Five ways national health screening programs exclude men

The national conversation about men’s health commonly focuses on men’s perceived reluctance to get help, when compared with women. Yet the more time you spend examining how health systems work, the more you discover the many different ways we invest less time, money and resources into men’s health.

See The Five Ways National Screening Programs Exclude Men Below 

One of the clearest demonstrations of this fact, is the amount of resources we invest in running national screening programs to help spot the signs of physical, mental and social health issues. 

The rationale that underpins national screening programs is that we don’t wait for an individual to reach out and get help, rather we take collective responsibility for reaching out to a particular population to offer preventative help.

At present, the vast majority of national health screening targets women. If we view these programs as a reasonable measure of help-giving, we are at least 10 times more likely to systemically reach out and offer help to women than men.

For example, each year the Government spends more than $400m screening around 7 million Australians for cancer. 91% of people screened are women and 9% are men. In total, an estimated 7% of the $409m we spent on cancer screening in 2015-2016, was targeted at male cancer. 

Stating this fact isn’t an argument for the introduction of a national screening program targeting male cancers (e.g. prostate cancer) as it is broadly agreed that there is insufficient evidence for the benefits of such a program.

But seeking out and sharing facts like these can help focus our collective minds on the challenge of improving men’s health in new and innovative ways.

Three Ways To Think About The Problem With Men's Health 

If we simply say the problem with men’s health is behavioural (e.g “men don’t get help”), our only solution is to berate men about their unhealthy behaviours and tell them to “man up” and get help.

If we say the problem with men’s health is cultural (e.g. “masculinity is bad for men’s health”), we can end up in a divisive culture war, with opposing sides fighting over the "right" and "wrong" way to think about sex, gender and masculinity. 

But if we say the problem with men’s health is trying to find fairer and better ways to invest more time, money and resources in improving men’s health, we can take a more inclusive approach the encourages people to work together to find solutions.

Taking an inclusive approach doesn’t mean we should exclude efforts to increase men’s access to services or find more positive and effective ways  to connect masculinity and men’s health, but it does mean working harder to find fair and effective ways to improve men’s ways.

It may be, for example, that we could find ways to provide more and better health screening to men; whether that’s by working harder to promote the benefits of existing screening programs; extending existing screening to a wider age range of men or introducing new screening that may be available in other countries, but not Australia.

Five Ways National Screening Programs Are Excluding Men

1. Sex-Specific Cancer Screening

At present national screening programs for sex-specific cancers (e.g. breast, prostate, cervical and testicular) only target female cancers. In 2015-2016, an estimated $350m was spent on screening 5.5 million women for breast cancer and cervical cancer.

There is no sex-specific cancer screening program for men as cancers such as prostate and testicular are among the cancers (such as lung cancer and skin cancer) where it is generally agreed that there is insufficient evidence for the benefits of a screening program. It is likely that men will continue to be excluded from sex-specific cancer screening until such time as better screening methods are developed. 

2. Bowel Cancer Screening

There are more than 4,000 bowel cancer deaths in Australia every year. There are slightly more bowel cancer deaths in men, with men more likely to get the disease at a younger age. When we look at our risk of of developing bowel cancer in the next 10 years:

  • The risk to men in their 30s is 3% higher (than women of the same age)
  • The risk to men in their 40s is 20% higher 
  • The risk to men in their 50s is 45% higher 
  • The risk to men in their 60s is 60% higher 
  • The risk to men in their 70s is 55% higher 

In 2015–16, an estimated $56.1 million was spent screening approximately 1.3 million Australians for bowel cancer(around 600,000 men and 700,000 women). At present, 39% of men and 43% of women in the 50-74 age range are screened. We currently exclude men and women under 50 from screening and low participation rates means that around 3 in 5 men and women who are eligible for screening, don't take part. 

As bowel cancer screening is the only national health screening program to include men (and men are at higher risk of bowel cancer) this is one area where we could be exploring the benefits of innovative ways to actively include more men in the program, such as lowering the age for male screening to 45 or investing more time, money and resources, promoting screening to men.

3. Screening For New Parents

In Australia, screening for mental health conditions, alcohol and substance misuse and domestic violence is a Medicare requirement for women in pregnancy and the postnatal period. There is currently no screening program for new and expectant dads, despite the fact that an estimated 1 in 3 new parents who experience depression are men, with around 30,000 new dads affected every year.

Approximately 300,000 men become dads every year in Australia. In recent months fatherhood experts in Australia have called for more action to identify and support new dads with mental health issues following news from the UK that fathers are to be included in perinatal mental health initiatives as part of a long-term national health plan.

4. 'Triple A' Screening For Men

Several countries screen older men for Abdominal Aortic Aneurysms (AAA). In the UK, for example, AAA has a higher participation rate than screening for breast cancer, cervical cancer and bowel cancer.

Current Medicare rules prohibit reimbursement for population screening of men for AAA; however, targeted screening of individual patients can be requested by any medical practitioner and may be eligible for Medicare.

AAA is another area where the health system could be exploring innovative ways to invest more time, money and resources reaching out to men.

5. Heart Disease Screening

Coronary Heart Disease is the biggest killer of men and women in Australia. Men under the age of 65 are over four times more likely to die from Coronary Heart Disease than women.

The Heart Foundation has recently launched a pre-election campaign to persuade the Federal Government to make heart check ups available on Medicare. According to media reports, nine in ten New Zealanders had a public-funded heart check in the last five years and around 12 million people in the UK were offered the test.

Heart checks need to take account the different needs of men and women. With men experiencing higher rates of Coronary Heart Disease at an earlier age, this is another area where we could be seeking ways to invest more time, money and resources into improving men’s health.

TELL US WHAT YOU THINK 

We pride ourselves in being an inclusive forum that welcomes a diversity of views on how we can improve the lives and health of men and boys in Australia. We'd love to hear your thoughts on how we could invest more more time, money and resources into improving men’s health, particularly in relation to health screening. You can use the comments section on the website or email us at development@amhf.org.au.

 

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    commented on 5 Ways National Health Screening Programs Exclude Men 2019-02-18 13:08:21 +1000
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    commented on 5 Ways National Health Screening Programs Exclude Men 2019-02-18 13:08:20 +1000
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    commented on 5 Ways National Health Screening Programs Exclude Men 2019-02-18 13:07:01 +1000
    I agree wholeheartedly with these suggestions…it’s become “the norm” for women to undergo breast exrays and pap smears… we didn’t like or want it but we got used to it. Providing similar servicces to men in those deseases which we know adversely affect men is not giving them the same opportunity to active participation in preventing illness. Perhaps free national healths for men and women which cover an annual prostate tests, heart check and mental health check, breast screen, pap smear. A one stop shop facility in each city and regional centre. And getting it right, with followup care etc.