Discussion 1

okay well good morning everyone thank you for being here I do have a fairly large presentation I’m aware there are a lot of other speakers so I’m going to try to go fast you do have the presentation in your packet so I’m going to just touch on the major points the first problem we have is that men are overall a lot not well involved in preventive care this study by the CDC found that even if you excluded pregnancy-related visits that women use doctors twice as often as men did this study which is available online out of touch American men in the healthcare system the Commonwealth Fund study by David salmon and associates did a telephone survey and they found that men a third of men who has less less than official women had no regular position with the divide especially wide in the 18 to 29 year age group and narrowing with age those who haven’t seen a doctor in the past year again with three times as likely to have not seen a doctor in the past year and again the divide was especially wide in the 18 to 29 year age group now with age now this is significant because at the World Congress for men’s health and nice france and 2010 Professor Ian banks said that the time from the onset of symptoms to a diagnosis of diabetes and a woman in the United Kingdom averaged about one year with for a man it was ten years if a person has been carrying around diabetes or hypertension or high cholesterol for 10 years they obviously have a very different prognosis from someone who was diagnosed and treated early the Commonwealth study found that even when men were in pain was sick only eighteen percent stated that they would seek help promptly twenty-four percent stated they would delay health care as long as possible seventeen percent said they would delay going to a doctor for a week or more professor Sherman James coined the term concerning African and john henry ism about how african american men may drive themselves to protracted high level high effort coping because the stress is trying to win against society it’s based on The Legend of John Henry that won a contest for the steel driving machine but uh but his heart failed during there and he died minority males were found to be twice as likely as minority females to have no physician contacts in the past year black and Latino men were less likely to carry health insurance than their female counterparts and that’s true of white males as well this study this is rather sliders was put together by the Men’s Health Network showed that in nineteen twenty there was only one years difference in life expectancy between the genders and then that widened and it raises a different question we asked why do why don’t men live as long as women perhaps the question should be why didn’t the improvement and life expectancies that took place in the 20th century why didn’t that improvement for men keep pace with the improvement for women and this slide really by again by the men’s health network really shocked me because it showed that when you look at excess mortality the peak is between 15 to 24 year age group when you compare you are the mortality of males compared to females and this is not what you would expect if it was a biological origin because biologically the most vulnerable times of when the infancy and old age are the most biologically vulnerable times yet the peak and the difference in mortality occurs in the 15 to 24 year age group so it raises another question what are we doing to a young men because the main cause of death in this age group is not cancer or heart disease its injuries so let’s say what are the barriers what’s key policing we know that men are staying out of preventive health care what’s keeping them out well our gender roles our work roles distrust of the health care system in certain groups fatalism to believe that you can’t do anything about it when it’s you to go with your times to go maladaptive self-reliance some some men just basically feel you know even if even if a man has a problem you should handle it himself information barriers is not much information on themselves out their schedule conflicts that’s the hardest thing for me when I have a clinic full of people but I’m not feeling well what do i do you know work hours and our health care availability hours tend to overlap there’s a lack of male targeted health programs and also the economic barriers that men is a gender or less likely to carry health insurance why men have stoic attitudes towards pain and fear remember the Commonwealth study men wouldn’t go to the doctor even if they were ill or in pain our gender role training with told not to run from danger and not to wrestling with tire

not to give in to pain and if you work in a manual labor job or something that requires high tolerance for discomfort you’re not going to turn on your your attention to the discomfort in your body on the weekend I’d like to say when the boys skins his knee at age 80 to get kids he gets told brave boys don’t cry but then when he gets hurt playing football and gets toe take one for the team so when he’s 50 and having chest pain he says it’s only indigestion men expect it when they don’t feel well it’ll go away if they leave it alone and the rules of the game and changes you get older and middle-aged small problems can become worse with time some authors Braithwaite and Taylor I pointed out how this unhealthy stoicism may affect african-american men and other minority men out of proportion because they tend to work in jobs that are physically painful and dangerous and dirty dangerous jobs once will actually call Negro work this is trust of the health care system and in my experience racial minorities veterans Latinos the Tuskegee syphilis trial and sure most people here are familiar with but that’s a self-fulfilling prophecy because if you stay away from the doctor because you don’t trust what doctors will do you stay away until you’re so sick that they really can’t help you this article was talking about distrust among african-american african-american men and the contributing factors were lack of interpersonal and technical competence or at least perceived or perceived quest for profit beliefs and racism fear that they’ll be experimented on among Latinos they found that Latinos are less like even less likely than blacks or whites to trust healthcare providers and they did a survey on that and they said that among Latinos they were they were they were very concerned about being a guinea pig and and we’ll also embarrassed by certain types of cancer screening we also have to consider in this length and this and this group we have to consider language and communication barriers of the factor in the VA culture we’ve all seen the reports of problems in the VA system information barriers how many people have you heard say prostrate cancer and we actually have to do and we do prostate cancer screening we actually have to get up and announce that women do not need this screening we’ve had women threatened to sue us because we because we told them that we didn’t that they didn’t need that and men men are ignorant about it to a lot of men can’t say what the prostate does or where it’s located people who are fatalistic especially people knows low socioeconomic status they may feel that nothing they can do will make a difference in the outcome then there’s also the self-efficacy question does the person believe if you tell them to stop smoking lose weight do they believe that they can do that when you ask the person to perform a healthy behavior because they have the confidence to believe that they can actually accomplish that this was something that the women at Morehouse School of Medicine gave me because when I talked about how men’s health was impacting women children and society they shared their experience that his girls they were seen by the pediatrician and as soon as they became old enough to be considered women they were referred to the gynecologist thereby maintaining a continuity of care when male health care tends to fall off the face of the earth after the PD at your age group female targeted medical specialties help to habituate women into regular contact with physicians but men don’t see anything with a male face and if a man has a problem does he know where to go because men for men’s health care’s fragmented across many specialties and he’d go back to the Commonwealth study that I talked about early the David salmon study it was in 18 to 29 year age group that we saw the most separation between men and healthcare system okay we talked we’re here to talk about what works dr. James Bennett has done a lot in the city of Atlanta in order to get men into health screening and we did the general types of screenings not just prostate cancer but dental health cardiovascular risk profiling blood pressure glucose cholesterol and the like he had a very big day at his own office men’s health day in 1999 we did a health initiative for men in 2002 and since 2003 to this year we’ve been doing the community health events promotions on that chance at various locations in Atlanta what made men come in engaging entire families to bring men and not just not necessarily just a spouse or significant other it could be a brother it could be a father it could be a lost spring they can help that because we’ve alien culture doesn’t support men taking care of themselves but the family can create a mini culture that counteracts that taking time to explain and promote understanding of disease processes and in management when we do the screenings we have people lecturing telling people about the disease why they’re getting

screened you tell a man to take a pill for his blood pressure and he doesn’t even feel bad the ones why should I take this as giving me side effects I have to spend money if they understand what what you’re asking them to do and there are ways to explain things to people even if they have a 2nd grade education I I make an analogy between cancer and weeds taking over a garden if you don’t get the first weeds it will take over the entire go on just like it takes over your body I tell a high blood pressure when your heart is a very powerful muscle if your pressure is too high it’s beating you up from the inside out it’s damaging your organs so you can make very simple analogies to help people understand why you want them to do things and men tend to be more cooperative when they understand the health fairs are held on weekend so as to not conflict with most men’s working hours we don’t treat the men as just a prostate but a whole person we address performance concerns much more broadly than sexual performance because men are socialized to want to achieve and perform we talk about looking younger being stronger faster being able to work better being able to support your families we link health a healthy state to manhood we provide flavorful samples of healthy foods a lot of people don’t like to eat like to eat a lot of things that aren’t good for them because they taste good we showed them that their ways to make things that are good for you taste good and we have people chefs and people prepare health foods and let people sample it we publicize the health screenings to multiple media venues radio television newspapers posters flyers and churches we’re now finding the social media to be very important as taken over especially with young people but men need to know what’s out there for them we have to address cultural and language barriers we thought we have networks with Latino and Asian American associations Asians and Pacific Islands have about 120 different languages so we need to be able to communicate with people not only with regard to the language they speak but also the reading level because if we go there talking a lot of medical leaves we lose people I once saw a doctor talk to a woman who had a coronary stenting which was talking about myocardium the perfusion I said wait a minute she doesn’t understand you know you got to talk to people on their level men may be more receptive to healthcare often in the form of a group or community event men go to football games baseball games things that men won’t do as individuals they sometimes will do in a group it’s important that we don’t that we don’t fall into the trap of belittling men or making them feel belittle because they’re not taking care of themselves ken Goldberg was talking about how men take care of their cars if it burns one drop of oil or makes a noise in the hood like that men ignore their health because we haven’t been told to apply that to our own bodies I had a man who was a PhD psychologist he came to washington DC he was having the symptoms of a heart attack but he waited until he was done with his work before he went in and got checked so men even highly educated men are going to put work before themselves and we need to get a culture about what men are being taught to consider important we also need to be as caregivers we need to learn to listen to men who may not have a lot of skill at communicating their problems you know be be patient be attentive you know ask ask questions and try to get to the bottom of it because the men may not be accustomed to explaining his problem the health belief model this is something that I use a lot from public health and behavioral sciences they in the 1950s they were wondering why people wouldn’t come for free screenings and they determined that people will come for a screen if they have awareness of perceived susceptibility they must believe some certain condition can happen to them they also have to believe that it’s that is severe that it would affect their life was perceived severity which is together they’re called perceived threat they also have to perceive benefits they have to believe that there’s something they can do if a person believes if I get cancer there’s nothing that they can do for me they’re not going to get screened for cancer and we have to lower the barriers to take the action such as financial costs fear of pain having to travel on this is having to wait long times and also promoting the individuals confidence that they’re actually capable of taking the actions required for prevention and this is a vet you can find information on the health belief model online for instance promoting perception of the risk of HIV prevention some people say well I’m not gay so I can’t get it you know you have to make people realize that everybody is susceptible some young gay men are having unprotected sex because they don’t think it’s severe they think that if they just take a few pills they’ll be fine and you need to explain to them to medicines expensive it has side effects it will affect your life they have to see the severity you have to talk when people don’t want to get tested you have to talk about the benefits of testing how this can potentially keep you from spreading the

disease and potentially save your life of his quarterly then lowering costs distance and time to testing we go out to Morehouse and Clark Atlanta University and we test the college students that we bring the testing to them then promoting self efficacy for prevention behaviors we give out condoms and things like that an explanation so that’s how the health belief model can work and it can be applied to many different conditions the peer-to-peer approach use of celebrities politicians sports heroes in the light it helps to combat the lack of awareness and also makes it okay to have the health issue and talk about it publicly it puts a face on the health issue that reflects the target group and so we use help help you try to use when we can health care providers match demographically to the target group but regardless of the demographic group of the provider to provide his attitude is the most important thing but it helps overcome mistrust yeah I gotta brag on myself a little bit yeah James Brown was a yeah he was a prostate cancer patient and dr Bennett did his surgery so he came to help us with chance so I got to jam in front of him ok that’s the few of the older peer-to-peer approach bringing now this is something that the men’s health network has led the way in bringing screenings to places where men normally gather we can you can do that in barbershop sporting events follow shots people are sitting around with nothing to do you can screen blood pressure and things like that we need to talk about gender specific programs targeting young males to keep them engaged after the pediatric age group and one suggestion is to engage young men to link a health screening to sports activities women can it can help us a lot can go berserk material that is where this comes from the men do the best when they have motivated partners the best approach is a tactful non blaming tailor to the men’s individual personality and for instance if he values his appearance you can comment that he’s getting a spare tire to motivate him to diet if he takes pride and being responsible appeal to responsibility you know stay stay healthy making appointments of the family doesn’t have to worry if he’s afraid shift the fear from going to the doctor to not going to the doctor saying that you know if we find this early we can probably do something about it if he likes to be in charge you challenge them you’re high brush your blood pressure was high what are you going to do about it you know so based on its personality is a way to do it this is a really excellent article depression in men communication diagnosis and therapy I would recommend that people look at it who are giving counseling to men because it talks about how depression is underdiagnosed in men how it manifests differently and was the best approaches two men are in Western culture and men great deal of emphasis is placed on achievement and productivity you look at how athletes will use steroids human growth hormone etc viagra propecia but not just sexual men want to perform they want to be a vital they want be productive they want to be strong they want to be veral they want to have concentration attractiveness and the things that make them feel like men and then we’ll go for fear but they’ll go because I they’re having sexual problems so it’s performance issues men’s health network as we said before pioneer bringing men’s health projects to the workplace on that they did it at the Georgia State Capitol they’ve done it here in Washington DC a conventional work settings like ups and that works on several barriers to men’s health simultaneously it men have trouble taking off time to go to the doctor we bring some screenings to them we’re having a program that’s targeting men and also we also boost their awareness we teach them we don’t just screen them we don’t know what’s going on and why okay the final thing issue I want to cover is we need to look at the apathy and political opposition to men’s health programs by stressing that men’s health has a widespread economic as widespread economic and social effects on society as a whole dr. Landry Tredwell who was a female professor at Morehouse School of Medicine she tries to get more attention to the health of african-american men and including the ex incarcerated opposition says that men have everything but I agreed the highest death rate from cancer the hyatt the death rate from homicide suicide earlier just from heart disease and higher rates from at least 910 leading causes of death so by ignoring men’s health the whole society’s impacted adversely it’s an overlooked aspect of community health we’re not trying to place him in self above or within the context of women and children’s health but it’s an important variable while it’s independent in many respects and that’s with a profound impact on the physical emotional and economic health of other demographic groups I was called by my next-door neighbor’s wife in September for 2002

her husband was on a to move and she couldn’t wake him up and he died the next day he had a stroke what had happened to her she lost her companion of 32 years if he had survived she would have had to take care of him for the rest of his life when a man becomes disabled who asked what is the burden of care falta it falls to the woman I family earnings are diminished a widow is that increased risk of dying herself older women have poor prospects for remarriage usually and if you have disability does increase health care expense in the face of diminished earnings but that’s not just limited to the family if men are sick unnecessarily you get lost time from work diminished productivity a form of provider can become a dependent to form a taxpayer can become a tax burden I work with a physician who he’s not disabled but he has trouble coming in because of rheumatoid arthritis he’s in so much pain in the morning he can’t meet his appointments so he has trouble maintaining gainful employment because of chronic illness short of disability the widowhood and orphaned children increase family health care costs are part of our part of the economic effects it is also direct exposure of spouse and children to disease agents how are we ever going to control sexually transmitted disease and women if we don’t address it among men they call me to ask we’re giving us this new vaccine two girls for human papillomavirus should boys get her also I really didn’t think that was a very intelligent question I said you know who’s going to give it to the girls you know you don’t know if you don’t vaccinate the boys and then also there’s other things sexually transmitted diseases are often more devastating in women than in men herpes simplex virus can can make a woman unable to give birth that have to do a caesarean section if she has an outbreak human papilloma virus can cause cervical cancer chlamydia can make a woman sterile you know a lot of these diseases are worse for women and men then you also consider other diseases and us smoking and substance use disorders how they affect women and the whole family one of the things that’s come out about epigenetics is that they’re finding out that a father’s health can affect children also we talked about maternal and child health but I think we need to be talking about parental and child health they found that our offspring of teenaged fathers are increased risk of prematurity low birth weight death of birth or death shortly after workers like firefighters painters men exposed to solvents and other chemicals in the workplace the offspring can be miscarried still going to develop cancer later a life of the father smokes that their children are greater risk of brain tumors it’s a father we’ve told women that if you’re too old a baby can have down syndrome but older fathers cannot have children or who have a counter plastic autism they can have a progeria autism schizophrenia Down syndrome the more frequent breast cancer and daughters group group of researchers went in his colleagues they examine birth records for the children of teenage fathers and 20-something mothers and they found that the teenage fathers the babies had an elevated risk of stillbirth low birth weight and other birth problems epigenetic changes we found that that genes do not have to mutate to be changed that their regulators of the genes that can that can vary according to the father’s experience and that when they tried an experiment they found that when they gave a rat’s mother rats morphine the pups was smaller than average and an eight and when they gave it to the fathers the pups were also small smaller than average and they said how could this be but apparently was an epigenetic change when male mice were exposed to cocaine through inhalation and made it through non-exposed females the pulse had trouble learning and remembering where to find food and simple maze is especially the female offspring they didn’t find DNA damage but they found altered levels of enzymes involved in chemical changes specifically a method nation of DNA in the sperm producing tissue of the paternal mice this is a whole bunch of abnormalities that can be related to paternal age cigarette smoking and alcohol I’m not going to read off all this medical leaves but you get that you get the picture that what the father does can’t affect the health of the child in the main point men who served in Vietnam and Cambodia had that Dale offspring had a had an increased risk of acute myelogenous leukemia especially when four children diagnosed before the age of two if the father has mental health problems it tends to be more associated with behavioral problems in the children and emotional problems but the psychiatric disorders that affect fathers are associated with an increased risk of behavioral and emotional difficulties and their children similar in magnitude to maternal psychiatric disorders so the father’s mental health can affect a

child as well then we have the address sociological consequences of fatherless and as fatherless children are at greater risk of drug and alcohol abuse growing up in single-parent homes can be a risk factor children who live with one parent tend to have lower grade point average or college aspirations poor attendance records higher dropout rates more likely to drop out of schools they found that are more likely to become offenders regard it both genders are more than half the elderly widows now living in poverty were not poor before the deaths of their husband’s death rates are after women become widows the all cause mortality doubles in the first month after widowhood widowhood is even more devastating to women economically then divorce forty percent of widows in over one-quarter of the horse women fall into poverty or at least sometime during the first five years after the end marriage so what it comes down to is that what we need to argue against the apathy and opposition to men’s health is that by reducing up with that men’s health has a potential to benefit the whole community we’re reducing or controlling rising health care costs by preventing costly advanced disease we’re reducing the economic cost of preventable male illness including lost time from work disability diminished income and reduce work productivity we’re improving the longevity figures and healthcare outcomes compared with other regions and other nations we have the most expensive health care system in the world yet our life expectancy statistics on the middle of middle of the road and our infant mortality statistics are pretty bad and I think a lot of it has to do with the health care not reaching everybody you know you can my attitude about health is a rising tide lifts all boats you can’t effectively weed half a garden optimal health of the agenda is not an either or question it’s a both or neither if we don’t optimize men’s health will fail to optimize women and children’s health so increased attention to the health of American mentioned not be seen as antagonistic to meeting to health concerns of women and children it should be welcomed as a logical complement to women’s health and children’s health men’s health and minority men’s health is an essential component of building a complete and inclusive healthcare system and achieving optimal overall health and our communities and in the nation as a whole and with that I think I’ll close thank you