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 down! • Suicide Older years • • • • Heart disease (L) Lung cancer/COPD (L) Bowel cancer (L) Prostate cancer (80% at 80yo: gotta die of something) • 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 ……………………………………………..no 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 mastery) 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…. •Ins!piration 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 THINK BIG. 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 but… 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!!