Health: The well man (a rare sight)

Men are notoriously ignorant about their health, particularly, says one GP, the `below the belt' stuff. Some men want a national network of clinics just for them; the rest are too busy enjoying their beer, fags and greasy breakfasts. Peter Baker on the message that so many men don't want to hear.

"I had an erection problem for two years before if I did anything about it," says John Scott, a 54-year-old surveyor. "I didn't see my GP, partly because I was embarrassed, but mainly because I thought he'd be unsympathetic.

"I eventually went to a Harley Street clinic, but the doctor ripped me off something rotten. He prescribed penile injections: it effectively cost me pounds 50 every time I had sex with my wife.

"I heard about the Open For Men clinic in Lewisham [south London] and made an appointment. I was astonished when they discovered I had diabetes, since it hadn't been detected by the private doctor I'd seen, even though it's known to be a common cause of impotence.

"I now control the diabetes through my diet, and Open For Men supply me with the drugs I inject to get an erection. They also give me a general check-up every six months.

"I've found it a brilliant service. If I hadn't gone there, my diabetes might not have been detected and my marriage might well have broken up. The atmosphere of the clinic is very different from a GP service. There's more time, I'm not embarrassed, and I feel I can be completely honest."

In one way, Mr Scott is lucky. Although it takes him 20 minutes to drive to Open For Men, he still has relatively easy access to one of just a handful of specialist men's clinics operating within the NHS.(There are also a few private "well man" clinics providing much the same, for often considerable amounts of cash.) But a survey published today by Men's Health Matters, a new health education campaign, claims that many more men are demanding this service.

The survey, for which the pollsters Gallup interviewed 839 men, found almost three-quarters would like to see more men's health clinics, and two-thirds believe a men's confidential health helpline would be a good idea. Men's notoriously blase attitude to their health could at last be changing; the survey found no major differences between the sexes as to how long they say they would wait before seeing their GP if feeling unwell.

But can this evidence justify the cost of setting up a national network of men's health clinics? Despite all the improvements in public health this century, men can still expect to live six years fewer than women. They also have more accidents, drink more, take more drugs, and are four times as likely to commit suicide. Mortality rates have generally been falling for men and women, but the rate for men aged 15-44 was 5 per cent higher in 1995 than in 1985. Despite all this, the average man makes half as many visits to his GP as the average woman.

The Department of Health has at last funded research into the reasons why so many men avoid taking better care of their health, while the minister for public health, Tessa Jowell, is known to be interested in men's health issues.

Proposals to tackle gender inequalities are expected to feature in a forthcoming Green Paper on public health. Ms Jowell's department is also working on a health advice leaflet for men, aimed particularly at the 40-plus age group, likely to be published next spring.

Ministerial backing for a national network of men's health clinics remains unlikely, however, not only for financial reasons but also because of doubts about whether men would use them.

One such service has been run since 1980 by Dr Tim Watkin Jones from his GP surgery in Flintshire. Each weekly afternoon clinic attracts an average of six patients for routine check-ups, as well as consultations about specific problems.

"I set up this clinic because I felt that, while women's health was fairly high on the agenda, we were letting men down," says Dr Watkin Jones. It is difficult to measure the effectiveness of his service, but it has detected several cases of potentially serious high blood pressure. "Most men are still not genned up on male-specific, below-the-belt stuff. Some young men think you can't get cancer down there; we've seen some things, such as testicular lumps, which men often think are trivial but which could be quite serious." More widely, says Dr Watkin Jones, "the clinic helps build up a rapport between men and the GP's surgery."

Open For Men sees about 10 men each Friday evening. "Some men come from quite a long distance to see us," says Dr Lesley Bacon, who runs the service. "Most of our clients are between 25 and 44, and they want to discuss sexual health problems, although quite a few come because they're worried about their cardiovascular system, obesity and smoking, or because they want a general check-up."

Dr Bacon finds that men "often don't go to see GPs because they feel the surgeries are too busy, or that asking for a check-up is wasting their doctor's time." She has found that many men visit Open For Men because their partners have asked them to after seeing publicity for the service at a local well woman clinic.

The evidence from these two clinics indicates the importance of offering men the opportunity for a general check-up, as well as a longer appointment than is normally available at a GPs' surgery. The check-up seems to provide the "excuse" many men feel they need to use a health service, and they often find that a more relaxed consultation gives them time to disclose whatever is really worrying them.

As John Scott's experience also suggests, when it comes to sexual health, the availability of a confidential service can also be critical. Indeed, this is what seems to have underpinned the success of the Impotence Association's telephone helpline. It has received more than 12,000 calls since its launch in January 1995; in September 1997 alone, it received more than 700 calls, as well as 300 letters.

About 135 calls a month are also handled by the general men's health helpline operated since 1995 by the Medical Advisory Service. (The men's helpline is now being funded by Yamanouchi, the drug company that is also sponsoring the Men's Health Matters campaign.)

"The anonymity of the helpline is very important," says Kathleen McGrath, MAS's director of medical services. "Our male callers can ask questions that they might think are too silly to put to their GP. I think many men are asking us for `permission' to go to their doctor, or are rehearsing what they'll say when they get there."

It does seem as though telephone helplines are another useful way of reaching men who might otherwise delay getting medical advice.

What of the survey's claim that men are getting more health-conscious? "My impression is that men's attitudes haven't yet changed an awful lot," says Dr Ian Banks, a GP with a special interest in men's health. "Where there has been an increase in men's interest in their health, it may well be just amongst younger, middle-class men. Working-class men have probably been much less affected."

Dr Sian Griffiths, director of public health for Oxfordshire and a committed men's health advocate, also believes the Men's Health Matters' survey is "optimistic". She would like to see more evidence of change before starting to celebrate.

More clinics and helplines could well make some difference, but the gender gap in health may only begin to close only when many more men change their lifestyles by stopping smoking, cutting down on their drinking, eating less saturated fat, tackling their stress and generally taking fewer risks with their health. That will require campaigns that appeal directly to the male psyche, rather than relying on the traditional, and dubious, notion that the best way to reach men is by targeting health messages at their wives. Such work with men is in its infancy; until it becomes mainstream, too many men will die too young.

Medical Advisory Service men's helpline: 0181-995 4448; Impotence Association helpline: 0181-767 7791. A `Waterworks' information leaflet on prostate problems is available from Men's Health Matters, Blythe Hall, 100 Blythe Road, London W14 0HB (send sae).