Greg Malcher - presentation

Engaging men in health care
when informed by a clearer understanding
of men’s differing health needs……..
health promotion, policy and services can be
more effective
Minties reminder: typo and hero
Dr Greg Malcher
So what’s the problem?
• Outcomes: men die earlier, on average
• Behaviour: many men ignore their health
• Political: men are so pissed off about the
failure of the system to provide for their
(different) needs that they are going to storm
the bastions of government and we had better
do something that works….
Unnecessary losses
• Every premature death represents a personal
and family tragedy with long-lasting impacts
• Can we approach this systematically?
• In what stages of life do we see the major
losses which we could (potentially) influence?
Teenage and early adult
Suicide (S-)
Road trauma (L)
Violence (L)
Alcohol and drug use often implicated (L)
• (S) = screenable
• (L) = lifestyle related so preventable
Middle years
Heart disease (L)
Lung cancer (L)
Bowel cancer (L) (S+)
Prostrate cancer (S-)…….don’t take it lying
• Suicide
Older years
Heart disease (L)
Lung cancer/COPD (L)
Bowel cancer (L)
Prostate cancer (80% at 80yo: gotta die of
• Dementia incl Alzheimers (L)
General Practice (in name) but now
much more Primary Care (1SS)
• 5 yrs ago: 2 x 3 GP practices with 1 part-time nurse in each
and 1/5 physio and 1/5 psychologist
• Now: 1 amalgamated practice
– 10 GPs
– 1 clinical manager ( nurse)
– 6 nurses incl wound care, chronic disease, diabetes, breast
cancer, immunisation, COPD/asthma
– P/T physio x2, psychologist, mental health social worker,
podiatrist, dietitian, oncology masseur
– P/T surgeon, cardiologist (soon)
– 2 full-time medical students; nursing
– On site pathology
…………………………………………… CT or MRI……………. yet!
What we offer to men
• 2 late clinics/week: 4.30- 7.30pm; plus Sat morning…..but
bad for doctors who want to live a normal life
• Practice nurses: act as brokers for chronic disease
management (loved by patients and docs)
• The Lounge: adolescent clinic at DSC (prev @CHC) : better
uptake by boys
• Tuned-in receptionists who understand what men dislike,
and then are on their side
• waiting (ugggh): men can ring to see how the doc’s going
• crappy women’s magazines (newspapers, golf, fishing, New Scientist)
• dealing with medicare (impenetrable, counter-intuitive and
frequently-changing system…. so is disliked by men who value
Where do we draw the line?
In our clinics, CHCs and hospitals?
In our communities?
In our workplaces?
In our schools?
• Where can we put in effort that works?
• What can we try that’s new?
What we need is….
Nobel Peace Prize 1983
At age 40
Left school age 18: motor mechanic
Joined the army
Later: president of his country 1990-1995
In between: electrician in shipyard
Strike leader, then jailed
Major impact on the dismantling of Soviet
bloc and the collapse of the Iron Curtain
Lech Walesa
What can we learn from Lech?
Be convinced you are right
Keep trying
Wait for your time
Make your time
What would I change?
Young men
• More effort in early secondary school with
trials of programs of initiation, which currently
happen ad hoc, often without adult
involvement, at parties, clubs and on the road
• Financial support for clinics at schools
• Support for young fathers who view M&CH as
not being for them: PND in dads is real
• smaller houses and mortgages: no evidence
What would I change?
Middle aged men
• a national bowel cancer screening program…so
obvious…the Swan tragedy
• workplace health: system for small/isolated
workplaces: ROI: $4-5 for every $1 invested
• smaller houses and mortgages: no evidence but…
• encourage men to exercise:
– subsided car-parking 1km from work
– more cycle-friendly cities/towns
– decentralise our CBD so people have reduced
commute times (less road rage, more exercise)
What would I change?
Older men
• falls prevention programs
• better aged care facilities for men
– Internet for all
– Gardening and food preparation
– Access to men’s sheds ….finally Australia gets
something right!
• Thank you!!
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