The Global Case for ActionThe Global Case for ActionAcknowledging Poverty as a Acknowledging Poverty as a Determinant of Men’s HealthDeterminant of Men’s Health

Third Japan-ASEAN Men’s Health Third Japan-ASEAN Men’s Health && Aging AgingConferenceConferenceSingaporeSingapore

03 December 200803 December 2008

April M. W. Young, PhD, April M. W. Young, PhD, Collins Center for Public Policy Collins Center for Public Policy

Siegfried Meryn, MD, Siegfried Meryn, MD, International Society for Men’s HealthInternational Society for Men’s Health

JMH-ISMHjoint lecture

Three Key PointsThree Key Points

Health Health disparitiesdisparities among men among men related to related to social vulnerabilitysocial vulnerability deserve deserve attentionattention..

Reducing inequitiesReducing inequities should be should be an indicator of our field’s an indicator of our field’s progress.progress.

Men’s health field can contribute Men’s health field can contribute to to global structural reformglobal structural reform..

Social vulnerabilitySocial vulnerability ((including povertyincluding poverty)) is is

associated with associated with health disparities health disparities

among men.among men.

Point OnePoint One

Poor men lack access to basic Poor men lack access to basic health carehealth care

For example, in the U.S.:For example, in the U.S.:

No national policy or program for No national policy or program for physical exams, screenings, or physical exams, screenings, or health-promotion for menhealth-promotion for men

Existing programs are for poor Existing programs are for poor children and poor motherschildren and poor mothers

Sources of Insurance Coverage in 2004

Employer Medicare Medicaid/SCHP Direct-purchase Military Uninsured

Percentage of men with usual primary care provider by income, U.S. 1999

Negative/poor Near poor/low Middle High

Percentage of men uninsured for any Percentage of men uninsured for any

period in past year by race, U.S. 1999period in past year by race, U.S. 1999

White Black Asian/Pacific Islander American Indian/Alaska Native

Percentage of men with usual primary Percentage of men with usual primary care provider by education, U.S. 1999care provider by education, U.S. 1999

Less than high school grad High school grad At least some college

Percentage of men uninsured for any period in past year by education, U.S. 1999

Less than high school grad High school grad At least some college

Distribution of uninsured andDistribution of uninsured andtotal U.S. population by incometotal U.S. population by income

as measured by Federal Poverty Level (FPL) in 2004as measured by Federal Poverty Level (FPL) in 2004

Below poverty 100-199%FPL

200-299%FPL

300-399%FPL

400-499%FPL

Over 500%FPL

Probability of males dying (per 100) ages 15-59 years by income in Latin American and Caribbean countries

Chile

Costa

Rica Ecua

dor

Hondu

ras

Nicarag

uaPe

ruBrazil Colombia DominicanRepublic

Guatemala Mexico Panama Venezuela

Life expectancy and disability-free life Life expectancy and disability-free life expectancy by income for men in Canadaexpectancy by income for men in Canada

Life expectancy Disability-freelife expectancy

Global Attention toMen’s Health Disparities

Point TwoPoint Two

Reducing disparitiesReducing disparitiesshould be ashould be a

performance indicatorperformance indicatorfor our fieldfor our field

Men’s health field is usually Men’s health field is usually evaluated by:evaluated by:

scientific advancesscientific advances detection capabilitiesdetection capabilities treatment capabilitiestreatment capabilities

Men’s health field’sMen’s health field’s

greater potential to detect greater potential to detect diseases and conditions…diseases and conditions…

greater potential to treat greater potential to treat diseases and conditions…diseases and conditions…

… are unrealized among socially vulnerable men.

How many/whoseHow many/whoselives do we improve?lives do we improve?

Persistent socioeconomic inequalities in ischemic heart disease for 6 Euro nations

Persistent socioeconomic inequalities in stroke mortality for 6 Euro nations

Men’s HealthMen’s HealthGlobal Field GoalGlobal Field Goal

KeyKey:: attention to social determinants of attention to social determinants of men’s health men’s health

KeyKey:: closing gaps, diminishing disparitiesclosing gaps, diminishing disparities

effect multi-state cooperationeffect multi-state cooperation quantify existing disparitiesquantify existing disparities establish performance indicatorsestablish performance indicators

MEN’S HEALTH FIELD CAN HELP!

More research on poor men and health disparities related to poverty.

Attention to health concerns of poor men in clinical settings (e.g., lack of access to care, low health literacy, labor and environmental exposure risks, possibility of incarceration history).

Advocacy for poor men’s health needs in international health and development discourse (as complement to maternal and child health).

Point ThreePoint Three

The men’s health field can The men’s health field can contribute to global contribute to global

structural reformstructural reform

Areas to make a contributionAreas to make a contribution

policies for aid to developing policies for aid to developing nationsnations

policies for assisting policies for assisting marginalized sub-populationsmarginalized sub-populations

immigration policiesimmigration policies health education standardshealth education standards

Centers on health and well-beingInsists upon access

Requires appropriate services, advice, and informationAdvocates focus on men’s health

Describes current conditions and their impactCalls on nation states, EU organizations, health providers,

others

The Vienna Declaration on the HealthThe Vienna Declaration on the Healthof Men and Boys in Europeof Men and Boys in Europe

The Vienna The Vienna DeclarationDeclaration

Recognise men’s Recognise men’s health as a distincthealth as a distinctand important issueand important issueDevelop a better Develop a better

understanding of men’s attitudes to healthunderstanding of men’s attitudes to healthInvest in ‘male sensitive’ approaches to Invest in ‘male sensitive’ approaches to providing healthcareproviding healthcareInitiate work on health for boys and young men Initiate work on health for boys and young men in school and community settingsin school and community settingsDevelop coordinated health and social policies Develop coordinated health and social policies that promote men’s health.that promote men’s health.

Call to ActionCall to Action

Men’s health fieldMen’s health field cliniciansclinicians researchersresearchers policy analystspolicy analysts advocatesadvocates

measure track intervene

should

Encouraging signsEncouraging signs CJ Ng and colleagues, “What matters most CJ Ng and colleagues, “What matters most

to men in Japan and Malaysia?...”to men in Japan and Malaysia?...” WY Low and colleagues, “Satisfaction with WY Low and colleagues, “Satisfaction with

quality of life among men with erectile quality of life among men with erectile dysfunction…”dysfunction…”

SH Teoh and colleagues, “Can sexual health SH Teoh and colleagues, “Can sexual health be a successful and sustaining portal to be a successful and sustaining portal to men’s health?”men’s health?”

WS Tan and colleagues, “Relationship WS Tan and colleagues, “Relationship between SLOH and other co-morbidities in between SLOH and other co-morbidities in Malaysian men”Malaysian men”

H Sasaki, “ED guidelines in Japan”H Sasaki, “ED guidelines in Japan” EM Khoo, “Cardiovascular risk in aging EM Khoo, “Cardiovascular risk in aging

men.”men.”

INCARCERATION CRISISU.S. has less than 5% of the world’s

population. But it has almost 25% of the world’s prisoners (2.3 million people).

China is second, with 1.6 million people in prison (excluding hundreds of thousands in “administrative detention”).

63Japan

88Germany

151England

627Russia

751USA

Prisoners per 100K population

Source: International Center for Prison Studies at King’s College London

InequitiesInequities racial/ethnic marginalizationracial/ethnic marginalization low educational attainmentlow educational attainment low literacylow literacy poor housing, living poor housing, living

environmentsenvironments contact with state coercive contact with state coercive

apparatusapparatus exposure to war, violenceexposure to war, violence

Result in…Result in…

hindered employment hindered employment opportunitiesopportunities

economic insecurityeconomic insecurity desperate survival tacticsdesperate survival tactics catastrophic illnessescatastrophic illnesses disabling, traumatic injuriesdisabling, traumatic injuries

Men’s health fieldMen’s health field can intervene by can intervene by focusing on needs focusing on needs and experiences of and experiences of marginalized men.marginalized men.

Global Global Goal for theGoal for theMen’s Health FieldMen’s Health Field

healthhealth equity equityMany thanks to

Collins Center for Public Policy

International Society for Men’s HealthJournal for Men’s Health

Community Voices: Healthcare for the Underserved

Third Japan-ASEAN Men’s Health Conference Organising Committee