Seán Power (Kildare South, Fianna Fail)

In recent years, there has been a growing awareness, and indeed concern, about the burden of ill health experienced by men in Ireland. We know that men are dying too young. Currently male life expectancy in Ireland is approximately 75 years, five years younger than that of females. Men have higher death rates for all leading causes of deaths and at all ages and it is projected that this pattern may worsen in the future. Given current trends, it is predicted that by 2015 one third of all men in Ireland will be clinically obese, thereby increasing their risk of cardiovascular disease and diabetes in particular. Should this trend continue, it is likely to impact in a significant way upon the gains made in recent years in the battle against cardiovascular disease which the Government has initiated through the cardiovascular strategy.

For certain groups of men the gravity of the situation is even worse. Compared with men in the highest occupational classes, men from the lower occupational classes have poorer health outcomes and experience significantly higher mortality rates for the five major causes of death in Ireland. Young men are also at particular risk — they are almost four times more likely to die prematurely than their female counterparts and currently have the second highest suicide rate of the 30 OECD member states.

Yet, despite their poor health profile, men in Ireland are reluctant users of health services and are continuing to present too late in the course of an illness. There is however, an increasing recognition that existing services have not always met men's needs, and that this also is a contributory factor to men's poor presentation at primary care services in particular. It should also be acknowledged that men's health has not, until recent years, become the focus of attention at a policy or service level. Indeed while men have been to the forefront of health in every way, as policy makers, doctors, surgeons, oncologists, cardiologists, hospital managers, etc., rarely has the spotlight focused on the value men place upon their own health at a personal or individual level.

In response to this rather grave health profile of men in Ireland, men were identified for the first time in the national health promotion strategy and in the national health strategy, Quality and Fairness, as a specific population group for the strategic planning of health. The National Health Promotion Strategy 2002-2005, targets men as a population group, with the strategic aim to develop a plan for men's health. The strategy also contains a number of specific objectives which include initiating research in the area of men's health; working in partnership to inform the development of a plan for men's health; facilitating the development and implementation of current health promotion initiatives aimed at men; and identifying and developing models of working with men to promote their physical and mental wellbeing.

Action 15 of Quality and Fairness called for the development of "a policy for men's health and health promotion". This policy and action plan is now at an advanced stage of development. In setting out to develop such a policy, the health promotion unit of the Department of Health and Children has endeavoured to ensure that it will be based upon sound evidence and that it will also reflect the issues of all stakeholders regarding men's health. To achieve this goal, a three-year research study was commissioned followed by an extensive nationwide consultation process over a 12-month period.

Health boards have also begun to address men's health. Some examples of activities include the appointment of men's health development officers, the publication of a men's health strategy and a national conference on men's health. The former North Eastern Health Board has published findings from a qualitative study on men's health beliefs, attitudes and perceptions entitled Men Talking, and the former Mid-Western Health Board has published a plan for men's health. The Institute of Public Health has also published an all-Ireland men's health directory, mapping out activity in the area of men's health.

In the non-statutory sector, a men's health advocacy group, the Men's Health Forum Ireland has been formed and has published a report on the health status of men in Ireland. From 2002 to 2004, the health promotion unit of the Department of Health and Children funded a men's health research project which was conducted in the former South Eastern Health Board area. The findings of the research entitled, Getting Inside Men's Health, were launched at a national conference on men's health which took place in December 2004. This report offered unique insights into the crucial role of gender on men's health. It demonstrated that the ways in which men perceive their health, take risks with their health and manage their health within the health care system are inherently related to how men define their masculinity.

Among the most pertinent findings from this report were that men tend not to be health conscious or proactive about their own health. Sadly, it is very often on foot of a health crisis that they only then become conscious about paying more attention to their health. Men's knowledge of fundamental health issues remains poor, for example, over a third of older men surveyed were not aware of common prostate cancer symptoms. There is an overall lack of a preventive health ethos among men in Ireland. While men are slow to access primary care services when they are sick, they are slower still to engage in preventive health checks. Indeed, the report showed clearly that men are very often afraid and anxious about seeking help, with fear and uncertainty about "what might be wrong" possibly posing a bigger threat to men's health than the reality of ill health itself.

Men are particularly reluctant to seek help for certain conditions. The continued stigma that is perceived to be associated with depression, for example, may prompt many men to "self medicate" with alcohol rather than to seek professional help. Men also play down the gravity of certain risk or health damaging behaviours. With regard to alcohol consumption, for example, half of those consuming over 50 units per week, that is, over twice the recommended maximum limit, considered themselves to be "moderate" drinkers, while nine out of ten weekly binge drinkers similarly considered themselves to be "light" or "moderate" drinkers.

These are just some of findings from the report, which offered many further insights into the issues underlying the very worrying statistics on men's health. Crucially, the report drew attention to the need for a gender-specific response to men's health to replace the traditional generic approach. In other words, how men are "as men" influences their understanding and approach to their health, the extent to which they engage in preventive health behaviours or risk behaviours and how timely they are in accessing health services. The 36 specific recommendations in the report offer a clear blueprint for the development of policy and service delivery measures that are more gender-sensitive in the context of men.

In implementing the recommendations of the health promotion strategy and Action 15 of the health strategy, a national interdepartmental and multisectoral steering group was appointed to oversee the development of the policy following the completion of the three-year research project in November 2004. Under the terms of reference of the steering group, it was agreed that the development of a men's health policy should also be informed by consultation with key stakeholders from statutory and voluntary sectors, health professionals and, indeed, men themselves.

Under the direction of the national steering group, an extensive, three-phase national consultation process was conducted from February to December 2005. Phase 1 comprised six nationwide one-day consultation days, where all relevant stakeholders were invited to identify both the health needs for men in Ireland and appropriate actions to target these needs. Phase 2 comprised eight focus groups with particular populations of men whose voices were not represented in phase 1 of the consultation and for whom it was felt a more targeted consultation was necessary. Phase 3 invited submissions from both specific organisations and target groups and an open call for submissions through the national press.

Some of the most pertinent issues to emerge from this consultation process included the need to depart from the traditional focus on the "deficiencies" of men with respect to their health. Unfortunately, the public and media focus around men's health tends to be dominated by what has been described as the "men behaving badly" model, whereby men are blamed for failing the health services by not attending, for ignoring health messages and for taking risks. While these problems cannot be overlooked, it is clear from the consultation process that there has been insufficient focus on tackling the underlying causes of these problems or on overcoming the barriers to health within men themselves. There is a need to work with men in a more positive and holistic way and to examine how existing services can be made more responsive and gender-competent for men.

The consultation process has also highlighted the need to embrace a broader, social determinant view of men's health. While it is incumbent on a national men's health policy to promote health-affirming changes to men's attitudes and behaviours, it is fundamentally important to create supportive environments for men, for example, in the workplace, and to strengthen community action to support men's health. In the case of poorer and less-educated men, for example, we know that health outcomes are very closely linked to education, income and housing. These factors are compounded by issues such as isolation and access to services for many rural men. There is, therefore, the challenge for this policy to embrace the diversity within men and to acknowledge that, within Irish society, there are many different ways to be a man.

Policy also needs to embrace the many paradoxes that impact upon the lives of men and their health, for example, there is now the widespread expectation in modern Ireland that men need to respond to changing roles and demands in society. However, it is known that social, cultural and practical constraints pose significant barriers for men who want to change and in terms of the choices they wish to make. In the case of fathers, for example, the complexities of balancing the notion of new fatherhood with factors such as inflexible work demands, the harsh reality of economic necessity for many men and disapproval or ridicule from other men are often overlooked.

The consultation process also stressed the need for an intersectoral approach at all levels to address men's health. By adopting a strategic approach to policy implementation, there is much potential to develop alliances and partnerships with many other sectors — transport, education, employment, environment and so forth — and to promote men's health in synergy with other policies and frameworks within and beyond the health sector.

Finally, the consultation process has made it clear that to adopt a coherent and strategic approach to men's health in the years ahead, it is vital that there is adequate provision for appropriate structures and resources for men's health policy at both national and regional levels. This is also important in terms of providing sustainable mechanisms to co-ordinate the work of different agencies to avoid overlap and duplication. It is also imperative that research should continue to underpin the implementation and ongoing evaluation of the policy.

A great amount of preparatory work has been undertaken in advance of the publication of the men's health policy. While the national steering group has a wide range of expertise, it also now has access to specific Irish research on men's health and specific information from the national consultation process. The steering group is continuing apace to draft the men's health policy. Under its terms of reference, the steering group has agreed that both a policy containing higher order recommendations and a specific action plan with costed and time-framed actions will be developed in two separate documents. The men's health policy is scheduled for publication by the middle of this year, with the action plan to follow by the end of 2006.

In conclusion, while many challenges lie ahead in addressing the grave statistics on men's health, we will, on publication of a national policy by mid-year, be in a strong position for the first time to tackle these issues in a strategic way. The health promotion unit of the Department of Health and Children has adopted a systematic and coherent approach to the development of the national policy for men's health that will be both evidence-based and will have consulted all relevant stakeholders.

While there is unequivocal evidence for a specific focus on men's health, it should be made clear that the potential benefits of a men's health policy extend far beyond men. As the policy will demonstrate, targeting men's health can also impact in positive and specific ways on the lives of women and children and on society as a whole. It will also show that efforts to promote a healthier male workforce will inevitably lead to a more productive workforce. A gender-sensitive approach to men's health, therefore, has the potential to benefit men and, indeed, men's families and society as a whole.