Whilst there is no doubt that the term “Men’s Health” has been around for many years, in more recent times there has been a more intense focus on this field. Not only taking in the important physical aspects of health, but with the real shift in our thinking to include a more broad overview including mental and emotional health.  This has been emphasised by the increased awareness and publicity surrounding the rising incidents of mental health issues in the community generally.

It is interesting when I reflect on how far we have come in the past 10 years when the topic of men’s health was somewhat of a taboo issue.  It was rarely spoken about in public discussion and most men held a fear of attending for a full medical check-up and in particular trepidation that surrounded the concept of a full prostate assessment which might even include the dreaded DRE (digital rectal examination!). 

So what has changed and why has this come about? 

The simple fact is that men were dying due to lack of awareness of medical conditions that could have been detected with a proper health assessment.  We are now aware that there are many preventable deaths through early detection and we have the ability to offset pain and anxiety of illness through early treatment of many of the conditions which were traditionally cause of death in our parents or grandparents.  There have been many advances in the treatment options available.

In the past, men have adopted a macho attitude which is partly related to cultural upbringing and the concept of a stoic role that the male would traditionally hold in society.  In addition, there was a sense of embarrassment mixed with ignorance and sometimes a sense of apathy amongst males in relation to their personal health protection.   In the past a men’s health assessment has traditionally focussed on physical issues with assessment aimed at attempting to identify risk factors for common mortality causes such as heart disease, stroke, cancers and diabetes.  In more recent times the move has been including assessments for both emotional and spiritual health due the large impact that mental illness has had on society and people’s ability to function at an optimal level.

The traditional approach has also been easy to understand since physical health is something that is easier to embrace for most people.  It is often visible and is something that you are able to measure in a more meaningful way.  Issues such as weight and obesity, blood pressure, blood sugar levels, blood lipids (including cholesterol) and PSA (prostate specific antigen) levels are real life measurements that people are able to see, touch and understand.  Even more complicated tests such as bowel colonoscopy or cardiac screening using CT angiography or echocardiography are tangible measurements that are all benefitting from developments in diagnostic technology. These tests are more accessible than ever these days.  Women have traditionally had an ingrained sense of attending for health check-ups since their teenage years and society have clearly accepted that women undergo breast screening, pap smears and other “women’s health checks” as a routine virtually from the time of puberty and all through their reproductive life.  Most men are aware of this, but did not see the need to undergo an equivalent check of their health profile.

I have reflected on the various stages and “equal behaviours” that men have followed over many decades and have summarised them into five stages represented by ASOSS.

A – Alcohol – whilst alcohol excess is an ongoing issue even in today’s era, certainly in the 1960’s and 1970’s it was a major concern with conditions such as liver cirrhosis and alcoholic brain damage being associated with many health issues in the community

S – Smoking – in the 1980’s the focus became one of the health risks of smoking and whilst doctors used to actively promote and even advertise smoking in the 1960’s and 1970’s certainly the research is unchallenged now in relation to the health risks of smoking.

O – Obesity – certainly this condition is not exclusive to men, but the emphasis has moved away from anti-smoking campaigns and the focus in more recent years on the risks of obesity and various implications it has on multiple health risks (to be discussed further later).

S – Sedentary – the changes in lifestyle over the last 30 years has resulted in people being much less physically activity with sedentary occupations and an increasing percentage of the population who are not participating in any regular physical activity.  Being active has been shown to be one of the most important interventions that can be undertaken to assist with health promotion of prevention of many of the current known causes of illness and mortality in society (to be discussed further later).

S – Sugar – whilst blood lipids (including cholesterol) have been a focus of nutritional education for many years, the current focus has been more on the role of excessive sugar in the diet and the negative impact that can have on many of risk factors for ill health. 

However, there is one condition that does not receive much publicity, which I believe is a major contributor to community and men’s health issues not being properly understood.  I have termed this condition LRD, which stands for Listener Receptor Deficit.  Whilst again, this condition is not exclusive to men it is more common in men and simply relates to the fact that men do not listen to the advice given to them or register the information that is being provided in relation to matters that they should take into their own hands to assist with their health promotion.

The health landscape from a publicity point of view has certainly changed a lot in recent years.  The emphasis on mental and emotional health is now headline news in so many areas of our society.  Mental illness has always carried a definite stigma (and probably still does in many areas), but we need to move away from this and understand the importance of this topic and the terrible impact it can have on people’s health and society overall.  There have been many public stories in relation to politicians, entertainers, media, high profile sports people, community workers and military – all of whom have been affected by mental health conditions.  It is estimated that as many as 10 to 20% of the population are undergoing mental health treatment at any given time and there is a concerning statistic which shows that it may be as high as 25% in school age children.  The incidence is higher in indigenous communities.  (see my more detailed article on Mental and Emotional Health).

Without wanting to make this a religious topic, there is also the concept of spiritual health – your sense of self – which reflects your value set as it can be influential in how you function as an individual and your ability to be a valued co-worker, parent, partner, good mate or trusted colleague.  It is an essential component of what I refer to overall as “inner health”.

In recent workplace satisfaction and wellbeing surveys the factors that were most frequently being reported as being important to the subjects were stress, anxiety and depression.  Much lower down the list they reported factors such as blood pressure, cholesterol or diabetes as being an issue for them.  Things they valued most were onsite physical activity opportunities, in house education, walking groups and even the presence of good quality and healthy food at their workplace.

So what determines good health?

There are three broad categories of influence I wish to discuss

1.     Genetics

2.     Environment

3.     Behaviour

Genetics

Clearly you DNA can have an influence on your health profile.  There are certain families that have higher incidence of medical conditions such as breast cancer, bowel cancer, heart disease or other inflictions which seem to be inherited and passed down from generation to generation, sometimes skipping one generation, but appearing again.  It highlights the importance of knowing your family background and being aware of having regular testing for the known high risk conditions which may be more frequent in your bloodlines.  These can impact on both quality of life and longevity and of course, there are even circumstances where some testing is done in utero to determine whether the unborn child may be carrying a medical condition that will impact on their ability to thrive.  This raises all sorts of ethical questions in relation to how any of the information uncovered will be handled by the parents to be.  I do not wish to explore this from an ethical point of view at the present time, but simply highlight that it is important to have some information regarding your family background as this is one particular risk determinant that be difficult to influence.

Environment

There are many health conditions which are influenced by both the living and occupational environment in which individuals function.  Cities with air pollution, poor water quality and toxic chemicals associated with waste product production from fuel consumption can be associated with medical conditions including chronic respiratory disorders and certain cancers.  In third world countries where solid fuel burning is a staple for survival both for cooking and heating the incidence of respiratory disease is higher which clearly impacts on quality of life.  This is again a topic which requires more detailed discussion in another article, but further information is available from the WHO (World Health Organisation) website.

Behaviour

Its determinate of health status has been estimated as contributing to more than 50% of quality of life and health risk.  Personal lifestyle choices such as smoking, poor nutrition habits and physical inactivity are all contributing factors to which the individual has some control and therefore is able to influence their own personal health direction.  “Acquired” health conditions such as obesity, diabetes or excessive alcohol intake are associated with poor health outcomes are often synergistic in determining health risks when combined with other environmental and lifestyle behaviours. 

This is where the onus falls back on the individual to seek appropriate advice on their respective profile and to assess the measurable factors such as blood pressure, cholesterol, blood sugar, nutrition profile, weight management advice in order to prevent their onset.  To my mind, we function in a “back to front” healthcare system where we spend $170 billion dollars per year in Australia on healthcare when in fact the expenditure is really being directed at illness care.  Too many individuals have a “fix it once it’s broken”.  In Australia we spend over $23 billion per annum on pharmaceutical medications to treat illness conditions.  In any one year over 100 million prescriptions for cardiovascular medications alone are written.  We seek out pills to treat blood pressure, high cholesterol, diabetes, obesity and mental health conditions.  The $170 billion includes enormous costs associated with sophisticated treatments for heart disease and cancers, which are of course important in the community, but are often detected late and require lengthy and difficult treatment protocols. 

What if there was a single non pharmaceutical product that has a positive influence of virtually all of the known medical conditions listed above, as well as a positive benefit on risk factor reduction.  What if this product was free!

This product is currently available and has been substantiated with decades of random controlled scientific studies to validate its benefit.  The “drug” is called physical activity. There are studies dating back to almost early into the 20th century documenting the value of the physical activity and exercise on reduction of common afflictions such heart disease, diabetes and blood pressure.  With advent of more sophisticated and rigorous trial techniques these results have been reproduced consistently and yet the message is still not well heard by the community.  Another case of listener receptor deficit!

Scientific studies have shown that a mixture of aerobic (cardiovascular) activity combined with some regular strength training has a positive benefit on heart disease, diabetes, blood pressure, obesity and some more recent ground breaking studies the management of many cancers.  One of the greatest advances I have seen in the exercise is medicine field has been validated studies showing that the incidence, response to treatment and recurrence rate of many common cancers is positively enhanced by people who are regularly physically active.  These studies have been undertaken with breast cancer, bowel cancer, prostate cancer and lung cancer.  There will be many studies pending which will reinforce this.

A clear message also is that you do not need to be training as an athlete to get these exercise related benefits.  You just need to do activity at a low to moderate level to have a positive impact on your health.  In fact, the biggest gain occurs when people move from doing absolutely nothing to as little as 60 minutes per week of activity.  This simple change can achieve the biggest gain of a 25% reduction in all causes of death.  There is really no drug in the world that has that impact.  Of course, there are additional benefits as you move to some higher levels of exercise per week with the ultimate sweet spot being around 150 minutes per week.  Those individuals that consistently exercise in the range of 150 to 200 minutes per week have shown to have up to a 40% reduction in mortality for the common conditions in society.

It is important to undergo a health check prior to beginning a physical activity programme, particularly if you have been inactive for many years and are currently being treated for existing medical conditions.  It is important to start at a low level as even walking 5 to 10 minutes per day – and gradually build up over a period of time towards the ultimate goal of 150 minutes per week.  Health benefits will occur at an early stage, but like any drug exercise has a correct dose for individuals and must be taken appropriately to avoid unwanted side effects, eg. Injury.

What health check do I need?

The sophistication of the health check required depends on your medical background and your age group.  As a general rule, those individuals under 40 do not require sophisticated check ups unless they have a strong family history of some of the medical conditions listed above.  After 40 your family medical practitioner/GP can conduct a simple questionnaire on your background health together with some lifestyle and some basic office examinations.  From there, it can be determined if any special tests are required, eg. Cardiac screening, bowel colonoscopy particularly if there are early indications or risk factors uncovered.  A mental health assessment should be a critical part of this assessment, not just the physically measureable factors.

The ultimate prescription your doctor should be prescribing is to undertake a regular physical activity programme which will help you keep away from your doctors’ office!  The level of exercise does not need to be intensive in the beginning, but can gradually increase to provide more fitness benefits as time goes by.  There are no short cuts in this process, but the results are cumulative and consistent.  “Exercise is Medicine” is the ultimate message I wish to spread and the best medication you will ever be prescribed by your doctor does not come in a bottle or blister pack. 

 “Lack of physical activity destroys the good condition of every human being – while movement and methodical physical exercise save it and preserve it”  (Plato)

“ If you can’t fly,  then run,

if you can run, then walk,

if you can’t walk, then crawl,

but whatever you do you have to keep moving forward”  (Martin Luther King)