Brendan Ryan (Labour)

I rushed up here because I did not realise that I was contributing so soon, but I am a bad example of how men should look after their health. I should probably have proceeded at a more leisurely pace but I was afraid that we would have no speakers. I had not seen that Senator Feeney was present.

When it comes to health matters, there is no doubt that men are a dreadful bunch of cowards. They try to pretend that health is not an issue or pretend not to know the appropriate vocabulary. They will always try to dismiss, hide or avoid any symptoms in all possible circumstances. I knew a young man from the Gaeltacht, whose vocabulary in English would probably not have extended to a term such as testicular cancer but, unfortunately, he died from it before he was 40. I admire a well known intercounty footballer who was afflicted with testicular cancer in his 20s and has had no problem in advertising this fact to the world.

If one sits in the company of five men and mentions testicular cancer, the reactions will vary from giggles or mild obscenities to changing the subject. I am not pretending to be one bit superior but one should contrast that with how women react to discussing health issues. Women will talk with considerably less inhibition about their health and the manifestations of ill health. They will also pursue recommended methods of self examination. The prospect of self examination to deal with testicular cancer, however, would send any collection of hardened rugby players into a fit of embarrassed giggles.

This is a serious issue and before I even talk about health services, there are many matters to discuss concerning role models. On a related issue, I bring these matters up in my own chemical engineering classes in Cork Institute of Technology when dealing with safety. There is a need to overcome the machismo culture in looking after one's health sensibly. Women working in industrial settings are much more likely to heed, respond to and take seriously less visible threats such as low level exposure to potentially hazardous chemicals or background radiation. Women will mostly follow the recommended procedures in this regard.

My evidence for women being more safety conscious than men is specifically based on car insurance data. Despite the fact that women drive more safely, one of the classic symptoms of this machismo culture is that most men will swear that women are dreadfully dangerous drivers. It is an overwhelming male belief, although the figures prove otherwise. Insurance companies do not make these things up. They will dangle offers in front of women because they know that women are a lower risk as they take safety more seriously. I do not think this fact is universal, however, as I have discussed this subject with a few young women and I am beginning to notice a fairly masculine style of driving among some of them. Overwhelmingly, however, the evidence proves that men do not take fundamental issues of sensible, safe living, including driving, in the same way as women do.

We should have screening programmes for testicular cancer. Most people seem to believe that a similar screening programme would be a good thing for prostate cancer, although there are serious arguments on both sides. I understand that in half such cases, prostate cancer does not spread, while in the other half it does. Nobody is quite sure why. Men who are treated for prostate cancer go through a traumatic process of radiotherapy and possibly even surgery, although in half the cases such treatment is unnecessary. There may well be unpleasant consequences including impotence and other matters that deeply affect the male psyche and subconscious.

There is an overwhelming case for a testicular cancer screening programme. The uptake figures for the BreastCheck programme do not reach 100%, but if an equivalent screening service were offered for testicular cancer to every man aged between 15 and 35 or 40, I predict the uptake would not be half that for BreastCheck because of the incredible issue of male machismo. We know, for example, that men visit doctors far less than women. Men try to pretend that is because women are all hypochondriacs, but it is an easier excuse than saying that men are afraid to go to a doctor for a check-up if something is wrong. How many men have been warned that they have high blood pressure, yet ignore the issue? Women, on the other hand, will conscientiously and in an organised fashion take whatever medication is prescribed for them.

If one drives around any city and watches people out walking as the evenings grow longer, some 80% of walkers on any given evening are women. Men are in a tiny minority of walkers, even though walking is the simplest form of exercise and the least likely to do any damage if one is unfit. Overwhelmingly, however, one finds that most of those walking and taking other forms of exercise are women. In addition, most of those attending yoga classes and keep fit programmes are women. That is true although until recently field sports were predominantly played by men. I know that the situation has spectacularly and dramatically changed with the spread of women's football in particular. However, until recently field sports were predominantly a male preoccupation. Outside the competitive machismo of such sports, when it comes to the basic idea of looking after their own health, men have been fairly useless. Let us not even mention alcohol, smoking and other things that are not gender-specific.

Having said that, we must start by talking about such things to young men before they leave school. We must get them to begin to discuss their health. I do not want us to turn them into a generation of hypochondriacs. However, I believe that there is a sensible balance. The first thing is to get young men, before they leave secondary school, to be aware of their health and overcome inhibitions regarding self-examination, and visiting doctors regularly. We must inform them of the undoubted fact that, whatever is wrong with one, attending a doctor will not make it any worse. If it is anything serious, doing so gives one a very good chance of something being done about it.

I have no evidence, but I am convinced that a great number of men who die from various cancers do so as much because they are late, slow or reluctant in finding out what is wrong and getting anything done about it, so that matters progress too far. I have always believed that women, while there are obviously exceptions, are far less inhibited.

The first thing is to introduce young men to the vocabulary and the idea that there is nothing redolent of a tough guy or macho man in ignoring one's health. It is a strange and contradictory belief that ignoring one's health somehow shows that one is tougher than those who look after themselves; I hope that it is changing. Once we have done that and, one hopes, created a demand for basic services, we must of course introduce effective forms of screening for those cancers that most afflict men, just as we have begun the process with forms specific to women.

It is not just about cancer, and once we have done that we must examine what I believe is a problem, namely, the fact that we have no culture of exercise or fitness among men once they move beyond the age at which they participate in competitive sports. I do not know whether there is still a serious fitness culture or serious opportunities for men, particularly for those not as well-off as most of us. If one has a limited income, what does one do for exercise once one has moved beyond hurling, football, soccer or rugby? One can walk, but apparently most men do not. One can swim, but our municipal swimming pools are limited in number, expensive and in many cases not much encouragement is given. We must discuss how we can get men into a pattern of healthy living.

There is no point in our shooting off into high-level puritanism and telling people that they must all stop drinking. We should tell them all to stop smoking, however. A man is prepared to fool himself by saying, for example, that he smokes 60 a day as his father did from 16 until his death at 96. That proves nothing other than that the father died at 96. There is a need too for us to confront the culture of binge drinking. It is a predominantly but, unfortunately, no longer exclusively, male issue. There are genuine health questions not appropriate to this debate concerning how we deal with those who end up in hospital because of self-inflicted damage caused by binge drinking. However, that is not a matter for today.

Once we have established a culture whereby men discuss their health, many of the other issues will remedy themselves. If I am ever asked about men's health, I return to the basic truth that they are cowards. As far as possible, they want to duck the issues. They run away and turn their backs on them to avoid them. They are also extraordinarily prudish regarding such basic things as self-examination. One need only listen to an all-male conversation to realise that most men would not in a million years conduct the sort of routine self-examination that a reasonably health-conscious woman will carry out. We must change that culture.

Thereafter, we can move on to service provision. However, until we get men to begin to take their health seriously, we could provide all the services in the world without effect. If we announced tomorrow that we would have a nationwide testicular cancer screening service, we would have a take-up of perhaps no more than 25%.