Gearing Up for Men’s Health Week: June 2011

Last week Peter Baker, Chief Executive of the Men’s Health Forum (MHF), signalled in the BBC health news, men’s ignorance towards obesity and its associated health risks, “Too many men are simply failing to recognise the health risks of being overweight”.  Peter Baker claims that, while women tend to have a good understanding of the factors that affect their weight, because of the desire and cultural pressure to be slim, men on the other hand, do not.  As a result, a higher proportion of men are now considered to be overweight or obese, which can create serious health problems and lead to premature death.  The statistics reveal that sixty-six percent of men compared to fifty-seven percent of women are overweight.

The health news has been published just two months prior to Men’s Health Week in June: Get a Man Online.  This year, the focus will be on how new technology can be used to improve men's health. 

The Health Issues:

Evidence from the Men’s Health Forum makes it clear that men’s health is unnecessarily poor.  Too many men still die too young – Twenty-two percent of men in England and Wales die before they reach sixty-four compared to thirteen percent of women. 

Obesity and overweight are considered as a major cause for the excess burden of male death.  Not only does being overweight increase the risks of heart disease, stroke and diabetes but it is also an important risk factor for several cancers.  The statistics reveal that men are seventy percent more likely to die from cancers common to both sexes and are sixty percent more likely to get such a cancer.  The number of prostrate cancer has grown to over 34,000 a year. 

Additionally, studies have consistently demonstrated that men are more likely to commit suicide, smoke, have poorer diets and consume higher levels of alcohol.  The statistics show that one in eight men is dependent on alcohol, are three times more likely than women to become dependent on alcohol and twice as likely to die from alcohol-related diseases.  All these health issues are further exacerbated by the fact that men are less likely to access health services available to them, or to take part in health improvement programmes.  

Why the gender inequality?

Men tend to believe that weight is a “women’s issue” and they appear to be less aware of the connection between excess weight and poorer health.  Being physically active could make a notable difference in men’s health, particularly as evidence shows that active men have a twenty to thirty percent reduced risk of early death and up to fifty percent reduced risk of developing major diseases.  However, as men get older they stop partaking in exercise because they become worried about injuries or fearful of not being able to “keep up” like when they were younger.  Peter Baker said, “We need to improve men's physical activity levels, whether through sports or building exercise into routine”.

Moreover, studies have shown that men visit their GPs twenty percent less often than women and are less likely to use pharmacies and other health services.  In a survey of UK male consultations in 2008, it was found that only one in eight men (12%) had visited their GP in the last 14 days compared to 17% of women.  The reason for this “under utilisation” of preventative health care has been attributed to physical and social factors including machism, men’s relative lack of articulacy and inexpressiveness and the inaccessibility of service.

Peter Baker argues that society and men’s own attitude to men’s weight means that services do not really cater well for men.  Thus, services such as NHS weight loss are not man friendly; “We need male-friendly approaches capable of engaging with men and we need them soon - especially in primary care and health promotion”. 

Men’s Health Week (13-19 June 2011) Get A Man Online

--Trips to the doctor may be uncomfortable experience for some men, whereas the internet is discreet and can direct men towards the right services--

Many health problems, which affect men, can be prevented with increased education and intervention or be cured with early detection and treatment.  Consequently, it is essential that men take responsibility for their own health and well-being.  This year Men’s Health Week, supported by RSPH, will focus on how new technologies can be used to improve men’s health.  It is believed that technology may be the tool needed to engage men into taking responsibility for their own health.  If information can be presented in a format that is both appealing and easy to access, they are more likely to use it.  Technology, such as smartphone apps, could potentially deliver health prevention messages in a clear, manageable and interesting way as well as signposting them to health services.  For further information on Men’s Health Week, please visit http://www.menshealthforum.org.uk/21706-mens-health-week-2011. 

As a lead up to Men’s Health Week, the Royal Society for Public Health has developed an innovative Men’s Health course on the 13^th May.  The one day event, which is supported by the Men’s Health Forum, aims to increase health and community practitioners’ understanding of how gender socialisation and masculinity can affect male health beliefs and behaviour.   The course will also aim to increase awareness of the main health problems affecting men; lifestyle factors, which influence men’s health, and barriers men face in using health services.  By identifying appropriate ways to engage men in healthy lifestyle initiatives and increasing male service access, we become closer to reducing existing gender health inequalities.  For further information or to book onto the course please click here or contact Nicolette Smith. 

When talking about men’s health it is also important to remember that any health problems men face are likely not only to affect their lives, but also that of their family, friends and colleagues. Therefore men need to make sure they are looking after their health for the benefit of others as well as themselves.

A Drink Too Many - The Health Implications of Alcohol
Evidence reveals that alcohol causes 13,000 cancer cases a year in Britain

There is a misconception that only people who binge drink or get drunk are most at risk of developing health problems.  However, evidence now shows that most people who regularly drink more than the NHS recommended guidelines (3-4 units for men and 2-3 units for women daily) may in fact be damaging their health, and increasing their chance of getting cancer. 

The adverse effects of excessive alcohol consumption were made clear in last weeks health news reports, which used the findings from a large European study to highlight the correlation between cancer and alcohol.   

The research used data from the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort study which examined how diet and lifestyle related to the development of cancer.  The study included 363,988 people who were followed over a nine year period from eight European countries.  Participants taking part in the study, were requested to answer specific questions on the amount, frequency and type of any alcoholic drinks they consumed in the past and at present. 

The results published in the British Medical journal, “Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study” found that one in ten of all cancers in men and one in thirty-three in women were caused by past or current alcohol intake.  It revealed that alcohol consumption above the daily maximum, caused 33,037 of 178,587 alcohol-related cancers in men (18.5 percent) and 17,470 of the 397,043 alcohol-related cancers in women (4.4 percent).

The European study found that although there was a variation in average alcohol consumption across the European countries, alcohol was responsible for the following cancers:

-     - Upper digestive tract cancers (mouth, throat oesophagus) 44% for males and 25% for females

-     - Liver cancer 33% for males and 18% for females

-     - Colorectal cancer (bowel) 17% for males and 4% for females

-     - Female breast cancer 5%

In the UK specifically, drinking has caused 2,500 cases of breast cancers, 3,000 bowel cancers and 6,000 cases of cancers of the mouth, throat or windpipe. 

It is understood that when alcohol is broken down in the body it turns into acetaldehyde, a compound that damages DNA , which increases the risk of cells becoming cancerous.

Professor Sir Ian Gilmore, Chairman of the UK Alcohol Health Alliance said, "In the last 10 years, mouth cancer has become much more common and one reason for this could be because of higher levels of drinking - as this study reflects.”

Information from NHS Choices, The Risks of Drinking Too Much highlights that alcohols hidden harms usually only emerge after a number of years, and these can consist of, liver problems, reduced fertility, high blood pressure, heart attack and increased risk of various cancers.  

The research concluded that there was a stronger association with cancers that are already known to be causally associated with alcohol, such as cancers of the mouth, throat, oesophagus and liver. For these cancers, much of the excess risk was due to drinking above the maximum daily limit, defined in the study as more than 24g of pure alcohol for men (3 units) and more than 12g for women (1.5 units).  

A Call For Action

In light of the evidence, cancer charities have affirmed that people should limit their drinking to lower the risk.  Cancer Partners UK medical director Prof Karol Sikora stated that this is the best data we are likely to get, therefore the message is clear “the more alcohol you drink, some of the common cancers - the four cancers that have been identified - do increase, and that's worrying. So the message has to be 'look at drinking habits, and reduce.'"

Co-author Naomi Allen, a Cancer Research UK epidemiologist based at Oxford University in the UK, said that this study adds to existing evidence that alcohol consumption causes cancer, and that even drinking moderate amounts can increase the risk, "The results from this study reflect the impact of people's drinking habits about ten years ago. People are drinking even more now than then and this could lead to more people developing cancer because of alcohol in the future," said Allen.

Madlen Schutze, lead researcher and study author from the German Institute of Human Nutrition, said that many cancer cases are avoidable if alcohol consumption was limited or stopped all together.   

Charities are now calling on governments to introduce tougher measures  to curb alcohol consumption.  Professor Gilmore told the BBC “that sitting back and waiting for people to change their habits, perhaps with voluntary partnerships with the drinks industry included in policies, will not bring about results”. 

What Can We All Do?

Eating healthily, doing exercise, not smoking and limiting our alcohol intake can all help prevent the risk of developing cancer.  RSPH Training Solutions has developed courses specifically to help people understand and improve their health and well-being.  The level 2 Award in Understanding Health Improvement provides knowledge and understanding of the benefits of good health and well being, and of the barriers to making a change of lifestyle.  This qualification is specifically designed for people who work with the public in a healthcare environment and those who have an interest in developing public health skills.  For further information on the course please click here or contact Nicolette Smith.  

World Health Day
Combating Drug Resistance - No action today means no cure tomorrow

Today (7th April) is World Health Day and this year’s theme is "Antimicrobial resistance and its global spread".  The World Health Organisation (WHO), who are sponsors of the day, have warned that drug resistance is becoming more severe and many infections are no longer easily cured.  As a result, this is leading to prolonged and expensive treatment and greater risk of death.  WHO calls for “urgent and concerted action by governments, health professionals, industry and civil society and patients to slow down the spread of drug resistance, and preserve medical advances for future generations”. 

What are Antimicrobial Agents?
Antimicrobial agents are medicines used to treat infections caused by microorganisms, such as bacteria, fungi, parasites and viruses.  The medicines include antibiotics, chemotherapeutic agents, antifungals, antivirals and antiparasite medicines.  Over the past seventy years, the advancement of medicine has played a pivotal role in helping us to live longer and healthier lives.  Antimicrobials have been responsible for alleviating suffering from disease and saving the lives of billions of people.  In today’s society we could not imagine living without them. 

“The discovery and use of antimicrobial drugs to treat diseases such as leprosy, tuberculosis, gonorrhoea and syphilis changed the course of medical and human history. Now, those discoveries and the generations of drugs that followed them are at risk, as high levels of drug resistance threaten their effectiveness”.   

The Health Concern
Antimicrobial resistance, also known as drug resistance, occurs when microorganisms adapt such that the medications used to treat the infections are ineffective.  When microorganisms become resistant to antimicrobials they are referred to as "super bugs".  WHO regard this as a major concern because infections that become resistant have the potential to kill, spread to others and imposes huge costs to the individuals and society. 

Last year, at least 440 000 new cases of multidrug resistant-tuberculosis were detected and extensively drug-resistant tuberculosis has been reported in 69 countries to date. The malaria parasite is acquiring resistance to even the latest generation of medicines, and resistant strains causing gonorrhea and shigella are limiting treatment options. Resistance is also emerging to the antiretroviral medicines used to treat people living with HIV.

In the Economic Times "Combat antimicrobial resistance on World Health Day" the article highlighted that, "Antibiotic resistance has now become one of the world's most pressing health problems"

WHO Director-General Dr Margaret Chan said, “The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures,”

Click here for more information on antimicrobial resistance.

What Causes Antimicrobial Resistance?
Antimicrobial resistance is usually the result of inappropriate use of medicines, for example, by taking substandard doses or not finishing a prescribed course of treatment.  Low-quality medicines, wrong prescriptions also encourage the development and spread of drug resistance. 

The Economic Times points out that, "Antibiotics should not be used when not needed. Various studies have shown that nearly 50 percent of the use of antibiotics is inappropriate".  It is clear that more needs to be done to ensure that when patients visit doctors they desist taking antibiotics unless absolutely necessary.       

Call For Action
WHO believes that although antimicrobial is not a new problem it is worsening and all countries should take action to avoid regressing into a pre-antibiotic era.
WHO has published a six-point policy package that sets out the measures governments and their national partners need to combat drug resistance.  They argue that although governments need to take the lead, everyone has a role to play and that health professionals, civil society and other groups can also make important contributions to combat drug resistance.  

“On this World Health Day, WHO is issuing a policy package to get everyone, especially governments and their drug regulatory systems, on the right track, with the right measures, quickly,” said Dr Chan.

“The trends are clear and ominous. No action today means no cure tomorrow. At a time of multiple calamities in the world, we cannot allow the loss of essential medicines – essential cures for many millions of people – to become the next global crisis.”

To view the WHO news press release, please click here 

World Health Day and RSPH
For a list of our Training Solutions courses and to see the difference you can make please click here. 

World Health Day provides a great opportunity for us to raise awareness of current health issues, but more importantly to highlight the critical role we can play in understanding and improving health.  By understanding the needs of different people and the health barriers they face, we can help people take responsibility and make healthier life choices.

Shish' of a Time? The Health Implications of Waterpipe Smoking

“Every human being is the author of his own health or disease” Buddha

Smoking through a waterpipe, otherwise referred to as shisha, attracted attention in this weeks BBC health news: 'Shisha pipe smoking among young 'rising in Leicester'. The article expressed concern over the recent increase in Shisha users and once again challenged the misconception that Shisha smoking is safer than cigarettes. There is clearly a need for more to be done to get the health message across that smoking, in any form, is dangerous.

Over the past two decades tobacco smoking using waterpipes has become a massively popular and fashionable pastime among younger people. An activity normally shared with friends in homes, restaurants and cafes, shisha smoking has become socially accepted and widely regarded as a relaxing and an enjoyable experience. However, the rise in shisha smokers gives cause for concern because of the multiple associated health risks, of which people are either unaware or choose to ignore.  A report conducted in 2006 by the World Health Organisation (WHO) entitled, "Tobacco use in Shisha: Studies on waterpipe smoking in Egypt", claims that waterpipe smoking represents both a "modern renaissance of an old public health threat and the emergence of a new tobacco epidemic". 

Tobacco consumption has been linked to a high death rate worldwide (5 million deaths each year) and is considered to be the second major cause of death in the world that is completely preventable. With this statistic in mind, it raises the question; why do so many continue to smoke? 

The studies carried about by the WHO examining the effects of waterpipe smoking have all concluded that it is hazardous for our health. However, its growing popularity as a social, glamorous and harmless activity means much of the research has been overshadowed by people's misconceptions. Shisha smokers are thus left ill-informed and ignorant of the risks.

Dr Alan Shidaheh of the American University in Beirut says; "The historical lack of evidence has unfortunately allowed many Shisha users to believe that the practice was safe, or at least safer than other forms of tobacco use. We have recently learned otherwise.”

The History

The 2005 WHO Study Group on Tobacco Product Regulation "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions" found that shisha has been smoked by people in Africa and Asia for at least four centuries. It is believed that a waterpipe was invented in India by a physician named Hakim Abul Fath who suggested that tobacco would be rendered less harmful if smoke was passed through a small receptacle of water. Thus, this widespread and unsubstantiated belief held by shisha users today - that the practice is safe - is as old as the waterpipe itself. 

Since the 1990s waterpipe smoking has become increasingly popular and is no longer dominated by older males in Middle Eastern countries.  Shisha smoking appears to have spread to new populations such as college students and young persons in the United States, UK and other European countries. 

Health Awareness - Battling the misconception

Although waterpipe smoking has not been studied as intensively as cigarette smoking, the preliminary research claims that it is associated with many of the same risks as cigarettes, and may in fact involve unique health risks.

The evidence affirms that the smoke that emerges from a waterpipe contains numerous toxicants which are responsible for causing oral cavity cancer, heart disease, tuberculosis and respiratory diseases. 

Waterpipe smoking, compared to cigarettes, is characterised by less frequent exposure (one to four sessions per day) but with a much more intense exposure per session, which can typically vary between 15 and 90 minutes. The uptake of tobacco nicotine is equivalent to 2-12 cigarettes per portion of tobacco used (hagar) and one person usually smokes several hagar per session. This translates into a nicotine intake equivalent to more than one pack of cigarettes per session. However, the waterpipe produces more smoke than cigarette smoking and thus overall smoke exposure could be as much as 100-200 cigarettes per session.

In addition, the temperature of burning tobacco in waterpipes is much lower than that in cigarettes, and the force needed to pull air through the high resistance of the water pathway, causes the smoke to be inhaled very deeply into the lungs. This is likely to cause patterns of cell injury in the oral and respiratory tracts. Smoking has also been shown to cause an accelerated decline in lung function.    

While it has been noted that the water does absorb some of the nicotine, waterpipe smokers can be exposed to a sufficient dose of this drug to cause addiction. Nicotine level intake in a standard session is similar to a single cigarette, yet the tar intake is 20 times greater. It is likely that the reduced concentration of nicotine in waterpipe smoke may result in smokers inhaling higher amounts of smoke and thus exposing themselves to higher levels of cancer-causing chemicals, alongside higher levels of arsenic, chromium and lead, as well as hazardous gases such as carbon monoxide.   

Professor Mostafa Mohamed, Professor of Community Medicine in Cairo and author of the 2006 WHO report stated that, “Heat sources that are commonly used in Shisha pipes to burn the tobacco are likely to increase the health risks because when they burn they produce their own toxins".

The report also points out that waterpipe smokers are exposed to a large number of genotoxicants via ingestion, respiration or absorption through the skin. Tobacco has been linked to mutations in the p53 tumour suppressor gene which leads to uncontrolled cell division and is found in over 50% of all human tumours.   

The study found that people who were waterpipe smokers were significantly more prone to develop hypertension and have higher blood pressure than non-smokers. The report also identified that waterpipe smokers are prone to repeated infections due to lowered immunity, and the habit of sharing waterpipes heightened the chance of contracting communicable diseases such as tuberculosis and hepatitis. There was ample evidence which showed that people who smoked were more likely to experience sleep disturbance. Thus the perception that smoking will help them relax and elevate their mood is, in fact, incorrect. 

The report highlighted that although further research needs to be done, there is strong viable evidence that exposure to waterpipe smoking is as harmful as the exposure to cigarette smoking, if not more so. 

Professor Mohamed affirmed that "Waterpipe smoking is growing epidemic. Any intervention programme to prevent this new threat must disabuse the public notion that waterpipes are less risky than cigarettes."  

What can we do?  

Changing our behaviour and habits is hard. Many people are reluctant to give up something they enjoy, particularly if its a social activity with friends. Hence it is easier to ignore the facts and live for the "now" rather than thinking about the consequences of our actions or wrongfully assuming that "it won't happen to me". 

We have to remember that our health is paramount and making sensible choices now can prevent unnecessary suffering later. 

Both the studies by the WHO point out that despite the strong evidence of health risks associated with waterpipe smoking, there remains few published studies on its negative effects. This has created an ambivalent and misguided picture of Shisha smoking.  More needs to be done to ensure people are educated about the dangers so that its reputation as a harmless and glamorous pastime gets demoted to unfashionable and unsafe!   

  

Education of health professionals, regulators and the public at large is urgently needed to make information more available. The WHO researchers stressed, “Waterpipes should be subjected to the same regulations as cigarettes and other tobacco products and should contain health warnings". 

RSPH  

The Royal Society for Public Health offer a course on Understanding Health Improvement Level 2 designed to provide knowledge and understanding of the benefits of good health and well being, and of the barriers to making a change of lifestyle.  For further information please contact Gina Mohajer.