of local, national and international
  organisations

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Framework 7
Capacities
Cooperation

• Health
• Food, Agriculture and Biotechnology
• Information and Communication Technologies
• Nanosciences, Nanotechnologies, Materials and New
  Production Technologies
• Energy
• Environment (including Climate Change)
• Transport (including Aeronautics)
• Socio-economic Sciences and the Humanities
• Security and Space.

• Research Infrastructures
• Research for the Benefit of SMEs
• Regions of Knowledge
• Research Potential
• Science in Society
• Activities of International Co-operation
• Coherent Development of Policies

People Marie Curie
Ideas

• Initial Training of Researchers
• Lifelong Learning and Career Development
• Industry-Academia Partnerships and Pathways
• The International Dimension
• Specific Actions

• research aimed at discovering new
  
  knowledge
  that fundamentally changes our vision of the
  world and our way of life.
• Starting Independent Researcher Grants
• Advanced Investigator Grants

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FW 6 GenderBasic meeting, 2007

• Integrating the dimension of sex and gender into
  basic life sciences research
• Gender differences in asthma development and
  progression
• Methodological ramifications of gender
  differences in clinical research
• Integrating a gender dimension in osteoporosis
  and fracture risk research
• Sexually dimorphic gene expression in somatic
  tissue
• The metabolic syndrome sex and gender related
  issues
• Methodological and ethical ramifications of sex
  and gender differences in public health research.
  
• Anxiety disorders a gender test case within
  mental health (care) research
• A tool for distinguishing gender research from
  gender difference research
• Gender, a major player in the crosstalk between
  genes, environment and health
• Incorporating a gender dimension in food allergy
  research a review

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