Men Lag in Caring for Themselves

A different kind of health care reform is needed in America — how men treat themselves.
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By all sorts of measures — including the ultimate one of dying about five years earlier — men suffer compared with women in terms of their health.

Men have higher mortality rates for 14 of the 15 leading causes of death, according to Will Courtenay, director of Men's Health Consulting. (The exception is Alzheimer's.)

Courtenay, who started his Berkeley, Calif.-based company 16 years ago, also says men suffer 94 percent of workplace fatalities even though they account for only around half the labor force.

That same imbalance shows up in grim statistics relating to driving fatalities, drug and alcohol-related deaths, smoking and poor diet, depression, suicide and homicide.

For years, Courtenay and other researchers have been exploring this disparity and asking why men seem to have a built-in aversion to looking after themselves — why they don't visit the doctor, take preventative health measures or follow medical advice to the same extent women do. Women in the reproductive years, for example, spend 68 percent more money on health care in the U.S. than do men.

The reasons have physical, psychological, social and cultural roots. From birth, males are saddled with certain macho expectations which, combined with a misplaced sense of invincibility, ironically leaves them more vulnerable — they take big risks, are reluctant to ask for help, and won't easily admit pain or weakness.

While these factors continue to exact a heavy toll on men, women's health care has blossomed (admittedly from a low base), further widening the gender gap and sparking renewed efforts to correct a health system that is arguably under-serving half the population.

Demetrius Porche, professor of the School of Nursing at Louisiana State University's Health Sciences Center, in New Orleans, laments that the health education message is not reaching men.

One example: the way men and women are treated differently by doctors on issues of self-examination. He says women are routinely taught to look for signs of breast cancer, but men are rarely instructed on examining themselves for testicular cancer.

Courtenay agrees, quoting research showing 86 percent of doctors instruct on breast self-examination but only 29 percent teach testicular self-examination. There's a similar gender imbalance on issues like skin cancer, osteoporosis and, paradoxically, postpartum depression.

Courtenay is writing a book about postpartum depression ... among men. Though the condition is widely associated with new moms, "Sad Dads" shows many men also suffer.

"Very few people realize that," he says.

Porche favors better training for doctors, nurses and other health professionals. He also edits the American Journal of Men's Health, which launched in March 2007. Another academic periodical, The Journal of Men's Health & Gender, launched in 2004.

Hoping to integrate men's health care into the core curriculum, Porche has drafted a funding proposal for a study that could provide the foundations for such a course.

As president of the American Assembly for Men in Nursing, he believes more male nurses would help but says that's not the complete answer. He points out that today's gender imbalance in health care exists despite doctors traditionally being mostly men.

However, Courtenay believes male nurses are more sensitive, attuned and "far more educated about men's health" than male physicians. "Doctors can be very stereotypically masculine," he says.

He has devised a six-point plan offering advice to doctors on how best to interact with male patients; he believes asking open-ended questions, providing information and counseling can be as important as clinical examinations and tests.

Courtenay also offers practical solutions to improve access to medical services for men, things like evening clinics that working men could more easily attend, or mobile clinics that visit workplaces.

In addition, he hosts several Web sites targeting men's health issues, some with online forums. He says it's a popular myth that men don't want to talk about health concerns; given this sort of supportive context, he says men willingly open up about deeply personal topics.

At government level, Courtenay thinks the U.S. is far behind countries like the United Kingdom and Australia in terms of national policies specifically aligned with men's health care needs.

A proposed Office of Men's Health within the Department of Health and Human Services — envisioned as complementary to offices on women's health and minority health — is "dead in the water at this point," he says.

The European Men's Health Forum, in a just-published review of policies in 11 countries, gives high marks to several governments but describes the situation for men's health in the U.S. as "dire."

But Scott Williams, vice president for professional relations and public policy with the Men's Health Network in Washington, D.C., is "cautiously optimistic" such an office will become a reality.

He sees this happening either as part of the current push toward health care reform or through specific legislation introduced in April and now before the House Energy and Commerce Committee.

Marsha Gelt, family planning training director at the Oakland, Calif., office of the Center for Health Training, sees the value of involving men and women in each other's health care.

In the last 20 years, she says, people have come to realize that reproductive health care is not exclusively a women's issue. "It's everyone's issue, certainly the male partners. There's an effort now to remember there are two people in a relationship."

Gelt describes the inclusion of men as equal partners as a "paradigm shift" in reproductive health care and argues strongly in favor of women being more closely involved in men's health.

The Men's Health Network is doing just that. "Engaging women in the men's health care debate has moved things forward," says Williams. "We want to tap into the passion and energy women have for health care and for the men in their lives."

In one campaign, Women Against Prostate Cancer, women talk about the impact the loss of a husband, father or other male can have emotionally, physically and financially on them and their families.

Joe Zoske, administrator of the social work program at Siena College, in Loudonville, N.Y., sees the need for a deep cultural shift if society is going to rethink men's health.

"We've never equated men's and women's well-being," he says, referencing the "women and children first" mentality of the Titanic and the way men are always the first to go off to war.

"We value men in lots of ways but not their physical well-being. We need to elevate men and make them feel more welcomed into health care, more than just penises and prostates."

After a national survey he conducted revealed very few professional men's health courses, Zoske created Gender Health, now an elective in the nursing program at Empire State College, State University of New York.

The author of Men's Health & Wellness: 50 Health Promotion Ideas for Educators, Planners and Practitioners, Zoske believes education should also include teaching young schoolboys to develop a more nurturing relationship with their bodies.

"Health care in lots of ways is very feminine," he says. "Women pay attention to their bodies. When they have a concern, they go to the doctor and get it resolved. Men don't do that. That's the opposite to the male way of thinking."

To deliver its message where people "live, work, play and pray," the Men's Health Network presents workplace programs for men and women, while Healthy Sundays introduces a faith-based dimension to the health and wellness debate.

The network has also embraced the appeal of sports and entertainment, most famously holding free health screenings and information sessions inside the Washington Redskins' locker room.

The chance to tread the same turf as NFL players has proved a big draw, says Williams — during one five-hour clinic, health professionals saw more than 700 veterans and their families.

The use of sports celebrities and major sporting venues is a model the network hopes to take on the road. "We've seen this work with the Redskins, and we know the interest is there," says Williams. "It depends on resources, but that's the dream."

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