How to be a Man is a series exploring masculinity and the challenges men face in Ireland today. If you would like to add your voice to this series, email howtobeaman@irishtimes.com
It’s a fairly common assumption that when it comes to regular medical check-ups or getting something out of the ordinary examined, women take the lead.
Certainly, in 2016, men of all ages are taking much better care of their physical health, be that regular gym sessions or plenty of outdoor action. However, when it comes to the health you cannot see – by this we mean the inner workings of the human body – there has long been a mindset of “ignorance is bliss” among too many Irish men.
Eager to explore this assumption, we spoke to a cross-section of Irish men aged from their mid-20s to their 60s. The eldest group, it appears, are more conscientious with health checks because with an ageing body comes the inevitable aches and pains that are hard to ignore.
Most of these men would be on some kind of medicine – perhaps cholesterol medicine or the anticoagulating Warfarin – so they have no choice but to sit down with their GP once every few months and make sure all is tip-top.
For Tony Ford (61), putting off a doctor’s visit is “no longer applicable, given my age”. Some others admitted dragging themselves to their GP, as this made for an easier life than listening to their “overly cautious” partners badgering them about getting a check-up.
“Well, I would always put it off until my wife nagged at me to go and see the doctor,” says Shane Hamilton (43). “I would be the type to say, ‘Ah, it will go away’ or ‘Ah, it’s no big deal’. Then my wife will keep at me to go. I wouldn’t go straight away based on my own concern; I have to be told.”
For the most part, the younger Irish men we spoke to didn’t feel any need for regular health checks in the absence of excruciating pain or the kind of symptoms that would keep you up at night.
“If it’s painful or stopping me from working, I’ll go [to the doctor] straight away; otherwise it’s not likely,” says Mike Sheridan (34).
Loved ones
Those approaching 40 and beyond have grown more wary of their own mortality only after witnessing a loved one go through something that hadn’t been anticipated or something they feel could also have happened to them. So, despite the efforts of awareness groups such as Movember Ireland or Blue September, do young Irish men still need a scare in order to stay on top of their internal health?
Noel Reidy (36), an Irish man and father to two-year-old Otis living in the very health-conscious state of California, has made regular health checks a priority in recent years.
“I lost my dad to cancer in 2000 and got into the habit of paying attention to my own health from the experience,” Reidy says. “By the time he was diagnosed it was too late . . . if he had been getting checked more frequently beforehand, he might have been diagnosed much earlier and lived longer as a result. My mum also had a cancerous kidney tumour removed earlier this year, so that provided me with yet another reason to remain vigilant.”
Simon Alvey (29) says: “I’ve seen both my parents go through cancer diagnosis and treatment. While I’d have thought that I was health-aware previously, this certainly reinforced the importance of early detection.”
Being a parent has further increased Reidy’s conscientious attitude: “Prevention is better than cure and now that I’m a parent, I feel I have a responsibility to take care of myself so I can be around to bother my son as a cranky old man.”
Self-examination
One of the easiest ways to increase your vigilance is with certain health checks at home. Is self-examination of the testicles something Irish men can incorporate into their daily or weekly rituals in the same way women are urged to get familiar with their own breasts?
“Checking for abnormalities on your testicles is a fairly straightforward process and brightens up an otherwise boring shower routine,” says Reidy.
However, other men we spoke to admit they almost never check down there. Worryingly, not one of the men in their 20s or 30s to whom we spoke was concerned about getting familiar with their bits.
“Occasionally and infrequently (note to self . . . ),” Alvey says, while Kevin Smith (29) says, “No, not really” when asked if he checks his. Paul McCabe (29) also says: “Nope, not really, but I think I would notice if something was wrong.”
Sheridan (34) admits self-health checks are probably important, but it never occurs to him to do them.
For many young Irish men, however, it’s not just their “ah, it’ll be grand” attitude that puts them off going to the doctor, but the hefty fees paid for “something that turns out to be nothing, of course”.
For Sheridan and Alvey, this is what discourages them. “It comes down to cost, a lot of the time. I weigh the pragmatism of what exactly a doctor can do for me for what I have to pay them. If it feels serious, that’s a different story,” says Sheridan.
Des Doyle (63) shares this view. “I’ve had regular health checks in the past but I’m not convinced of the need for these; often they’re quite expensive. The addressing of actual symptoms being encountered seems more appropriate to me.”
Dr Amy Morgan, a GP based in Drogheda, Co Louth, certainly sees far more women than men. "Women may have built up a rapport with their GP by virtue of attending for antenatal checks, cervical smears and contraception advice which offer regular opportunities for health promotion and discussion. Men, in contrast, may end up attending their GP only when they feel something is wrong," she says.
Under pressure
She says men may appear more health-conscious today, but she worries about the “pressures exerted on young men to maintain a certain body weight or muscle mass with aesthetics tending to take priority over general health”.
Movember Ireland, which champions the awareness, prevention and cure of male-related illnesses, confirms the assumed gender gap when it comes to health self-awareness among men and women.
To begin with, statistically speaking, gender has a huge impact on the life expectancy of an individual. Through its research, Movember found that the health outcomes of men are significantly worse than those of women in all parts of the world. More pointedly, on average, men die six years earlier than women.
However, add to this the behavioural trends of the male counterpart and things are looking less than favourable. Important research has confirmed that men are often reluctant to openly discuss their health, the impact of significant life events and how they feel about these.
They are also more unlikely to take action when they don’t feel physically or mentally well.
But why? Because they are not bothered? Or because this goes against the age-old tenets of masculinity? Sadly, the latter attitude seems to prevail.
“There’s an element of ‘get on with it’, I suppose, as stupid as that sounds,” says Sheridan.
Tony Ford (61) says: “I think it’s just fear of the unknown; if you ignore it, it will go away.”
According to Movember, these behaviours “are strongly linked to adherence to some harmful aspects of traditional masculinity. Men often feel pressured by society to appear strong, in control and never vulnerable. Talking about feeling mentally or physically unwell can be perceived as weakness. By allowing negative and harmful aspects of masculinity to be considered the norm, we’re making men feel there’s only one way they can be considered ‘manly’.”
Dr Morgan says: “When you explore the reasons why men are typically more reluctant to attend their doctor, factors such as a lack of general health education, embarrassment and fear of being told, particularly where there is a family history of disease, that ‘something is wrong’ prevail. Even simple factors such as the sex of the doctor treating them can be an issue.”
Paul McCabe (29) says: “I think Irish people in general tend to think, ‘It’ll be grand’, but yeah, it’s probably more prevalent with men. Perhaps it’s a kind of optimistic apathy that means you don’t spend too much time fretting about yourself?”
Alvey says: “I guess a lot of it is the hope that if you ignore it, it will go away. After that, I agree that some men have a certain level of embarrassment attached to going to the doctor or are afraid of the actual time spent with the doctor. They’re all pretty irrational reasons, though, when you look at them. I also think, in terms of having your prostate checked, that a lot of heterosexual men may attach a massive stigma to anything involving their nether regions, probably stemming from some subconscious homophobia.”
Shane Hamilton (43) believes it’s an attitude that’s been passed down from previous generations. “My da was like that for years. He was always , ‘Sure I’m grand, no need to waste your money’, so I learned from that,” he says.
“It wasn’t until he turned 47 that he was hit with a huge health problem that could have been detected earlier in his life. This cost him his life a few years after that. If he had a different, more positive attitude towards it, he would have lived longer. But my da was old school. He went on working stupidly long hours and it all cost him in the end.”
Tackling taboos
Movember was introduced to Ireland at a time when discussing the likes of prostate cancer was a “taboo in the Irish male psyche”. Though they still have a long way to go, today, “it’s something far more approachable and discursive. Ambassadors like
Jamie Heaslip
and Jason Hughes have really given weight to the discussion over the years, encouraging men to be more open about their overall health and wellbeing.”
Declan Branagan was 57 when he was diagnosed with prostate cancer. “Three seconds saved my life. As the founder chief executive of my company eXpd8, it was hard to switch off from work and focus on myself. However, my diagnosis was also a real eye-opener, it made me realise the stress I was under in work,” he says.
“With this in mind, I decided to take some time out to focus on myself and concentrate on getting better. After surgery and weeks of radiotherapy, I am now back to full health and back at work. It took getting ill for me to realise that I was stressed, and this can be a big factor that leads to cancer.
“I urge all men to ensure that you take some time to yourself to de-stress and to please go and get tested with both a blood and physical DRE [digital rectal examination]. Three seconds of your time could be priceless to you, as it was to me.”
Treat yousefl
Branagan urges other men to “treat themselves” to regular check-ups because for him, he says he had no concerning symptoms, other than an increased need to urinate. “I’ve hardly been sick a day in my life,” he says.
Alvey now undergoes a once-yearly medical as part of his job with the Reserve Defence Forces, but other than that he "tries to avoid the doctor". Still, he acknowledges that a man's self-awareness when it comes to their health could easily be "a matter of life and death".
“I think there is awareness, but the likes of these campaigns tend to drive fundraising activities as opposed to tackling men’s reluctance to see a GP or encouraging men to check themselves over,” he says.
Paul McCabe thinks the efforts so far have been commendable, but there is still room for plenty more. “I think these charities’ increased awareness is great. It probably doesn’t occupy as prevalent a place as breast cancer does in terms of awareness, but it’s brilliant that it’s increasing and improving all the time,” he says.
It needs to become the norm for men to be talking about their health and taking action. Men coming forward with problems isn’t a sign of weakness: there are plenty of different perceptions of “manliness” that aren’t contingent upon the stereotypical “strong and always in control” man.
Perhaps taking control of one’s health, with regular check-ups and knowing the importance of blood tests, is one way to restore some self-perceived lack of strength or masculinity.
“I think it’s up to men themselves to look after their own health. Women are much better at having regular checks, even when they feel fine. We should be no different. It’s so important,” says Ford.
On the other hand, Doyle (63) no longer sees a problem among his peers. “In my experience, none of my male friends or acquaintances have any difficulty with seeking medical advice for any health problems they encounter. Perhaps the myth of male indestructibility has vanished from the age group I socialise with.”
Gender gap
There is still work to be done to tackle the gender health gap and work towards a world where future generations of men are not faced with the same issues as today. Action needs to be taken at an individual, community and societal level which could be very powerful if delivered successfully here in Ireland.
This means engaging men and women, businesses, sporting groups, community organisations, governments, health policy makers and healthcare providers in the efforts to reduce the current gender health gap in outcomes.
The Movember Foundation undertakes an independent research survey every two years to confirm that the Awareness and Education programme is achieving its goal of increasing the understanding of the health risks men face and empowering them to act on that knowledge.
The results from the last survey (conducted in 2015, from 2014 participants) showed that as a result of the 2014 Movember Foundation Awareness and Education programme: 99% of participants talked to someone about their health
87% are aware of the health issues they face
71% had seen or were intending to see a medical professional to get their key personal numbers (blood pressure, cholesterol, waistline, weight)
70% told someone they should take action to improve their health
51% of the people who were spoken to about improving their health took action to improve their health
46% of the people who were spoken to about improving their health, said they would see a doctor to address a concern.
“We’re proud of all that we’ve achieved, but we have only one definition of success: funding breakthrough solutions that produce tangible improvements in the lives of men,” Movember says.
“We want to give more life to our brothers, fathers, sons, partners and friends. We want men and women to take action. We’re fighting to ensure the boys being born today live as long and as healthy as girls.”
Dr Morgan agrees: “I would highly encourage men, whatever their age, to see their GP once in awhile, if they have any concerns about their health or if they’re looking for general health advice and are not sure where to start. Whatever you do, don’t self diagnose!”
