Some years back, in response to the successful track record of a women's health clinic, the practice in which I worked decided to experiment with the concept of a men's health check-up. We were somewhat doubtful whether there would be a demand or not.
Surprisingly, there was a good response to the new notice in the waiting room. Initially, many of the appointments were made by concerned spouses and partners. As time went by, however, men themselves began to inquire what was involved and they subsequently booked in for a check-up designed specifically with their health needs in mind.
So what did we offer? Well, we decided to concentrate on those in the 40-plus age group, looking at the major risk factors affecting the mature male. Heart disease is one of the targets of such a consultation. We spent time looking at each man's individual cardiac risk profile. As part of a detailed clinical examination, we also looked specifically for prostate disease and diabetes. The risk factors for the common cancers for a particular individual were also analysed. The process finished with feed-back and advice on preventive health care for the future.
Our experience would not have been atypical of general practice in the 1990s. The last decade has seen a sea-change in men's attitudes towards their health. We have moved from a macho culture where the discussion of health problems by men was somehow seen as a sign of weakness. This barrier has now been truly broken.
Another landmark for men's health was the launch of Viagra in 1998. The drug itself was a major medical breakthrough - but the attitude change which accompanied the extensive publicity was remarkable. Suddenly it was acceptable for men to admit to impotence and to broach the subject with their doctors. And while for some of these men there is no need for treatment with the new impotence drug, the very discussion of the issue surrounding erectile dysfunction is a significant step forward and a "healthy" development in itself.
It will take some years for the full effects of these attitudinal changes to be felt. It is still relatively common to meet a male patient in his 60s who has not seen a doctor for 20 or 30 years.
An examination of consultation statistics confirms this impression of a male/female divide in health-seeking behaviour. Several studies have shown that, more than twice as many women as men attend their GP. There is some evidence that women make better use of these consultations as well.
A 1994 MORI poll in the UK found that, compared to women, men had less understanding of the anatomy and function of their own bodies. The poll also showed that over 40 per cent of men would not attend their GP unless told to by their partner. While doctors still find an element of "she told me to come and see you" in male consultations, it is probably fair to say that the percentage of men who attend a GP of their own volition has risen.
If there is a remaining area of concern in men's health, it is probably the younger male. The 18 to 36-year-old feels a certain invincibility where health matters are concerned and, with the exception of testicular cancer, this is a reasonable assumption. However, the habits of a lifetime are set during these years, and insofar as health in later life is concerned, we need to target young males. Health promotion and prevention are crucial for life-long health; mechanisms need to be found to reach out to the younger man and impress upon him the value of life-long exercise, the dangers of obesity and smoking and the importance of a general health awareness.
The Health Promotion Unit of the Department of Health launched a national cardiovascular health strategy in November 1999. If the medium-term objectives of this programme are to be met, then the health behaviour of young males must be targeted in a practical and pro-active way.
I would like to thank all of you who have taken the time and effort to contact the column since it started at the beginning of the year. Please continue to contact us with feedback on the various topics. If there are specific issues you would like the column to cover, we would love to hear from you and will do our best to oblige.
However, for those of you who have sought advice on specific health problems please understand that I am unable to answer individual queries.
Messages can be left at telephone 01-6707711 ext 8511, or by email: mhouston@irish-times.ie