the Home of the Brave

the Home of the Brave Vol. 14 •Issue 11 • Page 8

The Home of the Brave

Cultural attitudes keep America’s men from getting the care they need.

Mr. B didn’t know much about his prostate. So when the 60-year-old man started having trouble urinating, he figured it was merely an infection. The trouble continued and eventually got worse as Mr. B began to bleed during urination. But he was a man and was determined to solve his own problems.

Because he didn’t seek medical help, he didn’t know his prostate had grown so large that it was squeezing down on the outlet of his bladder. When Mr. B finally was brought to a hospital’s emergency department, he had bled so extensively through his urinary tract that he needed three pints of blood.

Lucky for Mr. B, he didn’t have a life-threatening condition such as prostate cancer, but his prostate had to be removed. He’s a perfect example of how too many American men handle their health problems.

‘Suck It Up, Grit It Out’
“Men tend to come to the doctor’s office with one foot in the grave and another on a banana peel,” said Jean Bonhomme, MD, MPH, an advisory board member of the Men’s Health Network in Washington and founder of the National Black Men’s Health Network in Atlanta. “Men come in when they hurt so bad they just can’t stand it anymore, … when they are so weak they can’t even function.”

Since childbirth, many men have been taught that when something hurts, they must soldier through the pain. When a little boy skins his knee, he’s often told, “Big boys don’t cry.” In high school, the same boy gets hurt playing football and is told to “take one for the team.” So it’s no surprise when in his 50s, that man dismisses chest pain as indigestion.

“Men are not very vocal about health care because it’s not considered our role to ask for help or to respond to anything as fearsome or dangerous,” Bonhomme says. “When something is threatening us, instead of focusing on removing that threat, we focus on how we handle the threat, how brave are we in the face of it. I think that’s why people haven’t been as sensitive to issues of men’s health.”

It’s this brave-boy attitude that brought Bonhomme’s father (Mr. B, the patient described above) close to death. This attitude has turned men’s health into a medical crisis, Bonhomme says.

Life Expectancy Lags
In the 1920s, life expectancies for men and women were equal. As years passed, the expectancies increased at unequal rates. Now, men’s life expectancy is almost 10 percent lower than women’s, and men’s death rates are higher for each of the top 10 causes of death.

Despite the statistics, men don’t seek medical help. “American men are socialized to seek health care only when it’s absolutely necessary,” said Maj. Ceabert J. Griffith, MPAS, PA-C, director of health promotion at the United States Air Force Clinic in Okinawa, Japan. “This low health-care-seeking behavior results in preventable problems coming to attention later rather than earlier—often when it’s too late to cure or lessen the impact on emotional, psychological or physical health.”

One reason why men don’t seek help is that health care isn’t emphasized as necessary to boys in the same way it’s emphasized to girls. When a girl turns 18, she is instructed to have a yearly gynecologic exam. This gets girls in the practice of asking for help when a problem arises and also puts a positive face on health care. “I don’t think boys have anything comparable to this as they are growing up,” Dr. Bonhomme says.

It’s not because men don’t have their own health problems; it’s just that health care doesn’t focus as much on prevention for men. The risk of this mindset, says Griffith, is high rates of cancers, heart disease, suicide and homicide. These are health problems that in many cases can be prevented or attenuated.

Celebrities Dispell Taboos
For example, little attention is paid to a man’s reproductive health. Testicular cancer is the leading form of cancer in men between the ages 28 and 35, but until recently little was heard about it.

Last year, comedian Tom Green, a talk show host on a popular MTV show, was diagnosed with testicular cancer. Green reached millions when he recorded his experience from beginning to end. He even had cameras follow him into the operating room and had his surgery broadcast on MTV.

World-class cyclist Lance Armstrong also brought attention to testicular cancer when he beat the disease after ignoring the symptoms for months. The cancer had metastasized from his testicles to his abdomen, lungs and brain.

Recently, other high profile men, including New York Yankees Manager Joe Torre and New York Mayor Rudolph Giuliani; made their prostate cancer diagnoses public. These men put a human face on a problem that many men ignore.

To change men’s opinion about reproductive system cancer, the importance of a testicular self-examination needs to be elevated to that of a woman’s breast self-examination, and the development of an enlarged prostate elevated to that of finding a breast lump, Griffith said.

It’s Risky Being Male
But prostate and testicular cancer aren’t men’s only health problems. Not only are men at a higher risk for things like hypertension, but also deaths from accidents and violence affect men out of proportion to women, Bonhomme says. This includes workplace accidents—94 percent of all people killed on the job are men.

Men are also at a higher risk for suicide. “When it comes to mental health, I’m probably the last person a man decides to call when he is having a problem,” says Alvin Baraff, PhD, founder of MenCenter Counseling in Washington. For a long time, he said, male patients were coming in only when at the crisis stage, and they felt like they didn’t have a choice or were “sent” by their wives or girlfriends. But he says that now men are coming to him more often, on their own, to talk about their problems before they reach a desperate state.

This is a good sign, Baraff and Bonhomme say. But more work still must be done. Many of the major killers of men are preventable, and somehow the word must get out that death is not the only option. “Some men have the idea that they are going to die of something anyway, so what’s the use,” Bonhomme said. “They need to see that maybe, if they intervene, they don’t have to die.”

For this to happen, Bonhomme said that as a society we need to change the paradigm. You cannot have a healthy society by only addressing the needs of one gender. Men’s health is an important part of the health of our society as a whole, because women and children are affected along with the men. “AIDS is one such example. Once thought to be exclusively a homosexual male disease, it has come to affect many thousands of women and children,” he said.

For this reason, the Men’s Health Network is working with Rep. Randy “Duke” Cunningham, R-Calif., toward the establishment of an Office of Men’s Health within the U.S. Department of Health and Human Services. Last year, Cunningham, who was diagnosed with prostate cancer a few years ago, introduced the Men’s Health Act of 2000, one goal of which was to establish a men’s health office, but the bill never made it out of committee. Cunningham has said he’d reintroduce the bill this year.

Such an office will bring balance to the health care equation, Bonhomme said. For instance, all aspects of prostate cancer awareness and research are severely underfunded. Establishing an office at the federal level could attract the necessary research funds.

Sex Discrimination?
However, Bonhomme said he’s encountered some resistance when talking about a federal men’s health agency, because some women believe that focusing on men’s health is discriminatory to women.

“I don’t find this to be so,” he says. “I think all individuals are entitled to health care that suits them as an individual, and gender is just one part of the individuality.” (Congress established the Office of Research on Women’s Health within the National Institutes of Health in 1990.)

Baraff himself has some concerns about the office. “My concern is that it might not be run by men, and men will listen more if a man is talking to them. However, I obviously think more attention needs to be paid to men’s health and would love to be part of the development of such an office.”

Also, Griffith feels that to effect any meaningful change, public health officials will need to enlist the help of sociologists and others familiar with the “backdrop” to men’s health care perceptions

Men’s Health Specialty
Taking the idea one step further, Griffith, Baraff and Bonhomme think it’s time to establish a men’s health specialty. A men’s health specialty will “give men ‘permission’ to seek timely health care for acute problems, and periodic care to prevent chronic problems,” Griffith says. “A specialty will help redefine what is it to be macho and what constitutes ‘weakness behavior,’” he adds.

In the meantime, more can be done to promote men’s health. More attention in the media is one way, says Baraff, who thinks the media are largely responsible for the attitude changes he’s seen recently.

In addition, well-positioned agencies, such as the American Cancer Society and the American Heart Association have done a good job at getting the word out so far, says Griffith. But what they need to do now, he says, is to develop psychological strategies to encourage men to hear the messages—and take action.

With more education, research and awareness, men may eventually see no shame in asking for medical help. “The health care system needs to be marketed to men as an ally of manhood, helping men retain their strength, vigor, and ability to function. Right now, too many men see going to a doctor as a sign of weakness,” he says.

“In getting help, you are looking to someone who can help you be strong, virile and healthy, and help you obtain your dreams.”

Joanna Vishio on staff at ADVANCE.