22 April 2005
Jo McCullagh goes where many others fear to tread – docksides, lorry drivers' cafés and construction sites – to hand out condoms, apples and safer sex literature. Her innovative efforts to make men more healthy are bearing fruit, finds Seamus Ward
Jo McCullagh never seems to stop laughing, but she admits that once the laugh was on her when she was giving sexual health advice to workers on a construction site. Her talk extolling the virtues of safer sex and always using a condom produced gales of laughter among the builders, who were quick to point out the paradox of being given such advice by someone who was more than eight months pregnant at the time.
The winner of the award for innovation – Breaking New Ground – was not fazed for long, as she is well used to taking such banter in her stride. Her campaign to improve men's health in Merseyside has brought her into a wide range of male-dominated workplaces, from ships and heavy goods vehicle rest stops to dockside pubs.
McCullagh, 36, realised she had to bring the information and services to men as they were unlikely to come to a clinic to ask for help. 'This is the most important thing because men find it difficult to access services outside working hours. Embarrassment is a factor, as well as the feeling that they must be seen to be strong, so they don't tend to come through the normal NHS route. You have to go where you've got a captive audience, which is why I've ended up on ships, in lorry parks and down at the docks.'
She has given up many of her evenings and weekends to distribute questionnaires and hand out leaflets and advice. Her men's health work was not part of her job initially – she was taken on by South Sefton Primary Care Trust three years ago as a health promotion specialist in cancer prevention.
'I was working on ways to get information on testicular cancer to men aged 16 to 44, the age group in which it is most common. So I went to the local football clubs and the rugby club and put together focus groups to ask them how and where they would like the information,' she says.
'We found they don't go to GPs as they don't have time, or can't get time off even for checks like blood pressure, diabetes or cholesterol levels.'
Through these discussions she realised that health information had to be brought to places where men felt most comfortable – their workplaces, pubs and sports clubs, for example.
The research on testicular cancer led to her Check Em Out campaign, which aims to raise awareness of the cancer among young men. The rate of testicular cancer has doubled in the past 20 years and approximately 1,900 new cases are diagnosed each year in the UK. Yet the cancer is treatable, particularly if diagnosed early. So it is important that men know how to examine themselves and what to look for. McCullagh has produced a range of information sources to prompt self-examination. Shower gel sachets, posters and waterproof stickers are placed in men's changing rooms, encouraging them to 'check 'em out'.
The programme has increased awareness among its target group – after a month of the campaign she carried out a survey of 400 men and found that self-examination had increased by 10%. Ten primary care trusts across the country have adopted the campaign, as well as the British Army in Germany.
Liverpool's Free Port attracts merchant ships from all over the world but many of the seafarers can spread sexually transmitted infections (STIs) to the local population as they often have unprotected sex. This knowledge took her on to the ships, to find out sailors' information needs and to provide details of local sexual health services.
'The ships have doctors on board but the seafarers don't go to them as they are afraid the company will sign them off and they won't get paid. They are also prevented from going by the embarrassment and stigma of STIs,' she adds.
McCullagh found a degree of ignorance about sexual health problems. She asked 212 seafarers about their sexual activity and 80% had never heard of gonorrhoea. This groundwork led her to develop the Seafarer Sam project, a booklet promoting safer sex. 'Our in-house designer came up with the booklet, which had to be a pictorial document as well as a literal one because a lot of the seafarers don't read in their own language. This project has now been adopted by six UK ports, as well as in Croatia.'
At the docks, she encountered a lot of lorry drivers and became aware that their lifestyles were far from healthy. She interviewed around 170 drivers and compared the results with data on local residents. The findings were startling – the drivers were three times more likely to be obese than their local counterparts. On average, they had one portion of fruit and vegetables a day, while local men had four. More of them smoked – around 39%, compared with 21% of local men. Only 28% of the drivers took moderate exercise twice a week, compared with 60% of the resident males.
The Tommy the Trucker campaign was born. McCullagh's research found that a piece of fruit might cost a driver 80p at a service station, so the campaign offers subsidised fruit at the lorry park (at 20p a piece). Also, she has convinced the lorry park café to offer healthier options, such as baked potatoes. The campaign also offers free sun visors for cab windscreens, which have helpline numbers printed on the reverse, while a leaflet offering advice on following a healthier lifestyle is available in the lorry park office.
The lifestyle questionnaire also found that drivers often left home on a Sunday evening or Monday morning and did not get back until Friday night or Saturday morning, leaving them little chance to get to a gym.
So she is applying for a grant to set up a gym at the docks. 'Sometimes they are hanging around for two or three hours waiting to unload, which is time they could spend exercising. The gym could have a PA to let them know it was their turn to unload their lorries,' McCullagh says.
With other competing priorities, PCTs find it difficult to allocate money to men's health issues and South Sefton was no different. So McCullagh had to apply for grants to carry out her work. However, her enthusiasm has been rewarded and her PCT has now ring-fenced a small amount of funding for men's health promotion.
She has plans to expand the work and is developing ideas for Billy the Bus Driver and Colin the Cabbie campaigns when she returns from maternity leave in the summer. 'I think most people who work in the NHS do more than they should but once I started this, I realised just how unhealthy men are. But I get a lot from it too. At workshops, particularly on testicular cancer, men would come up to me afterwards, anxious about things. But by talking to them you can relieve their anxiety and that's a wonderful thing to do.'
Her enthusiasm has not gone unnoticed. Gareth Lewis, the men's health nurse who nominated McCullagh for the award, applauds her commitment to her work. 'She did the research first hand. She helped get the information, did the questionnaires and gave up her own time. She evaluated the information and from that worked out how the projects should pan out.'
Her work is also recognised at national level. Peter Baker, director of the Men's Health Forum charity, believes McCullagh is one of the country's leading exponents of men's health promotion. 'The work she does is very important. Men's health issues are under-developed in the UK and there are not many people doing the work Jo is doing. There is very little encouragement from the NHS either at senior or local level,' he says.
Two of her projects with hard-to-reach groups are particularly striking. 'I don't know of anyone else who is working with seafarers but it's important to change their behaviour around safer sex. They are difficult to reach, not just because they spend so much time at sea but also because of the different languages and cultures.'
And he adds: 'Truck drivers have pretty sedentary jobs and a typical meal at a truck stop is not particularly good for you. You couldn't set yourself a tougher task than taking on this group of men and trying to change their behaviour but the early signs are very encouraging. She is one of the people at the forefront of this work in the UK.'
McCullagh has worked in public health for 12 years, following a degree in biological sciences and an MPhil from Manchester medical school. She is well versed in getting information to hard-to-reach groups, having spent four years working with sex trade workers.
But how did she feel entering such male environments for her latest projects? 'I was always treated with respect, though at first people are always a bit suspicious. Gareth Lewis assists me. It's practical to have a male nurse there but I also believe men talk more openly to a woman.
'I would be lying if I said I hadn't been afraid a couple of times. The first time I went on board the ships, the captain and chief engineer brought me in to see the men. But once they know who you are, why you are there and that you're not trying to get something out of them, they are fine.'
It takes a special personality to take on such difficult clients, get the healthy lifestyle message across and keep a sense of humour, but McCullagh has done so. She did break new ground and her award is richly deserved.