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Thursday 17 April 2014

What men in Ireland need to do about their health

The National Men's Health Policy 2008-2013 shows that men have a lower life expectancy than women and are more likely to die from the major causes of death in Ireland, says Muiris FitzGerald. Here are 10 tips to help Irish males deal with their health

There is a crisis in men's health in Ireland, but all too few seem to be aware of it. The National Men's Health Policy 2008-2013 from the Department of Health spells it out. Male life expectancy is 71 years -- five years lower than women. Worse again, of those men who make it to 65 years of age, many will suffer disease or disability. Not a pretty prospect.

Men are more likely to die from the leading causes of death in Ireland. Three quarters will die of the big three killers -- heart disease/stroke, cancer and respiratory disease. Many of these are preventable, or if diagnosed in time, treatable. Young men and boys have six to seven times the suicide rate of young women. Men in the poorest socio-economic groups are six times more likely to die from respiratory disease and 16 times more likely to die from alcohol abuse. Death rates in male unemployed, homeless, and Travellers are frighteningly high.

The authors of the National Men's Health Policy declared these issues a major public health concern. Why then, has there been so little debate about men's health? Maybe it's due to traditional male attitudes -- 'sure I'll go to a doctor when I'm sick', 'sure we all have to die sometime', 'sure we all have to die of something', 'worrying about health and attending doctors, that's women's stuff'. But recently men's health is forcing its way into the public consciousness, driven by suicide prevention groups, road accident campaigns and Irish Cancer Society publicity on male cancers. All of that is encouraging but how does the average Irish male deal practically with looking after their individual health? Here's a list of 10 things you should do right now.

1 Get to know the key facts about male health

What causes shorter life expectancy, greater infirmity, and leaves you old before your time?

Find out the facts about the killing and crippling diseases likely to affect you -- heart disease/stroke, smoker's lung, cancer and accidents, drug/alcohol abuse and suicide. Identify the ways that you can reduce your risk -- exercise, diet, not smoking or doing drugs, avoiding alcohol excess, reducing risky male behaviour (speeding, aggression and unsafe sex).

How do you start? Simple. Use Google and consult Irish websites.

2Get a general practitioner now -- even if you are well

Get a good local GP recommended by family or friends. Ideally in a group practice with a team of doctors, physiotherapists, nurses, counsellors.

Make an appointment now while your health is your focus. It might not last.

Ask for a health check-up tailored to your needs, age, medical and family history to identify your risks. Have a physical examination with blood pressure and breathing test measurements and necessary investigations, such as blood cholesterol, to establish a baseline.

Ask for a personalised preventive health plan. Then, act on the advice given about lifestyle modification, exercise and diet. Get a yearly review, stay with the programme.

3Diet and exercise -- strike a balance

Exercise is essential. You feel good, your heart benefits, it reduces the risk of cancer. And it stops you joining the fat/obesity/ diabetes epidemic.

It is predicted that by 2015, a third of Irish males will be clinically obese. That's major-league fatness. Balancing exercise and what we eat is crucial. Portion size has ballooned and accounts for expanding waist-size. So, exercise regularly and reduce portion size. But healthy eating also helps prevent gut cancers, such as colon and stomach, especially when enough vegetables and high-fibre cereals are eaten regularly.

A word about exercise. We are not talking about Jane Fonda gyrations or buying barbells. Just use the stairs instead of the lift, walk instead of driving to the shop, take the kids and dog for walks, spread regular exercise throughout the day and increase it on active weekends. If you are a gym-bunny with all the gear, that's fine. Exercise in your own way and enjoy it.

4Smoking -- don't even think about it or cut it out -- now

This is an absolute -- one of the few -- and that includes marijuana. The reasons are self-evident but here goes. It is the biggest contributory factor to the main killer cancers, especially lung cancer, where it accounts for a whopping 95 per cent.

An almost completely preventable killer cancer -- it's a bargain. Cutting out smoking is the single most effective anti-cancer measure. And you drastically reduce your risk of heart attack, stroke and hardening of the arteries.

The bonus is you prevent the clogged-up brain arteries that can cause dementia. A no-brainer.

5Alcohol and drugs -- caution and major advisory

The health plan for any man must seriously consider how to handle alcohol. There is too much historical baggage of the 'drunken Irish' in our folk memory to ignore it. And besides, a survey shows that men in Ireland drink twice that reported for males in other EU countries.

For males around their 20s, the figure is higher again a world-beating glugathon of 17.9 litres of pure alcohol per annum per Irish male. Worse again, binge drinking -- the most health-damaging form of alcohol excess -- is endemic in Irish males and is already producing disturbing health problems.

Too often Irish drinkers console themselves that we drink in moderation -- 'just the few quiet pints'. A dangerous delusion. In fact, we drink to excess frequently. Go to any emergency department to view our growing national shame.

So, if you drink, drink in true moderation: two or three units at a session and no more than a couple of nights a week.

Alcohol causes liver disease, cancers and accounts for carnage in road accident fatalities -- male drivers are involved 90 per cent of the time. These are the dramatic headline items. Just as damaging is the terrible human and psychological toll that alcohol inflicts on individuals, their families, spouses and children.

Go to women's refuges or listen in on psychologically disturbed children and the brutal horror of male drinking on families is revealed. For their sake and your own, handle alcohol with care.

6Cut down on risky male behaviour

No, we are not stereotyping males ('female equals good, male equals bad'). It's an evolutionary fact. Males come equipped with brain hormones and a physique that makes them more prone to risky, impulsive behaviour. All the statistics bear this out.

Excessive speeding and prior alcohol consumption are the hallmarks of the involved male driver. Illegal drug use is three times more common in men than in women, with all the physical and social consequences. Men more often initiate unprotected sex, sexual assaults and other aggressions.

Don't believe it? Not convinced? Can't be that bad? For your answer, ask any garda on weekend night duty, any nurse or doctor at hospital A&Es, or any pub doorman. They'll tell you.

7Look after your psycho-logical health and well-being

Men and boys are less in touch with their feelings and less attuned to their emotions, compared with women and girls. Added to that, they are culturally reluctant to seek help when they are stressed.

This is reflected in their bottling-up of emotional pain caused by family strife, sexual/gender identity, bullying, relationship problems, doubts about self-worth, anxiety and depression, and other crises.

And the increasing stresses of unemployment and finances leave them unprepared and ill-equipped to cope.

Doctors report anxiety, depression and ideas of self-harm have all greatly increased in men and boys. Refuge in alcohol, drugs or aggression is sometimes the initial response.

The alarming increase in young male suicide and self-harm emphasises the importance of psychological health and well-being in childhood and adolescent years.

There is no simple solution. The best advice for men under stress is that they talk about it, let their feelings come out.

Who to talk to? Anyone. Spouse, relative, friend, pub companion, workmate, helpline or guidance counsellor. At the level of society, a revolution must take place in how the family home, the school, the church, the workplace, could contribute to promote psychological health.

No conventional 'medical model' will adequately respond to this challenge. Put simply, we need a holistic program of 'emotional vaccination' at a national level, through intensive educational programmes to promote psychological self-awareness from the earliest age.

8Be the best father, husband and citizen you can be

"Love and work are the cornerstones of our humanness." A phrase attributed to Freud.

It emphasises that happiness, love, work and health are interwoven. Fatherhood is a wonderful opportunity to contribute to personal happiness and health and that of the family.

By contrast, look at the generational impact of an unhappy Irish childhood in novels such as Angela's Ashes and Amongst Women caused by a neglectful, tyrannical or alcoholic father. And just as bad an influence is the absent, non-involved father, who leaves an emotional void at the heart of the family and no trace of a fatherly role-model, which is important for children's emotional formation. The good news is that, over the past two decades, men are taking fatherhood seriously. And studies have shown the hugely beneficial effects of active fathering on the psychological well-being of not just the father and spouse but the future behaviour of the children.

You don't have to ask sociologists about the benefits of a happy family life. The advice is simple -- cultivate your fatherhood skills, read the books on it, consult the websites, take a course on parenting.

It will be well worth it in the long run and do immense good for generations -- a wonderful legacy. You won't whisper on your deathbed, "My only regret -- I wish I had spent more time with my family."

9Work and be active -- paid or voluntary, active or retired

In Freud's attributed quotation, 'work' is vital. In another attributed quote, he described "the compulsion to work" as a foundation for "the communal life of human beings".

Work often means paid employment. But in an era of job lay-offs and enforced retirement, work can also be voluntary, in the community or in the home.

The key element of 'work' that contributes to health is the mental and psychological benefit that human interaction and being active and involved gives. Doing useful things that matter, being needed, making a contribution and a difference are all vital for a feeling of self-worth, which is the bedrock of psychological health.

And it has beneficial physical effects too. Social, intellectual and physical deterioration can occur after retirement if work and activity suddenly cease.

People live longer and are healthier when they are either employed or do voluntary work. The physical and psychological effect of continued human interaction and the feeling of being a contributor to society cannot be underestimated.

So to live a longer and healthier life, keep active, keep 'working', keep engaged.

It's a life-saver -- literally.

10Join the cam-paign for better men's health

The National Men's Health Report 2008-2013 recorded the huge task required to improve men's health. Only recently has this issue reached national agenda.

And there are too few activists. That needs to change, and it is best coming from men, in common cause with women on shared health issues.

Among recommendations on men's health are more educational programmes in the classroom and in the workplace, paternity leave legislation, 'men-friendly' initiatives for a better work/life balance, more medical services and screening clinics that promote men's health and more targeted public campaigns to increase awareness among men of healthy living and illness prevention.

If men from all walks of life do not participate, then men's health issues are likely to lag woefully behind. So join the campaign!

Professor Muiris X FitzGerald is Emeritus Professor of Medicine, University College Dublin, and former consultant physician, St Vincent's University Hospital Dublin

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