This is the best treatise on men’s healthcare issues I’ve seen in
some time. There are too many quotable facts listed below to
mention.

Men’s Health:
A Critical Need
The time for action is Now

By Jean Bonhomme,M.D.

The 2000 Georgia Legislature was in session, voting on whether to
create a State
Commission on Men’s Health. In the course of the discussion,
several male
legislators ridiculed the idea and asked, “Why do we need
something like this?”
Female legislators reportedly retorted, “You men end up dying
early and leaving
us all alone.” The bill passed, and the first Commission on Men’s
Health in the
United States became a reality.

These women legislators demonstrated an uncommon insight into the
nature of public health issues. The repercussions of men’s health
are not strictly confined to men. Women and children are affected
on many levels by illness and disease among men. Women are
widowed, children are orphaned, providers become disabled,
families are disrupted, family earnings are diminished,
health-care expenses are increased and loved ones are lost.

Sometimes, illness in men becomes a direct threat to the health
of women. Consider the fact that AIDS was once called GRID, or
Gay Related Immune Disease,
and thought to be a male disease. The CDC now states that one out
of every 160 African-American women in the US is HIV positive.

We live in a very exciting time. For the first time in my 20
years of practicing
medicine, people are beginning to talk openly about such issues
as men’s traditional reluctance to go to doctors, male suicide,
prostate cancer and other men’s health issues. Health screenings
targeting men are becoming an increasingly commonplace
occurrence. Traditional as well as established medical
publications that would not have done so a few years ago are now
beginning to carry articles about men’s health. The debate was
not always this open. When I first started advocating greater
aware-ness of men’s health issues 15 years ago, the reception was
rarely supportive.

Responses usually ranged from the indifferent to the outright
hostile. I was treated by some as a cross between Idi Amin,
Sadaam Hussein and Osama Bin Laden.
It was puzzling that some people seemed very threatened by the
idea while others
just did not seem to care.

All I was trying to do was to raise awareness in order to help
African-American men, a population with extremely high death
rates. *The very issue that had turned my attention to men’s
health was that the average African-American man was not living
long enough to collect Medicare or Social Security.*

Many public health problems fall with disproportionate weight on
African-American males. While public attitudes have improved
gradually over the years, we still have a long way to go.

Part of the problem is that some people see men’s health and
women’s health like
opposite ends of a seesaw, believing that if one side rises the
other must fall. They think that in order to have one, you must
suppress the other. My view is completely different. The health
of any nation depends upon a positive balance between the
genders. If you don’t address the concerns of both genders, you
cannot thoroughly address the concerns of either.

Some take the attitude that men have all the advantages, have
already benefited more than their share from medical research,
don’t have any real problems or that males dying young is the
natural, unchangeable order of things.

However,the United States’ medical system is the most expensive
in the world. And, in spite of this, men’s life expectancies are
mediocre in comparison to other developed nations. Part of this
picture is that advanced technology is not reaching everyone. The
numbers demonstrate that men and minorities underutilize the
health-care system.

The Commonwealth Study of 2000 found that men are less likely to
have health insurance or have visited a doctor in the past year.
Ironically, as a group, men are receiving less health care but
are accused of unfairly benefiting from medical research.

All 10 of the 10 leading causes of death affect men at higher
rates. Until the health-care system achieves sufficient
inclusiveness and addresses everyone’s needs, the impaired life
expectancies of those on the outside will continue to pull down
the average for all Americans.

When we look at the 10 leading causes of death suffered by men,
eight out of 10
affect African-Americans at an even higher rate. African-American
men are at the
bottom of just about every health measure you can find including
overall longevity, heart disease, cancer, strokes, homicide,
cirrhosis and AIDS. Driven by the new interest in health
disparities, questions are being raised as to why some
demo-graphic groups often have vastly different health outcomes
than do others.

Any question of health disparities must point strongly to gender
differences. One young African-American man once told me that,
unfortunately, African-American men
are a walking health disparity in the United States. Why has this
state of affairs gone unchallenged for so long?

There is little in our culture that encourages men to seek
health care or to stay in the health-care system. *Male role
upbringing fosters attitudinal barriers to health-conscious
behavior. Males are frequently brought up to be stoic, to regard
yielding to pain or fear as weak or cowardly*.

Typically, boys are taught not to cry and to handle problems on
their own. Many males have been taught from childhood that if you
simply ignore something painful, it will just go away with time.
With the minor injuries of childhood, that’s usually true.
However, when adult men carry these attitudes into middle age,
the consequences can be life limiting. Conditions like heart
disease or early cancer may quickly go from treat-able to fatal
if not addressed promptly.

A family practitioner in Atlanta once told me that his male
patients often come to him with one foot in the grave and the
other on a banana peel. Furthermore, men’s work roles often
rein-force cultural stoic attitudes. Over 95% of workers in the
10 most hazardous jobs are men, and over 90% of occupational
deaths are among men.

Men are disproportionately represented in manual labor jobs that
are both physically painful and hazardous. Have you ever tried to
work on a hot roof in the summer? Lifting back-straining objects
or working in the burning heat or the freezing cold creates a
need to disconnect from your own feelings just to get the job
done.

*Painful and hazardous work has a twofold deleterious effect on
health.* First, there is considerable injury and possible loss of
life on the job itself. Secondly, when you learn to ignore the
feelings in your body 40 hours per week, you don’t necessarily
turn that habit off when you leave work. Pay no attention to your
aching back at work, and the chances are higher that you will
ignore a pain in your chest over the weekend when you are at
home. The cultural and attitudinal barriers that men face when
they interact with the health-care system are compounded by a
pervasive lack of public awareness and information regarding
men’s health issues.

In 1988, my father was having symptoms of urinary obstruction
and thought he must have had an infection. He did not consult a
physician, instead he just took some antibiotics. By the time he< br />got to an emergency room, he had started bleeding so badly
through his urinary tract that he required blood transfusions.
His diagnosis was benign prostatic hypertrophy (BPH), and he
underwent suprapubic prostatectomy.

BPH will occur in the lives of at least 50% of men, but he had
never heard of such a thing. His lack of information was far from
unusual. Many men could not tell you what the prostate gland does
or where it is located. I frequently hear people mispronounce
“prostrate” cancer.

A most striking demonstration of public ignorance about men’s
health is that when prostate cancer screenings are held, women
sometimes ask for PSAs on themselves. Clearly, a great deal of
public education will need to be done before men and the general
public are as well informed about their reproductive health as
women.

Men also face identification barriers in building a relationship
with the health-care system. Women have an exclusive field,
obstetrics and gynecology, which helps many females get into the
habit of seeing doctors regularly from their teens.

There is virtually nothing in the structure of the health-care
system that has a man’s face on it so that men can readily
identify. When an individual man’s health takes a serious
downturn in middle age, often around age 50, it is usually the
result of lack of appropriate monitoring and intervention in the
preceding decades of life.

Males have a number of gender-specific issues such as X-linked
recessive genetic diseases, developmental problems such as higher
rates of autism and stuttering, earlier heart disease and
reproductive and sexual health issues. If there were specific
health programs and/or a health specialty for men, some of these
identification barriers could be overcome.

Men’s lack of attention to their own health has nothing to do
with a lack of intelligence. My father was a man who could speak
five languages, and he had degrees in physics. He was diagnosed
with hypertension and diabetes but didn’t feel too bad, so he
often ignored his condition. Eventually, he had a stroke and
kidney failure and died. In spite of his consider-able intellect,
it was very hard for him to take care of his health because he
was never taught to.

Perhaps more accurately, he was specifically trained not to. He
was taught to be stoic and “strong” and to handle his own
problems. As Dr. Ken Goldberg puts it, men can take incredible
care of their cars. If the engine makes the slightest odd noise
or burns a single drop of oil, men are right on it. Through
re-education, men can be taught to take a similar approach to
their own bodies.

There is a lot of work ahead of us. We need many more public
service announcements to raise the level of public awareness on
men’s issues. The peer-to-peer approach can be used to promote
men’s identification with health-care issues. The use of people
like the one you are trying to reach, especially a survivor of
the disease, puts a face “just like mine” on the problem.

Culturally, we need to stop shaming boys and men into thinking
that feeling pain or fear is always weak or cowardly. Instead,
we should teach children of both sexes that there are times when
pain can be safely ignored and times when pain needs to be
addressed, and intellect can determine which approach is more
appropriate in any given situation.

Above all, we need to shift the paradigm so that men no longer
view being ill or going to a doctor as a personal failure or a
defeat. Instead, we can market health care to men as an ally of
masculinity that helps men attain, maintain or regain their
vitality, productivity, functionality and masculinity. No one
need be threatened by the emergence of a men’s health movement.

Instead, it should be welcomed as a logical complement to women’s
health that will ultimately bolster and uplift the health status
of both genders. Men’s health is an essential component of
building a complete and inclusive health-care system, optimally
healthy communities, which are part of an optimally healthy
nation.

Jean Bonhomme, M.D., is the founder of the National Black Men’s
Health Network.

For more information, please contact him
at www.menshealthnetwork.org.

Pardon the formatting – I copied it from its original PDF format
and cleaned it up a bit.

http://www.menshealthnetwork.org/library/mthdbonhomme1.pdf