The Men’s Health Forum (MHF) has published its government-funded Gender Equity Audit Report as a tool to help the N…
VOL: 103, ISSUE: 26, PAGE NO: 23
The Men’s Health Forum (MHF) has published its government-funded Gender Equity Audit Report as a tool to help the NHS provide gender-sensitive services for achieving much-needed improvements in the health of men and boys (Department of Health, 2007).
The report is aimed at PCTs and all primary healthcare professionals. It was produced by the MHF working in partnership with the Essex Primary Care Research Network (EPCRN).
Gender is an important determinant of health status and it is recognised that inequalities affect both sexes in different circumstances (DH, 2007).
In recent years attempts have been made to address gender inequalities for both sexes. In 2003 the DH published guidance for mental health practitioners on effective working with women (DH, 2003), which suggested there was ‘a strong evidence base’ for ‘the need for gender-sensitive and gender-specific services’.
In 2004 the MHF published Getting It Sorted (MHF, 2004), which looked at how to incorporate the specific needs of men into policymaking at national and local levels.
The Equality Act 2006 amalgamated the UK’s existing equality agencies into a single new Commission for Equality and Human Rights (CEHR), and established a commitment to achieve gender-equitable policymaking and service provision.
This element of the act took effect from April and has become known as the ‘gender duty’.
The MHF report set out to establish what the ‘gender duty’ provision of the act would mean for the health of men.
The MHF report says gender differences in how women and men access and use health services are common, and there are significant differences between men and women in disease incidence and health outcomes. In preparing the report, the MHF:
- Carried out a survey of all English PCTs to establish the existing knowledge of gender issues and understanding of what is expected under the ‘gender duty’;
- Gathered case studies of one particular aspect of current service provision within each of the five PCTs who had a commitment to tackling gender inequalities;
- Conducted a series of interviews with the PCTs about gender equality.
Overall, the MHF found that there may be a lack of commitment and capacity to tackle gender inequalities in healthcare in a wholehearted way. It also revealed that there was a shortage of expertise in working specifically with men.
The survey of PCTs received responses from 89 trusts, a 32% response rate. It found that just over half (57%) of PCTs ‘always’ or ‘often’ took into account the differences in health needs, behaviours and attitudes between men and women when developing public health policy.
It also found that only a third of PCTs ‘always’ kept data on specific service areas including cancer, heart disease and diabetes that is broken down by gender when it comes to planning and decision-making.
Case studies were carried out at Bradford City Teaching PCT, Epping Forest PCT in Essex, South Worcestershire PCT, Southwark PCT in London, and Uttlesford PCT in Essex. Each said it would study a particular area of provision in relation to gender equity.
The areas looked at were:
- A statistical analysis of secondary data held by the PCT to identify any differences in experience and outcomes between men and women, looking at disease patterns, risk factors and service use;
- A study to establish whether any male-specific services had been developed locally in response to needs and to explore why men are less willing to use services;
- Why there are more older men than older women in the high-risk group for hospital admission;
- The use of smoking cessation services and incidence of heart failure;
- The use of care pathways by patients who had experienced a heart attack and to determine the adequacy of service provision from patients’ point of view during admission and after discharge from hospital.
The work threw up several useful findings, one of which was that between the ages of 25-34 women were three times more likely to visit their GP than men.
An audit of all GP practices in one PCT’s area revealed that not one practice ran a Well Man clinic but all provided a Well Woman clinic. When asked if a specific appointment could be made for a man’s health check, one practice said it ‘could not be done by a nurse’ and required an appointment with the GP.
More than half (55%) of all smokers in one PCT area were male but men made up only 38% of people using smoking cessation services.
One study of patients and their carers carried out by a cardiac community liaison nurse for Uttlesford PCT in Essex found:
- The incidence of MI was shown to be twice as high for men as for women;
- Men were more likely to be referred for investigation post-MI and more likely to be referred for revascularisation procedures;
- Women were significantly less likely than men to comply with their post-MI medication regimen (64% of women complied, compared with 87% of men);
- Women were less likely to be offered cardiac rehabilitation programme places.
Interviews with the five PCTs found that there may be a need for a dedicated member of staff with responsibility for developing gender-sensitive services.
One PCT said that data collected in general practice is not yet sophisticated enough to be gender sensitive, and the Quality and Outcomes Framework data that is requested from GPs by the PCT for funding reasons is not separated by gender.
More than one PCT recommended that health professionals should receive training and education to encourage them to set up gender-sensitive services and that general awareness of inequalities has to increase.
The report concludes that PCTs have not been as sensitive to the gender issue in the past as the new legislation intends they should be. It says that hard work lies ahead and that that recognition of the gender issue, expertise in working with men, commitment to tackling problems and the capacity to do so, all need to improve.
THE WAY FORWARD
The report makes recommendations that are said to be ‘straightforward, workable and pragmatic’ and which will build capacity without requiring significant resources (see Box). While many of the recommendations require a lead to be taken at strategic level, healthcare professionals need to become more gender aware when setting up services. They also need to pay attention to gender-related issues in their day-to-day practice and interactions with patients.
THE MHF’S RECOMMENDATIONS FOR ACTION
- All datasets that are in regular use at both a national and a local level should be routinely collected, presented and considered in a form that is separated by gender;
- Data that is made available to the general public (for example in media releases, information material, annual reports) should always be broken down by gender;
- Strategic health authorities should appoint a ‘gender lead’ with responsibility to see that gender inequalities are tackled effectively;
- A training programme should be developed for senior managers, which is capable of being ‘cascaded down’ and backed up by an online resource aimed at NHS staff at all levels;
- An online searchable central database of good practice should be developed - preferably in advance of the implementation of the ‘gender duty’;
- PCTs should establish standing advisory groups of men and women whose role is to comment on local policy and practice from a ‘gendered’ viewpoint;
- The DH should establish an advisory group with expertise in tackling gender inequalities to advise on policy and practice, and scrutinise implementation of the ‘gender duty’;
- PCTs should be encouraged to review all local targets and, wherever possible, rewrite them in a form that is separated by gender. Future targets should all be expressed in this way to comply with the Equality Act 2006 www.opsi.gov.uk/ACTS/acts2006/ukpga_20060003_en.pdf. (Stationery Office, 2006).