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Time to man up

In August 2018, the Office for National Statistics (ONS) warned that life expectancy growth in Britain had stalled, and, in some areas, life expectancy had actually declined. Figures from the ONS for 2015 to 2017 show that men’s life expectancy from birth is 79.2 years, while for women it is 82.9 years. 

In Men’s Health Week this June, the Men’s Health Forum (MHF) highlighted the 10-year local gap in men’s life expectancy across local authorities in England and Wales (2009 to 2013) and called for urgent action. The Forum’s analysis revealed that there is a big difference in deaths from suicide, heart disease, diabetes and cancer – not just between men and women, but also between men in different areas.

“Although men on average don’t live as long as women, the gap in life expectancy between men in the richest and poorest areas is much, much bigger than the gap between men and women,” says Martin Tod, chief executive of the Forum. “One man in five in the UK still doesn’t live until 65.”

Local inequalities

The MHF’s analysis highlighted geographical inequalities in health, even within local authorities. The Forum revealed an average 9.5-year gap between the census wards with the highest and lowest life expectancy across every local authority in England and Wales, with the biggest gap between Warfield Harvest Ride ward in Bracknell Forest, which has a male life expectancy of 90, and Bloomfield ward in Blackpool, which has a male life expectancy of 68 – a difference of 22 years. 

“Areas such as Leeds have started with a robust analysis of the men’s health challenges locally,” says Martin Tod. “They have a particular focus on the men with the worst health – because they can vary significantly by area – and have put together plans that tackle those issues, with outreach to the men with the worst health to help them improve.” 

Pharmacies can use the data to think about the services they offer and whether they could do more to encourage men to access them

Healthy life expectancy, assessing how many years are being spent in poor health, also varies across local authority. In December 2018, ONS data revealed that healthy life expectancy at birth across local authority areas in the UK differed by 21.5 years for females and 15.8 years for males in 2015 to 2017. People living in more affluent areas live significantly longer than people living in deprived areas, with a substantial difference between north and south England. According to epidemiologist Veena Raleigh, writing on The King’s Fund website in August 2018: “There is a persistent north-south divide in life expectancy and healthy life expectancy, with people in the southern regions of England on average living longer and with fewer years in poor health than those living further north.”

In July 2019, leading experts across the north announced the launch of the Northern Universities’ Public Health Alliance (NUPHA) at the International Festival of Public Health. New analysis of figures, to coincide with the launch, revealed that in 46 per cent of areas in the North, male life expectancy is lower than the area with the lowest male life expectancy in the South. 

10 Local authorities with a large gap in male life expectancy (LE, in years)

  • Wrexham (Wales) — 16.6 LE gap between Marford and Hoseley (88.1) and Gwersyllt West (71.5)
  • North Somerset (South West) — 15.9 LE gap between Gordano (85.2) and Weston-super-Mare Central (69.3)
  • Mansfield (East Midlands) — 15.5 year LE gap between Eakring (87.7) and Ransom Wood (72.2)
  • Middlesborough (North East) — 15.5 LE gap between Marton (84.9) and University (69.4)
  • Denbighshire (Wales) — 15.5 LE gap between Llanfair Dyffryn Clwyd/Gwyddelwern (83.8) and Rhyl West (68.3)
  • Oxford (South East)— 15.4 LE gap between North (87.0) and Carfax (71.6)
  • North Devon (South West) — 14.8 LE gap between Chittlehampton (85.8) and Ilfracombe Central (71.0)
  • Arun (South East) — 14.6 LE gap between Findon (86.0) and River (71.3)
  • Carlisle (North West) — 14.2 LE gap between Wetheral (85.2) and Castle (71.0)
  • South Norfolk (East of England) — 14.1 LE gap between Easton (89.6) and Hingham and Deopham (75.5)

10 Local authorities with a small gap in male life expectancy (LE, in years)

  • Merthyr Tydfil (Wales) — 3.3 LE gap between Treharris (79.1) and Gurnos (75.8)
  • Eden (North West) — 3.5 LE gap between Penrith West (82.4) and Penrith North (78.9)
  • Tamworth (West Midlands) — 4.6 LE gap between Trinity (81.9) and Castle (77.3)
  • Ribble Valley (North West) — 4.7 LE gap between Wilpshire (82.2) and Salthill (77.5)
  • Purbeck (South West) — 4.7 LE gap between Lytchett Minster and Upton West (83.2) and Wareham (78.5)
  • Rossendale (North West) — 4.9 LE gap between Eden (80.1) and Worsley (75.2)
  • Forest Heath (East of England) — 5.0 LE gap between All Saints (83.3) and St Mary’s (78.3)
  • Fareham (South East) — 5.2 LE gap between Fareham West (83.1) and Fareham North-West (77.9)
  • Blaenau Gwent (Wales) — 5.2 LE gap between Cwm (78.0) and Tredegar Central and West (72.8)
  • Barking and Dagenham (London) — 5.3 LE gap between Abbey (80.3) and River (75.0)

The figures for every region and local authority in England and Wales (2009 to 2013) are available on the Men's Health Forum website 

Making improvements

The MHF recommends that every area should have a Men’s Health Action Plan, which targets men with the poorest health so that they get the extra support they need. This should include for mental health and suicide prevention, and targeted NHS health checks to help tackle terrible rates of heart disease. 

The Who Self Cares Wins report by Global Action on Men’s Health in April 2019 states that community pharmacies could play a particularly important role in improving men’s self care. Using the MHF data may help pharmacies see how their particular area is faring in the male life expectancy stakes. “It’s relatively straightforward for pharmacists to find the data for their particular ward and it probably won’t be a huge surprise to them,” says Martin Tod. “But pharmacies can use the data to think about the services they offer and whether they could do more to encourage men to access them, especially health checks. Smoking prevalence, in particular, is more likely to be determined by deprivation than by gender.”

The Who Self Cares Wins report states that primary care services in traditional settings can be made more accessible to men, by addressing practical barriers (such as limited opening hours), using more digital technology (for making appointments and for information, advice and even some consultations), and better outreach services. The report suggests that to improve male uptake, community pharmacies need to:

  • Introduce male-targeted marketing
  • Offer health checks
  • Provide private consultation areas
  • Display male-targeted health information.

Martin Tod recommends pharmacies tap in to national campaigns, such as Men’s Health Week and Movember, as well as taking part in local events, such as sporting activities where men will be spectators. This year, Men’s Health Week focused on ‘men’s health by numbers’. According to the MHF, the seven numbers men should know about their health are:

37 – a waist size of 37 inches or above puts people at increased risk of heart disease, diabetes and cancer

150 – men should aim for 150 minutes of moderate physical activity a week

5 – everyone should aim to eat five portions of fruit and vegetables a day

14 – men and women should drink a maximum 14 units of alcohol a week

10 – cigarette smokers die 10 years younger on average than non-smokers

120/80 – this is normal blood pressure

75 – men account for 75 per cent of suicides.

For men who want to get to know their numbers better, the MHF has published Man MOT, a new interactive manual that enables men to check their own health. 

Sharpening the pharmacy focus

According to the Who Self Cares Wins report, male grooming products and the increasing over-the-counter availability of previously prescription-only drugs (such as Viagra Connect) may help to attract more men in-store. 

In March 2019, a year after Viagra Connect became available in pharmacies, Pfizer Consumer Healthcare launched its Men Reconnected campaign to encourage men to better understand their health, bodies and relationships. A Pfizer survey revealed that since the POM to P switch, 72 per cent of men over 40 who have sought advice for erectile dysfunction (ED) admitted to paying more attention to their health and are taking active steps to improve it. This included being more aware of their heart health, eating less sugar, exercising more and trying to manage their cholesterol. 

“With cardiovascular disease still being such a major cause of premature death amongst men and ED being an indicator of cardiovascular risk, we strongly supported the switch of Viagra,” says Martin Tod. “Aside from the benefits of tackling ED, if it has led to more men having conversations about their heart health, that can only be good. More could be done for heart health and for diabetes, as many people don’t realise men are more at risk.”

We try to ask open questions and encourage the patient to explain how their issue is affecting them

According to Pfizer, just over half of men over 40 who have sought advice for ED are now more likely to visit a pharmacist or GP about other health issues. A quarter of Viagra Connect users also said they now feel less embarrassed talking to their pharmacist about their health. However, Natalie Masters, pharmacist independent prescriber at Boots UK, says many men are still embarrassed to discuss their sexual health needs. 

“We have known patients who travel to pharmacies far away from their immediate neighbourhoods to maintain anonymity,” she says. “We try to ask open questions and encourage the patient to explain how their issue is affecting them, which helps us to get a better understanding of their condition and its physical and psychological impact. Having a consultation room provides the option of a safe space to have these conversations.”

It is estimated that ED affects 4.3 million UK men, with many suffering in silence. Data from Pfizer Consumer Health in March 2019 revealed that 20 percent of men who have purchased Viagra Connect admitted that they regretted waiting so long to do it, with some men taking an average of nine months to seek advice.

Sadik Al-Hassan, pharmacist branch manager at Well Pharmacy, Lodgeside in Bristol says that since the Viagra Connect launch, the pharmacy has seen a rise in footfall from both existing and new customers. “The level of interest in the product has remained steady but is continuing to bring new patients into the pharmacy,” he says. “We launched Viagra Connect with a healthy living campaign about sexual health – a topic rarely talked about in pharmacy. In our branch, we had brief customer interventions where we offered sexual health advice for males and females. Afterwards, we saw an increase in customers referring their partners in for advice too.”

Assured Pharmacy in Wilmslow, an online pharmacy that specialises in prescription treatments for men, especially erectile dysfunction, was unsure how the OTC availability of Viagra Connect would affect its business. “Surprisingly we actually saw an uptick in sales,” says Ashley Ellis, head of e-commerce at Assured, “most notably from younger men who are commonly known to be less likely to seek out help, especially with such sensitive issues. When Viagra Connect came to market, it started a conversation that most men would have previously ignored which has then led the way to search for more discreet and affordable options, such as ourselves.”

P3pharmacy panel view

Yolanda Kong

Kellaway Pharmacy, Bristol

Lila Thakerar

Shaftesbury Pharmacy, Harrow

Yasmeen Afsar

Well Pharmacy, Hartlepool

“Men tend not to seek advice from a pharmacy as often as women do, but in the past year, since the launch of Viagra Connect, many more men have come in to talk to us about erectile dysfunction. It’s made them more willing to talk about potentially embarrassing topics and has encouraged them to come and talk to us about other health issues, too. To encourage sales in men’s health products, display a list of the men’s health services you offer. Men may not be aware of what you provide and may not want to ask you either.” “This is quite a limited category for us. Men still don’t look after their health the way women do. However, they are interested in protein products and sport-related products that will improve their appearance rather than their inner health. Viagra Connect has changed the market. It has brought more men into the pharmacy. Other products that sell well are Listerine and other dental brands, ibuprofen gel for sports injuries and grooming products. Put out lots of information leaflets, especially for topics such as erectile dysfunction and cystitis.” “Having a designated area for men’s health is a vital part of our pharmacy. Typical queries are around physical health, such as vitamins. We have seen an increase in men asking about weight loss and smoking cessation services. Viagra Connect has given men the opportunity to come in and discuss their health. The top sellers are Vitabiotics Wellman, Nicorette, Viagra Connect, Lynx and Gillette. Our summer displays for hay fever and sun protection prompted an increase in younger men asking for advice and purchasing products.”

 

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