As Dr. Howard Stoate (MP) rightly pointed out in his recent speech to the house of commons (5 March): “Work – or more specifically getting a job, maintaining a job, and most importantly of all, deriving a sense of personal fulfillment and satisfaction from that job – is the key to good health”. Stoate went on to acknowledge the link between full-time employment and men’s poor use of health services, stating: “When you consider the extent to which work continues to dominate the lives of men, it’s little wonder that men make much less use of primary healthcare provision than women.”
It is widely accepted that men under-use existing primary healthcare services, but the role of the workplace in relation to improving their health is a relatively new addition to the debate. On top of this (and the stress the workplace often inflicts upon male employees), the threat of mass unemployment is also set to take its toll on the UK’s male workforce. So is using the workplace as a platform for the delivery of primary healthcare services the next step towards improving men’s health?
Why the workplace?
Men tend to be less inclined to seek help or advice when faced with a health concern, which often leads to delayed presentation and subsequently worse health outcomes, compared with women who are generally quite forthcoming and proactive in their approach to their health. Research from Denmark suggests that men’s poor use of GPs leads to increased in-patient admissions. The government’s Cancer Reform Strategy cites the example of malignant melanoma. It is more common in women, yet the death rate is higher for men. The most plausible explanation for this is delayed presentation by men.
This reluctance to seek help stems partly from the restrictions placed upon males as a result of society’s concepts of what a man should be: invincible, competitive, emotionally silent, and so on. But men’s reluctance to address their health concerns is not helped, and in fact is seriously disadvantaged by, the current primary care services available – which simply do not cater for their needs, especially those of working age.
However, The Equality Act’s Gender Equality Duty (2006) places an obligation upon the NHS to provide a service that is tailored to the different needs of men and women. And if men are failing to use the current services on offer (due to location, opening hours, alienating environments or a lack of outreach), it is essential that, to comply with the legislation, service delivery is changed. The workplace represents a perfect opportunity for the health service to demonstrate compliance with the legislation but, more importantly, to address the gender gap in a genuine way.
From checking blood pressure to implementing weight management programmes and providing counselling sessions, utilising the workplace as a venue to aid the delivery of primary care services for men is far more than a ‘great in theory’ idea. This approach also fits well with government policy on promoting wider choice and greater flexibility in the delivery of primary care and Dame Carol Black’s agenda to improve the health of the working-age population.
Changing role of OH
The current economic climate is a serious concern for us all. With an estimated three million people likely to be without work in the next few months, unemployment represents not only an economic issue but a public health issue too. Overall, there are more men than women in paid employment (15.9 million men compared with 13.5 million women), and men are twice as likely to work full-time (14.1 million men, 7.8 million women).1 A recent study from Cambridge University showed that men are more likely than women to become stressed and depressed when they lose their jobs. Taking this into consideration, and in addition to supporting health services to tackle men’s health through bringing primary care to where men are (and feel comfortable), occupational health professionals also have a role to play in anticipating the health implications of employee uncertainty, the threat of redundancy and consequent job insecurity.
At a recent Men’s Health Forum expert symposium on health and work, Dr Stuart Whitaker, senior lecturer in occupational health at the University of Cumbria, noted the increase in men’s use of GP and hospital services, symptom reporting and minor mental health problems (such as anxiety and depression) before, during and after a large factory closure. That said, we must ensure that staff at risk of redundancy are targeted by health professionals (either internally or externally) to address their changing health needs. Whether this takes the form of counselling sessions, blood pressure checks or workshops on dealing with stress, diet and alcohol misuse is subject to the demands and set-up of the organisation in question.
The state of men’s health in the UK is currently unacceptably poor, and mass unemployment has the potential to make it a lot worse, if closing the gender gap and improving men’s access to healthcare is not made a priority soon. We know that men identify with the workplace, and that it is a familiar and safe environment for them. However, the health service has yet to make a real connection between men, work and the delivery of primary healthcare services.
In my view, OH professionals have the ability to bridge this gap, improve workforce productivity, reduce absenteeism and, ultimately, promote better health and wellbeing for men.
Dr. Ian Banks is president of the Men’s Health Forum
National Men’s Health Week has two main objectives:
To improve men’s awareness of the range of health and related services and how to use them effectively.
To improve the understanding of health policy makers and practitioners about how to develop and deliver services that men will use.