Self Care in Primary Care: Findings

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Men and health-seeking practices what do we know
and what does it mean for policy and practice?
Steve Robertson Centre for Mens Health Leeds
Metropolitan University
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Females are more likely than males to consult a
GP 16 per cent of females and 11 per cent of
males did so in the 14 days before interview in
2004/05.
Living in Britain, 2006 National Statistics
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Percentage consulting with an NHS GP in the 14
days before interview by sex and age
Living in Britain, 2002 National Statistics
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Geographical differences
There is a distinct north/south divide for life
expectancy at birth. For men in the north, life
expectancy at birth is around two years shorter
than for men in the south. In Yorkshire and
Humber male life expectancy is 75.8yrs compared
to a national average of 76.6 and a South West
average of 77.8yrs DoH (2006) Health Profile of
England DoH, London
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Relative impact of socio-economic factors
Men
Women
Trends in life expectancy by social class 1972
2001 ONS Longitudinal Study
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Average number of consultations per person per
year, by sex, age, and economic activity status
Living in Britain, 2002 National Statistics
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Inpatient stays in the 12 months before interview
by sex and age, 2002
Living in Britain, 2002 National Statistics
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Do men have a problem going to the doctors?
Women were no more likely than men to consult
a GP in the previous year when experiencing the
five most common groups of conditions. In
addition, women were no more likely than men to
consult at a given level of severity for a given
condition type. Hunt K, Ford G, Harkins L, Wyke
S. Are women more ready to consult than men?
Gender differences in family practitioner
consultation for common chronic conditions.
Journal of Health Services Research Policy,
1999 4(2) 96-100.
A review of gender-comparative studies does not
support the hypothesis that men are less likely
than women to seek help when they experience
ill-health. Galdas P, Cheater F, Marshall P. Men
and health help-seeking behaviour literature
review. Journal of Advanced Nursing, 2005 49(6)
616-23.
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Do men have a problem going to the doctors?
Women who suffer from diabetes use more
healthcare services and have a higher morbidity
rate compared to men. This measured process
(visits to physicians) and outcomes (lipoprotein
cholesterol, triglycerides, HbA1c) Shalev, V. et
al (2004) Gender differences in health care
utilisation and medical indicators among patients
with diabetes. Public Health 119 45-49
Women were less likely than men to report that
they had talked to their GP or practice nurse
about their diabetes in the previous 12 months
Hippisley-Cox et al (2006) Sex inequalities in
access to care for patients with diabetes in
primary care. British Journal of General Practice
56(526) 342-348
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Blokes dont care
Yeah, cause its important to women innit, but
blokes dont really bother about it. Quinn
DM2 I think its, its not even an attitude,
its a non-attitude towards health. They men
dont see it as a problem. I dont think they
think that going out and having a binge on Friday
nights a problem. Martin CABS3
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. Well maybe a bit.
Generally, like smoking, drinking, drugs, you
know, if your doin it then obviously you should
know what your limit is David, GM1
I do keep fit. Um dont drink too much, dont
smoke too much, well I probably do at times
laughs. Watching what I eat to a certain
extent, eating fruit and vegetables. Um, so
keeping fit, eating healthily and not living life
in too much of an excess. Martin, CABS3
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Moral imperative?
SR What does health mean to you? Neil Er, it
does mean a lot, but I dont tend to it as much
as what I should do. Neil, GM5
Dichotomy
Dont care
Should care
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Frank If you enjoy a burger, eat it. If there
was a salad I didnt enjoy, and a burger that I
would enjoy that was gonna do me more harm, Im
sorry but Id eat the burger. SR So part of
living a full life is. Frank Enjoy your life,
yeah. I think you have to be a bit sensible, you
cant be totally brash, you have to be sensible
and responsible to a point. Theres a point and
once you get past that point your being silly
again. Some people are too careful, thats not
me. SR So its a balance? Frank Yeah,
youve got to get it right.
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Responsibility
Its like your car innit? If theres nowt wrong
with it you cant fix it. If theres nothing
wrong with you then youre just wasting their
time when they could be looking after someone
that is poorly. Every time you go to the doctors
theres a waiting list for appointments. So they
could be sorting someone out that is poorly,
someone who needs an emergency appointment, and
you go in and theres nothing wrong with yer. I
look at it, the less I go to the doctors, the
better of everyone else is thats poorly, Im not
taking his time up. Hugh, CABS2
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Importance for practice - Legitimation
1) Life stages or changes
2) Family history
3) Concern of family members
4) Non-gendered aspects of identity
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1) Life stages or changes
I was one of the beer swilling types not long
ago. But now things have changed and we still
enjoy ourselves but we take it easy as well until
shes their baby of an age where she can look
after herself. I want to know I am able to deal
with any emergency that may occur. Owen, CABS5
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2) Family history
My father died of skin cancer when I was young.
So I always get me mum, if Ive got a scratch on
me back I think is that a mole, I always get me
mum to check that out, she says, right you ought
to go and see a doctor. So certain things like
that Im very cautious about. Martin, CABS3
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3) Concern of family members
Jane wife phoned up to make the appointment,
she always phones the doctors and tells me when I
have to be there . . . Im not very good at that
sort of thing. Hugh, CABS2
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4) Non-gendered aspects of identity
I think gay men are more aware of their health
than straight men on the whole I think that gay
men are more health conscious Gary, GM3
I think since Ive been in the chair, Ive
watched what Ive eaten because I cant lose it
weight. Im worried about getting a belly and
not being able to get rid of it. Peter, DM1
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Importance for policy (1)
Initiatives need to be encouraged that take mens
health promotion outside the NHS
SR Do you think the NHS should have a role in
helping men stay well? Bob In the maintenance
respect? SR yeah I mean, yes, fantastic as
another part to the service yes, because its a
fabulous service it really is. As another part of
it yeah, I mean if there are the resources there
to do it, without affecting current standards
then yeah. But are they not stretched a little
bit far at the moment, I would have thought so.
Bob, CABS6
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Importance for policy (2)
There needs to be full evaluation of innovative
services both in terms of process (did they
manage to engage with men) and outcome (did they
improve the health of men)
Outreach services need to be more thoroughly
evaluated in terms of whether they create
enduring positive health practices that benefit
men and those around them. Robertson, S.
Williamson, P. (2005) Men and health promotion in
the UK Ten years further on? Health Education
Journal 64(4) 293-301
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Importance for policy (3)
Care needs to be taken to ensure that the new
Gender duty and implementation of gender
sensitive service delivery recognises that men,
and particular groups of men (Social Class V BME
men disabled men and others), also have specific
need in terms of service use and access.
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Dr.Steve RobertsonReader in Mens HealthCentre
for Mens HealthLeeds Metropolitan University
Leeds LS2 8AJ UK email s.s.robertson_at_leedsmet.ac
.uk