With extensive research on women’s health, it’s now time to take men’s health out of the closet—to examine all aspects of health, for all men, including men with intellectual disability. Rowe (2009) wrote that Irish men think their health is excellent, while at the same time they lack the knowledge, communication, and motivation to manage many of the preventable health conditions they may face.
He argued that many men have ‘doctor avoidance syndrome’, chronic internalisation of illness and value their independence so much that it can lead to their premature death. In the general population, research on men’s health has shown effective treatments via dietary control, exercise, medication and social supports. It is recognised that treating health issues will prolong life, reduce disability, and improve quality of life. What is less well acknowledged is the need for research into the health issues of men with intellectual disability. The Department of Health and Children published the document National Men’s Health Policy 2008-2013 (2008) which highlighted the need for a specific focus on men’s health. But there was no stated aspiration for supporting the health of men with intellectual disability, who remain a marginalised group.
In the wider population men die younger than women and suffer more from all the leading causes of death (McEvoy and Richardson 2004). While male life expectancy in Ireland is currently 78 years for men, the average age of death in Ireland for individuals with intellectual disability is 46 years. There is no difference in lifespan between men and women with intellectual disability or within the levels of disability (Lavin et al 2006). Men with intellectual disability die approximately 31 years earlier than men in the general population.
Morbidity can provide a better explanation and health indicator as to why there is a shorter life-expediency for people (and specifically for men) with intellectual disability. Prasher and Janicki (2002) identified poor nutrition, lack of exercise or inactivity and inappropriate or overused medication as three significant risk factors for ill-health for people with intellectual disability. According to Prasher and Janicki (2002), much of our knowledge on health issues for people with intellectual disability is based primarily on generalisations from clinical and research findings of the general population. There is limited health research and very few published articles on men’s health in intellectual disability. While no argument is made for a specific focus on men with an intellectual disability in the National Men’s Health Policy (2008), there are appalling statistics of mortality and morbidity in men in the general population??, and in a number of barriers that men face in achieving optimal health. More research is needed to understand the differences which may exist between the statistics for men with intellectual disability?? (Prasher and Janicki 2002). Health research on men with intellectual disability can lead to a clearer picture of their health, the barriers they face to prevent illness and how to promote high-quality health practices.
People with intellectual disability face many barriers to achieving good health and men with intellectual disability face their own unique barriers. The barriers to achieving good health for men with intellectual disability are specific to their peer group and vary in many indistinct ways. Many of the barriers to health are directly related to gender values, while others are barriers directly related to intellectual disability.
Gender neutrality and obscurity
Umb-Carlsson and Sonnander (2006) looked at the living conditions of people with intellectual disability from a gender perspective. They found that people with intellectual disability were treated as gender-neutral, rather than as men and women with individual preferences and needs. The study found that having an intellectual disability was a more important determinant than gender in regard to living conditions for people with intellectual disability. People with intellectual disability were treated as a standardised group categorised by their level of disability and general service needs. Health issues for men and women with intellectual disability can be disregarded because of the lack of gender identity in the gender-neutral world of intellectual disability. In Ireland, an example of this approach can be found in the National Intellectual Disability Database (NIDD). In the NIDD, which provides information to plan services for the population of people with intellectual disability, gender is recorded and noted, but it is not planned for (Kelly et al 2008).
People with intellectual disability seem to face a gender-neutral wall where, although gender is noted, it is not referred to or considered in service planning. Arrangements are made based on the whole intellectual disability group and not referring to of any gender difference. Society appears to be blind to the significance of gender in planning for individuals with intellectual disability—whether they are girls or boys, men or women. Frey et al (2008) argued that the combined gender groups used in studies obscure unique physical activity patterns associated with health determinants. Many research studies in intellectual disability can produce ambiguous patterns in results because specific gender is not reported or discussed. An Irish survey on health behaviours by Maguire et al (2007) found no significant gender difference in five health domains of diet, physical activity, smoking and alcohol, medical appointments, and level of choice. Although they found no gender difference in the results for individuals who smoked, a further look at the study showed that of the 4 people within the study who smoked, all were male.
Health promotion of homogeneous men’s health
Richardson (2004) carried out a comprehensive and influential study on men’s health in Ireland, entitled ‘Getting inside men’s health’. The study highlighted that men’s health can be viewed simplistically as a single homogeneous set of men’s health issues.?? Problems in men’s health, such as cardiovascular disease, overweight, prostate cancer, erectile dysfunction, are all treated individually, with no attempt to deal with the influence of cause and effect–in numerous cases due to male behaviour. Richardson (2004) argues that men’s health should be defined in its own right, while taking into account all the wider factors such as age, social class, race, marital status, disability, and living settings—all of which have a significant bearing on health status. Williams (2006) argued that men’s preventive health needs can be effectively met in primary care, but that a ‘one-size-fits-all’ approach to men’s health is unlikely to be effective. They suggest that a specific approach is needed for particular groups of men. This is especially relevant for men with an intellectual disability. In looking at the health of men with intellectual disability it is necessary to consider the different sub groups, and levels of disability which can affect health demands over a lifespan. Wass (2000) argued that people with intellectual disability do not fit neatly into the continuum of health promotion and disease prevention agendas. The causes of health problems and associated risk factors are confounding aspects that make it very difficult to understand and manage health issues for people with intellectual disability.
Nursing and women as a barrier to men’s health
Women are found to be a potential barrier in the treatment of men’s health, particularly in nursing and the caring professions where there is a majority of. Wilson et al. (2009) argued that women were one of the barriers to health for men’s with intellectual disability. They maintain that when men with intellectual disability are surrounded by women, as they are in many care settings, this can result in an insensitivity to managing men’s health issues. Peate (2004) recommended a focus on the training needs for health-related tasks that include a gender-sensitive approach to the health care of men. In the nursing area, Peate (2004) argued that nurses need a greater understanding of male gender and health and that this must be accomplished in partnership with men themselves.
Overshadowing sedentary lives
Wilson et al. (2009) argued that men with intellectual disability can face a ‘double jeopardy’ in relation to good health. There are barriers to good health associated with having an intellectual disability as well as barriers to health associated with being male. ‘Diagnostic overshadowing’ is a key restriction in meeting the health needs of people with intellectual disability, and it may similarly serve as a restriction in meeting the needs of men’s health in intellectual disability. Diagnostic overshadowing is the phenomenon in which the primary diagnosis of an intellectual disability overshadows the recognition of other health difficulties, where the presentation of health difficulties is attributed to the presence of the intellectual disability. It is quite feasible that in everyday practice, diagnostic overshadowing is highly relevant and may account for a large proportion of undetected health needs in men with intellectual disability (Moreland et al. 2008).
Temple and Walkley (2007) suggested that gender disparities in physical activity—where men are more active than women in the general population—are not evident in the intellectual disability population. People with intellectual disability, both men and women, have a more sedentary lifestyle which is a major barrier to good health. Temple and Walkley (2007) argued that the level of physical activity practised by men in the general population is not seen in the sedentary lives of men with intellectual disability.
Tyler and Parker (2001), in an article entitled ‘Men talk’, describe how they developed and evaluated a health group for men with intellectual disability. The group was formed in conjunction with the men’s move into community living, and the ability (or inability) of GP services to provide specific care for them. They concluded that there is a need to develop men’s groups in local areas, perhaps organised by community nurses, in order to improve men’s health and offer more choices in their lives. Such health groups could provide for the better understanding and overall management of men’s health in the future. (It is hoped to provide a follow-up article on the setting-up and running of a men’s health group in the next issue of Frontline.)