By Heather Ramsay--Too many men were not accessing health care services until it was too late and Northern Health wanted to know why.Hence the research and publication of a widespread report on men's health by the Population Health department at Northern Health under the direction of the chief medical health officer, Dr. David Bowering. In the report, called Where are the Men?, Dr. Bowering notes that Northern men appear to be missing: men do not often access preventive health services and, statistically, men die at an earlier age than women. In fact, Northern BC men die earlier than their counterparts in the Lower Mainland.According to the report, men in Northern BC are more likely to be injured or killed through workplace incidents, suicides, diseases, unintentional injuries and intentional violence. "This differential begins in childhood and persists throughout the lifespan."The report chronicles the challenges men face, not only accessing health care as adults, but socio-economic factors from childhood on that can lead to health issues.For example, Haida Gwaii has one of the highest percentages of children vulnerable to developmental challenges in the province. Almost 52 percent of children on the islands are arriving at kindergarten ill-prepared for learning, according to this report. Research shows that the roots of mental health problems, obesity, heart disease, criminality and more can all be traced back to early childhood.Education and literacy are key determinants for better health outcomes, but once a boy gets to school the challenges remain. According to the report, evidence is mounting that our education system is failing to adequately engage and meet the developmental needs of young men.Lifestyle choices in Northern men also put them at higher risk for bad health outcomes. For example, per capita alcohol and tobacco consumption is higher in northern men. In Northwestern BC, hospitalization attributable to alcohol-use is double the provincial average, according to the report. Queen Charlotte physician Dr. Tracy Morton said health care providers on the islands haven't crunched the numbers, but anecdotally the acute alcohol-related admissions are high here."The majority of emergency visits in the middle of the night are because of alcohol," he says.Northern BC men also have the highest alcohol and tobacco related mortality rates and the largest proportion of cancers related to tobacco use for all BC health areas.From 2005-2010, there were 83 accidental workplace deaths (81 were men) in the Northern Region, which account for 21 percent of all workplace fatalities in BC, although the region has less than 7 percent of the BC population. More than half of these deaths occurred in forestry, mining or commercial transportation.Risky behaviours aside, getting men to access health care services remains a huge issue. "We will see men that haven't seen a doctor in years and they've ignored symptoms," said Dr. Morton. Men are more likely to present at the hospital with conditions that would not have needed hospitalization if the patient had timely access to the appropriate services, says the report.Along with other reasons, men steer away from health services because of concerns about privacy and confidentiality, says Julie Kerr, director for population health at the Centre for Healthy Living in Prince George. Men in isolated rural settings are often reluctant to visit the clinic because their next door neighbour or auntie may be working there."People don't have the confidence that things will remain private," she says.Early sexual contact can be a health issue for young men who don't want to purchase condoms or other products at the corner store where they may know people as well.Focus groups and interviews with men in the north helped shape the report, but Ms Kerr says Northern Health is going to seek more input from communities in order to bring about change. Future community consultations will address the issues that are preventing men from accessing services.Public Health departments over the past several decades have made a real push to ensure services were accessible for women and children, says Ms Kerr."Maybe they are not so man-friendly," she said. The actual physical environments may not be comfortable for men, but health care providers now realize that other factors play in as well. Men have said they need to access health services after 5:00 pm for example, because they can't afford to give up work. Either that or health service providers need to bring health services to men, by partnering with workplaces, for example.In one focus group, Northern Health staff were told that the image of men in the media is a barrier to healthy behaviours. "It is a pretty boy image, he shaves everything every few days and has a ripped six pack. Girls get all the rituals of puberty; they get taught about their bodies; they get a supported passage into womanhood. Boys get nothing like that and, in fact, men are taught not to talk to other men about their bodies."The report itself was produced to be more "man friendly." Ms Kerr said they set out to create a document that is funny, colourful and not too 'researchy'.One key success in the realm of men's health was in response to the need to reduce deaths and injuries on northern roads. The RoadHealth Coalition, including RCMP, ICBC, Worksafe BC, Ministry of Transportation, Northern Health and more, focused on men who work on northern roads (truckers) and statistics have shown a reduction in deaths associated with the initiative. However, impaired driving remains a problem for men in Northern BC.According to the report, key priorities are indigenous men, who have poorer health outcomes than other groups of men or women on almost all health measures and young men, who die at twice or three times the rate of young women from avoidable factors (suicide, high risk behaviousrs). To view the report online go to http://www.northernhealth.ca/Portals/0/Your_Health/MensHealth/northen-health-mens-health-report.pdf.