Regulator refuses to “defend the indefensible” but says improvements are being made
Health check. London PCTs spend more money on outreach health services aimed at women.
Only a handful of London health trusts and councils commission services focused on men’s physical and mental wellbeing, despite a Bureau investigation showing a shocking disparity between male and female life expectancy in the capital.
In some of the most deprived areas of London women live up to 12 years more than men. The Bureau wanted to know if this disparity was being redressed.
The Bureau sent out freedom of information requests to Greater London’s 32 Primary Care Trusts and the capital’s councils. We asked them to disclose how much they paid for health and wellbeing services outside the NHS broken down by gender.
Of those that replied, only four borough PCTs commissioned specifically men’s services (at a cost of £11,135,291), while 15 PCTs commissioned women’s services (at a cost of between £13,156,785 and £13,429,785).
For those with gender-based services that replied, women’s health services received £1,775,766 to £2,048,766 more funding than men’s over the past five years. There is a range because some PCTs would only disclose that an amount between two figures was spent, rather than a specific figure (eg £50,000 – £100,000).
The disparity in spending among PCTs was greatest in Brent, where nearly £3.5m was spent on female-focused third sector initiatives over the past five years, and nothing spent on men’s. Yet male life expectancy in Stonebridge, Brent, is just 73.5 years, five years below the national average.
Alan White, Professor of men’s health at Leeds University and lead author of a recent EU report into men’s health, told the Bureau that there was a real lack of initiatives directed at the male population.
‘At the moment there is a blindness to the fact that there are men wanting to use the services and they can’t.’
He said a particular problem is with working class men, who cannot adjust their hours.
‘If you’re not in the van at 8am, you don’t get paid, and so any services that are set during the working day are understandably difficult to access unless you have to go.
‘So that means a lot of preventative services are not accessible to men – would you lose a day’s pay to get your blood pressure checked, just in case it’s high?
‘You tend to find no thought has been put into reaching out to men.’
Interestingly, however, Cathedrals, the ward with the greatest difference between male and female life expectancy, lies in the borough of Southwark. Southwark has bucked the trend – spending nearly £4.7m more on men’s initiatives.
Southwark PCT told the Bureau that it has ‘invested substantially in developing and implementing an extensive Men’s Health Programme’, targeting the parts of the borough with lowest life expectancy.
The programme worked at two levels, said the PCT: ‘promoting health and wellbeing’ and ‘improving detection and access to health services’.
Jin Lim, Consultant in Public Health at Southwark PCT told the Bureau that health inequalities continue to be a challenge: ‘We need to focus on the relatively more deprived parts of the borough and especially support communities that are disproportionately affected by the current economic climate,’ he said.
Campaign groups argue that it is not just more health services that are needed. Dan Taylor, London Coordinator for the campaign against living miserably, (CALM) says in London and nationally suicide kills more young men aged 15-34 than knife crime or car accidents put together.
He argues that this needs as much attention as health matters. ‘Men battling with depression, anxiety or going through a crisis often find it hard to go to a GP to discuss their problems [due to a] stigma around showing vulnerability and asking for help,’ he says.
Thus ‘council funding, beyond just health, is also urgently needed – to reach men in places that they work, socialise or commute,’ Taylor said.
The Bureau asked all local councils in London to disclose how much they had spent on third sector men’s and women’s services in the last five years, for example, in grants to charities or voluntary groups.
The largest disparity in funding was in Barking and Dagenham, where nearly £4.8m more was spent on women’s services. Men’s life expectancy in this borough is the sixth lowest in the capital.
Of the councils that provided a response, three times more was spent on services aimed at or predominantly used by women (£20,111,866.20), than men (£6,022,289.62).
Within these, the largest disparity in funding was in Barking and Dagenham, where nearly £4.8m more was spent on women’s services. Men’s life expectancy in this borough is the sixth lowest in the capital.
The huge gap in spending is in part because a lot of the money directed at women is for services aimed at children or women caring for older residents or women who have suffered domestic violence. But the large discrepancy is still worthy of note, particularly in areas where the gap between female and male life expectancy is great.
Related article: Why is men’s health suffering in London?
The lack of funding, says Taylor, ‘signifies the common error in commissioning that men don’t require specific services’.
However, ‘Community, leisure and support facilities patently enhance the lives of both men and women, and so the fact that there’s such a gap in funding really needs to be explained and, we’d argue, re-addressed,’ he added.
Why is more spent on women’s services?
Three of the wards with a large life-expectancy gap lie in Hammersmith and Fulham, where, borough-wide, the average life expectancy disparity between men and women is 6.5 years. In three of its 18 wards, the gap is 10 years or more.
However, in 2011/12 Hammersmith and Fulham Borough Council spent £2,282,022 on third sector services primarily used by women, and just £282,970 on third sector services targeted at or primarily used by men — eight times as much was spent on female focused services.
Meanwhile, the Borough’s PCT spent £428,319 on women’s third sector services and nothing at all on those for men.
Councillor Joe Carlebach, cabinet member for community care at Hammersmith and Fulham, said: ‘We do spend more money on women than men because many of the services we fund support those who look after children, care for adults or those who have suffered from domestic violence.
‘This is particularly true of services that work to improve the health and wellbeing of older people as there is a much higher proportion of older women than older men in the borough. All funding decisions are aimed at supporting those organisations who provide the services our local residents need most.’
However, not all of London’s authorities direct the majority of funding to female-focused third sector services.
Westminster City Council spent £1,841,885 on female-focused services, compared to £3,298,196 on those for men, or 80% more was spent on male services by the council.
In Southwark, which has some of the greatest life expectancy disparities, £1,071,164 was spent on men’s services in 2011/12, compared to £364,936 on women’s services – just under three times less.
Many councils and PCTs were unable to break down their funding by gender. However the broad picture that emerges is that women’s health, community, and leisure services receive far more funding than those directed at London’s male population, despite the life expectancy gap.
Calls to around twenty GPs listed by the NHS Choices website for wards with some of the widest gaps in men and women’s life expectancies, discovered only one GP that offered a targeted men’s health service – a GP in Westminster that offers a ‘well man’ clinic for two hours once a week.
In addition, a survey of council-run health and fitness facilities in boroughs with poor male health outcomes, showed a tendency for council gyms and swimming pools to run predominantly female-focused fitness classes and ‘women-only’ sessions.
Taylor, said: ‘Services that specifically address men and resonate with their lives and empower them to get help are urgently needed. Women’s services are important – but the balance needs to be equal, with support services that men can buy into getting their funded increased and matched to women’s services. This may require a rethink about how such services are developed and branded in the first place.’
He says this is becoming even more urgent in the current economic climate: ‘With the cuts to Connexions and youth services, and a changing political landscape making it harder to find and retain employment, we have a collective responsibility to support a generation of young men facing unparalleled unemployment and uncertainty. This had a devastating legacy during the last major recession of the early 1980s. Now is the time to fund services that do support and help young men in a way they can relate to.’
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