Men and Health Care

Men and health care is a topic that does not receive enough attention. This is unfortunate as we know men in the U.S. die seven years earlier than women do, often leaving their families at personal and financial risk. The rate of cancer in men has actually increased since 1950, and yet many men do not know about or take advantage of early treatment and diagnosis. The challenge is for men to be involved in preventive care and not wait until a medical crisis appears. Providers must also do a better job at reaching out to men and researching men’s health issues. We present the following articles to enhance the dialogue about improving fatherhood through improved health care - for men – and for all family members.

WHY MEN’S HEALTH?
In 1920, the life span gender gap was only one year. Over the years, the disparity steadily worsened, until the gap peaked in 1970 at 7.6 years. In 1997, men were dying six years sooner than women.

As a result, men have a higher death rate for every one of the top 10 leading causes of death (1):

Nobody really knows why the life span gender gap has widened over the years. Some have pointed to biological differences between men and women, but this is only a small part of the story. For example, biology cannot account for international differences in life expectancy. For example in 1994, Israeli men died only 3.8 years before women, whereas men in Russia died 15.4 years earlier (2). As Andrew Kadar, MD wrote, "We have come to accept women’s longer life span as natural, the consequence of their greater biological fitness. Yet this fitness never manifested itself in all the millennia of human history that preceded the present era" (3).

Is It Just Older Men Who Are Dying Early?

Many people mistakenly believe that most premature male deaths befall men in their 60s and 70s. In fact, the age group that has the greatest excess mortality are the 15-24 year-olds, who are almost three times more likely to die than their female peers. And men 25-54 years of age are still twice as likely to die as women of the same age. This means that when a man dies prematurely, he often leaves behind children who will grow up without a father, and a widow who will face retirement alone. She is also at greater risk of being placed in a nursing home and spending down her assets.

Minority Men at Highest Risk

A look at overall death rates by racial/ethnic group reveals that many minority men suffer an even greater disadvantage, compared to White men and to minority women (4):

	White	Black	Hispanic	American Indian
Men	591	967	475	556
Women	362	561	268	368
Gender Gap	63%	72%	77%	51%

Clearly, the health needs of minority men, especially African-Americans and Hispanics, deserve special attention.

Overcoming Complacency

One hundred years ago, it was common for women to die during childbirth. Many people believed that was "just the way things were." But a few people had the vision and courage to challenge the conventional wisdom. As a result, a myriad of maternal health programs were put into place, and now, maternal mortality has become almost a thing of the past.

On January 25, 2000, the Department of Health and Human Services released Healthy People 2010, the nation’s health agenda for the first decade of the millennium. Healthy People commits the DHHS to completely eliminating the life span gender gap by the year 2010. Healthy People challenges all people to question the conventional wisdom that men dying early is "just the way things are."

References

1. Department of Health and Human Services: Health, United States, 1998, Table 31. Rates for 1996.
2. Department of Health and Human Services: Health, United States, 1998, Table 28.
3. Kadar A. The sex-bias myth in medicine. Atlantic Monthly, August 1994.
4. Department of Health and Human Services: Health, United States, 1998, Table 37. Rates for 1996.
   

All mortality rates are age-adjusted per 100,000 population.

Date: February 1, 2000
Contact: Men’s Health America, eba@intr.net

Male Fear of Physicians
by Karen Goldberg Goff

Men generally avoid going to doctors - for checkups and even for care when they have a problem. The reason seems to be a mixture of fear, embarrassment and machismo; it’s not healthy.

A little more than a year ago, a medical facility called the Garage opened in the Seattle suburbs. Trying to appeal to men and their long-standing infatuation with the automobile, the clinic marketed men’s health as akin to car maintenance.

It offered reasonably priced "tune-ups" (checkups and preventive care), "spark-plug service" (Viagra prescriptions), "body work," (massage therapy, fitness evaluation), "emission control" (smoking cessation programs) and "fuel-injector" (prostate) care.

The Garage received lots of media attention for its clever marketing, but men still stayed away. In six months of operation, the Garage treated only seven patients. It closed last summer.

"I think the primary problem was that this is a tough group to reach," says Dr. Sam Harrell, a family physician and one of the clinic’s founders. "The great majority of the time a man comes into the office, it is because the woman in his life has kicked him in the tail to get him there."

Indeed, women visit family physicians about 2 1/2 times as often as men, according to data from the American Academy of Family Physicians. A nationwide survey of 1,000 adults conducted by Men’s Health magazine and CNN found that one-third of men would not go to the doctor even if they were experiencing chest pains or shortness of breath, two top indicators of a heart attack. The National Men’s Health Foundation estimates that nearly 7 million of the 87 million American men have not seen a doctor for a checkup in more than 10 years.

"I hate going to the doctor," says Bob Eller, a 42-year-old Silver Spring businessman. "I had some mild chest pains, and my wife practically twisted my arm to get me to the doctor’s office. I now go every couple of years for a physical, but I hate going. If you don’t go, then you won’t have to hear the bad news."

Avoiding the doctor can lead to worse news, however. It is important to have a relationship with a primary care doctor even if you are not sick, says Patrick Taylor, spokesman for the National Men’s Health Foundation, a nonprofit organization that tries to educate and motivate men to take better care of themselves.

"Men tend to only go to the doctor when there is something seriously wrong," Mr. Taylor says. "By then, they might have to rely on emergency care. When you are being wheeled into the ER, it is not exactly a place for an open dialogue."

Men’s perceptions of health care seem to be a mixture of fear, embarrassment and machismo, Mr. Taylor says. The problem begins in the late teens and early 20s. Though women are taught the importance of seeing a doctor for an annual pap smear to detect cervical cancer, men have no such scheduled tests and, once they are on their own, no mother to press them into going.

By contrast, reproductive issues such as birth control, childbirth and breast health generally ensure that women see a doctor at least once or twice a year. The fallout from that is that women usually are more amenable to seeing other specialists for various health problems, says Dr. Lanny Copeland, a family physician in Albany, Ga., and a board member of the American Academy of Family Physicians.

"We have done a good job of educating women about the importance of the pap smear and of family planning," he says. "And that has brought them into the office a great deal more than men. Men, particularly young men, just don’t think anything is going to happen to them."

"From 20 to 30, most men don’t feel they need a doctor," says Dr. Matthew Mintz, an internal medicine specialist and professor of medicine at George Washington University. "You see a pediatrician every year until you go away to college. Then you go to the school clinic if you need something. After that, you are thrown out there on your own."

The 20s should be a decade to educate oneself, Mr. Taylor says. It should be a time to establish a relationship with a doctor so when a man does need something simple, such as an antibiotic to treat a sinus infection, he will be able to get in to see a doctor as an established patient. While he is there, he can discuss other matters. "The 20s may be the Teflon years, but young men should get checked for testicular cancer and learn how to examine themselves," Mr. Taylor says. "They should start understanding the value of nutrition, about what bad eating and drinking habits can affect later. The 20s are more about information, not procedures." Dr. Mintz says two checkups should be enough to get a man through his 20s.

However, by age 30, a man should see a doctor at least every three years or so, especially if he has a family history of such things as heart disease or colon cancer, which have a strong hereditary link, he says. "The risk of those types of disorders is stratified by decade," Dr. Mintz says. "High blood pressure can start then if we don’t check it, as can diabetes and high cholesterol. Even if a man is a healthy, jock-type guy, he can have high cholesterol, which has a high genetic component."

Doctors recommend screening for those disorders by the late 30s or early 40s, particularly if there is a family history. Those without a strong family history can wait until age 50 to do annual tests for prostate and colon cancer, Dr. Copeland says.

Mr. Taylor says black men need to be aware that they have a 66 percent higher incidence of prostate cancer and also have higher rates of high blood pressure and stomach, prostate and liver cancer than white men. "African-Americans, or anyone who is at high risk, should get screened for these things in their 40s," he says.

The 40s also are the time to seriously think about heart health. Base-line tests such a stress test, a cholesterol test and an electrocardiogram (EKG) can help assess one’s risk of a heart attack. Through all the decades, it is important for men to recognize the signs of stress and depression, such as a racing heartbeat, loss of appetite, trouble sleeping or sadness that won’t go away.

"Mental health is one of the great, dark secrets that most men like to avoid," Mr. Taylor says.

Even if men are reluctant to see a doctor, there are other tools they can use to at least get them thinking about their health. The wealth of information on the Internet can be a valuable tool, Dr. Copeland says. "I think the Internet is a good thing," he says. "The better educated the patient is, the easier my job is. Some doctors are offended when a patient comes into their office with something he has downloaded, but that is the way it is today."

Dr. Copeland advises getting medical information from reputable sources such as hospitals, universities or medical association sites. "You had better be careful," he says. "There is some real garbage out there. But at least men are reading it, and it gets them in to see their doctor."

Another quick health-check tool is to take advantage of health services that large companies sometimes offer. When the bloodmobile or a free cholesterol screening is being offered in the cafeteria, use it, Dr. Mintz says. "I definitely recommend office health," he says. "Sometimes those tests are not totally accurate, but at least it promotes conversation.

Washington Times
Sunday, March 5, 2000
Page D1
MORE INFORMATION:

Books:

"Total Health for Men," edited by Neal Wertheimer, Rodale Press, 1997. This book contains preventive health tips and treatment options from more than 500 experts.

"The Black Man’s Guide to Good Health: Essential Advice for the Special Concerns of African-American Men," by James W. Reed, Neil B. Shulman and Charlene Shucker, Perigee Books, 1994. This book addresses conditions that affect a large number of black men, including hypertension and sickle cell anemia.

Associations:

* The National Men’s Health Foundation, 14 E. Minor St., Emmaus, Pa. 18098. Phone: 610/967-8620. Web site: (www.nationalmenshealthweek.com). This organization is devoted to motivating men to pay more attention to their health. It has information from its latest survey, along with guidelines on when to see the doctor and what to discuss with him or her.

The American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, Kan. 66211. Phone: 913/906-6000. Web site: (www.aafp.org). This professional organization has published, along with the editors of Men’s Health magazine, a 32-page booklet called "The Men’s Maintenance Manual." The booklet covers topics from exercise to stress management to warning signs of prostate and testicular cancer.

On-line:

Articles from past issues of Men’s Health magazine (www.menshealth.com) can be found on the magazine’s Web site.

The American Medical Association (www.ama-assn.org) has a section devoted to men’s health information in the consumer-oriented Family Focus section of its site.

Reprinted with permission from The Washington Times. Copyright (c) 2000 News World Communications, Inc. No further re-publication without copyright owner’s permission.
Visit their web site at www.washtimes.com

Men Tend to Keep Doctors at Bay
by Rita Rubin

A report out today confirms what many people have long suspected: On several counts, men are less likely to take care of their health than women.

"Out of Touch: American Men and the Health Care System" is based on a telephone survey conducted for the Commonwealth Fund by Louis Harris and Associates. The survey sample included national cross sections of 1,084 men and 2,011 women ages 18 and older. The Commonwealth Fund, a private foundation in New York, reported the women’s data last year but only recently analyzed the men’s .

"We realized that we had a gold mine of information," says lead author David Sandman. "This is one of the largest and most extensive surveys of American men on their health that has ever been conducted." Among the findings :

Nearly a quarter of the men said they had not seen a doctor in the previous year; only 8% of women had not. One out of three men had no regular doctor, compared with one out of five women.

6 out of 10 men had received some sort of preventive care in the previous year, compared with 6 out of 7 women.

"We didn’t imagine that so many men were having no contact with the health-care system," Sandman says. The gender gap narrows with age, Sandman says. For example, half of men 18-29 said they don’t have a regular doctor, compared with one-third of women that age. But only 10% of men and 6% of women 65 and older lack a physician.

At age 65, Americans become eligible for health coverage under Medicare, which at least partly explains the decline in the number of men without a regular physician, according to Sandman’s report. Actually, access probably doesn’t play a big role in the gender gap described by the Commonwealth Fund report, says psychotherapist Will Courtenay, director of Men’s Health Consulting, an educational and training firm in Berkeley, Calif.

Even when men have insurance, Courtenay says, research shows that they’re less likely to seek care than women. Only the healthiest men - mainly those who have been getting regular preventive care - make it to 65, he says, helping to explain the narrowed gap.

"Men tend to regard themselves as not as vulnerable as women do," says David Gremillion, an infectious-disease specialist at the University of North Carolina School of Medicine and a board member of the Men’s Health Network, an advocacy group. "As a result, they often neglect themselves."

USA TODAY
March 14, 2000
Page D1

Why Men’s Health is Also a Woman’s Issue

From the beginning, women have been among the most ardent supporters of men’s health. For example, when the American Heart Association sponsored a conference in 1964 on heart disease in men, 10,000 women reportedly showed up.

So why do women take such an interest in men’s health?

While men typically see themselves as financial providers and protectors of their wives and children, women view themselves as overseers of the family’s health needs (1,2). Thus, it is not surprising that women often encourage their husbands to seek medical attention (3,4). As one article boldly commented, "Females, more than physicians, might be viewed as the principal determiners of the health status of all members of society" (5). But there is more.

How the Life Span Gender Gap Affects Women

It is a well-known fact that 100 years ago men and women had similar life spans. After 1920, the gap began to widen. But many people do not know that the life span gender gap targets men in the prime of their lives. To understand why, we need to look at mortality ratios in each age group. A mortality ratio is simply a comparison of death rates---if men’s death rate is 10/1,000, and women’s rate is 5/1,000, their mortality ratio is 2:1.

In 1900, the mortality ratio for men and women was close to 1:1 throughout their entire life spans. But now, the male-to-female mortality ratio has came to resemble the spike of the Matterhorn, with a sharp vertical in the front and a more gradual fall-off in the back.

In the current era, the mortality ratio shoots up rapidly during adolescence. By the 25 year-old age group, the male-female mortality ratio hits its peak at 3:1! At age 45, men face TWICE the risk of death. And even for those men who reach the ripe old age of 85 years, their risk of death is still 50% greater. As a result of the life span gender gap, tens of thousands of American men die each year in their 20s, 30, 40s---right in the middle of establishing their careers and raising their families.

So a middle-aged man who dies prematurely usually leaves behind children who will grow up fatherless. Father absence is associated with a broad range of social, behavioral, academic, and health problems for his children (7).

And What about His Widow?

It is well-known that widows suffer a decline in their incomes and financial well-being (8). During the first six months after the death of their husbands, widows are also at a greater risk of death (9, 10). And widows suffer from greater emotional and psychiatric problems (11). But there is another important risk that widows face: institutionalization. And the risks are high. Widows are four-and-one-half times more likely to be placed in a nursing home, and twice as likely to require treatment in a mental hospital (12). And widows whose husbands die at a young age (that is, widows who are 25-44 years old) are at 14 times greater risk of being institutionalized, compared to married women of the same age (13).

Surely, women deserve better.

One hundred years ago, thousands of women died needlessly in the course of childbirth. This imposed a hardship on their surviving children and husbands. Now, a century later, the situation is reversed: tens of thousands of men die prematurely each year in the United States, placing their children and wives at risk.

Men’s health is an issue of vital concern to all -- male and female, young and old.

References:

1. Nathanson, C. Sex roles as variables in preventive health behavior. Journal of Community Health, 1988; 3: 142.
   
2. Hibbard, JH, Pope, CR. Gender roles, illness orientation, and use of medical services. Social Science and Medicine, 1983; 17: 129-137.
   
3. Umberson, D. Gender, marital status, and the social control of health behavior. Social Science and Medicine, 1992; 34: 907.
   
4. Norcross, WA, Ramirez, C., Palinkas, LA. The influence of women on the health care-seeking behavior of men. Journal of Family Practice, 1996; 43: 475-480.
   
5. Lewis, CE, Lewis MA. The potential impact of sexual equality on health. New England Journal of Medicine, 1977; 297: 863.
   
6. Perls, TT, Fretts, RC. Why women live longer than men. Scientific American, 1998; Vol. 9.
   
7. Horn, WF. Father Facts. Gaithersburg, MD: National Fatherhood Initiative, 1998.
   
8. Byles, JE, Feldman, S, Mishra, G. For richer, for poorer, in sickness and in health: Older widowed women’s health relationships and financial security. Women’s Health, 1999; 29(1):15-30.
   
9. Greenblatt, M. The grieving spouse. American Journal of Psychiatry, 1978; 135: 43-7.
   
10. Martikainen, P, Valkonen, T. Mortality after the death of a spouse: Rates and causes of death in a large Finnish cohort. American Journal of Public Health, 1996; 86 (Part 1): 1087-93.
    
11. Lichtenstein, P; Gatz, M; Berg, S. A twin study of mortality after spousal bereavement. Psychology of Medicine, 1998; 28: 635-43.
    
12. Verbrugge, LM. Marital status and health. Journal of Marriage and Family, 1979; 41: 267-285, Table 5.
    
13. Gove, WR, Style, CB, Hughes, M. The effect of marriage on the well-being of adults: A theoretical analysis. Journal of Family Issues, 1990; 11: 4-35, Table 3.
    

Date: March 8, 2000
Contact: Men’s Health America
www.egroups.com/group/menshealth/