Health Expectancy = number of years free from disability, illness and functional ...
Singapore. 79.3 ... Recognise men's health as a distinct and important issue.
Mens Health Initiative of BC Introduction and Overview Larry Goldenberg OBC, MD
Is there a need for a Mens Health Initiative?
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It should NOT be this way
The sorry statistics • • • •
39% more likely to die from diabetes 84% more likely to die from arterial diseases 78% more likely to die from heart disease 7 x more likely to die from HIV
• 29% more likely to be diagnosed with cancer and 52% more likely to die as a result
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The sorry statistics • 70% of developmental and learning disabilities (boys) • 65% of Teenage deaths • 80% of spinal cord injuries, substance abuse, violence and crime • 35% of suicide attempts are male, but 80% of successful suicides • 97% of workplace deaths (2005: 1,064 of 1,097)
Lifetime Statistics (not goals and assists) In Canada, men live on average 5 years less than women (4.4 yrs in BC) But average life expectancy is not the most informative parameter Health Expectancy = number of years free from disability, illness and functional dependence Potential Years of Life Lost (PYLLs) = number of years of life "lost" when a person dies "prematurely" from any cause - before age 75. These help us to describe the relative contribution of various health conditions to the total deficit of life expectancy for men vs women.
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Life expectancy: 1920-2004 (US) 1920: 1 yr 1940: 4.4 yrs 1970: 7.6 yrs 1990: 7 yrs 2001: 5.4 yrs 2004: 5.2 yrs 2007: 5.8 yrs
Global Life Expectancy Stats (2007) • • • • • •
Women outlive men in 212 of 221 countries Overall : men 63.9; women 67.8; gap of 3.9 yrs In most countries, gap is 4 to 10 years In 61 of 212, the gap is less than 4 years In 6 of 212, the gap exceeds 10 years Men outlive women in 9 of 221 countries by 0.3 to 2.4 years (Bhutan, Botswana, Lesotho, Malawi, Mozambique, Namibia, Nepal, S. Africa, Zimbabwe)
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Global Life Expectancy Stats (2007 est.) Country
Men
Women
Gap
Angola
37.0
38.9
1.9
Afghanistan
44.0
44.4
0.4
Australia
77.9
83.8
5.9
Brazil
68.6
76.6
8
Canada
77.1
84.0
6.9
Namibia
44.5
41.6
-2.9
Singapore
79.3
84.7
5.4
United States
75.3
81.1
5.8
Russia
59.2
73.1
13.9
Niger
44.3
44.3
0
The sorry statistics • First Nations men living on reserves die an average of 5 yrs younger than those living off reserve; 8.9 yrs younger than Canadian men in general (in Australia the gap between aboriginal and non-indigenous is 17 years!)
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Alternate Health Indicator Health expectancy: disability and functional dependence-free, life expectancy
Health Expectancy at Birth USA Italy UK Japan China France Germany Singapore Sweden Switzerland
65.7 69.5 68.3 71.2 60.9 68.5 67.4 66.8 70.1 70.4
63.8 - 67.5 68.4 - 70.8 66.8 - 69.7 69.9 - 72.5 59.5 - 62.5 67.4 - 69.5 66.0 - 68.7 64.3 - 69.0 68.7 - 71.6 68.7 - 72.1
Life Expectancy
Loss of Healthy years
76.4 80.6 76.8 79.6 70.5 78.6 76.6 78.1 79.2 79.3
10.7 11.1 8.5 8.4 9.7 10.2 9.2 11.3 9.2 8.8
International data base (IDB) Estimates 2005
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Potential Years of Life Lost
Excess mortality in males by age group: 2003 (Relative risk of mortality M:F)
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Consequence: • Close to 50% of women are widowed by age 65 • >50% of elderly widows living in poverty were not poor before the deaths of their husbands • At age 95, women outnumber men 8 to 1
Is there a need for a Mens Health Initiative?
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Commonwealth Foundation, 2000 “Out of Touch: American Men and the Health Care System”
• significantly reduced life expectancy • much higher rates of death from heart disease and chronic liver disease • substantially higher rates of suicide and violence related deaths • significant underutilization of healthcare services in all age groups
Commonwealth Foundation, 2000 “Out of Touch: American Men and the Health Care System”
This report called for "expanded efforts to address men’s special health concerns and risks, and their attitudes toward health care"
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WHO Madrid Statement, 2002 ‘to achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities’
Vienna Declaration on the Health of Men and Boys-2005 • 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 co-ordinated health and social policies that promote men’s health www.emhf.org/index.cfm/item_id/305
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MHIBC 11.17.09
Male Health Initiative of BC An “umbrella” initiative dedicated solely to the pursuit of excellence in male health
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MHIBC Mandate • Multidisciplinary centre of excellence in male health – Facilitate collaborative research in public and population health – Leadership in best practices – General awareness and education; social marketing tools
• Support to primary care physicians, specialists and healthcare workers across all communities and the continuum of care – provide evidence based ‘tools’ such as assessment nomograms, decision aids, standards of care
• Outreach with emphasis on health promotion, risk assessment, screening aids and disease prevention • to advocate for male healthcare planning and policy development, especially as pertains to specific groups of men most at risk
MHIBC Mandate (“the c’s”) • consolidate local expertise • coordinate clinical, education and research activities • central strategy for research and education • • • •
communication - social networking, media, website clinical healthcare guidelines and standards comprehensive care - biopsychosocial continuous measurement of patient outcomes
• community outreach to all socioeconomic groups • collaborate locally, nationally and internationally • creation of a Mens Health Policy
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The AIMS for the individual male are to: • engage more fully in the healthcare system • respond to their needs more appropriately • “add 10 quality years to the middle of life” through prevention and early intervention strategies • someday achieve equality of life expectancy between men and women.
Men are “more than a prostate and penis”
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Action Groups: Research & Education • Testosterone deficiency/impact on all systems • Endocrine/Metabolic syndrome • Sexual health • Contraception and reproductive health • Prostate: benign and malignant • Bone Health, Osteoporosis/fall prevention • Cardiovascular health • Mental health and addiction • lifestyle, nutrition, sports medicine • Risk-taking behaviours • Gay men’s health • Disease impacts (health, family, economic) • Social determinants of health
Across all decades of life • Boys and adolescents
• Teenage and young man • Middle years • Aging male • Geriatric men
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Governance Men’s Health Initiative of British Columbia
Steering Committee
Men’s Health Advisory Panel includes discipline or sector specific experts and partnership leads
Action Group
Action Group
Action Group
Action Group
Action Group
Mission: To optimize the health and health care of men in British Columbia.
Communications/Networking Branding Media Website Twitter Facebook Promotional events Advertising Fundraising/sponsorships
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Public and Professional Education
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Clinical Care • Clinics: eg TARC, Bone health,Andrology • Risk assessment • Standards of Care • Guidelines • Expert Opinion
Improving Men’s Health A commissioned population health based report for the Men’s Health Initiative of B.C. January, 2010
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Why this report is needed 60% 50% 40% 30% 20% 10% 0%
Women's Health
Men's Health
% of funded Canadian research
What are possible factors in men dying before women? •
Biological Factors –
•
Environmental Factors –
•
hormonal, brain structure,other physical differences
riskier jobs, less social support
Behavioural Factors – –
higher risk-taking, avoidance of health care, refusal of preventive lifestyle (exercise, nutrition, etc.) Masculine role
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The Report: Overview of Male Health Issues • What this report covers: » Male-specific conditions (e.g. prostate problems, testicular cancer, hypogonadism, ED) » Male-risk conditions (for which being male is a risk factor) Cardiovascular Disease/ Suicide/ Motor Vehicle Accidents/ Osteoporosis/ Lung Cancer/ HIV
• Healthcare database review to amass evidence related to priorizing male health • Systematic review academic and gray literature concerning key areas of male health • Preparation of a report synthesizing this knowledge • Knowledge Transfer strategy • Recommendations: research, clinical, policy
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Which conditions cause men to die before women? The Big Three:
Liver Diseases
• Cardiovascular Disease
Infectious Diseases
• Suicide
MVA
• Motor Vehicle Accidents
Suicide Cardiovascular Diseases 0
1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 Years of Life Lost by Men minus Years Lost by Women
• Strikes men more often and earlier than women • Does estrogen protect the heart? Factors in gender difference: • Poor nutritional habits (high sodium, low fruit & vegetable intake) • Overweight • Poor anger management?
Deaths by CVD
20
35
30
• Men carry out suicide 3-4 x more than women/ Highest rate in middle-age
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20
Factors in gender difference: • Willingness to use lethal methods • Reluctance to talk about emotional distress or seek help for it • Higher levels of alcohol use • Greater tendency to move quickly from thought to action
Males
15
Females
10
5
0 10 -‐14 15 -‐19 20 -‐24 25 -‐29 30 -‐34 35 -‐39 40 -‐44 45 -‐49 50 -‐54 55 -‐59 60 -‐64 65 -‐69 70 -‐74 75 -‐79 80 -‐84 85 -‐89
90+
Age Group
Deaths by Suicide
40
35
30
• High proportion of deaths in the late teens and 20s (= many years of life lost)
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20 Male Female
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Factors in gender difference: • High levels of risk-taking (speeding and reckless driving)
10
5
0 1-‐15 16-‐20 21-‐25 26-‐30 31-‐35 36-‐40 41-‐45 46-‐50 51-‐55 56-‐60 61-‐65 66-‐70 71-‐75 76-‐80 81-‐85 86+
Age Group
Deaths from MVAs
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7.0
6.0
Mortality from alcohol is 6 times higher for men than women Factors in gender difference: • Young men are socially reinforced for excessive drinking and the associated risk-taking • Masculine role
5.0
4.0
Male
3.0
Female
2.0
1.0
0.0 00-‐17
18-‐29
30-‐44
45-‐64
65+
Age Range
Incidence of alcohol abuse
Recommendations: Research Questions •
How can we enhance men’s health-protective behaviours? Risk-taking Preventive lifestyle
•
What are men’s pathways to suicidal behaviour? Why is the rate highest for middle-aged men?
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Recommendations: Clinical Practice • • •
Greater focus on men’s health issues in primary care, e.g. risky drinking, suicidal ideation, nutrition Decision Aids to support men in making decisions re PSA screening, Prostate Cancer treatment options, etc. Other ways to engage men in health-protective behaviour -- e.g. self-management materials around lifestyle, risky drinking and mood
Recommendations: Policy Directions • Development of male-friendly healthcare services, e.g. Men’s Health clinic • Prevention programs to address men’s suicide; and alcohol abuse, risky driving in youths & young men • Health Promotion activities targeting health-protective lifestyle changes in men (nutrition/exercise)
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Ultimate Goal: Decrease the gap between LE and HE:
“Add 10 quality years to the middle of your life”
“GROW OLDER WITHOUT GROWING OLD”
Aim at maintaining functional capacity, delaying ”frailty" and dependency through “the maintenance of physical, social, and spiritual activities throughout a lifetime”
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Preventive Strategies AWARENESS and RISK ASSESSMENT Promotion of a healthy life style with physical activity, healthy dietary habits (preventing alcohol abuse, encourage low fat consumption and high fiber diet, sufficient calcium/vitamin D, and anti oxidant intake such as vitamin A, C, E ) Identify and manage hormone deficiencies in over 50’s Avoid obesity and control hypertension in all ages.
Preventive Strategies for Over 40’s
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Early Therapeutic Interventions • • • • • • • •
Control of hypertension Diabetes Osteoporosis Control of high cholesterol Early interventions for BPH and incontinence Hormone therapy, when indicated Mental health management Aim at maintaining, restoring or improving sexual function
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Wayne Gretzky:
"You miss 100 percent of the shots you don't take."
Please help us take the shots!
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Male Health Initiative of BC 2009
No husband has ever been shot while doing the dishes
Seize the opportunity To be a world leader in improving men’s health and well being
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“What I wouldn’t give ! to be seventy again”! Oliver Wendell Holmes (age 92) on ! seeing a pretty girl walk by.
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$$$$$ Funding Sources $$$$$ – Seed funding (CFHU & VGH/UBC Foundation) – Ongoing fundraising – Need an Endowed Chair – Leverage: BC Government / health authorities – Research funding (e.g. CFI, CIHR, Health Canada) – Corporate partnerships and sponsorships
PROGRESS REQUIRES A VISION Alice said to the White rabbit, which road should take? Where do you want to go? asked the White Rabbit. I do not know, replied Alice. Well then, it doesn't matter which road you take, does it? Lewis Carroll, Alice’s Adventures in Wonderland
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Two more basic ingredients are curiosity and daring.
Unless one is willing to step out and take risks, experiment, try new things, without the worry of failure, success will be only superficial.
Are men stubborn, stupid or both?
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Young males need Role models - 1950’s and 60’s
Role model - today
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“Add 10 years to the middle of your life”
Men NEED their partners to steer them
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or as Nike promotes:
Aging is not always pretty!!
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..and its not about finding the Fountain of Youth
Ponce de Leon
• When men have car trouble they go to an expert - a mechanic. • But do men visit the doctor when their body sends warning signals? • A recent national survey found 84 percent of men say they've had their car serviced in the past year. But only 66 percent of these men have had an annual check-up with a doctor in the same period. • Men notice when their car doesn't perform properly, but don't listen when their body tells them it's time to see a doctor.
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Why men’s health is important as a perspective • Lack of focus on men’s health until past 10 yrs • New policy & planning emphasis (still tentative) • “Women’s lens” on healthcare planning should be matched by a “men’s health lens”
Societal and cultural norms undermine men’s health • Dangerous jobs • Military service • “Be tough” messages • Pain management • Sexual dysfunction management • Less time w/kids • Law enforcement violence • Emotional isolation & emotional illiteracy
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Barriers to men’s health • • • • •
Bravado Risk taking Strong and silent Take it like a man Denial
In an attempt to impress the new woman, Adam shows off his family tree.
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Goals • to identify and facilitate collaboration among the existing research areas of excellence in our province • to reach out to men with information and the opportunity to assess their personal risks and focus on prevention • to provide evidence-based tools to healthcare workers across the spectrum of community care to deal with men’s concerns • to advocate for male healthcare planning and policy development, especially as pertains to specific groups of men most at risk
How can we decrease the gap between life expectancy and health expectancy?
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