Evidence for Equality Delivery System
Name of organisation:The Newcastle upon Tyne Hospitals NHS Foundation Trust
Protected Characteristic
Sex Men and Women
Date: May 2015
General Points:
Link to Men’s Health Forum UK reports
http://www.menshealthforum.org.uk/professionals/search?f%5B0%5D=im_field_pro_content_type%3A29
Link to Women’s Health Equality Consortium reports
http://www.whec.org.uk/wordpress/?page_id=306
· Out of a total population of 280,177, 144,226 are male and 139,951 are female which equates to virtually an exact 50% division of males and females in the population (Census 2011).
· Life expectancy is 12.1 years lower for men and 10.1 years lower for women in the most deprived areas of Newcastle upon Tyne than in the least deprived areas. (PHE Health Profiles 2015)
· Major contributors to the gap in life expectancy between Newcastle and
England in men are lung cancer (18.6%), circulatory diseases (16.4%) and other cancers (15.3%), and in women are lung cancer (26.9%), respiratory diseases (14.5%) and circulatory diseases (14.1%).
· In 2012/13, there were 1.2 million female and 700,000 male victims of domestic abuse in England and Wales. Data from the Crime Survey for England and Wales suggests that 30 per cent of women and 16.3 per cent of men in England and Wales will experience domestic violence in their lifetime.
http://researchbriefings.files.parliament.uk/documents/SN06337/SN06337.pdf
· Pregnancies to women living in areas with the highest levels of social deprivation in the UK are over 50% more likely to end in stillbirth or neonatal death. Babies of Black or Black British and Asian or Asian British ethnicity had the highest risk of extended perinatal mortality with rates of 9.8 and 8.8 per 1,000 total births respectively. Both these findings show that inequalities in perinatal outcomes persist in the UK. (MBRRACE-UK - UK Perinatal Deaths for Births from January to December 2013)
· Lung cancer is the most common cancer to be newly diagnosed in Newcastle and statistically significantly higher than the North East 100 men per 100,000 males are diagnosed with lung cancer. This is compared to approx 68 women per 100,000 females. Male mortality for lung cancer is at approx 85 per 100,000 males compared to approx 56 women per 100,000 females
· Breast cancer is clearly the most common cancer for women.
· The incidence of colorectal cancer is higher in men than in women at approx 70 men per 100,000 male population compared to 40 women per 100,000 females
· Newcastle has high rates of premature death due to smoking, alongside the rest of the NE. In Newcastle there is little difference between males and females. However more young women (age 16-19) smoke and so are at risk of lung cancer, compared to young men. ONS (2008) ‘Focus on Gender’
· Poor lifestyle choices and preventable risk factors account for a high proportion of premature death in men (Courtenay, 2000, EC, 2011)
· Smoking prevalence is higher in men than women in Newcastle but approximately equal numbers are accessing the stop smoking service.
· The mental health needs of men is an unknown quantity but the literature highlights a potential unmet need for men who tend to try and cope by themselves rather than access services. Approximately one third of mental health service users are men.
· Adult overweight and obesity is roughly equal across men and women nationally and locally. Only one third to one fifth of weight management service users are male in Newcastle.
· Alcohol related deaths are higher in men than women in Newcastle and 70% of drug service users are male.
(Men Just Crack On, Men’s health Inequalities in Newcastle, Health Needs Assessment 2012)
· Men tend to access GP services less often than women. They also appear to ignore symptoms of ill-health and delay healthcare seeking more often than women, especially when it comes to seeking medical advice about illnesses deemed embarrassing or related to sexual health. Men may be more likely than women to self- medicate in harmful ways, e.g. through use of alcohol and drugs when experiencing mental distress.(The Mandate A mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015)
· There is a strong gender dimension to lifestyle choices and risk taking / health seeking behaviors (Courtenay, 2000, EC, 2001, Dolan 2011, Evans et l, 2008)
· Specifically, the Health, Illness, Men, Masculinities Framework depicts masculinities as a social determinant of health that intersects other determinants such as socio-economic status, race, ethnicity, sexuality, ability, geography, community, education, and employment. Because masculinities are socially constructed within particular social, political and historical contexts, the definitions and practices of masculinity vary among societies and men. Adding to the complexity of men’s health, practices of masculinity also vary across the life course of any one man’s life in response to aging, life events and history. (Health, Illness, Men, Masculinities (HIMM) Framework Evans et al, 2011)
· Women have a 50:50 likelihood of having substantial caring responsibilities before they are 59. Men reach this point at 79.
· In a survey of over 1000 women 45 per cent of BME women of screening age (50 to 70 years) had never attended the NHS breast cancer screening programme. (Same Difference. Breast awareness is for everyone. Breast Cancer Care 2005)
· The UN has acknowledged that refugee women are more affected by violence than any other women’s population in the world. This results from the multiple situations of vulnerability in which refugee women find themselves. As a result, a significant proportion of refugee women living in the UK have experienced violence, including rape or sexual violence prior to arrival and they remain vulnerable to violence in the UK. (The experiences of refugee women in the UK, Refugee Council, 2012)
Key messages from men
· Straight forward and direct information - Nothing too subliminal
· Solution focused – e.g. Quit smoking group on a Tuesday
· Conversation to be equal and empowering - The man needs to feel in control of their own health
· Male friendly space - No exercise to music and Heat magazine!
· Offer drop in sessions and specific appointment - Not just group activities
· Offer credible and robust information through social media and internet - A service does not always have to be face to face to be effective
To summarise what works for men
· Health checks in the workplace
· Extended evening appointments at GP
· Frank and direct information – no nonsense
· Internet and email – subtle and confidential
· Messages via a significant other – partner
· Personalized invitations / information
· Legitimize caring for your health – employers
· Provide a space for men to talk to men
(Men Just Crack On, Men’s health Inequalities in Newcastle, Health Needs Assessment 2012)
Keys messages from Women
· There is a definite and indeed growing need for women only space and women only or women friendly space services.
· Group work to support women; the use of groups, the mutual and peer support that is generated, can be more effective and longer lasting than if provided by a worker.
· Support for voluntary and community groups, which have for many years been building a safety net for communities. This is known about and used within the voluntary and community sector but there is no picture of it; it is not articulated and so possibly not recognised by the statutory sector
· Non-threatening courses and events around food, or language or literacy lessons could be attractive to women who have different problems, but needed to find a safe route into organisations.
· “Mental health services need more focus on women. A high proportion of female users using mental health services have domestic violence issues – how is it reflected?”
· There is a need for facilitated support for women from minority ethnic communities; whether newer arrivals or from settled communities
( ‘Changing Times: Women’s Organisations in Newcastle’, Jobbins,P. Young, S. Newcastle Council for Voluntary Service, 2012 )
Recommendations taken from ‘Why Women’s Health’? Women’s Health and Equality Forum
· Target pregnancy and maternity support to more vulnerable and disadvantaged families.
· Appropriate care that can meet the needs of all women must include the women’s voluntary and community sector, who are integral to the delivery of health and social care services and are able to provide the services women want and use (such as women only services).
· Take into account the diverse experiences of women’s lives, including poverty, sexual violence and abuse, reproduction, and understand how these experiences impact on women’s health and wellbeing. This must include a cross-government approach to address the issues that impact on women across their lives.
Examples of how the Trust meets the needs of Men and Women
· CQC evidence in relation to quality services for all
· All services apart from those that are gender specific are available for men and women.
· Single Sex Accommodation
· Pregnancy and Maternity Services
· Health Improvement Team Assertiveness Courses for Women
· Campaigns to promote screening such as breast screening and bowel cancer
· Partnership work to develop understanding and evidence in relation to health inequalities experienced by men
· Revised robust Equality Analysis process developed and applied to strategies and developments as well as polices
· Sexual Health Services are Raising Awareness of prostate cancer
· Same sex practitioner can be requested particularly in relation to sexual health matters
· Men’s Health Week event
· ‘Putting people at the heart of all we do’ resource
· Equality and Diversity week included men and women
· Developed links with Tyneside Women’s Health
· Domestic Violence Conference
· Cervical Screening Promotion with in the Women’s Zone & Steve Paske Health Zone – aimed particularly at Lesbian & Bisexual Women
· International Men’s Day (IMD) in Newcastle. The theme for 2014 an outreach day focused on men’s health and wellbeing. Men in a socially deprived area of the city were asked 3 questions about their health and given a link to NHS Choices. An event was also developed for staff focusing on reduction of stress for men.