By Peter Westwood, Bradford and Airedale PCT
The new Gender Equity Duty will force public authorities to address the health needs of men. Already there is a tool in place to help achieve this, in the form of the health MOT. This simple concept is well established in the portfolio of work carried out by the Bradford Health of Men (HOM) project. How might they fit into the evolving NHS structures?
Health MOTs are an important tool for meeting the health needs of men and form a central pillar of the work of the HOM Project. But with changes afoot in the form of the new Gender Equality Act that will come into force in April 2007, Practice Based Commissioning and the new PCT commissioning structures, it is a good time to reflect on the importance of the MOT work. Perhaps it is time to see this convergence of issues as an opportunity that cannot be missed.
The case for men?s health
The Men?s Health Forum (MHF) described a male health issue as '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 wellbeing at either the individual or population level?(MHF,2004).
Back in 2000, the then Minister for Public Health, Yvette Cooper recognised that the biggest health inequality of all in the UK exists between the life expectancy of men and women (DOH, 2000). She set this in the context of the government?s commitment to tackle all health inequalities.
The statistics paint a depressing picture. There is a growing body of evidence and a plethora of statistics now that detail the desperate plight of men (White, 2001). There is also now a growing awareness of the multi-factorial nature of the problem. At grass roots level, health professionals need to be aware of the man?s perspective on health and wellbeing, and critically they need to learn how to engage effectively with men.
On a local level, some parts of Bradford have the highest rates of heart disease in the world. 'Bradford is the fattest city in the UK? leapt up the standings and earned its title by consuming too much alcohol and takeaway food, watching too much television and not doing enough exercise? (Guardian, 2006). Bradford?s response is a two-pronged approach of treatment and prevention work but there is much more to do.
On a national level there are encouraging signs that progress is being made but there is a long way to go. While the Choosing Health agenda for example clearly hits all the buttons regarding the general direction of public health, there is nevertheless a need for gender sensitivity with health issues which should be clear in National Service Frameworks (NSFs). Only when there is clarity at planning and delivery level regarding the special case of men, can there be truly effective progress. White (2001) made this crystal clear in his report on the Scoping Study on Men?s Health where he set out a base line by which progress can be judged.
The HOM project recognises that one size certainly does not fit all when it comes to reaching men and women. However, neither is this the case with different groups of men or individual men. HOM has exploited the luxury of being able to experiment and innovate when trying to access the 'at risk? and 'hard to reach? men in our communities. Our work has extended right across the Choosing Health priority areas and has required targeting and tailoring the services to meet the needs of the most disadvantaged through informed choice, personalisation and partnership working.
Through the experience of bitter failure and sometimes surprising success, lessons have been learned which should be disseminated. We have sought to do this, for example through our national conference in 2005 and our forthcoming handbook.
TheBradfordHealth of Men Project
The present day HOM project was initially part-funded by the New Opportunities Fund 4 years ago and was set up to address the neglected area of men?s health and the historic lack of attention to this inequality across the Bradford and Airedale district. It grew out of a group of likeminded health professionals who initially provided a forum to share good practice and generate debate. Links and interest snowballed, culminating in the present district-wide service that seeks to meet the particular and ever changing needs of its clients. Key partners include the now reunited Bradford and Airedale Primary Care Trust, the City of Bradford Metropolitan District Council, Education Bradford, Worksafe and Leeds Metropolitan University, through which HOM commissioned Professor Alan White to undertake evaluation of the work being undertaken.
Activities within the project have been designed with the following objectives in mind:
- To raise awareness of health issues among men by providing accessible services and information to the local male population.
- To deliver services and information to men through innovative practice, removed from traditional health settings.
- To encourage and facilitate health-enhancing activities and to improve health outcomes in the male population.
- To generate and maintain a two-way flow of communication between providers and users to ensure the continuing relevance and effectiveness of delivery.(Health of Men, 2004)
One of the undoubted successes of the HOM project has been the use of Health MOTs in a variety of settings. This is very significant given the priority areas outlined in Choosing Health (2004);
- reducing smoking
- reducing obesity
- improving diet and nutrition
- promoting physical activity
- encouraging and supporting sensible drinking
- improving mental health
- improving sexual health
all of which are covered in the MOT either through discussion or in tandem with clinical measurements.
Undeniably, this work is far from the sole preserve of Bradford HOM. The briefest of literature searches reveals many variations on this tool such as Knowsley?s 'Pitstop? MOTs and Sefton?s 'Tommy the Trucker? programme. There are a multitude of internet programmes that cater for the curious and concerned who would prefer absolute privacy and control over the assessment including one called 'Funky Fogey?! Health clubs will often offer MOTs that are tailored to those who might also want to see improvements in sporting performance.
Chemists offer a variety of home test kits. It has also become an area of big business with BUPA adapting their provision to the varied requirements of the male public by offering a choice of 8 different MOTs. These range from a 15-minute paper questionnaire to a two and a half hour examination costing over £500.
Men?s Health Week, which is organised by the Men?s Health Forum (MHF) in June, annually stimulates events to raise awareness of men?s health issues. This often takes the form of health checks and MOTs that are delivered by a variety of health workers wherever men are to be found.
Men more likely to look after cars than their body!
The HOM MOT is an opportunity delivered direct to men, to have a detailed review of their current health, to receive advice on health matters and to discuss any aspect of their health and well-being. 'In truth, men are far more likely to look after their cars than their own bodies and whereas car MOTs are required by law, there is no such equivalent for the driver. Women see their doctor twice as often as men and invariably much sooner in the course of any given condition?(Banks,2002).
The setting of the MOT varies according to the availability of the client. In short, we go where men are. This may mean a GP surgery if the practice can attract the men to a clinic, but is more likely to be in the workplace, the pub, a barber?s shop, the sauna and many other non-traditional and often opportunistic settings where men are to be found.
It is not intended as a substitute for services available from GPs but it is instead an adjunct to primary care services but with an emphasis on promoting self-care through health awareness.
We have tried to access and target manual workers, over 50-year-olds, unemployed men and men living in neighbourhoods with a high level of deprivation and/or communities with specific health issues related to the ethnic origin of the male population.
Our experience is that men do indeed care about their health but the means by which they do that can sometimes be complicated and frustrating.
- Men will talk about their health when prompted but this is far more likely to happen in a safe, trusting, non-threatening environment that might be described as 'their territory?.
- Men need to know that it is 'ok? to talk and that they will not lose face if they do.
- Men benefit from the convenience of the location.
- Men often need to be sure of the expertise and the professionalism of the health worker.
- Men have difficulty equating their own interpretation of their health status with what the professional says.
- Men like to be given options not solutions.
The experience of the Bradford HOM Project is that the health MOTs work on a number of different levels. Although the MOT is much more than a screening exercise, even on this level it is extremely useful for opportunistically identifying clients with hypertension or abnormal blood glucose and cholesterol measurements who are subsequently directed to the relevant agency according to locally agreed referral criteria.
There is also rarely a consultation when a lifestyle issue is not identified and explored in a non-judgmental way. This may be around issues such as nutrition and exercise, alcohol consumption, overweight and obesity, smoking, drug use, mental health, sexual health or sometimes relationships. What is remarkable is to see the holistic nature of health in action and to spend an uninterrupted 30 minutes dedicated to health- something that is almost unheard of for most men. It is sometimes this focus that stimulates the choice for change.
For some men, they receive the satisfaction and reassurance that everything indeed is pretty much in order and that the attention that they show to their health is paying off!
Sometimes workplace-based programmes are extended to men-only Stop Smoking and Weight Management groups, usually during work time. These usually have a flavour that is quite different to those of mixed or women-only groups. If MOTs can sometimes be difficult to evaluate in terms of change in health behaviour, then these groups are far easier to evaluate and justify both qualitatively and quantitively.
The male health agenda is gaining ground as too is the concept of the Health MOT. If handled well it is a useful tool for empowering men and facilitating change in health behaviours. Bradford HOM project serves as an example of how existing NHS teams can work in different ways to address the health needs of men in an evolving political and legal climate
BBC News, 28/1/06 http://news.bbc.co.uk/1/hi/health/4656866.stm
Banks,I (2002) Man: Haynes Owners Workshop Manual, The Practical Step by Step Guide To Men?s Health, Haynes, Yeovil
Choosing Health White Paper (2004)
DOH (2000) Health Service Circular 2000/0123 Yvette Cooper.The Stationary Office London
Department of Trade and Industry (2005) Advancing Equality For Men And Women: Government Proposals To Introduce A Public Sector Duty To Promote Gender Equality. London: Women & Equality Unit, Department of Trade and Industry
Equality Bill (2005) HMSO www.publications.parliament.uk/pa/cm200405/cm bills/072/2005072.htm
Guardian (2006) http://society.guardian.co.uk/health/news/0,,1699580,00.html
Health of Men (2004) Annual Monitoring Report 2004. www.healthofmen.com
House of Commons Debates, 30/1/06 http://www.theyworkforyou.com/debates/?id=2006-01-30a.21.0&m=1622
Men?s Health Forum (MHF) (2004) Getting It Sorted: A Programme For Men?s Healthwww.menshealthforum.org.uk
Queen?s Nursing Institute, (2006) Briefing: Social EnterpriseNo.5
White,A (2001) Report on the Scoping Study on Men?s HealthHMSO
Williams,R and Robertson,S (2006) Masculinities,men and promoting health through primary carePrimary Health Care Vol 16 No8 10/06 25