Matt maycock understanding masculinity 27th jan 2014
Nmhw presentation 17 june 2017
1. A national update on Men’s Health statistics
in Scotland and Europe
Matt Maycock, PhD
Investigator Scientist
Social and Public Health Sciences Unit, University of Glasgow
Men's Health in Scotland – is it still a lost cause?
Seminar hosted by MHFS and NHS Forth Valley
Wednesday, June 17th 2015: 13:00 – 16:00
2. Overview of the presentation
• Men’s health in Scotland
• Overview of key issues in men’s health
• Men’s use of services
• What can be done about this?
• Examples from the UK and Scotland
3. Scottish Men’s Health – Summary
• In 2010 the healthy life expectancy among women in Scotland was
61.9 years, almost two years more than the healthy life expectancy
for men of 59.5 years.
• Heart disease incidence and mortality is consistently higher for males
than it is for females, across all age groups. Up to the age of 75,
stroke incidence and mortality rates are higher for males.
• Men consult their GP less often than women. For the years 2003/4 to
2011/12, the number of consultations per 1,000 populations has
been approximately 50% higher for women than for men.
• In 2010/11 males were 17% more likely to attend an NHS Scotland
emergency department than females, with 274 attendances per
1,000 population for males versus 235 for females.
4. • Men were more likely than women to be hazardous or harmful drinkers: 27%
of men drank at hazardous or harmful levels compared to 19% of women.
• Men were also significantly more likely to drink above the recommended daily
limit on their heaviest drinking day in the previous week (43% of men
compared to 34% of women).
• In 2010/11, rates of alcohol related hospital admissions for males were more
than double females rates (1,020 per 100,000 population compared to 395 per
100,000 population).
• There was no real difference in smoking prevalence between men and women.
The rate for men was slightly higher but the difference was not significant (26%
compared with 24%). However, men smoked an average of 2 cigarettes per day
more than women (15.2 compared with 13.3) and started smoking at a slightly
younger age (17.2 years) than women (17.8 years).
Scottish Health Survey (2012)
Alcohol/Smoking
5. • There was a small but significant gender difference in the proportion of men and
women eating 5 or more portions of fruit and vegetables per day (24% of
women compared with 21% of men) with a similar pattern in the mean number
of portions eaten per day (women ate 3.4 portions compared to 3.1 for men).
• There was no significant difference in the prevalence of obesity, although men
were more likely to be overweight than women (69% compared with 61%).
• For children, a lower proportion of boys are in the healthy weight range than
girls, although the size of the gap has varied over recent years. The indicators
also show that a higher proportion of men than women meet the physical
activity recommendations, with 45% of men meeting the requirements
compared to a third of women.
• There was a small but significant difference in the prevalence of cardio-vascular
disease (CVD) between men and women, with men being more likely to have a
CVD condition (16% vs 14%).
Scottish Health Survey (2012)
Diet/Obesity/CVD
6. Deaths from all causes in all adults
under 75, by sex, England, Wales,
Scotland, Northern Ireland and
United Kingdom 2010
Key Issues in
Men’s Health
7. Difference (%) between men
and women
in cancer survival across
Europe
0
2
4
6
8
10
12
14
16
18
Slovenia
M
alta
C
zech
R
epublic
The
N
etherlands
ItalyPoland
Spain
E
UR
O
C
AR
E-4
m
ean
N
orthern
Ireland
G
erm
anyBelgiumEngland
Scotland
Sw
itzerlandW
alesFinlandN
orw
ayIcelandIrelandAustriaSw
eden
%
Verdecchia et al (2007) Eurocare 4
Key Issues in
Men’s Health
8. • Middle-aged men twice as likely
to have diabetes as women.
• Men twice as likely to not know
they have diabetes.
• In Scotland there were also
significantly more men (6%) than
women (4%) with diabetes.
Diabetes
Key Issues in
Men’s Health
9. More women than men diagnosed with common
mental health problems, but:
• Almost three quarters of people who kill themselves are men.
• 73% of adults who “go missing” from home are men.
• 90% of rough sleepers are men.
• Men are three times more likely than women to be alcohol
dependent.
• Men are more than twice as likely
to use Class A drugs.
• 79% of drug-related deaths occur
in men.
Key Issues in
Men’s Health
Mental Health
11. Men are less likely than women to:
• See a GP
• Attend for a Health Check
• Opt for bowel cancer screening
• Visit a pharmacy
• Have a dental check-up
Key Issues in
Men’s Health
14. • Men on average visit a pharmacy four times a
year.
• Average for women may be closer to 18
times per year.
• Nearly half (47%) of people accessing the
New Medicines Service – a free advice
service for people taking a new medicine for
a long term condition ‐ are men.
Key Issues in
Men’s Health
NPA interim review:
men’s uptake of
pharmacy services (Nov 2012)
15. Dickey H, Ikenwilo D, Norwood P, et al. Utilisation of eye-care services: The
effect of Scotland’s free eye examination policy. Health Policy 2012; 108: 286-
293.
Key Issues in
Men’s Health
Gender differences in the impact of
free eye tests, Scotland
21. Football Fans in Training: a gender sensitised weight loss,
physical activity and healthy lifestyle programme for men
22. Global pandemic of inactivity
• Global pandemic of inactivity
Hallal et al,
Lancet 2012
MEN
WOMEN
23.
24. • 5-10% weight loss can produce
significant health benefits (NICE 2006; SIGN 2010)
• Traditional weight management services
do not reach many men
Less than 15% of referrals to
commercial sector
(Jebb et al Lancet 2011)
Only 23% of attendees at NHS
weight management services
(Counterweight Br J Gen Pract
2008)
26. …and may prefer to control their weight through exercise
Pliner et al. Pers Soc Psychol Bull 1990;16(2):263-73.
27. • Almost 4 million fans
pass through Scottish
Premier League club
turnstiles each season
(SPFL 2010)
• Most are male; a large
proportion from low
SES backgrounds
• Powerful social and
psychological
connections (often life-
long and cross-
generational)
(Hirt et al 2010)
Traditional male sporting environment
28. FFIT weight loss components
Alcohol
awareness
Weight loss
Long-term behaviour
change strategies
BANTER
Food
• Portion sizes
• Healthy, balanced diet
INCREASED PHYSICAL
ACTIVITY
Goal 5-10% weight loss
29. FFIT PA components
• Classroom:
Health benefits of PA
Making PA part of daily life
Barriers to PA
Facilitators of PA
Avoiding compensation
Rate of perceived exertion
Goal setting
Dealing with relapse
30. • “Homework”
Target: 45-60 mins moderate PA on most days of
week
Incremental, personal pedometer-based brisk
walking programme (Fitzsimons, Baker et al. 2012)
Progression to other activities (swimming/cycling)
Use of local facilities
Meeting up to exercise together
FFIT PA components
31. FFIT PA components
• In stadia training
Graduated (walking 5-a-side)
Aerobic, strength, flexibility (including principles)
Individualised (fitness, ability, preferences)
oCircuits
oBoxercise
oFootball drills
oGym work
oStreet dance!
33. World-leading research
• Participants: 747 men, 35-65 years, BMI≥28 kg/m2
• Measurement: baseline, 12 weeks (post-FFIT) and 12 months
• Primary outcome: objectively-measured weight loss at 12 months
• First-ever RCT of healthy lifestyle programme in professional sports
club setting and First-ever men’s health RCT
Secondary outcomes
Objective Self-reported Cost effectiveness
Waist circumference Physical Activity (IPAQ) Resource Use
BMI Food Frequency (DINE)
Body Composition (% Body Fat) Alcohol Intake (7-day diary)
Resting BP (Systolic/Diastolic) Self-esteem (Rosenberg)
Positive and Negative Affect (PANAS)
Health-related Quality of Life (SF-12)
35. Men at very high risk of ill health from all walks of life
• Mean age: 47.1 (±8.0) yrs
• Mean BMI: 35.3 (±4.9) kg/m2
• Mean BP: 140/89mmHg
BMI Category
Overweight (BMI 28-29.9) 8%
Obese I (BMI 30-34.9) 44%
Obese II (BMI 35-39.9) 31%
Obese III (BMI ≥40) 17%
Attended weight loss programmes in
last 3 months?
Commercial
programme
NHS Services
Not at all 96% 98%
Over 90% clinically obese
18% 18% 16%
22% 25%
0
20
40
1 2 3 4 5
SIMD Quintile*
36. What makes men want to attend FFIT?
What makes men want to attend FFIT?
Hunt et al, 2014, BMC Public Health
37. ‘Push’ and ‘Pull’: football club a powerful draw
I was very aware that, every time I was buying a new suit ... the trouser
size was getting bigger, and I just wasn’t happy with that, and I just
wanted to address it. And with it being, having a tie in with the team
I’ve supported all my life, I felt that the two kind of – they, it fitted
nicely. It meant I could do something and I could maybe get a wee
sneaky peek behind the scenes at Fir Park. [Club04_12wkFG_P2]
I’ve struggled with my weight since, maybe,
early-twenties and I’ve tried various diets,
various things, .... So, when I seen this
advertised in the paper ... I think the main
thing that drew us to it was because it’s Hibs.
You’re going to be involved at Hibs, whether
it just be at the ground, stadium ... That was
what really attracted me to it.
[Club07_12wkFG_P1]
38. Men like me
P1: The good thing was, straight
from the start, we all had
something in common with each
other. Rather than being sixteen
strangers, we’d all something in
common, and that was the club
and a love for it.
P5: Two things in common. We
were fat and we supported [the
club].
P1: …and that was the big factor.
So no matter, you met up the first
few weeks, you didn’t know each
other’s names, we immediately
were able to converse with each
other easily.
[Club03_12wkFG]
Insider view
Just the enjoyment of
coming along and being
involved in the club .. even
walking round [stadium],
to me, was an exciting part
of the Monday night, and
you know, walking up and
down the terraces. You
might only be restricted to
one area when you come
to a game, but you know,
the fact that you’ve got
carte blanche, you can go
wherever you like, other
than the pitch.
[Club02_12wkFG_P1]
Men were immediately comfortable and receptive
44. Increase in self-reported PA
Adjusted ratio geometric means 12 weeks 2.38 (CI 1.90, 2.98) p<.0001
Adjusted ratio geometric means 12 months 1.49 (CI 1.11, 1.99) p=.008
(Error bars represent
IQ range)
1485
1219
0
375
-2000
-1000
0
1000
2000
3000
4000
MedianincreaseintotalPA
(MET-mins/week)
Intervention
Comparison
12 months12 weeks
45. The value of the pedometer and walking
– The pedometer was widely accepted and its use
quickly became routinized in men’s daily lives
– A valued technology for motivation, self-
monitoring, and goal-setting
It’s given me a good kick up the
backside… every day after I’ve had
my shower and got dressed, the first
thing that I do is put my pedometer
on…it’s made me consciously go out
of my way to walk more. (TI-6)
46. The value of the pedometer and walking
• It’s an amazing wee device. .. Before
you maybe thought you’d been staying
active but when you look at your
pedometer you realise you hadnae. (TI-
18)
• I love that part of it but I never go out
without my (pedometer). It really is
amazing. I wear it every day and
record it every day .. That’s tangible,
something you can touch and see … I
think eveybody was highly delighted wi’
the pedometer (TI-12)
The value of the pedometer and walking
49. ‘Effervescence’ and renegotiation of identity
Effervescence and group identity
P2: The group helped, eh,
because to be honest… there was
naebody took a disliking to
anybody and we aw got on. We
were on the park and we were
help, ken, “come on, dae this.”
And we were aw hoping that
everybody came every week and
lost weight, eh?
I think self-encouragement is,
we’re there, because we’re part
of a group, we were all
encouraging each other. It’s not,
you were no longer an individual.
You were part of a team
[Club07_12wkFG_P1]
Renegotiation of habitual practice
and masculine identity
Blokes don’t do it…Until we get
that support from each other and
then we start looking at portion
controls, and what you’ve said
there, what’s on the labels – blokes
would just go and look for the easy
option. That’s what men do.
[Club12_12wkFG_P4]
It was funny, listening to men –
and I don’t want to sound sexist –
but men going on about weighing
themselves in the morning and
what diet they were on and what
they were eating, and, “I had my
porridge every morning,” and I
think and it was good. And there
was a really camaraderie about the
course. [Club10_12wkFG_P1]
50. What men said helped them
Self-monitoring
I find that the pedometer even now it’s my conscience. If I can look
back seven days and say, “Phew, I’m only averaging about seven thousand. I usually
should be doing eight or nine”. It’ll make me go for a longer walk some time later in the
week. [Club10_12mthFG_P2]
Behaviour change techniques
Implementation intentions
I think the thing for me is actually the planning of stuff […] You know about how, if you
want tae walk you’re gonna have to plan about “When am I gonna walk?” An’ also I
quite often end up staying at hotels or whatever for work, an’ you have to know, “What
am I gonna eat? Where am I gonna eat?” So you have to do a bit more planning about
how you do that. […] You have to sort of try an’ work something out there so you don’t
end up goin’ to Greggs or whatever.
[Club05_12mthFG_P3]
51. Barriers to maintenance
Injury and illness
I’ve got bother wi’ my Achilles heels and I stopped all my walking altogether […]
then I started getting doon. [Club10_P4]
Weather
I put it doon tae weather, because this year in particular there’s been a hell of a lot
of rainfall and you cannae get, you cannae go on the bowling green […] because it’s
been flooded for aboot three days. So you cannae get, that’s your activity oot the
window. [Club10_P6]
Life events
My brother passed away which is one o’ the difficult things […] basically he died in
his early fifties […] it was his heart that caused problems, so you think that well that
kinda would inspire you, but to a certain extent that was probably one of the worst
times where, you know, things were going wrong and it was just, you know, feeling
bad and eating. [Club09_P5]
Job related factors/lack of time, lack of money
52. Is FFIT is cost effective?
YES!
Within trial analysis
• Programme cost c£165 per man
• Incremental cost-effectiveness:
£13,847 per QALY gained - well below NICE thresholds for
cost-effectiveness
£20,000/QALY: 0.72; £30,000/QALY: 0.89
Long term analysis
• Gained 0.43 life years (95% CIs - 0.32, 0.56) and 0.38 QALYs
(95% CIs - 0.25, 0.55)
• £2,535 per life year gained; £2,810 per QALY gained
• If decision maker willing to pay £5,000 per QALY, no
uncertainty that FFIT is cost-effective
53. Conclusions
• FFIT succeeds in helping men satisfy basic
psychological needs in relation to PA
• Participants describe a trajectory of competence
– internalisation associated with successful
maintenance?
• Difficulties encountered included injury, illness,
life events and job related issues
• Men feel attracted to/comfortable in
football club setting
• Being with men like me permits challenges
to traditional male identities weight loss
and behaviour change
• Importance of role of wider social context in
negotiating lifestyle change
• Satisfaction of basic psychological needs can
promote sustained change
• Promising emerging findings from other
settings
What has FFIT shown us?
FFIT website: www. ffit.org.uk
54. Where next? – research cont.
FFIT for women
FFIT Mental Health
Greek FFIT
EuroFIT
EuroFIT
EuroFIT
EuroFIT
HockeyFIT
RuFIT NZ
55. Acknowledgements
Thanks to Participants, coaches, MRC/CSO SPHSU Survey Office and
Gender and HealthTeam, Tayside Clinical Trials Unit
Collaborators Sally Wyke, Kate Hunt, Cindy Gray, Chris Bunn,
Annie Anderson, Shaun Treweek, Peter Donnan, Nanette Mutrie,
Jim Leishman Elizabeth Fenwick, Alan White, Adrian Brady,
Petra Rauchaus, Eleanor Grieve, Nicki Boyer
FFIT Programme Delivery SPL Trust – Billy Singh, Euan Miller,
Stuart McPhee, Mark Dunlop and Iain Blair, Coaches in SPL clubs
FFIT Programme Funding Scottish Government, Football Pools
Research Funding SPL Trust, CSO, MRC/CSO SPHSU Gender and
Health programme, NIHR PHR programme, Bupa Foundation, EU FP7
This RCT was funded by the National Institute of Health Research Public Health
Research (NIHR PHR) programme (project number 09/3010/06). The views expressed
here are those of the authors and not necessarily those of the NIHR PHR programme
or the Department of Health
56. Standing break 3…
…and final questions?
• Hunt K, Wyke S, Gray CM et al. In: Sports-based health
interventions: case studies from around the world. New York:
Springer, [in press].
• Wyke S, Hunt K, Gray CM et al. Public Health Research [in press]
• Hunt K, Gray CM, Maclean A et al. BMC Public Health 2014;14:50
• Hunt K, Wyke S, Gray CM et al. The Lancet 2014;383:1211-21
• MacLean A, Hunt K, Gray CM et al. International Journal of Men’s
Health 2014;13:121-138
• Gray CM, Hunt K, Mutrie N et al. BMC Public Health 2013;13:232
• Gray CM, Hunt K, Mutrie N et al. International Journal of Behavioral
Nutrition and Physical Activity 2013;10:121
• Hunt K, McCann C, Gray CM, Mutrie N, Wyke S. Health
Psychology 2013;32:57-65
