Camillus Glynn (Fianna Fail)

Cuirim fáilte roimh an Aire Stáit. It could be said that everything comes to he who waits. We have been calling for this debate for quite some time. Having worked in the health area for a number of years, I am very much aware than men's health has not taken centre stage in the same way as women's health. There are a number of reasons for this. I am delighted to hear that if other Members are offering to contribute at the conclusion of this debate, it will be continued on another day. That is very important.

For men to reach their full health potential, there is a need for a wide range of agencies and community organisations to address the needs and support initiatives. The Health Service Executive or any other agency or group working alone will not be sufficient to effect the required changes to improve and sustain the gains in men's health that can be achieved by a multi-agency, multidisciplinary and cross-community approach. It is fair to say the subject is complex and cannot be dealt with in isolation. All facets of the health service and other support structures, be they social or otherwise, must be employed and merged to ensure the implementation of a positive policy on men's health.

I agree with the remarks of Senator Browne on reactionary services. When speaking in the House recently on diabetes, I said the services, including those associated with men's health, were pretty much reactionary — they are. There is a reason for this, which I will state later.

Parents should encourage their children to look after their health. Mothers especially have a pivotal role to play in this regard because, traditionally, the Irish male is the kind of individual who, in the main, does not like to admit he is cold if he is not wearing his coat on a cold day. If he puts his coat on it is seen as a sign of weakness. This is a stupid attitude. When I was a young lad and put on my coat on a cold day in the presence of a senior male, he would ask why a young lad would be feeling the cold. He would say I was not cold — this was the attitude. It is a fact that improving or conserving one's health in any shape or form was regarded as a sign of weakness. Women should encourage the men in their lives to look after their health and should encourage their male offspring to do so from an early age. It is a question of shaping attitudes now rather than reacting to them later.

Reference was made to suicide. Senator Browne will be aware that the suicide rate among young men is seven times higher than that among young women. This statistic, which is absolutely true, is frightening by any standards. It is true because Mary will go home and tell Mammy, Daddy or somebody else her problems while Johnny will not because he will regard doing so as a sign of weakness and not the manly thing to do. How stupid can one get?

Fostering positive attitudes to one's health should be an objective of parents and they should impart to their children a consciousness of their own health. In the main, once one reaches adulthood one is responsible for one's own health. Consider the diabetes epidemic, for example. As everybody who has taken an interest in the condition, especially type 2 diabetes, will note, there are some 250,000 diabetics in the country, 90% of whom have type 2 diabetes. Another 25% are as yet undiagnosed, many of them men, although I do not know the ratio.

We have primary responsibility for our own health but it should be pointed out that health has never been on the agenda for men. As a result, Irish men's lack of knowledge of fundamental health issues continues to be a key area of concern. For example, an ordinary man will have his car serviced but may never have visited a doctor in his life. That person could be suffering from type 2 diabetes but will not have been tested for it, nor will he have had a rectal examination, a prostate-specific antigen test or a blood pressure check. Men will service their cars but will not look after themselves, which is amazing.

There is a need for increased education and awareness of men's health issues, which should be targeted at both boys and men. Hence, the shaping of the person by parents in the home is of pivotal importance for sons, and also for spouses, brothers and uncles. Improved information, education and awareness is the most important factor for managing health problems more effectively. Male-specific preventive health continues to lag behind, with three out of four men aged 50 or over reporting never having had a digital rectal examination despite the incidence of colorectal as well as testicular and prostate cancer. The National Cancer Forum met with Members before Christmas to give us an in-depth view of men's health issues, particularly with regard to oncology, which was worthwhile.

Those men who reported having had a digital rectal examination in the past were significantly more likely to be well-educated and to be married or cohabiting. This does not suggest that education and spousal or partner support are key indicators in the preventive health-seeking behaviour of men, but they have a role. The importance of spousal or partner support is borne out by the fact that 98% of what may be termed "reluctant attenders" acknowledged going to the doctor at the behest of a woman. Partners, mothers and wives have a pivotal role to play. It would also appear that male-specific health issues are high on the list of factors that appear to cause men to be reluctant to go to their doctors in the first instance — it is not seen as the manly thing to do.

Men's health is not just a men's issue. Health problems affecting men can also have a significant impact on the welfare and qualify of life of women and children. For example, a man's drink problem has a serious adverse effect on his children and wife or partner. It affects everybody, as anyone who has had contact with Alcoholics Anonymous, Al-Anon, Alateen or other organisations that are supportive to those with drink problems will know.

Men's health must be viewed as much more than the sum of male-specific illnesses or diseases. A narrow focus can lead to misconceptions that male health problems are limited to the prostate gland, and the subsequent mindset that if the prostate gland is okay, there is nothing else to be concerned about. That is not the case. A more rounded approach that focuses on men's quality of life, and that supports men to experience optimal social, emotional and physical health, is called for. It is acknowledged that men are more likely to take risks with their health. We need to understand why this is so and why they are more likely to engage in behaviour that damages their health rather than preventing threats to health. We also need to encourage men not to seek help for an illness in its latter stages but when symptoms are first evident. The servicing of one's car remains a good comparison.

Raising awareness of health issues among Irish men is crucial because a psyche has existed over a number of generations which must change. Sometimes it takes a crisis to act as a wake-up call to an increased health consciousness. Late presentation to health services has been implicated as a key factor in men's higher mortality rates and lower life expectancy. There is a need to confront what might be described as the traditional male gender script, which confers status on health-damaging and risk behaviours, and which infers weakness and femininity from positive health care practices. In other words, any man who looks after his health is seen as a sissy. The concept that being sick or going to the doctor somehow represents failure or personal weakness in men must be reversed if we are to make progress.

I will detail statistics from one health agency, which speak volumes. On average 1,160 claims were made each year between 1999 and 2004 for myocardial infarction, otherwise known as heart attack, of which some 70% were for men. Recent studies have suggested that one of the reasons why women have a lower rate of heart disease than men is partly due to the protection provided by the natural hormone oestrogen, which is produced until menopause. However, once women have reached that stage, their risk of heart disease rapidly rises to equal that of men. In 2004, 1,185 claims were made, of which 801 were for men, which is 67.6%. Of these 801 claims, 99, or 12.3%, were for men under the age of 50, with the largest number, 234, or 29%, being for men aged between 61 and 70. The volume of heart bypass procedures overall has been reducing due to the use of angioplasty surgery and all that goes with it. The agency's statistics also deal with cost issues, but we are not concerned with that aspect.

According to national cancer registry statistics published in June 2005, based on studies carried out between 1994 and 2001, an average of 1,371 of the Irish population present with prostate cancer annually. On average, almost 520 men die from this type of cancer each year. Between 1994 and 2001, the number of prostate cancer cases rose by more than 6% per annum on average, which is a real cause of concern. Prostate cancer accounts for 12.8% of all cancer deaths in men. Almost 31% of prostate cancer patients are treated by surgery alone, with nearly 48% of the remainder receiving a combination of treatments including surgery, hormone therapy, chemotherapy or radiotherapy. Over 21% of prostate cancer patients receive no treatment, surgery or therapy for their cancer. The incidence of prostate cancer is higher in the south west than elsewhere, although this may be due to differences in diagnostic practices rather than underlying differences in incidence.

On average, 1,328 people claim each year for prostate gland surgery. Of this figure, some 25%, or 332 cases, present with prostate cancer. Last year the relevant health care agency paid out more than €5.5 million for prostate gland surgery. The average cost of prostate surgery in a private hospital is approximately €5,800. The number of claims for prostate cancer surgery to date in 2005 is up 6.4% on the figure for 1999.

A serious situation exists which must be addressed as a matter of urgency. A multifaceted, multi-agency approach must be taken across the board. The most recent report from the national cancer registry, Cancer in Ireland 1994-2002, estimates the annual incidence of prostate cancer to have increased by between 5% and 6%. The National Cancer Forum is finalising a new national cancer strategy. The forum comprises a multidisciplinary group of oncology experts. As part of its work it has reviewed all issues connected with screening, including examining specific diseases such as prostate and colorectal cancers. The latter condition is particularly pertinent to men's health. The forum has also developed criteria against which all future screening programmes will be assessed.

It is understood that the forum will decide there is insufficient evidence to recommend the introduction of a population-based prostate screening programme. I do not agree that this issue should be reassessed when the results are available from randomised control trials being conducted internationally. Most people would agree there should be screening. The statistics on the incidence for the dates I have mentioned, and the percentage increase per annum indicate that there are enough undiscovered cases to merit this approach.

This position is inconsistent with the recommendations adopted by the European Union which advocates the introduction of cancer screening programmes that have demonstrated their efficacy, having regard to professional expertise and priority setting for health care resources. The proposals do not provide for specific recommendations in respect of screening for prostate cancer. Appropriate treatment for men diagnosed with prostate cancer is available at all major hospitals throughout the country. Any man who is concerned about prostate cancer should do what he does with his car, namely, go for a service. In other words, he should visit his doctor.

I could continue on this subject. Men's health is of particular importance because men's health problems have an adverse effect on their families. This applies equally to men who live alone because all men have mothers, fathers, siblings and other relatives. If a man does not look after his health that has a negative effect on those close to him. I welcome the opportunity to debate this important subject. I hope I will have a further opportunity to engage in such a debate.