Plenary, 13 Sep 2001

Meeting date: Thursday, September 13, 2001

Official Report 625KB pdf

---

Men's Health Week

The final item of business today is a members' business debate on motion S1M-2066, in the name of Mary Scanlon, on men's health week in Scotland, from 7 to 14 September 2001.

Motion debated,

That the Parliament pledges its support for Men's Health Week, Scotland, from 7 to 14 September 2001; acknowledges the collaboration between Men's Health Forum Scotland, health boards, the business sector, community health initiatives and the voluntary sector to publicise Men's Health Week, Scotland; recognises that the majority of factors which impact negatively on men's health are preventable; notes that 75% of suicides are male and almost 60% of premature male deaths are from coronary heart disease and cancer, yet men attend their GPs less than half as often as women; further notes that co-ordinated efforts are necessary to ensure that men take responsibility for their health and that services commit themselves to the challenge of working with men, and believes that MSPs should support the collaboration by promoting positive messages about men's health and Men's Health Week, Scotland, thereby encouraging more men to take responsibility for their own health and well-being.

I am very pleased that the debate is being held in men's health week, and thank the business managers for rescheduling it for today. I hope that those who are not in the chamber and those who are watching the debate via the webcast will have their say in the internet chatroom, as this is undoubtedly an enormously complex issue.

There is no doubt that the women's movement has accomplished much in recent years. Women have succeeded in the battle for scarce resources, partly due to sheer power, and partly thanks to biology. Women visit their doctors regularly to talk about periods, family planning, pregnancy, birth and the menopause, alongside other medical problems.

It has been said that

"the whole system from birth to the grave does not allow men to be vulnerable or weak".

We need to overcome that laddish culture, where it is seen to be "vulnerable or weak" to talk about physical and mental problems, and we need to encourage more open dialogue between men and their health professionals.

This debate is unlikely to solve such complex issues, but I hope that it will help to raise awareness during men's health week. I would like to commend Kenny Gibson on the excellent work that he has done in highlighting male suicides. I also commend Maureen Macmillan's work on prostate cancer. Both issues are hugely important to men's health.

I hope members will bear with me while I mention some statistics. The life expectancy for men is 74, but for women it is 79. Even in 2021, men will be able to expect to live, on average, five years fewer than women. An important statistic that I noted is that even the most affluent man has a shorter life expectancy than the least affluent woman. More men die from cancer, cardiovascular disease and HIV than women. In education, the percentage of boys who achieve three highers or more is 8 percentage points lower than the percentage of girls.

A 1998 national health service survey found that 20 per cent more young women than young men visited their doctor. Men tend to access their doctor when a crisis point has been reached. Often, men spend more time worrying about a problem than gaining medical advice for it. Men tend to ignore symptoms of illness or delay seeking medical attention—the largest percentage prefer to treat themselves. One in four men tolerate symptoms, hoping that they will go away. When men do go to the doctor, the average consultation time is much shorter than it is for women. Visiting the dentist takes a similar pattern: 14 per cent more women than men regularly attend the dentist.

The most horrifying statistic relates to suicide. Men are three times more likely to commit suicide than women. Last year in the Highlands, out of 39 suicides, 36 were by men. I commend the work of the 1997 Scottish needs assessment programme—SNAP—report on suicidal behaviour among young adults. I hope that the minister will refer to acceptance of the report and undertaking its recommendations. A British Medical Journal report points out that men use more lethal and violent suicide methods than do women. That is thought to contribute to the higher rate of suicide among men.

Prisons are more than 90 per cent male. Homeless hostels are predominantly male. The only places that I have visited—as a member of the Health and Community Care Committee—where women outnumber men are care homes for the elderly, where it is often a case of spot the male. I visited two care homes in Shetland during the recess. One was a home for 36 people that had only one male resident and the other had no male residents at all.

In the best traditions of the Executive, I undertook my own consultation exercise and visited Inverness prison, where prisoners were offered a health check. At first there was much apprehension, but after the first group visited the nurse and reported back to the other prisoners, there was greater demand for the service. Some of the prisoners' responses were interesting. One said, "Men think they can deal with problems themselves." Another said, "If I am thinking of doing myself in I'll go to the doctor." Even then the same prisoner told us that he would be put in an observation cell, which would only make him feel worse. He compared that treatment to the treatment given to female prisoners at Cornton Vale. I do not mean to take anything away from the female prisoners at Cornton Vale, but we should perhaps consider giving the same compassionate treatment to men as we do to women.

A recent conference on men's health in the Highlands highlighted the many barriers to health care, such as tough guy images, a lack of political will to target men's health, inadequate services and general practitioners being too busy. Many men spoke of their fear, embarrassment and low self-esteem, their reluctance to admit fallibility, the difficulty in admitting that there is a problem, the fear of having a serious disease and the fear of discussing personal issues with strangers.

How can we alleviate or eliminate those problems? There are no easy answers. I hope that we can improve education in men's health and I hope that we can make doctors' waiting rooms and surgeries more male-friendly. Should we, for example, consider walk-in MOTs for men, especially in relation to chlamydia?

I read that men tend to take more care of their cars than their own health. We must encourage men to seek medical advice when they are healthy. Sixteen per cent more women than men attend doctors for preventive care. We must overcome the macho culture towards illness and we need to understand and address the embarrassment and stigma that are associated with seeking advice and help. We need more understanding of and education about health issues, symptoms and problems.

It is obvious from reading about men's health issues that the health care system has to target men, encourage them to attend doctors, and provide a more male-friendly environment. Perhaps we should consider taking health care to men, for example to job centres, workplaces, sports clubs, pubs, football clubs and even men's toilets. Undoubtedly, there is a need for a multi-agency approach, especially in relation to integrating mental health services.

In conclusion, too many men die early, too many die when it could have been prevented, and too many die at their own hand. There has to be a culture change, so that there is an improvement in preventive care, and so that there are moves to ensure that the health care system is best fitted to cope. Do we expect too much of men, or do men expect too much of themselves?

I congratulate Mary Scanlon on securing this debate and welcome the fact that a woman is promoting men's health week, which is an important issue for men.

All the data that have been collected in the UK testify to poorer access, uptake and outcomes in men's health. The most striking gap is, as Mary Scanlon suggested, in longevity, or premature death, because women have a greater life expectancy than men. Professor Ferguson Anderson, who was one of the most eminent geriatricians in Glasgow, used to say that the main role of geriatrics was to ensure that more men were kept alive to partner women in old age. I am not sure about that as an approach, but I understand what he was saying. The gap is closing, but regrettably it is closing for the wrong reason, because the numbers of men and women who smoke are equalising. One of the problems that we had until now was that more men than women smoked, so there were more premature deaths among males.

I must declare, not only as a man but as a doctor and a member of the early prostate cancer working party of the British Association of Urological Surgeons, that I have particular interests in this area, and one of them is prostatic disease. I have been involved in research in that area over the past 10 years, initially in the field of benign prostatic hyperplasia. We asked men why they did not come forward when they had symptoms of prostatic disease and it was interesting that they did not do so for a number of reasons. One is because they said there was no bleeding and no pain, which were the two main symptoms that would lead them to come forward. The other reason was that they simply accepted as part of normal aging the changes that were occurring in their urinary flow.

Of course, that is not appropriate. In our research, we estimated that more than a quarter of a million men had their activities of daily living affected and did not, in the vast majority of cases, consult a doctor. There is a profound need to educate people at all stages about what is normal and what is not normal. We need support at all levels of society.

Prostate cancer is a growing cause of death in men. I know that patient groups are pressing for prostate-specific antigen screening, but that is a particularly imprecise test. It tells us something, but a negative test result does not mean that one does not have cancer, and a positive test result does not mean that one has cancer. Because it is an imprecise test, it can lead to a lot of stress and strain for individuals if they have it without fully understanding its implications.

The current view is that mass screening is inappropriate. Alan Milburn in England said that any man who wants a test may have one. I have found, as a general practitioner, that it is extremely difficult to say no to a patient who wants the test to be done. I am not sure whether we need to make a statement about the test.

We need to understand that 80 per cent of men aged 80 have prostatic cancer, but the overwhelming majority of men with cancer will not die from it; they will die from some other cause.

At present, we cannot tell which microcancers will flare into symptomatic cancer, causing significant problems. If we knew that, a screening programme would be appropriate, but we do not.

I confess that, although I am approaching the age of 60, I have not had the test and I do not intend to. If a man has the test and finds that he might have cancer, he has to have a biopsy, with the risk of death. If he then finds that he has a microcancer, he has to decide whether he will take the risk of living with it or have a major operation, with the likelihood of a number of effects, including impotence and incontinence. Men have to consider whether they will have the quality of their life impaired. That decision is not easy.

We need to play a major education role and I entirely agree with Mary Scanlon's points about access in a variety of settings.

I congratulate Mary Scanlon on securing the debate and on her excellent contribution and I thank her for the compliment that she paid me in her presentation.

For every 100 girls born in the United Kingdom, 106 boys are born. The reason for that is that through the ages men have always been physiologically much weaker than women. It is regrettable that we develop much more slowly and suffer higher levels of mortality and morbidity. Men have lower life expectancies not just in this country, but across the world.

Of course matters would be much improved if males just occasionally took greater responsibility for their health. That is why this debate—and Mary Scanlon's raising of the issues related to it—is so important. The issue must be not only highlighted, but directly addressed. Lifestyle is key, but so are having regular check-ups and overcoming the frank embarrassment of seeing a health professional and discussing often intimate matters. Women manage to do it and if men were as brave as they like to think they are, they would have the courage to do it too.

As Dr Richard Simpson pointed out, one of the concerns about prostate cancer is that men often do not want to know and leave it far too late. Many of us males have an ostrich mentality when it comes to our health. I am one of the worst people in that respect. Despite the fact that I was once a medical representative, I suffer from a phobia about people in white coats. Luckily, Richard Simpson rarely wears his in the chamber, so I do not feel too intimidated by him.

For you, Kenny, I will wear it.

Only when we are together in private, Dr Simpson.

Mary Scanlon touched on the important issue of suicide. One in four men under the age of 35 who die in Scotland, die by their own hand. That is an astonishing figure, given the fact that many people who die under the age of 35 die from causes such as road accidents and cot deaths. The figure for females under 35 is still high, but it is lower than that for men: one in nine. The issue of suicide has to be addressed. We should think about mental health as well as physical health.

We must examine our culture and the macho ethos in which many of us were brought up. My father, for example, had a wonderful set of teeth. He was famous for his set of teeth when he was young. No doubt, my mother married him partly because of his beautiful, shiny, gleaming white teeth. However, he did not take care of them and by the time he reached his late 30s his teeth had started to deteriorate. When he was in his 40s, his teeth fell out, but he did not care, because in the group that he socialised with it was not an issue. Perhaps he took the attitude that he was married and did not have to look nice for the girls.

A fatalistic attitude has been taken towards health, particularly in the west of Scotland among men who care deeply for the health of their children, parents, spouses and partners. If anything, the debate must highlight to men how fragile they are and how important it is to take off the macho mask that many of them wear and have the courage to have a check-up and look after themselves.

Men do not have to change their lifestyles absolutely. They do not have to take up a macrobiotic diet suddenly, as Alex Johnstone has been thinking of doing, but they must alter their lifestyles and, as has been suggested, have an MOT at least occasionally. If men do not take responsibility for their health, little progress will be made, despite the best intentions of the Executive and the Parliament.

I will be brief. I stayed this evening to congratulate Mary Scanlon, as she told me that the debate was her first members' business debate. I also congratulate her on raising a vital issue. We all whole-heartedly support her. Well done. We are pleased to be here to support Mary.

I endorse the view that too many men do not have the same support mechanisms as women have. I support Mary Scanlon's view that men need to organise themselves in the same way as women have organised themselves. Women's lobbying has resulted in women being referred by their general practitioners to special clinics for same-day diagnosis of suspected breast cancer. I hope that we can achieve such a level of service for men.

As Richard Simpson rightly said, men need to access such services for complaints such as prostate cancer. I pay tribute to my colleague Maureen Macmillan's work on that.

I am not a member of the Health and Community Care Committee, but many of us are wives, mothers, sisters or aunts, for example, and care and worry about our men, because we are aware of their lack of similar collective action to that of women.

I am pleased about the development in the past year or two of men's health magazines. I congratulate the initiators of such magazines.

As Mary Scanlon said, a strategy needs to be developed that encourages society to pick up the gauntlet that this issue presents to us all. As Richard Simpson said, we need education and to raise awareness about what is normal and not normal, and about what to do when a problem has been identified.

In spring, my husband had a health scare. Of course, my family was upset. I learned many lessons from that experience. My husband and I vowed then that we would work together to help to tackle all the issues to do with improving men's health and welfare. I will honour that pledge, for I know the heartache that those anxious months gave us. I will work willingly with all who seek to change the culture that Kenneth Gibson describes as ostriches hiding their heads in the sand.

I congratulate Mary Scanlon on her first members' business debate, especially as it raises an important and often-underdeveloped topic. This is men's health week 2001, and I came across a document from the Men's Health Forum Scotland. I am amazed that we have got so far into the debate before the first mention of the forum because of its work and the stimulus that it provides to an essential issue.

The document states:

"Men don't make best use of health services in a number of different ways, and for a number of different reasons. Men often don't use screening or check up services, they may ignore symptoms until they become particularly acute, and they may be particularly wary of accessing sexual or mental health services.

Men often feel that services are not meant or designed for them, feel that there is a stigma involved in, or embarrassment about using some services, or simply lack familiarity with what is on offer to them."

That is a terrible indictment of the approach to a serious problem in our society.

What I will say might not sound caring and might be a little conservative. We must remember that men tend to be the breadwinners and that that puts tremendous pressure on them. It is important that their health is managed so that they can continue that economic activity, which provides for the wealth and care of their families, and particularly their youngsters.

An inability to perform at work is another issue that causes men stress and worry. The effect is cumulative. Another role that has to be mentioned is the leadership role that the man plays in his family. If the father does not look after his health, an example is not given to the next generation.

Many members have talked about education. It is not just education, but the style that education takes that grabs people's attention and makes them want to buy into doing something for themselves. Kenny Gibson wisely mentioned personal responsibility—which was not meant as a put-down. If people become more educated, they will become more responsible. We are not talking about people being lectured or about the state being a nanny state, telling people what to do. That said, I have some concerns about people who, although they have had support from the health service, continue to abuse themselves in over-use of alcohol and so on.

We are not in the chamber to lecture. We are trying to capture the public imagination as to what should be done. One example that I picked up in a document from Australia describes

"Australian MOT checks, oil plugs and exhaust—of men."

In Australia, a "pit stop" is done

"at motor races, agricultural shows and other haunts of the rural Australian male."

We have all seen the XXXX lager adverts that are set in the outback.

The document refers to testing blood pressure as similar to checking oil levels. Someone with "rust" may have a skin melanoma, while "dirty spark plugs" means that someone might have a potential problem with their testicles. That last word is one that we do not talk about. The three ailments that Richard Simpson touched on earlier include erectile dysfunction, which is caused by many things including heart problems and diabetes. Erectile dysfunction is a contributory factor in the breakdown of many relationships. That is one of the many issues which we need to get a hold of in Scotland.

Malcolm Chisholm, the minister who is present with us tonight, listens regularly to what goes on in members' business debates—he is a regular attendee. I would like him to take on board one or two points and to respond to them later in the debate. We have an Executive that is keen on initiatives, but not many initiatives are getting across the message that men have to start to look after themselves for the good of our nation.

As a population, we are aging and we are losing breadwinners. Mary Scanlon rightly said that difficulties exist in companionship later in life. The issue of why men are losing out is a national one. We have issues for children, pensioners and women—we have issues for this and that. However, not enough is done to get the message across to men. If this promotional week on men's health does anything, and if the Scottish Parliament does anything, it should be to try to reinforce that message. I hope that others will pay attention.

I welcome the opportunity to take part in raising awareness of men's health problems. I congratulate Mary Scanlon on securing the members' business debate today.

David Davidson pipped me to the post in applauding the work of the Men's Health Forum Scotland. The forum seeks to work in partnership with others to improve the health of men in Scotland. That work is important. As members have said, men have a disturbingly low uptake of primary health care services—the annual number of general practitioner consultations by men is less than half that by women. We have heard some of the reasons for men's reluctance to seek help when they are not coping or when they feel unwell. We should remember that men's health is not always about physical health; it can sometimes be about depression—men are reluctant to seek help with that. Further research would be in order, to find out more of the reasons for that reluctance.

Men's health problems start at an early age. A recent report indicated that there is a huge increase in the number of young men who are excluded from school, a steady increase in drug-related deaths among young men and a 75 per cent increase in the involvement of young men in crime. In addition, the report indicated where some of the solutions lie: young men could be educated in school about the need to look after themselves, and they should seek the advice and help that they require when things go wrong for them.

Our young men do not do very well in comparison with the young men in other European countries. They have lower learning achievements at age eight; they are less skilled and qualified when they leave school; and more of them grow up in poverty. We should look to our European neighbours for the reasons for that and act accordingly.

Accidents account for 42 per cent of all deaths of 15 to 24-year-old males, road traffic accidents being the largest single cause. The majority of fatal accidents at work or leisure also involve males. Research may indicate that that is linked to the likelihood of males indulging in risky behaviours, of which alcohol abuse is the main one.

Kenny Gibson has done a lot of work around the suicide rates among young men. I congratulate him on that work, which he has highlighted well. It is of concern that suicides are more than four times more likely to occur in men than in women. Clearly, work should be done in that area. It is of particular concern that, while the suicide rate appears to be flattening out in England and Wales, in Scotland it continues to increase. What makes Scotland different? We do not have enough information about why that is the case. Coronary heart disease is a major cause of death among young men, accounting for 29 per cent of all male deaths. Cancer deaths among males are significantly higher than in females. We have a lot of information, but we must start considering what lies behind it.

What do we do? For too long, men's health work has been neglected. We cannot afford to ignore it any longer. We require urgent action. There are some good examples throughout the country; however, I am wary of what I would describe as pilotitis. We embark on pilot initiatives and schemes, but what happens to them afterwards? Where such initiatives work, do we extend them across the country? I would like to know why, where something is working, we are not rolling it out. Perhaps we could have a little less pilotitis.

I end on a note about smoking. I do not want to make a party-political point, but there is something that the Parliament can do to address the issue of smoking: ban tobacco advertising. I make a plea for people to sign up to that.

It might improve or depress members' health to know—if they do not already—that Iain Duncan Smith won the Conservative leadership, with 60 per cent of the votes.

My colleague Margaret Smith was sorry to miss the debate. She recently visited what is now called Agilent Technologies UK Ltd and used to be called Hewlett Packard, at South Queensferry, and was very impressed by the in-house health service for its employees. It illustrates one of the points that we should be pursuing. If men are too embarrassed to go to the health, the health has to come to them. Workplace health clinics and so on are an important way in which we can pursue that, as is the idea of an MOT, which has been mentioned by others.

We could also use role models, such as footballers, and encourage the bigger football clubs to support health clinics for the men. The clubs could say that their footballers all went through those tests and so on, so the supporters should do so as well. That is one area in which we can try to improve things.

Men have a problem about embarrassment. We are much less tough than women and much more prone to embarrassment. A particular problem is that normal sexual activity makes greater demands on a male than on a female. I hope that that is an acceptable remark—it seems to me to be fairly clear. Many men find difficulty with that, and have even more difficulty admitting the difficulty. That is an area that we have to try to get over.

I first encountered the question of suicides when I was convener of the Edinburgh youth café just round the corner in Victoria Terrace. The premises were used by a counsellor appointed by Lothian Health to help young males, because the health board noticed that an unacceptable number of young males in Lothian were committing suicide. Although there was a big public display, with a lot of advertisements on buses and so on, in reality the whole thing amounted to one lady counsellor giving a few hours a week at the youth café. That is all it was, and it might have done some good, but doing things on a much bigger scale could enable us to do much more good and tackle suicidal tendencies among young men.

The overall problem is the stoical tendency that is bred into us as Britons or as Scots. For example, a manual worker might hurt himself quite badly but carry on to the end of his shift. In more exalted circles, when he was leading the British cavalry at Waterloo, the Earl of Uxbridge was riding along with the Duke of Wellington and said, "By Gad, sir, they've shot off my knee." The Duke of Wellington looked down and said, "By Gad, sir, so they have." That is the stoical, we-don't-cry-about-this approach that affects a lot of us, but it has a malign effect, as we do not take as much care of our health as we should. As other members have said, a lot of people—not me—take much more care of their motor car than of their own body. We have to educate people to do it the other way round.

I thank Mary Scanlon for securing this debate on men's health week. I have to declare an interest, as I have one husband, two sons and three grandsons, and I want them to live long and fulfilling lives and to stay healthy.

It is important that Parliament highlights issues that often go unmentioned. Talking about men's health is vital because, as the motion points out, men often find it difficult to express the problems that they are suffering from. I feel that that is particularly true of older men, even though getting early medical help can often mean that something can be done to stop diseases advancing or to improve the sufferer's quality of life, which is just as important as curing disease. I am told by my young male researcher that the culture of men not taking an interest in themselves and their health is changing, particularly since the advent of men's health magazines. I am glad that a change is perhaps coming, and I hope that younger men will be more open to seeking medical help and that the culture of silence will eventually end.

As other members have kindly mentioned, I introduced a debate on prostate cancer some time ago, and I want to return to that subject now. However, I shall talk today not so much about curing the disease as about the side effects that can arise and the quality of life for sufferers. In the prostate cancer debate I said that, although incidences of prostate cancer are commonplace, there was little information about the disease.

A year ago I was concerned that not enough was being done to encourage men to go for screening tests, and a year later I am still of that opinion. I understand that, on the recommendation of the United Kingdom National Screening Committee, a national screening programme has not been deemed appropriate. Although that is understandable, I find it difficult to understand why more information cannot be made available. As Richard Simpson has said, men can still receive a prostate-specific antigen test from their GP if they are concerned. Despite what Richard has said about the fact that he would not take one, I still think that men should be given the option and that the test should be better publicised.

I welcome the commitment by the United Kingdom National Screening Committee, in the cancer plan published by the Scottish Executive, to consider the results of screening trials and make recommendations on that basis. However, I notice from the cancer plan that the number of prostate cancer patients participating in the cancer trials is the lowest of all the types of cancer. I hope that, through better information and early diagnosis, that position might begin to change.

The Highland prostate cancer support group in my constituency is doing a crucial job to increase awareness of that cancer. Because of the nature of the disease, sufferers find it difficult to discuss the side effects. The last time that I attended one of the group's meetings, I was extremely moved by what I heard and saw. The people in the group were discussing the side effects of treatment—such as impotence and erectile dysfunction—and were being advised by a visiting specialist urology nurse on how such side effects might be overcome. I could see that that was deeply important and terribly embarrassing for them and was important for their relationships with their partners, many of whom had come with them. Their relationships and their image of themselves as men had been affected.

Sadly, not too many men turned up at the group meeting. The chairman said that that was because they were too embarrassed to discuss problems, even with others who had the same problems, and that they found it difficult to discuss things with their doctors. Their doctors had never discussed such issues with them. I do not say that to criticise doctors—it is difficult for a doctor to broach a subject if the patient is embarrassed.

In contrast to women, many of those men could barely discuss the matter with each other. Women who have had children are certainly used to discussing the most intimate details with their doctors and with each other, but men are not. We must somehow make it acceptable for men to discuss intimate details with doctors, nurses, their wives and whoever can help them. In particular, that is a problem for older men who are brought up to be private about their bodily functions.

I want to end by quoting from a letter from a man in the Highlands who has undergone treatment for prostate cancer and is campaigning for a full-time specialist nurse to advise on such matters. He said:

"I think that a special clinic run by a fully trained nurse … should be there for the benefit of all men who suffer from impotence or erectile dysfunction, and this includes men with diabetes, depression, certain heart problems and prostate cancer to name just a few. These people need help, but it has to be in such a way as there is no embarrassment, and a place which is designed solely for this purpose with a nurse that can put a man completely at ease. In addition to this clinic, the specialty nurse should go outwith the area to groups such as ours, and to other groups, as well as to small hospitals in the Highlands where clinics could be arranged."

I do not think that that is too much to ask. The quality of life for older men is important and I hope that the Executive will encourage the health boards to ensure that such facilities are available in every area of Scotland.

I will be brief. Maureen Macmillan spoke for longer than she should have, but I welcome some of the vital points that she made.

I congratulate Mary Scanlon on securing today's debate on a vital matter of social health policy. I cannot resist the temptation of taking up Donald Gorrie's point about health and relating it to Iain Duncan Smith winning the Tory leadership contest. I am sure that that will not be good for the health of the Tories, although Mary Scanlon and David Davidson will perhaps have different ideas on that matter.

I want to deal with three areas. The first is poverty, which I am sure the minister will refer to in relation to men's health. Two weeks ago, the Office of National Statistics revealed that a man in east Renrewshire lives on average seven years longer than a man in Glasgow. The main factor that contributes to a shorter life is poverty, and many in Glasgow face grinding poverty. Any social policy that is not designed to tackle poverty will not attack men's health problems and the factors that lead to their early deaths.

The second area is sports medicine.

Research confirms that, generally speaking, the most affluent men have a shorter lifespan than the least affluent women. Would Tommy Sheridan comment on that?

I thought that Mary Scanlon had misunderstood my point about poverty, but I understand her point. There is a need to separate discussion of men's health from health as a whole. Mary Scanlon is right. The most affluent men have a shorter lifespan than the least affluent women. Members have spoken about the factors that contribute to that.

The Scottish Executive can take initiatives on, and try to develop, sports medicine and physiotherapy. Quite rightly, we encourage more people to take part in physical exercise. Last night, I had the opportunity to attend a local authority sports centre to take part in physical exercise. The sports centre was mobbed and the swimming pool was packed, which was excellent. However, there is an imbalance that affects those involved in competitive sport in particular. Anyone who is involved in competitive sport sustains injury. The difficulty is that they will go to their doctor with that injury; if it is a bad injury, they might even go to the accident and emergency department at a hospital. They will be x-rayed, told that nothing is broken—although a few ligaments might be torn here and there—and that what they need is rest. The problem is that there are literally hundreds of thousands of younger men, particularly those in their mid to late 30s, who would still be involved in sport now if they had had access to decent sports medicine such as physiotherapy. If they had received treatment in the first place, they would have had the ability to avoid recurring injuries. I appeal to the minister to cover the idea of expanding access to physiotherapy and sports medicine throughout Scotland.

If we encourage people to get involved in sport, we must ensure that facilities are available to ensure that they can be fixed and patched up properly. Mary Scanlon mentioned the idea of an MOT: we also need to provide the garages to look after those who have unforeseen breakdowns. The fact is that, right now, there are nowhere near enough sports medicine and physiotherapy facilities in sport, in particular in amateur sport.

We are missing the opportunity to tackle health—specifically men's health—by not including health awareness of the functions of the body and of exercise on primary and secondary school core curricula. I have raised that point before and I know that other members support it.

If we can teach our primary school children between the ages of five and 12 about the importance of exercise and physical activity, and about their bones, muscles and the human body, by the time that they are 12 and 13 they will be more aware of the need to be involved in physical exercise and to think about their diet. My worry is that we sometimes wait to do that until boys are 12 or 13, which is often too late because children have a much more sedentary lifestyle than they had in past generations. We must address that problem.

I congratulate Mary Scanlon on securing the debate and on drawing attention to an important topic. The Scottish Executive is committed to promoting better health for all Scots as a central concern of health policy, but part of that involves recognising the income dimension that Tommy Sheridan referred to and the gender dimension that we are focusing on today.

Mary Scanlon and Shona Robison reminded us that part of the problem is that men are often unwilling to seek medical advice and help, and that they tend to have infrequent contact with health professionals. For example, between the ages of 15 and 64, women consult their general practitioners on average twice as often as men do. Those figures can be explained partially by the fact that women are more inclined to have regular contact with the health service for reasons of family planning, maternity and child health.

However, there is no doubt that many men believe that health and health services are of no concern to them. Too many men think that ill health cannot happen to them, or that if it is coming, there is nothing that they can do about it. However, ill health does happen to men—several members have reminded us that life expectancy is shorter for males than females and that mortality rates are greater in males of all ages for all the major causes of death. However, men can do something about it—the choices we make about how we live can affect our health.

Health is everyone's business, not just that of the national health service, health departments or Government. Men need to take responsibility for their own health and well-being to a much greater extent than hitherto. However, we must recognise that health and health inequalities are influenced by a range of factors that are not entirely within personal control. Men living in poverty have much worse health than well-off men do.

Tommy Sheridan reminded us of the seven-year gap between men living in the most affluent areas and those living in the poorest areas. The fight against inequality and social injustice is also a fight for good health and better, longer lives. However, recognising the great importance of life circumstances should not lead to the fatalistic attitude to which Kenny Gibson referred. Life circumstances matter, but so does lifestyle.

David Davidson asked about initiatives for men. I am sure that he will welcome the fact that the Executive has provided a grant of £180,000 over three years to the Men's Health Forum Scotland—the organisers of this week's men and health event—to help it raise awareness of some of the issues that affect men's health.

We also support a range of men's health initiatives through NHS Scotland. For example, Grampian health promotions has recently supported a men's health fortnight and a men's health fair, which consisted of mini health checks and advice on healthy eating and alcohol. Highland Health Board has supported a conference aimed at identifying some of the reasons for men's reluctance to seek medical advice, an issue that the Men's Health Forum deals with well on its very informative website.

Men will also benefit from a range of other health improvement measures that the Executive has put in place, such as the award-winning Scottish community diet project, which continues its work with low-income communities; extensive smoking-cessation measures and developments in relation to alcohol and drugs misuse; and the network of healthy living centres that are now in place around the country, which target the needs of communities that face particularly challenging circumstances.

There are several other initiatives, such as the physical activity task force. That connects with Tommy Sheridan's point. There is also the work on health-promoting schools, which will address Tommy Sheridan's concerns on education.

The Health Education Board for Scotland has a remit from the Executive's health department. What guidance has the Executive given it on men's health?

I am dealing with specific issues of men's health. I will go on to the three clinical priorities of cancer, heart disease and mental health. There are specific issues for men, but the big issues such as heart disease and cancer are big issues for men as well. Those issues have been taken on board in the Health Education Board for Scotland's remit.

Several members have mentioned mental health. We recognise that men often keep their feelings to themselves. That machismo, to which Mary Scanlon referred, can exacerbate mental health problems. Statistics show that young males in particular are a high suicide risk. In 2000, there were 878 suicides, 674 of which were males. We are committed to reducing those rates, and a framework for suicide prevention will be issued shortly. The framework will build on the work done by SNAP, to which Mary Scanlon referred. We also plan a telephone helpline for people who are at risk.

The recently launched cancer strategy, which provides a framework for further advance, has been widely welcomed. Moreover, as members know, there have been enormous advances in treatments in recent years. For example, testicular cancer is now curable in all but the most advanced and aggressive cases. It is therefore vital that men should check for lumps and seek medical help at the earliest opportunity. There is also the complex issue of prostate cancer, which Maureen Macmillan and Richard Simpson dealt with in detail. I refer members to what Richard Simpson said on the controversies around prostate-specific antigen screening, which is an imprecise test. As members, we often get letters and queries about it.

The third clinical priority is coronary heart disease, to which Shona Robison referred, which is a major killer of both men and women. However, as Shona Robison reminded us, in many cases it kills men at a younger age. Coronary heart disease can be prevented or delayed by following a healthy lifestyle. Many of the issues that have been mentioned already, such as smoking, poor diet and lack of physical activity, are highly relevant. I was pleased to visit over the summer the demonstration project, Have a Heart Paisley. I hope that the project is not, to use Shona Robison's words, guilty of pilotitis. The successful health demonstration projects will be rolled out across the country when they have been evaluated.

It is important to identify problems at an early stage, and I look forward to visiting on Monday the Lanarkshire body check bus, which offers blood pressure, cholesterol and other tests.

My time is up. I repeat that this has been an important debate and once again I congratulate Mary Scanlon on securing it. I welcome the opportunity to support initiatives such as men and health week, and I wish the Men's Health Forum Scotland every success as it continues to raise awareness and encourage men to access health services.

That concludes the members' business debate on men's health week.

Before members leave, I should say that this has been our first participatory debate via the Parliament's website. The debate has been webcast worldwide, and there are opportunities for the people of Scotland to consult associated health sites linked directly into our web pages and to post their comments on the debate. There will be many such opportunities in the weeks ahead, and I hope that members will be encouraged to work in partnership with the people of Scotland.

Meeting closed at 18:01.