MEN S HEALTH AND PRIMARY CARE: IMPROVING ACCESS AND OUTCOMES EUROPEAN ROUNDTABLE EVENTS PROPOSAL FOR DENMARK [DRAFT v1] Background Men s health across Europe is unnecessarily poor. In the European Union as a whole in 2012, average life expectancy at birth was 77.5 for men and 83.1 for women, a difference of almost six years. In Denmark specifically, the equivalent figures were 78.1 years for men and 82.1 years for women, a difference of four years. Of particular concern is the high level of premature mortality among men. There were 630,000 deaths among men of working age (15-64) in 2007 across Europe, of which almost a third (about 198,000) were before the age of 50 years. By comparison, there were 300,000 deaths in women of working age and around 86,500 deaths before the age of 50. An OECD analysis of PYLL (potential years of life lost) before the age of 70 shows that, in Denmark in 2009, males had a much higher level of premature mortality (4,311 per 100,000 males) than females (2,493 per 100,000 females). In other words, men were 1.7 times more likely to die prematurely. Recent improvements in the life expectancy at birth of men have mostly occurred at older ages; there has been little improvement in the high rate of premature death in younger men. The WHO European Region s review of social determinants and health, chaired by Sir Michael Marmot, concluded that men s poorer survival rates reflect several factors greater levels of occupational exposure to physical and chemical hazards, risk behaviours associated with male lifestyles, health behaviour paradigms related to masculinity and the fact that men are less likely to visit a doctor when they are ill and are less likely to report on the symptoms of disease or illness. A study of inequalities and discrimination in access to healthcare by the European Union Agency for Fundamental Rights also found that women are
generally more aware of their health status than men and are more frequent users of healthcare services. A BMJ editorial on men s health in Europe observed that a major challenge is to engage with the many men who do not access health services. Men s use of primary care Primary healthcare services are central to strategies to improve men s health in terms of prevention, early diagnosis and treatment. Currently, however, primary care services (general practice, dentists, pharmacy, optometry and others) are under-used by men with adverse impacts on their health, families and communities, employers and health budgets. According to the State of Men s Health in Europe report (EU, 2011), there is consistent evidence that men of different ages, ethnicities and social backgrounds access the full range of primary care services less frequently than women. According to the new book Mænds sundhed og sygdomme (Men s health and diseases) 1 by the president of Men s Health Society, Denmark, Svend Aage Madsen, one of the consequences of men s under-use of primary care are the big disparities between occurrence and mortality for men in the big diseases. Men in Denmark have a 10 pct. higher prevalence of cancer but 40 pct. higher mortality than women do. This higher mortality for men is also seen for diabetes, cardiovascular and other diseases. In England, in 2008 9, women aged 15 80 years had significantly more consultations with GPs than men; the biggest gap was in the 20-44 year age group. A study of middle-aged Lithuanians found that 54% of women and 41% of men attended dental check-ups habitually. A study of the uptake of free eye tests in Scotland after their introduction in 2006 found that a larger proportion of women had their eyes tested both before and after and that there was a significant increase in female utilisation after the change but no evidence of a change in male uptake. A Danish analysis based on almost 36 million GP contacts and 1.2 million hospitalisations in 2005 found a male pattern with a lower contact rate to the general practitioner, but higher hospitalization and mortality rates. This is compatible with a scenario in which men react later to severe symptoms than women so that they are more likely to be hospitalized for or die from these conditions. Spanish men aged 60 years and over have also been found to visit medical practitioners and receive home medical visits less frequently than women but to be admitted more frequently to hospital. When men do use primary care, research suggests that they tend to ask fewer questions and that their consultation times are shorter than for women.
EMHF s work programme The European Men s Health Forum (EMHF) has begun a work programme which will lead to improvements in men s use of primary care services. The first stage was a Roundtable meeting held in Brussels in June 2013 which brought together a wide range of relevant organisations with a Europe-wide remit to learn from their expertise and experience and to determine how best to tackle the problems. EMHF published a report 2 on the outcomes of the Roundtable which was discussed at an EMHF-hosted workshop on men s health and primary care at European Health Forum (EHF) Gastein in October 2013. 3 This event generated further high-level support for EMHF s work in this field. An article in the journal Trends in Urology and Men s Health, written by Professor Ian Banks and Peter Baker from EMHF, has been published on this issue. 4 A second article was published in the journal Eurohealth in spring 2014. 5 An oral presentation of the findings to date were presented at the Men, Health and Wellbeing Conference at Leeds Metropolitan University (UK) in July 2014. National Roundtables One of the key recommendations from the Roundtable in Brussels was that similar events should now be held in each European nation to take account of its specific circumstances. EMHF is therefore convening, in as many nations as is practicable, a one-day Roundtable meeting of the national organisations representing the different stakeholders in primary care, including general practitioners, nurses, dentists, pharmacists, optometrists, audiologists, occupational health, patients and the diagnostic and pharmaceutical industries. Representatives of men s health organisations, where they exist, will also be invited. It is envisaged that about 25-35 organisations will be represented at each Roundtable; the events will be chaired and facilitated by EMHF. Where appropriate, each Roundtable will be organised in partnership with one or more national organisations. Two such Roundtables have already been held, one in England (July 2014) 6 and one in Northern Ireland (November 2014) 7. A third will be held in Gibraltar in May 2015. EMHF, with its partner organisation Selskab for Mænds Sundhed, now wishes to hold a Roundtable in Denmark. The planned date is 28 October 2015 and the venue will be in Copenhagen. The purpose of each national meeting is to identify: The challenges facing primary care as a whole as well as specific professions (general practice, pharmacy, dentistry, etc.) The actions primary care and other stakeholders must take if men s access and outcomes are to be improved
A strategy and workplan for individual stakeholders and EMHF The Roundtables will also provide an opportunity to develop EMHF s contacts in each nation and to develop and strengthen its organisational network. The outcomes for each nation will be published in a report which will support future work in each nation and help to improve knowledge and understanding of the issues in Europe as a whole. The findings will be disseminated via journal articles and conferences. EMHF plans to hold a Europe-wide conference at the end of the project. The Roundtables already held in Brussels, London and Belfast have involved a wide range of key stakeholders and provided many significant insights into men s use of primary care. For example, it is clear that men use the range of primary care services in similar ways and poorly compared to women. But it may well also be the case that men s use of services is worse for some health problems than others and that they are particularly reluctant to seek help for mental health problems. The Roundtables have highlighted a potentially significant role for pharmacies to engage men through health checks, medication reviews, support for self-care, information and signposting, and public health initiatives (e.g. smoking cessation, alcohol, obesity and sexually transmitted infections). Roundtable format The format of each event will broadly follow that of the EMHF Roundtables in Brussels, London and Belfast: Short scene-setting presentations from government and the different primary care professions Workshops exploring the barriers and solutions A plenary discussion to agree conclusions and next steps A template programme for each roundtable is shown in Appendix 1. Timetable The programme of Roundtable meetings started in 2014 and it is envisaged that the Roundtables will be held over a five-year period. The first round of Roundtables will be held in countries where men s health work is well-established and where EMHF already has good connections. This will help to build momentum for Roundtables in other countries. About EMHF and Selskab for Mænds Sundhed
European Men s Health Forum (EHMF) is a not-for-profit NGO. It is the only European organisation dedicated to the improvement of the health of men and boys in all its aspects and provides a platform for the collaboration of a wide range of stakeholder groups across Europe. Established in 2001, it has succeeded in raising the profile of men s health through policy development, lobbying, campaigns, conferences and seminars, research and publications, and the provision of information directly to men. www.emhf.org. Selskab for Mænds Sundhed (Men's Health Society, Denmark) is a multidisciplinary organisation dedicated to the field of men's health in all its aspects. Selskab for Mænds Sundhed is a member of the EMHF and Global Action on Men's Health and is the leading body in Men's Health Forum, Denmark with more than 40 partners working together to better men's health. www.sundmand.dk For further information Contact: Peter Baker, Consultant, European Men s Health Forum Email: peter.baker@emhf.org Svend Aage Madsen, President, Selskab for Mænds Sundhed Email: svendaage@madsen.mail.dk 1 Madsen, S.Aa. (2014) Mænds sundhed og sygdomme [Men s Health and Diseases]. Copenhagen: Samfundslitteratur. 2 http://www.emhf.org/wpcontent/uploads/2013/12/menshealthprimarycareemhfroundtablereport2013.pdf 3 http://www.emhf.org/wp content/uploads/2013/12/ehf Gastein 2013 EMHF Mens Health Workshop Report.final_.pdf 4 http://onlinelibrary.wiley.com/doi/10.1002/tre.357/pdf 5 http://www.euro.who.int/ data/assets/pdf_file/0009/244863/eurohealth v20 n1.pdf 6 http://emhf.org/wp content/uploads/2013/12/emhf England Primary Care Roundtable.July 2014.Report.Final_5.pdf 7 http://emhf.org/wp content/uploads/2015/02/emhf NI Primary Care Roundtable November 2014 Report Final.pdf