With government’s plans for a men’s health strategy this year already announced, Peter Baker from Global Action on Men’s Health discusses how pharmacies can look at encouraging more engagement with men

‘Men don’t go the doctor’ has become one of the fundamental tenets of men’s health.

While obviously not literally true – many millions of men do see their GP every week – the phrase does highlight that far fewer men than women use primary care and that many potentially life-threatening conditions are diagnosed later in men. And it is not just general practice that many men make less effective use of: they also visit dentists and optometrists for check-ups more infrequently than women and make significantly poorer use of community pharmacies.

This helps to explain why men are much more likely to have undiagnosed hypertension than women: data for England for 2015-19 show that 44% of males aged 35-44 years with hypertension were undiagnosed compared with 34% of females. An analysis of the stage of cancer diagnosis for 18 sites found that women were more likely to be diagnosed with cancers at stages 1 and 2 than males for all the sites except two (the bladder and larynx). There is also evidence that men are more likely than women to have undiagnosed diabetes or to delay seeking help for severe dental infections.

The barriers to men’s use of primary care are both psychological and structural. Men are mostly brought up to value stoicism and self-reliance, to minimise the significance of symptoms, and to avoid asking for help. Disclosing a health problem, especially one related to mental health, is at the least embarrassing and experienced by many as shameful.

The way many services are delivered also makes them difficult to use, compounding men’s reluctance to seek help. The location of services, inconvenient opening hours, lengthy delays in waiting rooms and difficult-to-use appointment booking systems contribute to lower levels of uptake, especially by men of working age and whose employment may be precarious.

Men’s use of primary care has not been adequately addressed in health policy. Recent research published by Global Action on Men’s Health (GAMH) found that, of the almost 30 primary healthcare-related global policy reports reviewed, only two engaged explicitly with men’s health needs. The same is likely to be true at the national level. GAMH is making the case for policy change but, even before this is achieved, there is a clear opportunity for community pharmacy to help fill the gap.

Pharmacies have few of the structural barriers facing men using general practice or dentistry. They can be found on almost every high street, are often open for longer hours than GP clinics, and appointments are generally not required. Private consultation rooms, now standard in most pharmacies, remove the embarrassment of a conversation in a more public space.

There are some good examples of pharmacy initiatives aimed at men that show the sector’s potential. The Bedminster Pharmacy in Bristol, for example, set out to tackle men’s health inequalities in the local area. A group of local men was invited to audit the pharmacy and suggested ways to make the service more accessible and welcoming to men, including by improving the signposting of the consultation room. Men’s Health Week in June was used as an opportunity to promote health checks. The pharmacy also initiated regular blood pressure outreach clinics in a local pub.

While men’s health as a broad topic is absent from pre-qualification pharmacy education, there are still opportunities for pharmacists to improve their understanding of the issue and how to work more effectively with men. The Centre for Pharmacy Postgraduate Education (CPPE) at Manchester University provides an online learning programme specifically on men’s health.

But pharmacy nevertheless remain generally underused by men. Research by the Men’s Health Forum (published in 2009 but almost certainly still pertinent) found that this is partly because many men are unaware of the range of services pharmacies provide, such as blood pressure checks, and the qualifications of pharmacists. There is a lack of awareness of the availability of the consultation rooms. Men can perceive pharmacies, especially those run by the larger chains, to be primarily aimed at women. To reach the pharmacy counter can require a journey through a wide range of female beauty products (‘racks of make-up and no spanners’, as one man interviewed for the Men’s Health Forum study put it).

So what can the pharmacy sector do? These five steps would help to create momentum for changes in policy and practice:

  • Convene a working group of pharmacy organisations and pharmacists interested in promoting men’s health to consider the opportunities and challenges and to develop a strategy.
  • Commission research – there is currently relatively little in this field – to explore the issues and identify examples of good practice.
  • Develop pilots to test a range of interventions at the community level.
  • Encourage pharmacists to take advantage of education and training programmes around men’s health, such as that offered by CPPE.
  • Pharmacy organisations to include men’s health in their advocacy work and to encourage their members to take up the issue locally. In the UK specifically, the government plans to publish a men’s health strategy for England in 2025, creating an opportunity for pharmacy to position itself as a valuable primary healthcare service for men.

Dr Catherine Duggan, CEO of the International Pharmaceutical Federation (FIP), recognised pharmacy’s potential role at a webinar to launch GAMH’s report on primary care policy. ‘Pharmacies play an important role when it comes to engaging men to address their health needs’ she said. ‘Pharmacists can tailor their services accordingly and carry out interventions at a local level and create an inclusive environment in which men feel comfortable seeking help.’

Almost two in five men die prematurely – more than 133,000 – each year across the UK. Many of these deaths could be prevented by better-targeted services. It is vital that pharmacy plays its part alongside all the primary healthcare services.

Peter Baker MA, FRSPH, FRSA, is director at Global Action on Men’s Health

Global Action on Men’s Health is a UK-based international charity that works to improve men’s health through research, policy development and advocacy. [email protected]