Men's Health Week 2013: breaking the mental health stigma  

This year Men’s Health Week, led by the Men’s Health Forum, aims to tackle the stigma attached to men’s mental health and encourage more men to seek professional help.

It is understood that although equivalent numbers of men and women suffer from mental ill health, men are far less likely to receive diagnosis and treatment, because of their reluctance/hesitance to seek professional health advice.  Statistics from the Men’s Health Forum highlighted that in the UK, three in four suicides are committed by men and that around 4,500 men kill themselves each year.

The distressing truth is that men are not as comfortable talking about their feelings and are even more ashamed to admit that they may be feeling depressed/stressed/anxious, in fear that they will appear weak amongst their peers. As a result, men often suffer alone or indulge in high risk behaviour such as drinking and drugs as a coping mechanism, which can be equally as detrimental to their health.

Martin Tod, CEO of the Men’s Health Forum said; “If all men could talk about how they were feeling with confidence, I don’t think we’d be looking at horrific figures like these. Whatever the problem, your GP has heard it before. Don’t bottle it up”.

Shirley Cramer CBE, Chief Executive RSPH, says “the messages being raised in Men’s Health Week are vital, mental health is too often seen as a taboo subject especially amongst men. Good mental health is more than just the absence of mental illness and in addition to preventing and treating mental illness we should be actively promoting positive mental health. A key aspect of this is individuals feeling they can discuss their feelings and can ask for help.”

At the RSPH we strongly advocate the importance of maintaining good mental health. In our Mental Health report, we outlined the many harmful affects that poor mental health can have on the individual, on their family and society as a whole. In order to understand the importance of good mental health and ways this can be achieved, we have developed a new qualification in Understanding Mental Health and Wellbeing Level 2 Award. The interactive training day promotes the positive impacts of good mental health, as well as providing practical skills and knowledge of the measures that can be taken to prevent and protect against mental ill health. For more information on our training programme, click here or contact Gina Mohajer gmohajer@rsph.org.uk.  

For more information on men's health week see the Men’s Health Forum and to view the statistics on men’s mental health click here.  

Are we drinking too much? New report shows rises in death due to Liver Disease

Today a new report warns that the number of people dying from liver disease in England is on the increase, with the most common factor for mortality being attributed to unhealthy lifestyles and consequently preventable.

The report “Deaths from liver disease: Implications for the end of life care in England” the first ever national report on the statistics published by the National End of Life Care Intelligence Network, shows that between 2001 and 2009 there has been a 25 percent rise in liver disease deaths (from 9,231 to 11,575 people).

Figures indicate that although the numbers of deaths from cancer, vascular and respiratory disease still remain significantly higher, liver disease disproportionately kills people at a much younger age.

Alarmingly 90 percent of people who die from liver disease are under 70 years old and more than 1 in 10 are in their 40s.  The report also highlights that more men (60 percent) than women (40 percent) die from liver disease.

Lifestyle and Liver disease

Although there are many reasons for liver disease, the most common cause is alcohol related.

The British Liver Trust says that a healthy liver should contain little or no fat.  Fatty liver, where the liver contains too much fat, is regarded as the most common forms of liver disease.  The effects of having fat in the liver over a long duration of time may lead to inflammation causing swelling (hepatitis) and then scarring (fibrosis).  Where the condition may be the result of excess alcohol, it is referred to as alcoholic liver disease.

Alcoholic liver disease is the most common and preventable type of liver disease.  It accounts for over a third of all liver disease deaths and kills 3,880 people annually.  The figure for men is considerably higher at 2,588 deaths compared to that of women 1,292 deaths.  Regionally, the report demonstrates that alcoholic liver disease death is most prevalent in the North West, South East and West Midlands.  However, for both male and female the highest mortality rate is in the North West, approximately double that of the lowest in the East of England.

The Chief Executive of Alcohol Concern, Eric Appleby, said: "This report shows that loss of life through alcoholic liver disease remains as big a problem as ever, with a worrying tendency for those with the highest deprivation to suffer most, leading to a distinct north/south divide.

Cause for Concern

Liver disease is regarded as a challenging area for public health.  With over 70 percent of people with liver disease dying in hospital, patients tend to be younger, from poor socio-economic backgrounds (although this is not always the case) and often come from either isolated or ethnically diverse subcultures.  Those dying of alcoholic liver disease may have mental health problems drug dependency issues, which could further isolate them socially.  Additionally, people may feel stigmatised by their disease because of its degenerative nature.

Professor Martin Lombard, National Clinical Director for Liver Disease, said: "The key drivers for increasing numbers of deaths from liver disease are all preventable, such as alcohol, obesity, hepatitis C and hepatitis B. We must focus our efforts and tackle this problem sooner rather than later."

What can you do?

One of the key objectives of the Government’s White Papers Liberating the NHS and Healthy Lives, Healthy People, was to reduce mortality in people under 75 years of age.

The report shows that death from liver disease can affect any one of us and is largely the result of our lifestyle.  Rises in alcohol consumption and obesity are clearly huge areas for concern.  Therefore, in order to tackle the issues and reduce mortality rates, advocates believe we need to address the underlying causes of liver disease.  It becomes essential that we help to educate people about the consequences of unhealthy living and ways to improve their lives, as well as, reaching out to the most deprived and isolated people in society.

Prof Julia Verne, lead author of the report and clinical lead for the National End of Life Care Intelligence Network, said: "It is crucial that commissioners and providers of health and social care services know the prevalence of liver disease in their local areas, so that more people can receive the care they need to allow them to die in the place of their choosing."

RSPH Training Solutions offer a number of low cost training programmes on health improvement, JSNA’s, and provide training on key aspects of health to help you, help others and people in your community to lead longer and healthier lives.  For more information click here.

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.  

Getting It Out In The Open - Lesbian, Gay and Bisexual People
Reducing Health Inequalities!

Sometimes as a society we tend to avoid issues that we do not feel comfortable with or perhaps do not understand and we may even falsely assume that everyone has the same health needs.  As a result, some people who are perceived as the most vulnerable and most in need of help, either get side stepped or fall through the net.  The Public Health White Paper Healthy Lives Healthy People, advocates a new approach to "reach across and reach out" to address the root causes of poor health to the people who need the most support.  With a particular emphasis on tackling health inequalities, high alcohol levels, smoking, mental health, sexual transmitted infections (STIs) and obesity.  We therefore have a responsibility to ensure people who experience health inequalities and are likely to be the most susceptible to the above, are not isolated or discriminated against, but are brought to the forefront of public health.

Lesbian, gay and bisexual (LGB) people tend to be vulnerable to a number of health risks because of people's reactions to their identity.  This can leave them feeling stigmatised and they are often unrecognised in health and social care settings.  Healthcare and other professionals have a misconception that LGB people's health needs are the same as those of heterosexual people, unless their health needs are related to sexual health.

A briefing written in 2007 by Dr Julie Fish as part of the Department of Health's Sexual Orientation and Gender Identity Advisory Group's work programme entitled "Reducing health inequalities for lesbian, gay, bisexual and trans people - briefings for health and social care staff" sought to highlight that LGB people can be younger, older, bisexual, lesbians, gay men, trans, from black and minority ethnic (BME) communities and disabled, and to dispel assumptions that they form a homogeneous group. 

Health Issues: What We Don’t know
Many young people know they are lesbian, gay or bisexual by the age of 11 or 12, but do not come out until they are 15 or 16 years of age.  The period between 11-16 years, has been described as the isolation years and has been identified as the time when young LGB’s need the most support and information.  During these critical “isolation years” LGB's may feel alone, confused and stigmatised particularly as it is also the period where they may encounter homophobic bullying in schools.  Evidence suggests that between 30% to 50% of young people in secondary schools, attracted to people of the same sex, would have experienced homophobic bullying, and that "gay" is the most frequent term of abuse in the playgrounds.  Young LGB people are also at risk of violence and victimisation and are likely to face verbal abuse, teasing, physical assault both in schools and on the streets. 

Feelings of isolation, fear of being unable to talk about their sexual orientation and the consequences of homophobic bullying can have an impact on a young person's mental health and which could have negative repercussions during their adult life.  The evidence taken from the briefing into young lesbian, gay and bisexual people, highlights that these young people are at increased risk of mental problems, are more likely to suffer from depression, to have attempted suicide (as a result of family denial, self loathing and leaving home) and lead unhealthier lifestyles than their heterosexual peers.  The statistics reveal that compared to their heterosexual peers, lesbian and bisexual girls are more likely to smoke and binge drink.  There is also an increased risk that young gay and bisexual men may take illicit drugs and may not be aware of  health risks from unprotected sex.  

The unhealthy lifestyles experienced by young LGB people can follow them into adult life.  Researchers have pointed out that LGB’s may use drugs, alcohol and tobacco as coping mechanisms in dealing with their homophobia.  However, they have also argued that the lack of social spaces for LGB’s means they are more likely to congregate in clubs and pubs and hence are more obliged to use the "scene" and fit in with a drinking culture. 

The Statistics:

Smoking: Young lesbian and bisexual women were almost 10 times more likely to smoke at least weekly compared with heterosexual women.
- 25% of lesbians are smokers compared with 15% of heterosexual women.
- 33% of gay men are smokers compared with 21% heterosexual men

Alcohol: Lesbian and bisexual women aged 20-30 years reported higher weekly alcohol consumption and less abstinence compared with heterosexual women

Drugs: In comparison with young heterosexual people, young LGB’s are:
- 3 times more likely to use MBMA/ecstasy
- 8 times more likely to use ketamine
- 26 times more likely to use crystal methamphetamine. 

Eating disorders:
- Gay men are more likely to engage in recurrent binge eating and purging which is often linked to aspirations to the ideal gay male body shape (slim and muscular).
- Lesbians are believed to have a higher body mass index than heterosexual women and may be more at risk of obesity. 

Good health should include everyone and that means reaching out to all segments of the population and understanding that different groups have different needs and requirements.  The rising levels of STIs and the fact that LGB people still feel discriminated against and continue to experience a number of health inequalities, signifies that more needs to be done to support them.  This may include how commissioners and providers deliver their services and how they are perceived by LGB service users.    

What Can You Do?
Training Solutions are offering a programme on Addressing Health Inequalities Experienced by Lesbian, Gay and Bisexual People on the 7th April.  The one-day course aims to raise awareness of the health and social care needs of lesbian, gay and bisexual (LGB) people, who are disproportionately affected by health and social inequalities. It will identify key research findings that affect LGB communities specifically, and examine how these relate to the statutory obligations for services. As the public health agenda broadens in the light of the forthcoming Equality Act, it is essential that health and social care services are accessible and meet the needs of all potential service users.

For further information please click here or contact Nicolette Smith 

World Cancer Day - 4 February 2011

Recommendations to help reduce the risk of cancer

This year World Cancer Day falls on Friday 4th February.  The purpose of the day is to raise awareness of the disease and to help people take the right steps to prevent them from getting Cancer. 

The most up to date statistics on Cancer rates and deaths are available from GLOBOCAN 2008  published in June 2010.  According to GLOBOCAN around 12.7 million people worldwide are diagnosed with cancer each year and 7.6 million people die from the disease.  It has been estimated that if people do not take the necessary precautions to limit the risk of getting cancer, 26 million people could be diagnosed with the disease by 2030.  

However, figures taken from the official World Cancer Day website also shows that 20 to 30 percent of all cancers can be prevented and one third can be cured by early diagnosis and treatment.  Thus the aim of the one day event is to help people understand that by changing ones lifestyle they can prevent cancer and live a healthier and longer life.

Below are some of the recommended steps to help prevent cancer:

1. Drink less Alcohol
It is widely acknowledged that alcohol abuse has a major impact on public health. It is ranked as the fifth leading risk factor for premature death and disability in the world. 
Although the link between alcohol and cancer is still not completely understood, there is an association found between alcohol and mouth, oesophageal, laryngeal, pharyngeal, breast and liver cancers.  Therefore the more alcohol one consumes the higher risk of getting cancer.  
By drinking moderately and keeping within the Governments recommended guidelines can be key in preventing cancer.

2. Maintain a Healthy Diet
Eating healthily and doing regular exercise can be crucial in preventing cancer.
A report published by The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) called Food, Nutrition Physical Activity and the Prevention of Cancer: is the most extensive and comprehensive literature on diet, physical activity and cancer currently available. 

The report which was developed by 21 leading scientists from around the world, put forward 10 recommendations for the prevention of cancer.  Some of these measures included the following:
- To be lean, but not underweight
- Limit consumption of energy dense foods (processed food, high in added sugar, and high in fat)
- Eat more fruit and vegetables
- Limit consumption of red meats (pork, lamb, beef)

3. Do More Exercise
Statistics from the World Health Organisation (WHO) reveal that globally there are approximately 1.6 billion adults who are overweight and around 400 million who are clinically obese . It is expected that by 2015 these figures will have risen to 2.3 billion and > 700 million respectively. 
Undeniably, obesity has many health implications such as diabetes, cardiovascular diseases and it may account for 20-30 percent of several cancers.  As such, experts state that by preventing excessive weight gain by being more active physically, can reduce the risk of many cancers. 
It is recommended that people partake in at least 30 minutes of physical activity each day.

4. Avoid Smoking
Statistics from the WHO shows that tobacco is the single biggest cause of cancer in the world.  It is responsible for killing 5 million a year - an average of one person every six seconds.  Smoking is responsible for a quarter of all cancer deaths, including, lung, mouth, throat cancers as well as, liver, pancreas, stomach, breast, bowel, kidney and bladder.
As such, studies continually demonstrate that by stopping tobacco use greatly reduces the risk of cancers and other short and long term health risks. 

Get Healthy!!

The Royal Society for Public health through Training Solutions run a Foundation Programme in Health Improvement.  This particular course offers candidates the opportunity of developing a firm foundation in health improvement while also making aware the health and lifestyle choices that affect personal and public health.  For more information click here or contact Nicolette Smith. 

British Women - Unhealthy Lifestyles Have Led to Higher Rates of Cancer!

Data from the World Health Organisation, found that Britain has higher rates of potential fatal disease than the USA, Australia, Germany and Spain.  The statistics reveal that British women are more likely to be diagnosed with breast cancer because of their unhealthy lifestyles.  Cause for concern for?   

A project called GLOBOCAN, set up by the WHO, collects figures on the incidence of and deaths from the most common types of cancer for countries across the world.  The data which was used and analysed for a recent study by the World Cancer Research Fund, found that Britain is the 12th worst of the 50 countries in terms of rates of all cancers among women, and is rated 11th worst for breast cancer.  The figures show that although Belgium is the worse with 109.2 cases per 100,000 women in 2008 with breast cancer, Britain is not far behind with 89.1 cases per 100,000.  There are around 46,000 breast cancer cases per year in the UK, of which a quarter die.

Although high levels of breast cancer rates may be attributed to better detection methods such as new technological advancements and increased awareness, experts claim that lifestyle choices also plays a significant factor.
Meg McArthur, Senior Policy and Information Officer for Breakthrough Breast Cancer, says that “Breast cancer is thought to be due to a combination of lifestyle, genetic and environmental factors and although some risk factors cannot be changed, women can reduce their risk by drinking less, maintaining a healthy weight and exercising regularly.”

Currently international studies demonstrates that Britons now eat and drink more than their counterparts in many other countries.  Recent figures from the Office for National Statistics shows that 56 percent of women over the age of 16 drinks more than double the recommended daily allowance of alcohol every week, while 24 per cent of women in England are classified obese.

Therefore, experts claim that the high number of women diagnosed with breast cancer in the UK could be avoided if women adopted healthier lifestyles, including drinking less alcohol, eating better and doing more exercise.
Sarah Woolnough, director of policy for Cancer Research UK said "We do know that up to half of all cancers could be prevented by changes to lifestyle such as giving up smoking, keeping a healthy weight and cutting down on alcohol"

The National Cancer Director, Professor Sir Mike Richards, said "We want to vastly improve cancer outcomes - that’s why we will shortly be launching the first ever Government awareness campaign for cancer, to promote earlier diagnosis and to save more lives.”

Raise awareness for women's health! 
In aid of International Women’s Day this year, the Royal Society for Public Health will be running a programme on the 8^th March on "Women’s Health and Well-being".  The event will raise awareness of interrelationship between lifestyle and health, while educating participants about the steps they can take to empower women to improve their physical and mental health.  For further information or to attend the programme please contact Nicolette Smith or by phone 020 3177 1625. 

Smoking - The Main Reason Why Men Die Sooner Than Women

In a report published by Tobacco Control "Contribution of smoking-related and alcohol related deaths to the gender gap in mortality: Evidence from 30 European countries" found that smoking continues to be the most important cause for gender differences in mortality across Europe.  

Since the 1990's emerging evidence has revealed that women outlive men in all countries of the world.  Historical records demonstrate that in England, Wales and some of the Nordic countries, the life expectancy of women has exceeded that of men since the mid to late 18th Century.  Currently in the UK women are estimated to live four years longer than men.  There has been a great deal of speculation as to why this appears to be the case.  Many expects claim that simple biology or the fact that women seek medical help more readily than men are the reasons for the disparity in life expectancy.

However, as the report discovers, smoking is the main cause followed by alcohol, which accounts for 20 percent of the difference. 

The report which studied the data extracted from the World Health Organization database, looked at thirty European countries.  It found that in all countries death from all causes were higher for men than for women.  However, the report also noted that there continues to be a considerable variation in the extent of gender difference in contemporary Europe.  The gender gap in all-cause death rates varied from 188 excess deaths per 100,000 in Iceland and the UK, to over 800 in Ukraine and Lithuania.    

Despite the variations, the researchers discovered that smoking-related deaths alone contributed to around 40 to 60 percent of the gender gap in all countries, excluding Denmark, France and Portugal where it is considerably lower, and Malta where it is higher at over 70 percent. 
The data demonstrated that in the UK, smoking-related diseases such as lung cancer and heart disease caused 60 percent of the excess male deaths. 

The researchers highlighted that, "It is no surprise that two of the most important health behaviours, smoking and hazardous drinking continue to account for substantial proportions of the gender gap in mortality because health behaviours have long been a powerful way of portraying gendered identities." 

Thus the report makes clear that there is an "ongoing need for public health measures to reduce health damaging behaviours". 

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said: "It is never too late to give up smoking so it's important we invest in support services to help people quit the habit as well as ensuring our young people don't start smoking in the first place.”

Men's Health Week 13 - 19 June
-To Raise awareness of preventable health problems among men and boys -

In light of Men's Health Week this year, the RSPH will be hosting a one day Men's Health course on May 13th.  The purpose of the event is to facilitate men’s access to information, empower them to be more aware and access health leisure services, in order to improve key lifestyle behaviours.
For further information or to book onto the course please contact Nicolette Smith.