“Your guys are here to see you.” These matter-of-fact words from a veteran nurse spurred my interest in men's health as a young physician. She hadn’t checked the appointment schedule. She simply knew. So rare were young men’s visits that their appearance meant they must be looking for me.
Two decades later, men continue to be seriously under-represented in our nation’s health care system. One telling study found that women were three times more likely than men to see a doctor on a regular basis. Moreover, more than half of all men had not seen a primary care physician for a physical exam in the past year, while more than 40 percent had been diagnosed with chronic conditions including high blood pressure, heart disease, arthritis, cancer, or diabetes, according to another study. And as reflected in my own experience, the trend starts early. By mid to late adolescence, boys’ trips to primary care physicians have already started to drop off.
The results are both predictable and tragic. Simply put, men get sick and die far earlier than they should, with men living in poverty being the hardest hit. In my practice, I have seen men in their early thirties who require triple bypass heart surgery because of uncontrolled high cholesterol. I have seen other young men present for the first time with renal failure caused by undiagnosed hypertension. And I have lost count of the young men who come to me having unrecognized and uncontrolled hypertension and diabetes.
Over the past decade, our community-based health program has seen a 450 percent increase in unique patients.
What accounts for the health care disparities between men and women? One obvious reason is that just as boys stop visiting their childhood physicians, girls are making their first visits to gynecologists. More broadly, young women come of age amidst a range of medical specialties geared toward addressing their health concerns. High-profile campaigns around breast cancer and reproductive health choices have raised awareness, putting women’s health at the center of the public conversation. Annual Pap smears up to now have been rites of passage for young women.
There is nothing comparable for young men, a fact that undoubtedly contributes to their reluctance to talk about health issues. But silence should not be confused with the absence of anxiety. Yes, many adolescent and young adult men are healthy, but again and again I have discovered that this veneer conceals deep concerns that they haven’t shared with anyone.
If we ascribe to the World Health Organization’s definition of health that goes beyond the absence of disease—and we should—we will recognize the importance of finding ways to encourage boys and men to make use of the health care system in ways that optimize their health and help prevent early complications of preventable conditions.
One promising strategy: investing in reproductive health services for adolescent and young adult men. This has been our approach at the Young Men's Clinic in New York City, where I have served as medical director for the past 16 years. One clear sign of its effectiveness: Over the past decade, our community-based health program has seen a 450 percent increase in unique patients, with most of this increase occurring over the past four years.
Along with solidifying their connection with the health care system, reproductive health services support young men in making better and healthier decisions throughout their lives. In this way, women stand to benefit too, as men absorb new and better norms around issues including intimacy, sexual violence, and pregnancy prevention.
Sexual and reproductive health services also provide a route to addressing other medical issues, including mental health. It’s significant that all of the high-profile mass shootings in the last decade were the acts of young adult men, as of course was the recent Germanwings tragedy. Overall, males are disproportionately likely to die due to suicide.
Happily, we are seeing signs of some positive momentum, driven both by the non-profit world and the government. Significantly, Planned Parenthood is making a concerted effort to extend its reach to men. More broadly, the early provision of the Affordable Care Act to include young adults on their parents’ health care plans was a great step toward increasing access for young adults—men as well as women—something I’ve seen firsthand in my clinical service.
We can build on this. In my experience, a majority of young men are open to increased contraceptive knowledge and aspire to increased preventative behaviors in all areas. However, apart from the New York clinic where I work, there are no other dedicated services and few providers across the country that truly engage young men into the care that is respectful and with the support to navigate what is a relatively new world for them.
This needs to change. For all the promising efforts now under way, we still live in a nation where far too few physicians get the message that “your guys are here to see you.”