Life expectancy

Men’s Health Forum: why is there a mortality gap between men and women?

Yvette Cooper: It’s clear that there is a fundamental inequality in life expectancy between men and women. We’ve made clear we want to tackle health inequalities and this is one. Everybody has different theories and explanations of the causes and the issues around men’s health. There’s no point in government taking a nagging nanny approach. It’s up to men to make their own choices but there are issues around access to services and making sure health information is as available for men as for women.

Traditionally health promotion has been aimed at women and families and we’re trying to tackle that. Our teenage pregnancy campaign is as much about boys as girls. When we’re designing campaign material we’re thinking about boys receiving them too. It’s about content and where the message will be seen. Also the flu jab campaign will be launched by Henry Cooper making it very clear that getting a flu jab is as much about men as women. Its not a traditional stereotype and the idea that there any problem with men having a flu vaccination.

The second step is about what works to make a difference. We’ve asked the Health Development Agency to look at what works and make a difference in terms of improving men’s health and preventing them becoming ill. It’s the role of the HDA to inform health professionals right across the board about what works and what doesn’t.

MHF: How are they evaluating what works?

YC: We're trying to find that out. They’re looking at risk-taking among young men - drugs, alcohol, tobacco, sexual health - and are due to report next year. We want to find out what works to provide guidance. Another aspect is looking at what types of community programmes work including good practice guides on opening clinics in community settings which could include pubs and clubs.

The third area is around improving access to health services, making sure they’re not designed around a traditional model of women and children. If it’s a hassle to get to the doctor then you’re less likely to go.

Access to services

MHF: What are the other factors that stop men going to the doctor’s apart from surgery opening times?

YC: I think that’s up to men and that’s what we need the HDA to tell us. (Former Forum trustee) Jane De Ville-Almond’s pubs project is very interesting. She found out what men want. That’s better than trying to design services in isolation. It’s important to evaluate what is working. Other areas include football clubs and sporting work. It will be interesting to see if they have more effect.

In my area Castleford Tigers have joined up with the Primary Care Group and British Heart Foundation to set up ‘tiger beat for life’ based around preventing heart disease. This helps make health about boys and men and not just women. These programmes have huge potential and we need to spread the lessons to other areas Then there’s the stuff about expanding access - walk-in centres, NHS Direct and, of course, the internet, the work that the MHF are doing and building on that.

MHF: Men may be on the internet but they aren’t looking at health sites

YC: It’s one source of information and for people who do want to know making sure that they get proper information is important. It’s one route among many and it’s an expanding one. There are other issues around specific men’s health issues - two obvious examples are heart disease and prostate cancer.

On prostate cancer we’ve accelerated out work over the last year. It was clear that prostate cancer was the common cancer we knew the least about. It hadn’t had the attention other cancers had had and we’d not made the progress that had been made in other cancers. We asked the cancer research funders’ forum to look at research into prostate cancer early last year - the forum includes voluntary organisations, government and the medical research council - and at same time starting working across govt on a prostate cancer programme. It’s the only cancer we’ve pulled out specifically for a campaign. We’re doing a national cancer plan in the autumn but we singled this one out as the area we needed to do most. Prostate cancer is the second biggest killer of men in terms of cancers and is likely to overtake lung cancer as lung cancer deaths fall. When we launched the campaign, it included investment in research rising up to £4m making it, in term of the government’s specifically commissioned research, the highest funded of the cancers. So in terms of the Department of Health budget we’ve prioritised prostate cancer.

We’re also looking at heart disease. Two thirds of deaths from heart disease are men so we’re opening rapid access chest pain clinics. Some already open and we’ll have 139 in place by April.

MHF: do you need to be referred by your GP?

YC: there are two different models. Some are GP referral; some are at accident and emergency. But the ones’ we’re launching at the moment are GP focused - patients with chest pain will be referred within two weeks.

MHF: how did you get interested personally in men’s health?

YC: my driving interest is health inequalities wherever they might be - between people on high income and low income, ethnic minorities, geography - postcode lottery issues. On some issues there are concerns about women getting treatments quickly enough - for example, heart operations. We need to be sensitive to inequalities wherever they arise but men’s health is not just an issue for men, it’s an issue for the women who care for them too. Whole families are affected.

Crisis in masculinity

MHF: Is there a crisis in masculinity with men suffering and unable to ask for help?

YC: the health of men on high income is improving. They’re closing the gap with women. The area with most problems is men on low income. So it clearly is possible to improve men’s health or make a difference because for some men that’s what is happening. The new deal for the over 50s or the young unemployed and other issues around tackling unemployment can have a huge impact on people’s health and are as important if not more important than anything you can do directly through the health service.

MHF: surely a lot needs to be done in school to get men to seek help?

YC: yes, particularly in low income areas. To prevent people getting ill in the first place you have to look at deep-rooted causes of ill health including poverty, unemployment, poor housing, low skill levels. Only by looking across the board can you make a real difference. 

MHF: you could argue that if you’re a man on low income who’s never going to have a decent pension you may as well live fast and die young.

YC: every individual has got make their own choices about the life they lead. I don’t think it up to the government to tell them how to live their lives. What comes down to government is making sure that they have the information to make those choices and fair access to services and support. Take smoking, 70% of smokers want to give up so we must provide smoking cessation services to support people who want to give up. If it comes to it, giving people opportunities and aspirations so they feel life is worthwhile, that means opportunities for men as well as women and at whatever age - not just for teenagers but older people too.

MHF: what opportunities?

YC: If you look at teenagers, it means better opportunities to stay on. In my constituency in some schools only 30% stay on at 16. Education action zones are trying to boost those rates. That kind of thing is about boys as well as girls. Equally the new deal for the over 50s is about improving opportunities for people to get a new job or go back to work later on in life.

MHF: but schools are only interested in their percentage of A-C grades in examinations not talking to kids about condoms or whatever

YC: first of all, helping teenagers get qualifications that others in better off areas are getting is one way of tackling health inequalities, so we shouldn’t underestimate the role of education and of improving standards. Secondly, we now have the personal and social health education framework which includes sex and relationships and citizenship. Our role has been as part of the healthy schools work. Later on in the year we’ll also be launching a pilot programme to give free fruit to children.

MHF: How can organisations like the Forum work with government to help men the health care they need?

YC: there’s a huge role for MHF and other groups to work with the department and with men across country. It’s not simply about what government do. Often voluntary organisations can be extremely effective in coming up with new ideas, communicating them and spreading best practice and stimulating debate and raising awareness. I’ve met with the MHF before and hope to continue to do so. I think there’s scope for building more of a network around men’s health and finding ways to feed in ideas from that network to the department and develop closer working in the future.

Minister for men

MHF: should there be a minister for men?

YC: it’s a mixed picture. There are lots of issues where women lag a long way behind. There is a clear men’s health question around life expectancy and we need to tackle that but different issues affect men and women differently. You take gender into account. Looking at how health policies affect men and women will sometimes show there’s more to do on women’s health and we need to be sensitive to this too. It’s about recognising where the impact is different and not assuming it’s the same for men and women. The classic example is teenage pregnancy. It has been seen as about girls but in fact boys are half the problem and half the solution.

MHF: do you think the problems get exacerbated by macho culture among young boys? The problem has been identified - men don’t go to doctors - the question is why?

YC: That’s one of the reasons why you need research but it’s a question men need to ask themselves. It’s important we provide services that respond to what men want such as clinics in community settings. There are all the stereotypes of men refusing to go the doctor and the wife nagging but we have to be careful not to deal in stereotypes. There may be all kinds of reasons why men might use some services rather than others. I don’t want to get into a game of stereotypes, looking for a simple answer as I think it’s often quite complex. I think you need to provide a diversity of services to provide what men want.

MHF: diversity of services sounds good but its expensive. Men weren’t even mentioned specifically in the NHS plan so is the money there?

YC: I think it is there for walk-in centres and NHS Direct and that’s what we said we’d do. The NHS Plan talks about inequalities across the board and we’re also putting extra money into prostate cancer and identifying extra investment for heart disease. It’s an issue that needs to be seen in the broad context of inequalities. There’s no magic answer. 

MHF: can the country afford to have all these men living beyond 65. You tell us we can’t afford the pensioners we have got.

YC: I don’t think that’s an accurate reflection of the pensions situation at all. Of course, you want to improve life expectancy for men, particularly for men who are on low income. That’s why we’ve set specific targets for reducing cancer and heart disease deaths in people under 75.

Men, women and health professionals

MHF: how can women help men to take more action about their health?

YC: Health is something people discuss within families and that’s why the idea of men’s health versus women’s health is a complete nonsense. Ill health among men affects all the women around them but men have to make their own decisions about the lifestyle they lead and the treatment they have or whatever. The more information and discussion in families, the more support, I’m sure it provides, not just for men but for women as well.

MHF: how do you encourage the men in your life to take an interest in their health?

YC: I was asked that one on Radio 5 and I just giggled and the presenters giggled and it turned into a completely incoherent discussion. I suppose the reason I’m reluctant to answer in the way that you want is that I hate all the stuff about the nanny state and I don’t think it’s for me as health minister to prescribe the lifestyle that people should lead and the way they should act. It’s not about me saying to men or women “this is what to do”. My job is to make sure they get the information that the doctors says is good but ultimately people make own choices. I want to make sure inequalities are tackled and that we’re aware of where inequalities are and don’t just ignore them.

MHF: Are you getting a good response to your initiatives from health professionals?

YC: When we talked about men’s health earlier in the year there was a lot of enthusiasm. The thing about having the HDA is to give people something that is helpful and useful and not just say this is an issue. I think there’s a lot of interest in this, to be honest. Men’s health has been an area of growing interest over the last few years. The challenge is finding out what it is that works and what makes the difference. There are no easy answers but there is the will to do it. No body will ever solve the problem in isolation. You need to raise awareness around it. And that’s what we’re trying to do.

MHF: Thanks very much

• This interview first appeared in 2000.
• in 2001, Yvette Cooper wrote the Foreword in the first issue of the Men's Health Journal, our official journal
• Image: Yvette Cooper by Rwendland licenced under CC4.