The Global Case For Action

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“THE GLOBAL CASE FOR ACTION: ACKNOWLEDGING POVERTY AS A DETERMINANT OF MEN’S HEALTH”

SCIENTIFIC PROGRAMME DAY THREE
THIRD JAPAN-ASEAN MEN’S HEALTH AND AGING CONFERENCE
03 DECEMBER 2008
SINGAPORE

Plenary 8: jmh and ISMH Joint Lecture
Dr. April M. W. Young

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The Global Case For Action

  1. 1. The Global Case for Action Acknowledging Poverty as a Determinant of Men’s Health Third Japan-ASEAN Men’s Health & Aging Conference Singapore 03 December 2008 April M. W. Young, PhD, Collins Center for Public Policy Siegfried Meryn, MD, International Society for Men’s Health JMH -ISMH joint lecture
  2. 2. Three Key Points <ul><li>Health disparities among men related to social vulnerability deserve attention . </li></ul><ul><li>Reducing inequities should be an indicator of our field’s progress. </li></ul><ul><li>Men’s health field can contribute to global structural reform . </li></ul>
  3. 3. <ul><li>Social vulnerability </li></ul><ul><li>( including poverty ) is associated with health disparities among men. </li></ul>Point One
  4. 4. Poor men lack access to basic health care <ul><li>For example, in the U.S.: </li></ul><ul><li>No national policy or program for physical exams, screenings, or health-promotion for men </li></ul><ul><li>Existing programs are for poor children and poor mothers </li></ul>
  5. 5. Sources of Insurance Coverage in 2004 Employer Medicare Medicaid/SCHP Direct-purchase Military Uninsured
  6. 6. Percentage of men with usual primary care provider by income, U.S. 1999 Negative/poor Near poor/low Middle High
  7. 7. Percentage of men uninsured for any period in past year by race, U.S. 1999 White Black Asian/Pacific Islander American Indian/ Alaska Native
  8. 8. Percentage of men with usual primary care provider by education, U.S. 1999 Less than high school grad High school grad At least some college
  9. 9. 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
  10. 10. Distribution of uninsured and total U.S. population by income as 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
  11. 11. Probability of males dying (per 100) ages 15-59 years by income in Latin American and Caribbean countries Chile Costa Rica Ecuador Honduras Nicaragua Peru Brazil Colombia Dominican Republic Guatemala Mexico Panama Venezuela
  12. 12. Life expectancy and disability-free life expectancy by income for men in Canada Life expectancy Disability-free life expectancy
  13. 13. Global Attention to Men’s Health Disparities
  14. 14. Point Two <ul><li>Reducing disparities </li></ul><ul><li>should be a </li></ul><ul><li>performance indicator </li></ul><ul><li>for our field </li></ul>
  15. 15. Men’s health field is usually evaluated by: <ul><li>scientific advances </li></ul><ul><li>detection capabilities </li></ul><ul><li>treatment capabilities </li></ul>
  16. 16. Men’s health field’s <ul><li>greater potential to detect diseases and conditions… </li></ul><ul><li>greater potential to treat diseases and conditions… </li></ul>… are unrealized among socially vulnerable men.
  17. 17. <ul><li>How many/whose </li></ul><ul><li>lives do we improve? </li></ul>
  18. 18. Persistent socioeconomic inequalities in ischemic heart disease for 6 Euro nations
  19. 19. Persistent socioeconomic inequalities in stroke mortality for 6 Euro nations
  20. 20. Men’s Health Global Field Goal <ul><li>Key : attention to social determinants of men’s health </li></ul><ul><li>Key : closing gaps, diminishing disparities </li></ul><ul><li>effect multi-state cooperation </li></ul><ul><li>quantify existing disparities </li></ul><ul><li>establish performance indicators </li></ul>
  21. 21. MEN’S HEALTH FIELD CAN HELP! <ul><li>More research on poor men and health disparities related to poverty. </li></ul><ul><li>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) . </li></ul><ul><li>Advocacy for poor men’s health needs in international health and development discourse (as complement to maternal and child health) . </li></ul>
  22. 22. Point Three <ul><li>The men’s health field can contribute to global structural reform </li></ul>
  23. 23. Areas to make a contribution <ul><li>policies for aid to developing nations </li></ul><ul><li>policies for assisting marginalized sub-populations </li></ul><ul><li>immigration policies </li></ul><ul><li>health education standards </li></ul>
  24. 24. Centers on health and well-being Insists upon access Requires appropriate services, advice, and information Advocates focus on men’s health Describes current conditions and their impact Calls on nation states, EU organizations, health providers, others The Vienna Declaration on the Health of Men and Boys in Europe
  25. 25. The Vienna Declaration Recognise men’s health as a distinct and important issue Develop a better understanding of men’s attitudes to health Invest in ‘male sensitive’ approaches to providing healthcare Initiate work on health for boys and young men in school and community settings Develop coordinated health and social policies that promote men’s health.
  26. 26. Call to Action <ul><li>Men’s health field </li></ul><ul><ul><li>clinicians </li></ul></ul><ul><ul><li>researchers </li></ul></ul><ul><ul><li>policy analysts </li></ul></ul><ul><ul><li>advocates </li></ul></ul><ul><li>measure </li></ul><ul><li>track </li></ul><ul><li>intervene </li></ul>should
  27. 27. Encouraging signs <ul><li>CJ Ng and colleagues, “What matters most to men in Japan and Malaysia?...” </li></ul><ul><li>WY Low and colleagues, “Satisfaction with quality of life among men with erectile dysfunction…” </li></ul><ul><li>SH Teoh and colleagues, “Can sexual health be a successful and sustaining portal to men’s health?” </li></ul><ul><li>WS Tan and colleagues, “Relationship between SLOH and other co-morbidities in Malaysian men” </li></ul><ul><li>H Sasaki, “ED guidelines in Japan” </li></ul><ul><li>EM Khoo, “Cardiovascular risk in aging men.” </li></ul>
  28. 28. INCARCERATION CRISIS <ul><li>U.S. has less than 5% of the world’s population. But it has almost 25% of the world’s prisoners (2.3 million people). </li></ul><ul><li>China is second, with 1.6 million people in prison (excluding hundreds of thousands in “administrative detention”). </li></ul>Source: International Center for Prison Studies at King’s College London 63 Japan 88 Germany 151 England 627 Russia 751 USA Prisoners per 100K population
  29. 29. Inequities <ul><li>racial/ethnic marginalization </li></ul><ul><li>low educational attainment </li></ul><ul><li>low literacy </li></ul><ul><li>poor housing, living environments </li></ul><ul><li>contact with state coercive apparatus </li></ul><ul><li>exposure to war, violence </li></ul>
  30. 30. Result in… <ul><li>hindered employment opportunities </li></ul><ul><li>economic insecurity </li></ul><ul><li>desperate survival tactics </li></ul><ul><li>catastrophic illnesses </li></ul><ul><li>disabling, traumatic injuries </li></ul>
  31. 31. <ul><li>Men’s health field </li></ul><ul><li>can intervene by focusing on needs and experiences of marginalized men. </li></ul>
  32. 32. <ul><li>Global Goal for the </li></ul><ul><li>Men’s Health Field </li></ul><ul><li>health equity </li></ul>Many thanks to Collins Center for Public Policy International Society for Men’s Health Journal for Men’s Health Community Voices: Healthcare for the Underserved Third Japan-ASEAN Men’s Health Conference Organising Committee

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